In pragmatic trials, ascertainment or availability of study outcomes is often delayed, leading to a gap of many months between the end of the trial’s clinical activities and analyses of primary outcomes. This hiatus is another opportunity for pragmatic trial teams to debrief with health system partners about their experience with study implementation, especially regarding implementation or delivery of study interventions. Experience of clinical leaders and frontline clinical staff is especially valuable for exploring and understanding the feasibility and acceptability of interventions, heterogeneity in uptake and fidelity, and facilitators and barriers to subsequent implementation. Health system partners can identify changes in the local or national environment (such as regulatory changes, financial incentives, and organizational processes or priorities) during the trial.

Ideally, pragmatic trial teams can interview or debrief representatives from all levels of partner health systems: executive leaders, clinic-level leaders, and frontline staff from various roles or disciplines. Impressions may certainly vary across levels within the same organization. Discovering and exploring heterogeneity of experience is especially informative, since facilitators and barriers may vary across health systems or even within health systems.

Collecting feedback from health system partners may involve a variety of methods (for example, informal interviews, semistructured interviews, and brief surveys) depending on the resources and time available. Regardless of the type of data collected, implementation science frameworks, such as the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework (Glasgow et al 2019) or the Consolidated Framework for Implementation Research (Kirk et al 2016), can be helpful both in identifying questions to be explored and organizing information or responses from health system partners.