De-Implementation: The Other Half of Implementation Science

25 August 2026

Health systems cannot successfully modernise care unless they master de-implementation, the distinct operational skill of actively withdrawing outdated clinical practices from circulation.

Clinical practice does not automatically stop just because evidence changes. Turning off an obsolete protocol requires dedicated ownership and specific strategies, which are entirely separate from the skills needed to adopt a new intervention.

A clear example is the persistence of sliding-scale insulin charts for stable, non-critical patients with type 2 diabetes. While current guidelines favour preventive basal-bolus regimens, sliding-scale dosing remains the default in many facilities. This continuation occurs not because staff are unaware of the updated guidance, but because health systems routinely fail to assign anyone to the job of taking the old charts out of use.

For professionals managing the growing burden of non-communicable diseases (NCDs), understanding how to systematically dismantle these entrenched, ineffective practices is the critical, missing half of implementation science.

Stopping a Practice Takes as Much Deliberate Effort as Starting One

De-implementation is the deliberate process of stopping a practice that is no longer effective, safe, or worth its cost. It is not simply what happens when implementation is absent; a practice already embedded in daily routine keeps running by default unless something specifically displaces it.

A handful of forces tend to keep low-value practices in place long after the evidence has moved on:

• Clinical habit, built up over years of training and repetition
• Fear of missing something without the old routine as a safety net
• No designated owner for retiring outdated protocols
• No clear replacement to slot into the gap the old practice leaves behind
• Patient or family expectations built around the old routine continuing

The Same Outcomes Used to Judge New Programmes Apply to Retiring Old Ones

Implementation outcomes aren’t only useful for judging whether something new took hold. The same questions work in reverse for something being phased out:

• Was stopping this practice acceptable to staff?
• Was the replacement feasible to deliver with existing resources?
• Did the change actually reach every part of the facility, or did the old chart quietly survive in one ward?

Treating de-implementation with the same rigour as implementation is what keeps a ‘we have updated the guidance’ memo from becoming the entire plan.

IS4NCDs Training Helps Teams Retire Low-Value Practices as Deliberately as Adopting New Ones

Training with IS4NCDs equips health professionals to approach decommissioning outdated clinical habits as a structured, intentional strategy. Rather than assuming old routines will simply vanish when new guidelines arrive, this initiative transforms de-implementation into a standard, teachable skill in the Southern African region. It shifts the focus from what to adopt to the far more complex task of managing how to stop.

IS4NCDs has scheduled the Core Modules pilot to launch in early October 2026, followed by the Intermediate Modules pilot in the third week of October, and the Advanced Modules pilot in November. Acceptance of Expressions of Interest is coming soon. The training modules, valued at approximately ZAR 6,000 per module, are fully funded — there is no cost to participants during the pilot phase.