1. Where is the Implementation in Implementation Science?
Rohit Ramaswamy
January 21, 2014

2. From Knowing to Doing: The Gap
“Our thinking about health care has to change and we have to begin to look at health care as a systems and delivery problem, not a disease problem”
Dr. Jim Yong Kim, President, World Bank

3. What is Implementation Science?
NIH
Implementation science is the study of methods to promote the integration of research findings and evidence into healthcare policy and practice.
Implementation Science Journal
the scientific study of methods to promote the systematic uptake of clinical research findings and other evidence-based practices into routine practice, and hence to improve the quality and effectiveness of health care.
Canadian Institute of Health Research
the exchange, synthesis and ethically-sound application of knowledge- within a complex system of interactions among researchers and users - to accelerate the capture of the benefits of research for [people] through improved health, more effective services and products, and a strengthened health care system

4. Implementation Science Steps (Bhattacharya)
1. Identify care gaps and the need for change. 2. Identify barriers to consistent use of guidelines. 3. Review evidence on implementation interventions. 4. Tailor or develop intervention to improve performance. 5. Implement intervention. 6. Evaluate the process of implementation. 7. Evaluate outcomes of the intervention (Grahamet al., 2006b).

5. What is Implementation ?
NIH Definition:
“the use of strategies to adopt and integrate evidence-based health interventions and change practice patterns within specific settings”
NIRN Definition:
“a specified set of activities designed to put into practice an activity or program of known dimensions”

6. The Implementation Research/Applied Implementation Continuum
IMPLEMENTATION SCIENCE
IMPLEMENTATION RESEARCH
WHAT APPROACHES WORK BEST IN THE TRANSLATION OF RESEARCH TO APPLICATION ?
CONTEXT SPECIFIC
KNOWLEDGE ABOUT
GOOD IMPLEMENTATION
PRACTICE
GENERALIZABLE KNOWLEDGE
ABOUT APPROACHES
APPLIED IMPLEMENTATION
HOW SHOULD THESE APPROACHES BE ADAPTED AND APPLIED IN PARTICULAR PRACTICE CONTEXTS AND SETTINGS TO ACHIEVE SUSTAINABLE OUTCOMES ?

7. Applied Implementation – Key Components
PROCESSES
ORGANIZATIONS
FACILITIES
EQUIPMENT
SUPPLIES
IMPLEMENTATION
FRAMEWORKS
AND TOOLS
IMPLEMENTATION
SYSTEM
DESIGN
EVALUATION
EVALUATION
EVALUATION
SIX SIGMA
LEAN
MFI
CONTINUOUS QUALITY
IMPROVEMENT

8. Designing Implementation Systems: Design Process (Brown)

9. Designing Implementation Systems: Design Approach

10. Mental Health Delivery System Design – Sehore District, Madhya Pradesh, India

11. Applied Implementation – Key Components
PROCESSES
ORGANIZATIONS
FACILITIES
EQUIPMENT
SUPPLIES
IMPLEMENTATION
FRAMEWORKS
AND TOOLS
IMPLEMENTATION
SYSTEM
DESIGN
EVALUATION
EVALUATION
EVALUATION
SIX SIGMA
LEAN
MFI
CONTINUOUS QUALITY
IMPROVEMENT

12. Getting to Outcomes (Wandersman)#2
Goals &
Objectives #3
Best
Practices #4
Fit #1
Needs/
Resources/
Readiness #5
Capacities
RESULTS
#10
Sustain #6
Plan #7
Process
Evaluation #9
Improve /
CQI #8
Outcome
Evaluation

13. NIRN Framework (Fixsen)

14. Implementation Example
Tobacco-Cessation Strategy
NIRN Framework
Exploration
Installation
Initial Implementation
Full Implementation
Fixsen, Blase, Bartley, Duda, Metz, Naoom, Sims, Van Dyke, 2011

15. Applied Implementation – Key Components
PROCESSES
ORGANIZATIONS
FACILITIES
EQUIPMENT
SUPPLIES
IMPLEMENTATION
FRAMEWORKS
AND TOOLS
IMPLEMENTATION
SYSTEM
DESIGN
EVALUATION
EVALUATION
EVALUATION
SIX SIGMA
LEAN
MFI
CONTINUOUS QUALITY
IMPROVEMENT

16. What is Quality Improvement ?
Quality Improvement is a formal approach to the analysis of system performance and systematic efforts to improve it.
Key words:
Formal approach
Analysis
System performance
Systematic efforts

17. Improving Healthcare – Quality Goals
Effective
Safe
Equitable
Patient Centered
Timely
Efficient

18. QI Methods
Several methodologies developed and tested for industrial quality applications are now being used in healthcare
Most popular QI methodologies:
Lean
Six Sigma
PDSA/Model for Improvement

19. QI Tools: A Suite of Options

20. Example – Jacaranda Health Maternity Clinic – Nairobi Kenya

21. Example – Flow Improvement in Ghana
Monitoring changes after quality improvement

22. Example – Flow Improvement in Wake County
74% reduction in patients turned away
Reduction in wait time variability
Under 1 hour: 60%
1-1.5 hours: 40%
Over 1.5 hours: 0%

23. ONLINE GLOBAL MPH
New concentration area in Applied Implementation Science
Design of Implementation Systems
Implementing Global Health Programs
Gillings Global Implementation Laboratory
Monitoring and Evaluation

24. Thank You!