Implementation science is a growing field and there are several avenues through which it could continue to develop, including integrating its practices into healthcare, creating opportunities to enter the field, and attaching a complexity lens to the domain.
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In 2018, we were invited to join the team of associate editors for Scientific implementation communications (ISC), a new journal – companion of Implementation science – devoted to the study of how health care programs and services are adopted, adapted and supported. As a Canadian Research Fellow (Holmes) and American Implementation Scientist (Hamilton), we have seized the opportunity to support an emerging field that has tremendous potential to improve patient care and public health. .
Who knew the world would soon face a global pandemic that would put the science of implementation, and indeed the scientific enterprise itself, to the test? Over the past year, researchers have focused on how implementation science fits English et al call “the world’s largest and most concentrated effort to overhaul health services.” In this article, we comment on the implementation, capacity and complexity of the science of implementation in the context of the pandemic and how these phenomena present opportunities for future growth in the field.
Prepare the decor
To begin with, a context of definition: the American terms dissemination and implementation and the Canadian term knowledge translation (KT) are roughly parallel. All three terms encompass processes to promote the adoption of evidence-based health and health care practices in common use. The diffusion and implementation sciences, and the KT science, respectively, are the study of these processes.
Implementation science is the scientific study of methods to promote the systematic adoption of proven clinical treatments, practices, organizational and managerial interventions into routine practice.
The science of implementation, in particular, is “the scientific study of methods to promote the systematic adoption of clinical treatments, practices, organizational and managerial interventions proven in routine practice, and therefore to improve health. The Implementation Scientists are experts in individual, group, organizational and system behavior change.
Our observation is that the field is less developed in Canada than in the United States. The distinction between implementation as practice and implementation as science is sometimes blurred in the broad research community, including among funders, and the small pool of Canadian scientists charged with implementing it. implementation is about to answer calls for support. The good news is the keen interest on both sides of the border to understand how best to implement and de-implement evidence-based practices.
Opportunity 1: Integrate implementation science into healthcare
The world has seen remarkable innovations on many fronts related to the pandemic at the global, national, jurisdictional and community levels, in everything from face masks to funeral practices, but particularly in healthcare services.
We wonder how many of these innovations could have been more effective if the implementation science and the implementation scientists themselves had been integrated into healthcare. There was little time to reflect on the evidence and theory behind the successful adoption of the interventions. It is perhaps too little understood why such thinking is important: that it saves time and resources in the long run. Where are the implementation scientists among the public health and health professionals critical to the pandemic response? Were they also critical? Has knowledge of implementation at least been essential? If not why?
We recognize the productive relationships between implementation scientists and those implementing interventions in some jurisdictions; We also know of organizations that value implementation science and use its theories and frameworks in practice, although they do not always involve scientists in their work. However, we argue that healthcare systems as a whole do not maximize the knowledge gained through implementation science, leading to unclear results. As Taylor Note, sometimes it is not possible to tell whether an intervention is failing because it is not effective or because it was not implemented effectively.
Sometimes it is not possible to tell whether an intervention is failing because it is not effective or because it was not implemented effectively.
Health systems are overloaded and implementers are working under incredibly complex and demanding circumstances, often without enough time to eat, sleep and see their families. We are not blaming them – or the implementing scientists. We simply note – and hopefully – an opportunity to further integrate implementation science into healthcare.
Opportunity 2: Strengthen scientific capacities for implementation
Part of the reason that implementing scientists don’t play a bigger role in healthcare is because there aren’t enough of them. Unfortunately, there is neither a sufficient number no diversity of opportunities available to increase capacity. The training currently available is exceptional, but highly competitive. And although online resources are increasingly accessible, they may not be robust enough to develop the necessary cadre of implementation scientists.
It is time to recognize that the pool of experts on methods of implementation is too small. Therefore, there is a need to attract trainees, as well as emerging and established researchers, to the field.
It is time to recognize that the pool of experts on methods of implementation is too small.
Many comments pointed to the untold effects of the pandemic on the entire health research enterprise, with grim perceptions of science as a viable job prospect and considerable challenges in sustaining science production. Implementation science, more nascent than other fields, may suffer from this veil on science as a profession, but we believe it is more relevant and viable than ever.
Finally, we note two other capacity gaps: capacity for scientific review of implementation with regard to journal submissions and funding possibilities, and the capacity to accommodate in the health care system. On this last point, implementation training for health workers would certainly help, but finally a commitment at the level of the health system to the generation and use of research data for better health care.
Opportunity 3: Bring a complexity perspective to implementation science
Over the past decade, much has been said about the need to accommodate the complexity of health system change. However, when it’s time to act – especially during a crisis – there seems to be a natural human tendency to try to simplify, rather than working in complexity.
We suggest that the pandemic, as a complex problem within complex systems, provides an opportunity to demonstrate the importance and practicality of the science of implementation. There is increased attention to a range of interventions, all of which involve a range of stakeholders, organizations and sectors with varying responsibilities, responsibilities, allegiances, power and influence. The world is not left behind as these interventions are implemented, and indeed, the interventions themselves have their own systemic impacts.
Implementation scientists live and breathe this reality, and their efforts to move “context assessment” beyond an initial, one-time activity have paid off. We hope that implementing scientists take the opportunity to further integrate complex systemic approaches in their work, advancing knowledge that will be useful for years to come as the world recovers from the effects of the pandemic.
Summary: Where to go from here?
Our commitment to implementation science has only grown stronger over the past year of rapid and unprecedented changes in healthcare and societiesand the resulting opportunities.
How can these opportunities be realized? Who should do what? There is no shortage of advice provided to implementing scientists in recent pandemic commentaries. However, implementation scientists cannot make the changes necessary to maximize the potential contributions of the field on its own. Funders have a role to play in advancing the science of implementation through grants – especially those that provide time to develop the relationships necessary to study change in complex systems. Donors can also partner with universities to develop implementation science talent. Health system leaders can build scientific capacity for implementation in organizations by encouraging the production and use of evidence, supporting skills development, providing resources, and building partnerships with universities.
And finally, reviews such as Scientific implementation communications can increase their efforts to promote this critical area of study, by promoting and publishing a wide range of articles that can virtually contribute to improved health care delivery and health outcomes.
About the authors:
Bev Holmes, PhD., Is President and CEO of the Michael Smith Foundation for Health Research, British Columbia’s health research funding agency.
Alison Hamilton, Ph.D., MPH, is Head of Implementation and Policy at the VA Center for the Study of Healthcare Innovation, Implementation & Policy at the Greater Los Angeles Healthcare System, and Professor in Residence in the Department of Psychiatry and Science biobehaviourals at UCLA.