Implementation science: A critical but undervalued part of the healthcare innovation ecosystem
Sze Ling Chan
Health Services Research Centre, SingHealth, Singapore, Singapore
Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
Contribution: Conceptualization (lead), Data curation (lead), Writing - original draft (lead), Writing - review & editing (equal)
Search for more papers by this authorElaine Lum
Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
Contribution: Conceptualization (supporting), Writing - review & editing (equal)
Search for more papers by this authorMarcus E. H. Ong
Health Services Research Centre, SingHealth, Singapore, Singapore
Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
Contribution: Writing - review & editing (equal)
Search for more papers by this authorCorresponding Author
Nicholas Graves
Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
Correspondence Nicholas Graves, Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore 169857, Singapore.
Email: [email protected]
Contribution: Conceptualization (equal), Writing - review & editing (equal)
Search for more papers by this authorSze Ling Chan
Health Services Research Centre, SingHealth, Singapore, Singapore
Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
Contribution: Conceptualization (lead), Data curation (lead), Writing - original draft (lead), Writing - review & editing (equal)
Search for more papers by this authorElaine Lum
Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
Contribution: Conceptualization (supporting), Writing - review & editing (equal)
Search for more papers by this authorMarcus E. H. Ong
Health Services Research Centre, SingHealth, Singapore, Singapore
Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
Contribution: Writing - review & editing (equal)
Search for more papers by this authorCorresponding Author
Nicholas Graves
Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
Correspondence Nicholas Graves, Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore 169857, Singapore.
Email: [email protected]
Contribution: Conceptualization (equal), Writing - review & editing (equal)
Search for more papers by this authorAdditional information for HCS-2022-0020.R1.
Abstract
Healthcare systems face many competing demands and insufficient resources. Service innovations to improve efficiency are important to address this challenge. Innovations can range from new pharmaceuticals, alternate models of care, novel devices, and the use other technologies. Suboptimal implementation can mean lost benefits. This review article aims to highlight the role of implementation science, summarize how settings have leveraged this methodology to promote translation of innovation into practice, and describe our own experience of embedding implementation science into an academic medical center in Singapore. Implementation science offers a range of methods to promote systematic uptake of research findings about innovations and is gaining recognition worldwide as an important discipline for health services researchers. Health systems around the world have tried to promote implementation research in their settings by establishing (1) dedicated centers/programs, (2) offering funding, and (3) building knowledge and capacity among staff. Implementation science is a critical piece in the translational pathway of “evidence to innovation.” The three efforts we describe should be strengthened to integrate implementation science into the innovation ecosystem around the world.
CONFLICT OF INTEREST
The authors declare no conflict of interest.
Open Research
DATA AVAILABILITY STATEMENT
There is no data for this review.
References
- 1Savitz LA, Savitz ST. Can delivery systems use cost-effectiveness analysis to reduce healthcare costs and improve value. F1000Res. 2016; 5: 5. https://doi.org/10.12688/f1000research.7531.1
10.12688/f1000research.7531.1 Google Scholar
- 2Padula Wv, Sculpher MJ. Ideas about resourcing health care in the United States: can economic evaluation achieve meaningful use. Ann Intern Med. 2021; 174(1): 80–5. https://doi.org/10.7326/M20-1234
- 3Rawlins MD, Culyer AJ. National Institute for Clinical Excellence and its value judgments. BMJ. 2004; 329(7459): 224–7. https://doi.org/10.1136/bmj.329.7459.224
