A framework to support best practice emulation in healthcare

Background Hospitals frequently seek to improve care by copying best practices from high-performing peers, yet comparable outcomes are often not achieved. While implementation science recognises context as a key determinant of success, existing frameworks are generic and unequipped to actively map and compare the unique contextual conditions of both the source and receiving organisations. To bridge this gap, we developed the implementation-oriented Two-Dimensional Practice Context (2DPC) framework capturing the context of best practices in hospital care to support their emulation in other settings. Methods We developed the 2DPC-framework through a two-phase scoping review and evidence-mapping study. Phase 1 built the framework’s two axes. Searching MEDLINE for publications on the contextual factors that shape best practices in healthcare, we thematically synthesised these factors into distinct domains (Step 1a) and arrayed them against established levels of implementation context (Step 1b). Phase 2 populated the resulting grid. A second MEDLINE search identified empirical studies that implemented or evaluated best practices in hospital settings, and from each we extracted the reported contextual influences, mapped them onto the grid, and thematically analysed the contents of every cell. Results Phase 1 included 13 publications and yielded six best-practice context domains (Support, Knowledge, Coordination, Resources, Quality monitoring, and Patient-centeredness), organised against established implementation context levels into the 2DPC-framework. Phase 2 included 173 empirical studies, from which 992 contextual extracts were identified, predominantly barriers ( n = 881), and a smaller fraction facilitators ( n = 108). The most populated implementation levels were healthcare professionals ( n = 261), organisational support ( n = 257), and the wider environment ( n = 147). The most populated domains were Knowledge ( n = 271), Resources ( n = 249), Coordination ( n = 199), and Support ( n = 129), while Quality monitoring ( n = 20) and Patient-centeredness ( n = 24) were less frequently represented. Conclusions Rather than generic solutions, replicating best practices requires a granular alignment between the source and receiving hospital’s context. The 2DPC framework operationalises this, providing an actionable mapping tool for healthcare leaders to evaluate and compare implementation readiness across settings. Furthermore, by exposing a critical deficit in how best practices are documented, this framework challenges both practitioners and researchers to shift from tracking implementation barriers toward actively capturing the enabling conditions that drive success.