5 minute read
The new “science” of Implementation Science
Incorporating evidence-based research into everyday practice
By Liz Dylke
According to PubMed, there are over 1,000 papers per year published on lymphedema. This volume of research is both impossible to read and engage with in its entirety, nor will the vast majority of findings be brought into clinical practice. It has been widely reported that it takes, on average, 17 years for evidence-based practice to make its way from first suggestion into routine practice.1 Even more depressingly, the majority of good evidence-based practices never make it into widespread clinical use. This represents a waste of good research and potentially missed opportunities for patients. There are many factors that lead to this, but importantly, major barriers to implementing findings include practitioners having insufficient knowledge, skills or resources to deliver the practices in their clinical environment. Even more frequently though, the research undertaken doesn’t align with priorities of healthcare systems and practitioners working in them. Acknowledging this misalignment, a field of research, implementation science, has developed.
Implementation Science has been defined as the ‘scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine care, and, hence, to improve the quality and effectiveness of health services and care’.2 This is fundamentally different to clinical research, such as a typical randomized control trial or cohort study, as the outcomes analyzed in an implementation study are more often around the use of a practice, including the barriers and facilitators as well as costs of implementing a practice or model of care, rather than just its effectiveness. Implementation studies will also apply strategies to overcome the challenges that are identified.3 This developing form of research is therefore an exciting and critical look into how to bring proven assessments, treatments and models of care into a real clinical workplace. But it’s also quite a different approach to research from traditional clinical research as it approaches the research question and hypothesis with some different assumptions that need to guide the development of the study protocols.
1. Behaviour change is critical to bringing in research findings to practice, as well as policy.
2. Wide stakeholder engagement is necessary to identify all barriers and facilitators to bring the research findings into practice.
3. Flexibility, or a non-linear approach, is often necessary in order to examine how a practice will work within the real world.
Unlike other types of research, clear guidelines on how to interpret implementation sciencefocused studies have not yet been developed. However, when reading an implementation science study, there are some areas to consider most closely to determine if you believe the practice they have evaluated may be applicable in your clinical environment:
1. What is the outcome gap that they were looking to address and is this a practice or outcome gap that you experience? An outcome gap can be defined as the difference between the current health outcomes and what would be expected if the recommended practice were utilized.
2. What is the performance gap that they were looking to address and is it relevant in your clinical setting? A performance gap is the difference between current clinical practice and what would be considered ideal practice. This may focus on providers or systems, and may look at capability, motivation or opportunity of either the provider or the system to undertake the practice.
If you do not experience the same performance or outcome gaps that are identified in setting up the study, the findings of the barriers and facilitators may not apply to your practice. If the gaps do, however, it is worthwhile to then consider how the researchers evaluated their implementation study, to learn about the processes they used and implemented, what they modified or targeted to improve outcomes and how they determined if the practice was adopted or not, and if not, why not.
If you are considering undertaking an implementation-focused study yourself, the most critical thing is planning. A clear idea of the health gap, discussion with all key stakeholders, an understanding of the practice gap and awareness of the system’s or practice’s readiness for change are all necessary to properly develop an implementation study that will provide useful outcomes for the system that you are working within and beyond. Find your local implementation science experts and read the literature widely. There are some great websites out there as well to get you started. An increased focus on the study of how to implement findings into real-world clinical practice will continue to grow, expanding the field of Implementation Science. While a totally different way to approach research, supporting good evidence-based practice brought into clinical arenas—as well as understanding what clinical practice is interested to bring in and support—is critical for delivering quality care to our patients.
This article was first published in LYMPH EXCHANGE, November 2022 and reprinted with permission from the Australasian Lymphology Association.
A full set of references can be found at https://www.canadalymph.ca/pathwaysreferences/
Implementation Science website resources:
Sydney Health Partners: https://implementationscience.com.au
National Centre of Implementation Science: https://ncois.org.au/
Global Alliance for Chronic Disease: https://www.gacd.org/about/what-we-do/implementation-science
Liz Dylke
Liz Dylke PhD is Associate Professor, Head of Discipline: Physiotherapy/ Faculty of Medicine and Health at the University of Sydney. She is currently the President of the Australasian Lymphology Association. Dr. Dylke has a passion for demystifying the scientific process for those who are new to research.
