Three opportunities to boost implementation science at a critical time of need

Implementation science is an emerging field with a tremendous capacity to improve the global healthcare landscape. In this blog,实施科学通讯作为sociate Editors, Bev Holmes & Alison Hamilton, expand upon implementation science as a field of study, and explore three opportunities that would push this emerging field forward at a time of critical need.

In 2018, we were invited to join the team of associate editors for实施科学通讯(ISC),新期刊 -Implementation Science– devoted to the study of how health care programs and services are taken up, adapted, and sustained. As a Canadian funder-researcher (Holmes) and an American implementation scientist (Hamilton), we seized the opportunity to support an emerging field that has tremendous potential to improve patient care and public health.

大流行暂停世界和整个年代cientific process to the test.
© Delphotostock / stock.adobe.com

谁知道世界将很快面临全球大流行,这将使实施科学乃至科学企业本身。在过去的一年中,研究人员专注于实施科学在什么期间的表现English等称呼“全球最大,最集中的医疗服务重新设计工作”。在这篇文章中,我们评论了大流行背景下的实施科学嵌入,能力和复杂性,以及这些现象如何为该领域的进一步增长带来机会。

Setting the scene

To start, some definitional context: the US terms dissemination and implementation and the Canadian term knowledge translation (KT)大致平行。这三个术语涵盖了将基于证据的健康和医疗保健实践促进常规使用的过程。分别对这些过程的研究分别是传播和实施科学和KT科学。

实施科学是对促进经过验证的临床治疗,实践,组织和管理干预措施对常规实践进行系统性吸收的方法的科学研究。

特别是实施科学是“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 health.” Implementation scientists are experts in individual, group, organizational and system behavior change.

Our observation is that the field is less well developed in Canada than in the US. The distinction between implementation as a practice versus implementation as a science is sometimes confused in the broad research community, including among funders, and the small pool of Canadian implementation scientists is stretched thin responding to calls for support. The good news is the keen interest on both sides of the border in understanding how best to implement and de-implement evidence-based practices.

Opportunity 1: Embedding implementation science in health care

The world has seen remarkable innovation on many pandemic-related fronts at global, national, jurisdictional, and community levels, in everything from face masks to funeral practices, but particularly in health care services.

可以实现科学是一个缺失的难题piece in the healthcare system?
©Ababil12 / Getty Images / Istock

我们想知道,如果实施科学和实施科学家本身被嵌入了医疗保健中,那么其中有多少创新可以更有效。成功采用干预措施背后的证据和理论几乎没有时间反思。也许对为什么这种反思很重要的理解太少了:从长远来看,它可以节省时间和资源。在公共卫生和医疗保健专业人员中,实施科学家在哪里对大流行反应至关重要?他们也很关键吗?实施知识至少至少是至关重要的吗?如果没有,为什么?

我们知道实施科学家与某些司法管辖区实施干预措施之间的生产关系;我们还知道,即使他们并不总是让科学家参与其工作,即使他们并不总是让他们在实践中使用其理论和框架。但是,我们认为总体上并没有最大限度地提高实施科学中获得的知识,从而导致不清楚的结果。作为泰勒注意,有时不可能说干预措施是否失败是因为它无效,或者因为没有有效实施。

有时不可能说干预措施是否失败是因为它没有效果,或者因为没有有效实施。

医疗保健系统负担重大,实施者在异常复杂且苛刻的情况下工作,通常没有足够的时间吃饭,睡觉和与家人见面。我们不是对他们或实施科学家构成责备。我们简单而乐观地指出了将实施科学进一步融入医疗保健的机会。

机会2:建筑实施科学能力

Part of the reason implementation scientists are not playing a larger role in health care is that there aren’t enough of them. Unfortunately, there is neither a sufficient numbernor diversity of opportunities可用于增加容量。当前可用的培训非常出色,但竞争激烈。尽管在线资源越来越容易获得,但它们可能不够强大,无法开发必要的实施科学家。

是时候承认实施方法的专家库太小了。因此,有必要吸引学员以及新兴的调查人员进入该领域。

是时候承认实施方法的专家库太小了。

Many commentaries have noted the incalculable effects of the pandemic on the entire health research enterprise, with bleak perceptions of science as a viable job prospect and considerable challenges with maintaining the production of science. Implementation science, more nascent than other fields, may suffer from this pall over science as a profession, but we believe it is more relevant and viable than ever.

Finally, we note two other capacity gaps:implementation science review capacityas it relates to journal submissions and funding opportunities, and receptor capacity in the health care system. On the latter, implementation training for health care staff would certainly help, but最终在健康系统范围内的承诺to the production and use of research evidence for better health care is needed.

机会3:将复杂的镜头带入实施科学

在过去的十年中,关于卫生系统变化中复杂性的需求有很多讨论。但是,当该采取行动时(尤其是在危机期间),这似乎是一种自然的人倾向,试图简化而不是在复杂性内部工作。

Implementation science can help deal with complex problems that seem unsolvable.
© a-poselenov / Getty Images / iStock

We suggest the pandemic, as a complex problem within complex systems, provides an opportunity to demonstrate the importance and practicality of implementation science. There is heightened attention to a range of interventions, all of whichinvolve a range of stakeholders, organizations, and sectors with various accountabilities, responsibilities, allegiances, power, and influence. The world is not standing still as these interventions are implemented, and indeed, interventions themselves have their own systemic impacts.

Implementation scientists live and breathe this reality, and their efforts to move ‘context assessment’ beyond an up-front and one-time activity have realized results. We hope implementation scientists take the opportunity to incorporate morecomplex systems approaches进入他们的工作,促进知识将在未来几年内从大流行的影响中恢复过来,这将是有用的。

Summary: Where to from here?

Our commitment to the field of implementation science has only strengthened during this past year of医疗保健和社会的快速和前所未有的变化, and the resulting opportunities we see.

How can these opportunities be realized? Who needs to do what? There is no shortage of advice for implementation scientists in recent pandemic-related commentaries. However, implementation scientists can’t bring about the changes needed to maximize the potential contributions of the field alone. There is a role for funders in advancing the science of implementation through grants – especially those that provide for time to develop the relationships needed to study change in complex systems. Funders can also partner with universities to develop implementation science talent. Health system leaders can build implementation science capacity in organizations by encouraging evidence generation and use, supporting skill development, providing resources, and partnering with academia.

And finally, journals such as实施科学通讯can increase their efforts to promote this critical field of study, encouraging and publishing a wide range of articles that can practically contribute to improved health care delivery and health outcomes.

关于the authors:

Bev Holmes, PhD., is President and CEO of the Michael Smith Foundation for Health Research, British Columbia’s health research funding agency.

Alison Hamilton, Ph.D., M.P.H., is Chief Officer of Implementation and Policy at the VA Center for the Study of Healthcare Innovation, Implementation & Policy at the Greater Los Angeles Healthcare System, and a Professor-in-Residence in the Department of Psychiatry and Biobehavioral Sciences at UCLA.

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