- 4Tsevat J, Moriates C. Value-based health care meets cost-effectiveness analysis. Ann Intern Med. 2018; 169(5): 329–32. https://doi.org/10.7326/M18-0342
- 5Belloso WH. On innovation. Ther Innov Regul Sci. 2022; 54(5): 1068–75. https://doi.org/10.1007/s43441-020-00125-3
- 6Ting DSW, Cheung CYL, Lim G, Tan GSW, Quang ND, Gan A, et al. Development and validation of a deep learning system for diabetic retinopathy and related eye diseases using retinal images from multiethnic populations with diabetes. JAMA. 2017; 318(22): 2211–23. https://doi.org/10.1001/jama.2017.18152
- 7Perepelkina T, Fulton AB. Artificial Intelligence (AI) applications for Age-Related Macular Degeneration (AMD) and other retinal dystrophies. Semin Ophthalmol. 2021; 36(4): 304–9. https://doi.org/10.1080/08820538.2021.1896756
- 8Xie Y, Nguyen QD, Hamzah H, Lim G, Bellemo V, Gunasekeran Dv, et al. Artificial intelligence for teleophthalmology-based diabetic retinopathy screening in a national programme: an economic analysis modelling study. Lancet Digit Health. 2020; 2(5): e240–9. https://doi.org/10.1016/S2589-7500(20)30060-1
- 9Speerin R, Needs C, Chua J, Woodhouse LJ, Nordin M, McGlasson R, et al. Implementing models of care for musculoskeletal conditions in health systems to support value-based care. Best Pract Res Clin Rheumatol. 2020; 34(5):101548. https://doi.org/10.1016/j.berh.2020.101548
- 10Jafar TH, Gandhi M, de Silva HA, Jehan I, Naheed A, Finkelstein EA, et al. A community-based intervention for managing hypertension in rural South Asia. N Engl J Med. 2020; 382(8): 717–26. https://doi.org/10.1056/NEJMoa1911965
- 11Gunasekeran DV, Tham YC, Ting DSW, Tan GSW, Wong TY. Digital health during COVID-19: lessons from operationalising new models of care in ophthalmology. Lancet Digit Health. 2021; 3: e124–34. https://doi.org/10.1016/S2589-7500(20)30287-9
- 12Doraiswamy S, Abraham A, Mamtani R, Cheema S. Use of telehealth during the COVID-19 pandemic: scoping review. J Med Internet Res. 2020; 22(12):24087. https://doi.org/10.2196/24087
- 13Marten R, Mikkelsen B, Shao R, Dal Zennaro L, Berdzuli N, Fernando T, et al. Committing to implementation research for health systems to manage and control non-communicable diseases. Lancet Glob Health. 2021; 9(2): e108–9. https://doi.org/10.1016/S2214-109X(20)30485-X
- 14Green LW, Ottoson JM, García C, Hiatt RA. Diffusion theory and knowledge dissemination, utilization, and integration in public health. Annu Rev Public Health. 2009; 30: 151–74. https://doi.org/10.1146/annurev.publhealth.031308.100049
- 15Trochim W. Translation won't happen without dissemination and implementation: some measurement and evaluation issues. In: 3rd Annual Conference on the Science of Dissemination and Implementation. Bethesda, MD; 2010.
- 16Cooksey D. A review of UK health research funding [Internet]. London; 2006. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/228984/0118404881.pdf
- 17Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011; 104(12): 510–20. https://doi.org/10.1258/jrsm.2011.110180
- 18Wensing M, Sales A, Armstrong R, Wilson P. Implementation science in times of Covid-19. Implement Sci. 2020; 15(1): 42. https://doi:10.1186/s13012-020-01006-x
- 19Chu KM, Weiser TG. Real-world implementation challenges in low-resource settings. Lancet Glob Health. 2021; 9(10): e1341–2. https://doi.org/10.1016/S2214-109X(21)00310-7
- 20Eccles MP, Mittman BS. Welcome to implementation science. Implement Sci. 2006 1(1): 1–3. https://doi.org/10.1186/1748-5908-1-1
- 21Peters DH, Adam T, Alonge O, Agyepong IA, Tran N. Implementation research: what it is and how to do it. BMJ. 2013; 347(8): 731–6. https://doi.org/10.1136/bmj.f6753
10.1136/bmj.f6753 Google Scholar
- 22Bauer MS, Kirchner JA. Implementation science: what is it and why should I care? Psychiatry Res. 2020; 1: 283. https://doi.org/10.1016/j.psychres.2019.04.025
- 23Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non-specialist. BMC Psychol. 2015;16 3: 32. https://doi.org/10.1186/s40359-015-0089-9
- 24Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care. 2012; 50(3): 217–26. https://doi.org/10.1097/MLR.0b013e3182408812
