My experiences as an Implementation Research Fellow


by Alice Cunningham BSc, MSc, MBPsS, AFHEA

Alice Cunningham is an Implementation Research Fellow with the Yorkshire & Humber Improvement Academy working with researchers and practitioners across the Yorkshire & Humber Applied Research Collaboration.

Prior to starting this role, I had little knowledge of implementation science. My background is psychology and I worked for a local mental health crisis team prior to embarking on this journey. I am currently studying for my PhD in psychology which is quite different to implementation science! I have always been interested in research and this role intrigued me, it was different to what I was used to, it caught my eye as something new and exciting. I had read about the work of the Improvement Academy (IA) and was interested in the work they did.

I have been in this role almost three months now; one of the first things I learned about implementation science was that it’s not easy. Implementation science requires a great deal of engagement with many people, such as the people implementing the intervention and associated stakeholders. As a result, I have become very aware that the implementation team needs to be good at relating to others and encouraging multiple stakeholders to empathise with each other. Another thing I have learned is that in order for interventions to be implemented and sustained long term, they need to be continually optimised; our team leader, Implementation Specialist, Dr Kristian Hudson, said to think of interventions as living things that need to grow and adapt to their environment in order to survive. I found this fascinating as it demonstrates that research is ever changing and we, as researchers, need to adapt and accommodate the changes. Conversely, one limitation I have learned is that implementation science does not tell you ‘how to implement’, there is no step-by-step guide, yet, this could also be a positive as again, you are having to adapt the intervention and take contextual/environmental settings into account.

The array of research going on at the IA is fascinating; for me, coming from a mental health background, there is one project named Primrose – looking at the implementation of interventions to help those with serious mental illness lower their risk of cardiovascular disease – that is particularly interesting; it also draws on my two interests, mental health and research. I’m thoroughly enjoying working on this project alongside two research fellows, it’s quite nice to know we’re all in the same boat and are able to support each other. I’m excited to get going with data collection; it will be my first real taste of implementation science in practice.

Implementation science is different to any research I’ve done before; for the last twenty years, it has been aiming to bridge the gap between research and practice and I have found that fasincating! Very often, it is left to hospital staff to implement interventions that are developed outside of their setting. They do not receive implementation support, there is rarely follow-up and staff are frequently left to ‘get on with it’ which tends not to lead to favourable implementation outcomes. People cannot benefit from interventions that are not implemented well, so it is important to get implementation right. This is where implementation science can help; by understanding the contexts we are implementing into, we can use implementation science to either, overcome barriers, reduce barriers, or amplify facilitators to enable successful implementation and help bridge the gap between research and practice. 

There are literally thousands of barriers and facilitators so perhaps one of the most useful contributions of implementation science is its various implementation models, theories and frameworks which can help us identify barriers and facilitators and then formulate an implementation strategy. We have been learning to use the Consolidated Framework for Implementation Research (CFIR) Framework. The CFIR is a comprehensive, organising taxonomy of operationally defined constructs that may impact implementation success. The CFIR captures five domains (intervention characteristics, outer setting, inner setting, characteristics of individuals and process), with constructs and some sub-constructs which can affect implementation success. It is a deductive coding approach, which initially, took me some time to get my head around as I am used to using interpretative phenomenological analysis (IPA) and thematic analysis (TA) for analysis. Yet, my favourite thing about the CFIR is that you can add codes; for example, if something occurs that appears to hinder/help implementation but is not on the framework, it can still be coded. I am enjoying learning to use the CFIR and we have been working on a team on analysing data, using the CFIR, looking at practices on an ICU ward to detect barriers and facilitators within the context; this work has been accepted as a poster presentation for a conference which is very exciting!

As I am still doing my PhD, I was apprehensive about switching from shift work to ‘normal’ working hours to balance both; however, I’ve found my work at the IA and the PhD complement one another and I am able to bring skills from one into another. For example, my PhD is primarily qualitative; this is something I can bring to subsequent research at the IA (such as Primrose).

I’ve learnt a lot about implementation science and myself as an academic too. I am hopeful we can improve the implementation of interventions. It is worth mentioning that the support I have had from the team at the IA has been incredible; everybody is lovely and asks how research is going – it’s refreshing! It is an honour to work with so many great researchers and clinicians who have an array of experience; couldn’t think of a better team of people to work with! 

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We need a more realistic approach to implementation in healthcare (Part 1)

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There are a lot of people post Covid, and a lot of practitioners who are traumatised. In my field of work this was most evident on ICU wards. There is also the idea of traumatised systems. Data has shown how hard these systems were before Covid and the moral injury that practitioners experience in the service settings. Unfortunately, there’s just not enough in the literature and the big implementation science journals and conferences which talk about these burnouts and these traumas.