In BMC Medicine Michel Wensing and Richard Grol observe that implementation science in health (and related fields) have met with increasing interest, particularly in North-America but also in other countries such as Germany. However, reflecting on the previous 30 years, they argue that relatively little scientific progress has made in the previous decade. They plea for dedicated research programs that address the current challenges in the field, such as the proliferation of concepts, the lack of validated methods for stakeholder involvement in intervention design, and the decreased use of rigorous designs for evaluation of implementation strategies. The development of the field should be supported by higher academic recognition of health research that directly supports decision makers.
Despite increasing interest in research on how to translate knowledge into practice and improve healthcare, the accumulation of scientific knowledge in this field is slow. Few substantial new insights have become available in the last decade.
Various problems hinder development in this field. There is a frequent misfit between problems and approaches to implementation, resulting in the use of implementation strategies that do not match with the targeted problems. The proliferation of concepts, theories and frameworks for knowledge transfer - many of which are untested - has not advanced the field. Stakeholder involvement is regarded as crucial for successful knowledge implementation, but many approaches are poorly specified and unvalidated. Despite the apparent decreased appreciation of rigorous designs for effect evaluation, such as randomized trials, these should remain within the portfolio of implementation research. Outcome measures for knowledge implementation tend to be crude, but it is important to integrate patient preferences and the increased precision of knowledge.
We suggest that the research enterprise be redesigned in several ways to address these problems and enhance scientific progress in the interests of patients and populations. It is crucially important to establish substantial programmes of research on implementation and improvement in healthcare, and better recognize the societal and practical benefits of research.
Knowledge translation in health: how implementation science could contribute more
Wensing M, Grol R.
Michel Wensing is member of theme Vascular damage.
Richard Grol is member of theme Healthcare improvement science.