Implementation Science Flashcards
What is Implementation Science?
- Knowledge mobilization
- Knowledge utilization
- Quality improvement
- Knowledge transfer
- Knowledge translation
Understand the Surgical Safety Checklist and how to interpret its effectiveness
- reduction in morbality after checklist implamented
- Look at outcomes before and after checklist implamentation
- Likely reason for lack of effectivity is not been used as if checklist is associated with change of behaviour
- checked at 3 points
Processes in implementation of evidence
ALL ABOUT Change in behaviour
* Replace a behaviour, reject a behaviour , or adopt a new behaviour –atan individual level, group level or system level
- Taxonomy of behaviour change techniques– 93
- Reference point for deciding the BCTs chosen to achieve a particularly behaviour outcome
- Requires understanding the behaviour change that is required
- Requires understanding the behaviour you want to change
How do we change behaviour in health care?
- Public health campaigns - media, health service, schools,
- Legislation–seatbelts, smoking, cleanair, childhood immunisations
- Screening programmes– cancer screening , early childhood screening
- Local commissioning of services (behaviour change programmes)– smoking , breastfeeding,
- Education of healthcare staff – prevention programmes
- Financial incentives - Quality and outcomes framework
- Commission for Quality and Innovation (Financial incentives in hospitals
- Policing of services– Care Quality Commission (independent body and assess them all)
What can be a reason for lack of replication in the results from the saftey security checklist?
- Different materials and protocols?
- Different location and contexts?
- Statistical regression to the mean?
Interventions we might use
- Provide an educational programme for all prescribers
- Run a national media programme to inform patients what to expect
- Prevent the dispensing by chemists of the more expensive statins without justification
- Install a pop-up in the computer
- Block the prescribing of the expensive versions of the drug within the NHS
NICE role in implementation?
NICE is committed to implementation of their guidance
* They offer >1100 pieces of guidance / advice on implementation of guidelines in local settings
* NICE Do not do recommendations - attempt to reduce bad actions but may not cause a huge change in behaviour as when will doctors refer to it
The research gaps
There is a common-sense approach–dominated by dissemination, audit, local service encouragement, and incentives
There is very little evidence for what works best in each circumstance
Obstacles to implementation
- Lack of experience in the executors of the implementation plan
- Inadequate planning
- Disorganised work culture
- Poor readiness to change
- Poor team structure
- Lack of necessary resources
- Lack of leadership
- Lack of commitment
- Lack of prioritisation
Main points to how implamentation can take place
- Implementation of evidence-based medicine / practice in healthcare is about behaviour change
- behaviour should be understood
- use right techniques to change the behaviour
- the obstacles to behaviour change should be understood
We can’t assume that evidence of benefit to health can be implemented in practice.
The proposed intervention to implement a change in health care should be designed and tested
