Simplifying implementation science

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by Dr Zuneera Khurshid and Dr Kristian Hudson

We often hear about how there is a seventeen-year gap between evidence being produced, and it getting translated into practice. Put simply, this means that as researchers even though we know we have better solutions available, we are struggling to put these into practice. This is particularly important for the healthcare sector because even though the evidence base is expanding, the effort to put this into practice is lagging. This is where implementation science comes in. It provides the tools and methods that can be used to help put knowledge into practice and can also explain what works and why it works. It also generates learning that others can use to inform similar work. Sounds simple right? Then why is it that we are no closer to bridging this gap between knowledge and practice. There is a plethora of interventions already available and it is quite likely whatever the problem is, there is already a research study that offers how to solve it however, it is still challenging to put it into practice.

‘Ivory tower research’ is being talked about more and more as research is sometimes inaccessible and disconnected from the complexities of the real world. Implementation science can help open the doors to the ivory tower and bring research to the frontline. However, researchers also need to be aware of the pitfall of assuming that the flow of knowledge is unidirectional, only from evidence to practice. Frontline practitioners are experts when it comes to the local context or the ‘real world’ and research, especially implementation research, should also incorporate the practice to evidence element, otherwise it can further increase the gap. 

Another challenge in the current implementation science landscape is that there is a plethora of frameworks, theories, and models available but not much being done to make these accessible for frontline teams. With so much choice available, how can someone working at the front line know what to use, and how it can help them? Even though implementation science is a separate research area, all research should be useful and practical; therefore consideration for ‘implementation’ should be a common denominator across all research. It complements all research areas and brings a touch of the real world to the research. 

The Yorkshire and Humber Improvement Academy is the ‘implementation arm’ of the NIHR-funded Yorkshire & Humber Applied Research Collaboration. The implementation team has a dynamic view of implementation science and is looking to move away from rigid and traditional methods to implementation science by using more practical approaches while still maintaining scientific rigour. This means trying out research methods that are more rapid, responsive, relevant, and easy to use for frontline staff. This requires an active implementation approach where we try to move away from just being advisers, observers, or evaluators, to being facilitators, and partners in the learning process. Rather than doing static traditional evaluations at different time points, our approach draws on the principles of learning evaluations. 

They key feature of this is to develop feedback loops where we work with implementation teams to continuously collect data by providing them the space where they can think about what is working well, what needs to be improved, and their insights and ideas. This is then quickly analysed and shared back to the implementation team so they could use this data to adapt the interventions in a timely manner and emphasising that adaptation is the key to implementation. Another area we are exploring is to work across different research areas where we can test integrating implementation knowledge and evaluations with other research areas. We have done this with improvement science methods and participatory action research which has resulted in more robust outcomes for researchers as well as participants. This has also resulted in approaches that are better able to capture the complexity of the implementation process and how teams handle uncertainty. 

We aim to continue expanding the knowledge base and working across disciplines, and methodologies. The purpose of implementation is to improve healthcare practice so the knowledge generated should be generalisable, contextual, but also transferable as well. The aim of the implementation team is to not just study implementation across different projects, but to also consolidate these learnings and contribute to system level learning, expanding the boundaries of implementation science and making it easier for front line teams to use implementation knowledge.  

In summary, while we are hoping to make implementation science simpler, we want to do so keeping in mind the complexity of the healthcare system and that researchers, participants, and context are all evolving which means we as implementation researchers need to evolve how we approach the research as well. 

 ‘In implementation research; you are always looking at a story that hasn’t finished yet’ – Carl May

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