In Reply: First let me express my appreciation to Dr. Karper for such a careful and considered reading of my cramped-for-space editorial. And then let me apologize for the confusing reference to (and misspelling of) Schön's "reflective practitioner." My purpose, ill-advised in retrospect, was to draw ironic attention to the unexpected role of improvisation in the implementation study that Palinkas and colleagues (1) reported on in the same issue. I was especially taken by their discussion of "adaptability" on the part of both participating clinicians and researchers and their joint efforts to arrive at workable amalgams of protocol-driven procedure and experience-based habit and judgment.
True, this is not what Schön (or Benner) meant by the phrase. Nor (and this is what I was awkwardly driving at) was its opposite—the unthinking drone at the wheel of unwavering routine—found to be the case in the implementation study. Instead, it was that all-too-familiar agent juggling a host of competing concerns and hectically trying to do justice to them all. That implementation research too easily assumes otherwise—that it can seem content to train and test for fidelity and then "black-box" actual performance as roughly what was intended by the original design—is precisely the assumption that Hohmann and Shear meant to challenge with the in-your-face phrase, "noise of real life." What Palinkas and colleagues demonstrated, it seems to me, was not only the operational value of "creativity and compromise" but also the research necessity of documenting it.
On reflection, then, it was Schön's modest subtitle ("How Professionals Think in Action"—in Palinkas and colleagues' study, action was interrupted by a research agenda) that I'd hoped to highlight as an example of the sort of hidden enablements that qualitative research methods are geared to uncover. My thanks, again, to Dr. Karper for the opportunity to clarify this point.
1.Palinkas LA, Schoenwald SK, Hoagwood K, et al: An ethnographic study of implementation of evidence-based treatments in child mental health: first steps. Psychiatric Services 59:738—746, 2008