Aligning implementation science with improvement practice: a call to action

Abstract

Background In several recent articles, authors have called for aligning the fields of implementation and improvement science. In this paper, we call for implementation science to also align with improvement practice. Multiple implementation scholars have highlighted the importance of designing implementation strategies to fit the existing culture, infrastructure, and practice of a healthcare system. Worldwide, healthcare systems are adopting improvement models as their primary approach to improving healthcare delivery and outcomes. The prevalence of improvement models raises the question of how implementation scientists might best align their efforts with healthcare systems’ existing improvement infrastructure and practice. Main body We describe three challenges and five benefits to aligning implementation science and improvement practice. Challenges include (1) use of different models, terminology, and methods, (2) a focus on generalizable versus local knowledge, and (3) limited evidence in support of the effectiveness of improvement tools and methods. We contend that implementation science needs to move beyond these challenges and work toward greater alignment with improvement practice. Aligning with improvement practice would benefit implementation science by (1) strengthening research/practice partnerships, (2) fostering local ownership of implementation, (3) generating practice-based evidence, (4) developing context-specific implementation strategies, and (5) building practice-level capacity to implement interventions and improve care. Each of these potential benefits is illustrated in a case study from the Centers for Disease Control and Prevention’s Cancer Prevention and Control Research Network. Conclusion To effectively integrate evidence-based interventions into routine practice, implementation scientists need to align their efforts with the improvement culture and practice that is driving change within healthcare systems worldwide. This paper provides concrete examples of how researchers have aligned implementation science with improvement practice across five implementation projects.

Bridging the Silos: A Comparative Analysis of Implementation Science and Improvement Science

“…A crucial element of improvement science is the wide range of generic QI tools, inherited from many years of QI work (15), that can be applied to quality and performance problems. Implementation science scholars also borrow some of these tools (13,14,80,83), but they were not developed in this field.…”

“…For example, both implementation science and improvement science scholars have laboured over how concepts such as context, determinants, frameworks, strategies and interventions should be defined, with considerable within-field inconsistency in the use of many terms (66,72,78,102). Differences in terminology can be a problem, particularly when implementation science scholars engage with practice settings, which are increasingly adopting QI approaches (14). As a result, health care practitioners are learning the language of improvement science.…”

“…These tools can facilitate description and analysis of problems and support the development of relevant solutions. There are still relatively few implementation science studies that use the tools, but interest seems to be increasing, which is encouraging (13,14).…”

“…The overlapping interest of implementation science and improvement science allows for common ground. Several scholars have argued that aligning the two fields could potentially improve treatment and care to benefit patient and population health (13,14). For example, greater alignment could benefit implementation science scholars' ability to align their work with the terminology and tools such as Root Cause Analysis used by health care practitioners, many of whom have adopted QI approaches to address problems in health care delivery identified by such methods (15).…”

An Implementation Science Laboratory as One Approach to Whole System Improvement: A Canadian Healthcare Perspective

“…The scientific discipline of implementation science (IS) studies the best methods to promote the systematic uptake of innovations into routine practice, to improve the quality and effectiveness of health service delivery and patient care [ 16 ]. Globally, a number of reviews and policies identify the need to integrate implementation practice and science to drive healthcare improvement at a system level [ 17 , 18 , 19 , 20 ]. However, to date, there has been limited convergence between these fields.…”