Bridging the ‘know-do’ gap in healthcare

Medical professional putting on surgical scrubs

CEI was recently invited by Singapore Institute of Technology to provide healthcare leaders, therapists and doctors with strategies to improve uptake of new, evidence-based interventions into routine practice.

CEI Director Dr Cheryl Seah reflects on the content of this workshop and highlights core resources for further reading.

Why is implementation science needed?

There is often a disconnect between what we know and what we do in healthcare. Countless studies have shown that it takes, on average, 17 years for an evidence-based intervention to be adopted into healthcare practice. And many evidence-based practices never even make it.

To reduce this research-to-practice gap, experts in implementation science have studied barriers and facilitators of implementation. There are also many tools to ensure that evidence-based interventions can be effectively delivered and ‘scaled-up’ within the healthcare system – so that more patients can benefit, sooner.

Participants at our recent workshop had the opportunity to apply implementation evaluation frameworks to their past and current innovations, and to build their understanding that the quality of an implementation has a strong influence on the effectiveness of an intervention. Facilitation of team collaboration, the use of innovation champions and good engagement with relevant stakeholders were frequently identified as important strategies in successful implementation and scaling.

What does the healthcare workforce need to know?

The healthcare challenge is to accelerate the uptake of clinical innovation.

We want healthcare workers to understand the basic principles of implementation science and be familiar with selected frameworks that can guide the implementation journey. It’s important to know what influences outcomes, how to tailor strategies to enhance uptake of innovation into routine practice, and how to overcome implementation barriers.

Apart from knowing ‘Does the new practice work?’ – usually the role of the clinical trial – the healthcare workforce also needs to ask: ‘How does it work?’ and ‘For whom does it work?’ to know how and whether the innovation needs adapting for local context. This will help with driving both effectiveness and implementation in each specific setting.

We can use implementation evaluation frameworks to provide a structure for describing the process of translating effective interventions into practice, in analysing what influences implementation outcomes and in evaluating implementation efforts. In pilot evaluations, we would ask questions such as: ‘Is this innovation appropriate, acceptable and feasible?’ or ‘What is the minimal implementation support required to ensure the same quality of service delivery?’

A participant’s reflection

One of the Singapore Institute of Technology workshop participants reflected on what they had learnt in the session.

“Now, when I come across an intervention that touts amazing outcomes, I will look deeper into the evaluation process, the fidelity of the intervention and the many other measures of implementation success that I have learnt are just as important as the desired outcomes…”

“[If] I were to scale up an intervention that looks promising… I need to know how to tailor it for my context.”

Key resources for further reading

  • General introduction to implementation science
    • Bauer, M. S., Damschroder, L. J., Hagedorn, H., Smith, J. L., & Kilbourne, A. M. (2015). An introduction to implementation science for the non-specialist. BMC Psychology, 3(1), 1–12.
    • Khalil, H. (2016). Knowledge translation and implementation science: what is the difference? International Journal of Evidence-Based Healthcare, 14(2), 39–40.
  • Implementation science books
    • Greenhalgh, T. (2017). How to implement evidence-based healthcare. John Wiley & Sons.
    • Implementation Science 3.0 Albers, B., Shlonsky, A., & Mildon, R. (Eds.). (2020). Implementation Science 3.0. Switzerland: Springer.
  • Implementation frameworks
    • PARIHS: Rycroft-Malone, J. (2004). The PARIHS Framework - A Framework for Guiding the Implementation of Evidence-based Practice. Journal of Nursing Care Quality, 19(4), 297–304.
    • CFIR: Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Scoping Studies: Advancing the Methodology, 4(1), 50.
    • EPIS: Aarons, G., Hurlburt, M., & Horwitz, S. M. (2010). Advancing a Conceptual Model of Evidence-Based Practice Implementation in Public Service Sectors. Administration and Policy in Mental Health and Mental Health Services Research, 38(1), 4–23.
    • AIF: Metz, A., & Bartley, L. (2012). Active Implementation Frameworks for Program Success. Zero to Three, 32(4), 11–18.
  • Implementation strategies
    • Powell, B. J., Beidas, R. S., Lewis, C. C., Aarons, G., McMillen, J. C., Proctor, E. K., & Mandell, D. S. (2015). Methods to Improve the Selection and Tailoring of Implementation Strategies. The Journal of Behavioral Health Services & Research, 1–18.
    • Powell, B. J., Waltz, T. J., Chinman, M. J., Damschroder, L. J., Smith, J. L., Matthieu, M. M., et al. (2015). A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Scoping Studies: Advancing the Methodology, 10(1), 1–14.
  • Sustainability