Implementation science is the research that looks at how to make things
It is a learning system that is not static but fluid , continually evolving , so the purpose of guidance around implementation is to make people aware of the science , and to allow them to enable the practice to ultimately lead to good outcomes .”
— Joshua Schaffzin , MD , PhD
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In the IDWeek presentation , “ You ’ ve Heard the Recommendations , Now What ? Implementation and the 2022 Compendium ,” Joshua Schaffzin , MD , PhD , associate professor of clinical pediatrics and director of the IP & C program at the University of Cincinnati , Cincinnati Children ’ s Hospital Medical Center , addressed implementation science , which is the scientific study of methods to promote the systematic uptake of research findings as well as other evidence-based practices into routine practice .
“ Implementation science is the research that looks at how to make things happen ,” Schaffzin explained . “ It is a learning system that is not static but fluid , continually evolving , so the purpose of guidance around implementation is to make people aware of the science , and to allow them to enable the practice to ultimately lead to good outcomes . So , implementation guidance , by its nature , must be different than other evidence-based guidance because implementation can ’ t really be prescriptive , and context is a huge piece of this . A successful implementation — rather than thinking about an individual patient — thinks about a system . How will this change affect the system ? How can we enact change in the system ? A lot of it must be matched to an organizational context , which has many factors involved , but it ’ s about how much infrastructure is there , how much operational support , how familiar people are with the methodology , and how willing they are to change your patient population .”
Schaffzin explained that every chapter in the Compendium contains an implementation section specific to that chapter focus , and the authors of each chapter have pulled together implementation evidence .
“ This year there ’ s an additional chapter dedicated to implementation , and it covers the rationale for needing purposeful implementation ; it tries to define a lot of these terms as well as provides a number of conceptual models and frameworks that people can use to implement , and then most importantly , it offers a number of resources . So , why do we need an implementation chapter ? The first reason is to close the knowing-versus-doing gap . It ’ s estimated that it takes about 17 years for a scientific finding to be implemented into practice . There ’ s a strong belief that implementation science can shorten that .”
He continued , “ Most people will focus on education , and education is very important , but it ’ s not reliable , and it doesn ’ t last . To create meaningful change , there needs to be system change . This is more of a C-suite argument , but from a regulatory standpoint , the expectation is that facilities will take evidence-based practices , put them in their policies , and then practice them , actually , do
them and so without the implementation piece , you ’ re liable to not be congruent with the regulatory expectation .”
Schaffzin pointed to several conceptual models and frameworks through which research can be translated into practice , calling out the 4-E ’ s approach of Engage , Educate , Execute and Evaluate . “ I think that it ’ s a nice comprehensive model that has been shown to work in infection prevention activities . Many of the Compendium chapters are going to cover a lot of the evidence that shows that this is something that can be done . So , the take-home message is that you must think big and small .”
He continued , “ The first step is to envision the problem within the larger system and engage local and central multidisciplinary teams . Meaning , what is the big picture , and then how is it going to affect the people and the patients ? You summarize the evidence , identify local barriers , measure performance , and ensure that all patients receive the intervention . So , you look at what is keeping people from doing what we need them to do , look at their performance , tell people how they ’ re doing , and you need to be able to assess whether what you ’ re doing is working .”
Schaffzin shared the analogy of getting one ’ s children to brush their teeth . “ Your goal is to create a lifelong skill that will prevent them from painful experiences and reduce their risk of that . You need to empower them to hold themselves accountable , and you explain to them why we do it ; you can ’ t just say ‘ Hey , brush your teeth ’ and expect them to do it . It ’ s not going to work . You educate them around why this is a healthy habit and then you have them do it as soon as they wake up in the morning and right before they go to bed . And you take them to the dentist to measure their performance . It ’ s very similar to what we are trying to enact within healthcare .”
Schaffzin also shared several keys to success , including breaking down a very large project into smaller , more manageable tasks .
“ Take one thing at a time , test it , learn from it , and change what isn ’ t working . Try to avoid saying , ‘ I was once in that position , so I think we should just do this and we ’ re done .’ That ’ s a 30,000-foot intervention . While it can be a good place to start , you must drill down into the different steps , taking one step at a time . Successful engagement is about everyone engaged in trying to achieve what we ’ re trying to do , and not just having people agree with me . You also need engagement at the leadership level that includes managers , directors as well as members of the C-suite who endorse that this is an organizational expectation , which can help remove barriers . You also need engagement at the front line , among the people who actually engage in the process . They make things happen and you need to understand their work process because you don ’ t want to give them extra work to do . You want to avoid death by a thousand paper cuts . Having champions among the frontline staff to help disseminate information and support the process is critical to success .”
As next steps , Schaffzin encouraged healthcare professionals to utilize the implementation methodologies to put the Compendium chapters into action .
“ I would also encourage you to publish your experiences ,” Schaffzin said . “ What we need to know is how have people done this and what has worked and what might work for me . Additionally , I would encourage you to advocate for resources , as the more infrastructure you have locally , the easier it is for you to engage in implementation .”