- 25Ovretveit J, Mittman B, Rubenstein L, Ganz DA. Using implementation tools to design and conduct quality improvement projects for faster and more effective improvement. Int J Health Care Qual Assur. 2017; 30(8): 755–68. https://doi.org/10.1108/IJHCQA-01-2017-0019
- 26Theobald S, Brandes N, Gyapong M, El-Saharty S, Proctor E, Diaz T, et al. Implementation research: new imperatives and opportunities in global health. Lancet. 2018; 392(10160): 2214–28. https://doi.org/10.1016/S0140-6736(18)32205-0
- 27Rangachari P. Innovation implementation in the context of hospital QI: lessons learned and strategies for success. Innov Entrep Health. 2018; 5: 1–14. https://doi.org/10.2147/IEH.S151040
- 28Tierney AA, Haverfield MC, McGovern MP, Zulman DM. Advancing evidence synthesis from effectiveness to implementation: integration of implementation measures into evidence Reviews. J Gen Intern Med. 2020; 35(4): 1219–26. https://doi.org/10.1007/s11606-019-05586-3
- 29Li J, Williams Mv, Page C, Cassis L, Kern PA, DiPaola RS. The Value of Innovation to Implementation Program (VI2P): a strategic approach to aligning and leveraging academic research and clinical care missions. Learn Health Syst. 2019; 3(4):10199. https://doi.org/10.1002/lrh2.10199
- 30Azar J, Adams N, Boustani M. The Indiana University Center for Healthcare Innovation and Implementation Science: bridging healthcare research and delivery to build a learning healthcare system. Z Evid Fortbild Qual Gesundhwes. 2015; 109(2): 138–43. https://doi.org/10.1016/j.zefq.2015.03.006
- 31Kilbourne AM, Braganza MZ, Bowersox NW, Goodrich DE, Miake-Lye I, Floyd N, et al. Research lifecycle to increase the substantial real-world impact of research: accelerating innovations to application. Med Care. 2019 57(10 Suppl 3): S206–12. https://doi.org/10.1097/MLR.0000000000001146
- 32Bhattacharyya O, Shapiro J, Schneider EC. Innovation centers in health care delivery systems: structures for success. J Med Internet Res. 2022; 24(2):33961. https://doi.org/10.2196/33961
- 33 Canadian Institutes of Health Research. Tri-agency interdisciplinary peer review committee—Evaluation Criteria [Internet]. 2022 [cited 2022 Aug 19]. Available from: https://cihr-irsc.gc.ca/e/52483.html
- 34Davis R, D'Lima D. Building capacity in dissemination and implementation science: a systematic review of the academic literature on teaching and training initiatives. Implement Sci. 2020; 15(1): 97. https://doi.org/10.1186/s13012-020-01051-6
- 35Zhao J, Bai W, Zhang Q, Su Y, Wang J, Du X, et al. Evidence-based practice implementation in healthcare in China: a living scoping review. Lancet Reg Health West Pac. 2022; 20:100355. https://doi.org/10.1016/j.lanwpc.2021.100355
- 36Luyckx VA, Reis A, Maher D, Vahedi M. Highlighting the ethics of implementation research. Lancet Glob Health. 2019; 7(9): e1170–1. https://doi.org/10.1016/S2214-109X(19)30310-9
- 37 National Medical Research Council. Singapore Translational Research Investigator Award [Internet]. [cited 2022 Jun 2]. Available from: https://www.nmrc.gov.sg/grants/talent-development/stria
- 38 Singhealth Duke-NUS Academic Medical Centre. HEARTS grants [Internet]. [cited 2022 Jun 2]. Available from: https://www.singhealthdukenus.com.sg/research/hsri/hearts-grants
- 39SingHealth Centre for Population Health Research and Implementation (CPHRI) [Internet]. 2022 [cited 2022 Jun 17]. Available from: https://www.singhealth.com.sg/rhs/cphri/Pages/About-Us.aspx
- 40Duke-NUS Medical School. Programme in Health Services and Systems Research (HSSR) [Internet]. [cited 2022 Jun 17]. Available from: https://www.duke-nus.edu.sg/hssr/
- 41Health Services Research Centre [Internet]. 2020 [cited 2022 Jun 17]. Available from: https://www.singhealthdukenus.com.sg/research/hsrc
- 42Graduate Certificate in Health Services Innovation [Internet]. 2021 [cited 2022 Jun 17]. Available from: https://www.singhealthdukenus.com.sg/research/hsrc/graduate-certificate-in-health-services-innovation
- 43Chow W, Lum E, Tyebally A, Chan SL, Lee LC, Ling ML, et al. The art and science of achieving zero COVID-19 transmissions in staff at a large community care facility in Singapore using implementation science: a retrospective analysis. F1000Research. 2021; 10: 212. https://doi.org/10.12688/f1000research.51328.1
