1. ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH www.indianactsi.org Engaging Hospitals in Research: Implementation Science Jose Azar, MD Medical Director, Quality Improvement. Patient safety and Inpatient Hematology/Oncology Unit IU Health Simon Cancer Center

2. ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH www.indianactsi.org Bridging Healthcare Discovery and Delivery: Implementation Science Fast Adoption of Proven Interventions In Everyday Practice Clinical Trials Health Services Research Implementa tion Science Learning Health System Better Care at Lower Cost

3. ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH www.indianactsi.org Bridging Healthcare Discovery and Delivery: Implementation Science Implementation research is the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and, hence, to improve the quality and effectiveness of health services and care. Implementation Science 2006; 1:1

4. ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH www.indianactsi.org Consolidated Framework for Implementation Science Un-adapted Intervention Outer Setting Inner Setting Individuals Involved Process Adapted Intervention Adaptable Periphery Core Components Adaptable Periphery Implementation Science, 2009; 4:50

5. ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH www.indianactsi.org Personalized Medicine Lean/Six Sigma Implementation Science Implementation Science: Sources of Variation in Healthcare Delivery Professional Informed Clinical Decision Making Patient Centered Systems and Processes Zero Error Zero Waste Patient Response Effectiveness of Care Boustani and Azar, 2012

6. ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH www.indianactsi.org Health Care System: Complex Adaptive System (CAS) Open, dynamic, flexible, adaptive and complex network Complex due to: –Numerous interconnected, semi-autonomous, competing, and collaborating professional members Adaptive due to: –Ability to learn from prior experiences –Dynamic and flexible connecting patterns among its members The performance of a CAS fluctuates over time due to: –Response to the external pressure or stressors –Resiliency of its internal network

7. ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH www.indianactsi.org Discovering solutions in a CAS: Reflective Adaptive Process (RAP) Process: –Shared Vision, Mission, and Values –Protected Time and Space –Safe Environment –Value Tension and Discomfort –Seek Diversity and Different Perspectives –Timely and ongoing feedback Accomplishments: –Critical Evaluation of Opportunities –Identification the Optimal Interventions –Scalability of positive solutions –Discontinuation of negative solutions

8. ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH www.indianactsi.org Application: Group-based Problem Solving Indianapolis Discovery Network for Dementia Group-based problem solving and solution generation forum Includes stakeholders from all five major health systems in Indianapolis Mission: –Conduct implementation science research activities –Provide a culture of discovery, cooperation and team work –Disseminate knowledge and innovations Outcome: –ROI of $32M in grant funding (NIH, CMS, PCORI)

9. ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH www.indianactsi.org Application: Group-based Problem Solving Hospital Unit-Based Innovation Team: Innovation team assembled to create resiliency/adaptability Engage with respect, purpose, empowerment Principles: –Innovation –Lean Methodology –Complexity Science Outcomes: –Rapid Cycle Improvement board – 18 projects in 6 months –Inpatient Relational Coordination based inter-professional daily care rounds

10. ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH www.indianactsi.org Inpatient Relational Coordination based Inter-professional Daily Care Rounds Relational Coordination Care Delivery Process Team: MD Fellows Residents Bedside RNs PharmDs Care Coordinators Case Managers Social Workers Outcomes: LOS Readmissions Discharge efficiency Falls Patient experience Outcomes: LOS Readmissions Discharge efficiency Falls Patient experience Role Definition to highlight expertise of each role Coaching to Enhance non-MD participation ? ?

11. ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH www.indianactsi.org Engaging Hospitals in Research: Find mutual goals and interest between healthcare research and delivery Focus on patient relevant outcomes in the clinical study design Factor optimal implementation / dissemination into clinical study design Consider economic and financial implications of the clinical study design Remember that healthcare systems are complex adaptive systems rather than linear hierarchical systems