Implementation Science Strategies

Sometimes we know what the evidence says is best practice, but we still have trouble getting people to consistently deliver best-evidence care. How do we enable and encourage clinicians and staff to use the evidence? We rely on implementation strategies. These strategies bring the evidence to clinicians’ attention, provide resources and skills, and encourage the right choice, all making it easier for clinicians to comply with evidence-based practice. Examples of implementation strategies include providing training or education, using peer influence, adding a new role to the health care setting, giving scripts or talking points, and getting people to simulate or role-play a desired behavior.

One commonly used implementation strategy is practice facilitation (PF). Similar to person-to-person coaching, in PF, trained individuals support health care frontline staff to achieve organizational goals and to make meaningful, transformative changes within their care setting. These “practice facilitators” draw on knowledge of organizational development, quality improvement, project management, and practice improvement to support their work.?

Practice facilitators can be internal or external to the unit and form close relationships with managers and frontline caregivers in order to provide tailored support to meet the specific goals of the unit. Facilitators work with units to set their own meaningful goals and then help access and summarize data, facilitate group analysis of problems and brainstorming solutions, and typically feedback quantitative and qualitative information on progress.?

PF is supported by literature showing its effectiveness, demonstrating stronger signals of impact as compared to other traditional quality improvement strategies such as audit and feedback alone or passive education1. A review of the Canadian literature shows that practice facilitation resulted in a 12% improvement of preventive service with a 40% rate of return over an 18-month period 2. More recently, a systematic review and meta-analysis showed that primary care practices that use practice facilitators are 2.8 times more likely to adopt evidence-based guidelines 3.

For a project in which you need to encourage people to use the evidence in their practice, but where barriers prevent people from complying, consider engaging a practice facilitator (or take on the role yourself!) to coach individuals and facilitate group problem-solving in order to increase the effectiveness of your project implementation. ?

Make a difference in your workplace by implementing evidence-based practice today.

References

1.?????Nagykaldi, Z., Mold, J. W., & Aspy, C. B. (2005). Practice facilitators: a review of the literature. Family Medicine-Kansas City, 37(8), 581.

2.?????Liddy, C., Laferriere, D., Baskerville, B., Dahrouge, S., Knox, L., & Hogg, W. (2013). An overview of practice facilitation programs in Canada: current perspectives and future directions. Healthcare Policy, 8(3), 58.

3.?????Baskerville, N. B., Liddy, C., & Hogg, W. (2012). Systematic review and meta-analysis of practice facilitation within primary care settings. The Annals of Family Medicine, 10(1), 63-74.

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?About the Author: Jill Marsteller, Ph.D. is a Professor of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health.?She is jointly appointed in the Johns Hopkins School of Medicine's Department of Anesthesia and Critical Care Medicine in the Armstrong Institute for Patient Safety and Quality, where she leads the Research Facilitation Council, and at the Johns Hopkins Carey Business School.?Jill specializes in organizational behavior and theory and focuses her research on the determinants of successful implementation, dissemination, and sustainability of knowledge. She conducts mixed methods research in both inpatient and ambulatory health care settings.