Right now , in healthcare in general , I think there ’ s a significant difficulty in recovering from COVID . “ Just like so many other things , the pandemic has uncovered challenges , including the risk of burnout and the concept of ongoing wellness among healthcare personnel , and people being able to sustain their careers . And the complexity of healthcare continues to grow .” — Joshua
Schaffzin , MD
the likelihood that the process of change is smooth , sustainable , and cost-effective .”
Hospitals are unique microcosms , with their specialized populations , processes and microsystems , which may encounter unique barriers to implementation science . Geerligs , et al . ( 2018 ) assert that , “ Translation of evidence-based interventions into hospital systems can provide immediate and substantial benefits to patient care and outcomes , but successful implementation is often not achieved .”
They point to various determinants ( barriers and facilitators ) of the implementation process , and in their systematic review , they identified relationships between these barriers and facilitators to highlight key domains that need to be addressed by researchers and clinicians seeking to implement hospital-based , patient-focused interventions . The researchers grouped staff-identified barriers and facilitators to implementation into three main domains : system , staff , and intervention . Barriers identified by Geerligs , et al . ( 2018 ) directly related to the hospital environment and included workload and workflow , physical structure , and resources : “ Staff workload and lack of time for implementation were the most commonly cited barriers . Staff shortages , high staff turnover , or changes in roster compounded this issue , resulting in burden for implementation falling on small numbers of staff who were most interested , rather than generating change at the institution level . Several studies targeted this issue by hiring additional staff , such as a research coordinator , or delegating parts of the intervention to the research team . In contrast , support provided at the institutional level for staff to have time for implementation was believed to be a more sustainable facilitator .”
The researchers found that barriers related to workplace culture centered around system-level commitment and change readiness : ” Low levels of commitment often occurred in response to structural changes , such as high turnover , which left staff feeling demoralized and unable to accept additional challenges required by implementing the intervention . Support from management regarding the importance of change and organization-level commitment to new processes was crucial to combating this . Several interventions also used champions or coordinators to facilitate motivation , although some staff reported experiencing negativity from colleagues as a barrier to carrying out this role effectively .
Geerligs , et al . ( 2018 ) also noted that workplace culture barriers also included the level of role flexibility and trust between different clinicians involved in the intervention : “ Congruence between the intervention requirements and staff roles was important . Staff who reported that implementation required them to perform duties beyond their role reported struggling , especially if they anticipated judgment from colleagues . However , other respondents felt that building trust across the team could address these concerns .”
The efficacy of communication was an important factor in the success of implementation science in healthcare , particularly where interventions required collaboration between staff of different disciplines . As Geerligs , et al . ( 2018 ) observe , “ Lack of interdepartmental collaboration , miscommunication , and fragmentation between practitioners could serve as a significant barrier to successful implementation . Environments that promoted open and clear communication motivated staff to take on challenges , and feel safe about reporting errors or issues , resulting in more successful implementation .”
The Knowing-Doing Gap
The crux of compliance with infection prevention and control ( IP & C ) principles usually is the “ knowing-doing ” gap , a term used to describe why practices in healthcare may diverge from those recommended according to the evidence .
The challenge is that while evidence-based practice guidance is prescriptive , guidance for implementation often is not intended to be so , in that “ Implementation as a concept is broad , and success in implementing practices or interventions depends on a systematic approach matched to an organization ’ s context ( such as local factors , such as operational support , informatics resources , experience , willingness to change , safety culture , and others ),” according to Trivedi and Schaffzin , et al . ( 2023 ).
As the researchers explain further , “ Implementation science emerged in the last 20 years to improve patient outcomes and healthcare personnel safety . As a field of study initially developed for industry , its principles have been adapted to integrate evidence-based practices sustainably in healthcare settings . Implementation science identifies generalizable methods and frameworks to increase the utilization of evidence-based interventions deliberately and systematically in healthcare . Various terms have been used to describe the field of implementation science , including the ‘ theory-practice gap ,’ ‘ knowledge transfer ,’ and ‘ knowledge utilization .’”
Simply put , the authors note that implementation science provides the tools and frameworks to help translate evidence-based interventions into everyday clinical practice : “ Studies in implementation science make it clear that identifying effective interventions is a necessary first step , and that transferring them into real-world settings requires an intentional process . Education and training have proven necessary but insufficient for improvement and behavior change . Implementation science directs us to evaluate contextual determinants of behavior to design more successful , customized interventions . Improvement science , a related field , focuses on the local context and provides guidance regarding how to perform trials of new practices rapidly and iteratively to improve care . These two fields , while having distinct models and terminology , can be aligned and complement each other to improve healthcare services . Healthcare