It takes on average 17 years to get research into practice and only 30-40% results in a demonstrable patient benefit. Therefore, implementation can enhance uptake of research and reduce research waste.
Implementation is a complex, multifaceted process that requires an interdisciplinary approach and considers patient and public priorities, and knowledge of theory. The health and care context is a key factor in implementation activities.
Consider the importance of leadership when mobilising knowledge across organisational boundaries. Knowledge may include research, clinical and patient experience. Leadership isn’t necessarily a formal position, rather it’s about influencing other stakeholders at all levels to play an active part in driving change across organisations. Anyone may have a role in ‘leading from the middle’ using key relationships to affect change.
Express values and culture clearly and early on. Values of stakeholder participation might include:
‘Patients are the most under-used resource in any health care system’
Patients, carers and public champions offer multi-faceted perspectives and should be involved in all stages of the research and implementation cycle providing:
Design a realistic implementation plan to achieve your goals. Consider:
Understanding and evaluating the implementation of complex interventions can be helped by the application of theory. Theory can not only contribute to planning the implementation activity but also to: understanding barriers and facilitators; explaining the processes of implementation and; the reasons for the success or failure of the uptake of best evidence into practice (1).
Make it easy for stakeholders to ‘do the right thing’. New interventions and innovations should be flexible and available in different formats, to aid successful adoption in different contexts.
Improvement practice teaches us that the sustainment of implementation is more associated with sharing the principles of good practice, rather than ensuring that everyone uses the same practice.
Knowledge mobilisers and champions may be clinicians, managers, policy makers, researchers, patients, and the public. Many knowledge mobilisers work within and across extensive networks. Identify individuals with a range of skills that lend themselves to improvement activities and innovation. These people may be the ‘change champions’ and knowledge mobilisers that make the difference between success and failure.
Implementation can start with a pilot to test and refine new approaches and to evaluate barriers and facilitators. Implementation activities can be accelerated by developing a group or Community of Practice (1) that can share experiences and insights throughout the implementation journey. Audit and feedback will gauge progress and help to refine, redesign and adapt approaches for scaling up.
Consider how to measure any change that has been achieved. Select measures that can be used readily in audit and feedback cycles. Capture evidence of impact. Stories, personal experiences as well as big data can be a part of the evaluation and reporting process. It is important to showcase and share progress including the lessons learnt from the project.
Decide what success looks like; quality of care; or specific outcomes? For whom?
Population health is another concern in implementation science, linking the individual to public health and health improvement.
Consider what success looks like for different stakeholders and across clinical pathways.How can you measure sustainability of a new approach?
Consider shared learning awards e.g. NICE.
1). Per Nilsen Making sense of implementation theories, models and frameworks. Implementation Science201510:53 https://doi.org/10.1186/s13012-015-0242-0
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Content developed by the following authors in association with the cahpr Keele & South Yorkshire Hubs
