Implementation science

Why can't we move research
into practice? Improving the
uptake of proven evidence.
Jill Hatchette, PhD
Consulting Scientist
IDR Team
Research Services
IWK Health Centre
First of all…..
• What are we talking about when
we say “uptake of proven
– Dissemination?
– Synthesis?
– Exchange?
– Application?
– Knowledge Translation?
• Dissemination involves identifying the
appropriate audience and tailoring the
message and medium to the audience.
• Dissemination activities include:
– summaries for stakeholders
– educational sessions with
• Patients
• Practitioners
• policy makers
– engaging knowledge users in developing and executing
• implementation plan,
• tools creation
• media engagement.
• The contextualization and integration of
research findings of individual research studies
within the larger body of knowledge on the
• A synthesis must be
– reproducible and transparent in its methods.
• E.g. systematic review, follow the methods
developed by the Cochrane Collaboration, result
from a consensus conference or expert panel or
synthesize qualitative or quantitative results.
• Realist syntheses, narrative syntheses, metaanalyses, meta-syntheses and practice guidelines
are all forms of synthesis.
• The interaction between knowledge user
and researcher, resulting in mutual learning.
– collaborative problem-solving between
researchers and decision-makers that happens
through linkage and exchange.
– mutual learning through the process of planning,
producing, disseminating, and applying existing
or new research in decision-making.
Ethically sound application of
• Activities for improved health consistent
with ethical principles and norms, social
values, as well as legal and other regulatory
• Application refers to the iterative process by
which knowledge is put into practice.
Knowledge Translation
Science….KT right? No….
• Implementation research is the scientific study
of methods to promote the systematic uptake
of proven clinical treatments, practices,
organizational, and management interventions
into routine practice, and hence to improve
• Research on implementation addresses the
level to which health interventions can fit
within real-world public health and clinical
service systems.
What does implementation
science study?
• Comparisons of two evidence-based
• How to promote the use of evidence
based guidelines.
• How to adapt an intervention to a
different population
• How to scale-up effective interventions
• The effects of a quality improvement
Why do we need
implementation science?
• Why can’t we just do the KT and
be done?
• Research is an iterative process.
However, the reality is….
• The NIH identifies similar areas of
• "Research-to-program “
– research evidence is not adequately or
appropriately considered and integrated
in the development of health outcomes.
• "Research-to-policy“
– research evidence is not adequately or
appropriately considered and integrated
in the development of health policy.
Why does implementation
• Short answer?
– We just don’t DO it.
• Preconditions not there
• Too costly
• Too difficult
• Just doesn’t fit
How is “implementation science” going to
make implementation actually happen?
• By changing the way we think about research,
who we do research with and how we actually
do research
• Implementation science is:
– A new way of thinking
– A new, but quickly developing field
• JAMA Pediatrics call for papers for Spring 2015
– Challenges:
• Current studies and existing research are small
• Dissemination remains somewhat localized
• Scientific methods are loose
• Implementation science is inherently
– Collaboration between researchers, implementers,
policymakers, the public
– Opportunities to learn from each other
– Challenges:
• Identifying methods of bringing people together
communicating in a meaningful way, developing
a common interest, goals and language.
• Identifying the expectations of researchers and
the expectations of those involved in the
implementation of new processes.
• Implementation science is not:
– Your typically scientifically rigorous research
– Opens up many opportunities to design research in
a context that is locally relevant
– Challenges
• Researchers and funders will need to appreciate the
value of findings from studies that are more loosely
controlled than the scientific norm.
• Implementation research will require a balance
between rigor and real world application
• MUST acknowledge that rigor ≠ quality.
• Scientific rigor must be balanced with a need to
conduct research that applies to real world settings.
• Researchers must be open to a range of methods
(qualitative/quantitative) and methods existing
outside their discipline.
TRIC funded
implementation science
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and outcomes
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