Working collaboratively with quality improvement and implementation science/ practice approaches

By Dr. Julia Moore , Executive Director, The Center for Implementation

As part of our Implementing Change Community, we host monthly Open Support sessions where members ask implementation-related questions. Some participants are there just to listen, others come with long lists of questions. These are fabulous sessions, much more casual and laid-back than workshops or training sessions, where people laugh and joke, and feel comfortable asking the really difficult questions.

We’ve been reflecting on some of the common questions we receive, and wanted to take the opportunity to share our responses to one of the most prominent questions we receive, as it is likely that many other implementation support practitioners around the world are asking the same thing.

Quality improvement and implementation science/practice: How do they interact?

Some?common questions we hear are:

• “How can I introduce the idea of using implementation science to inform practice to quality improvement professionals?”
• “Can implementation practice and quality improvement coexist? If yes, how?”

Training in quality improvement is common across many professions, and often those tasked with leading or supporting change initiatives within organizations may have some expertise or experience in quality improvement. Introducing the concept of using implementation science can sometimes ruffle a few feathers. By the time people ask a question about whether quality improvement and implementation science can coexist, it means tensions have already arisen on the team.

Working collaboratively across implementation practice and quality improvement

If you are looking to find synergies and truly work collaboratively with people trained in quality improvement, these are our 4 tips on getting started.

Tip #1: Learn more about quality improvement

Before jumping in and highlighting all of the benefits of using implementation science to inform implementation efforts, start by understanding a little bit more about quality improvement approaches and tools (e.g., 5 WHYs, fishbone diagrams), where they came from, and why they’ve become so popular and commonly used. Remember that there are multiple ways to create change, and it helps to understand why quality improvement resonates so much with people when attempting to stimulate change in organizations and systems.?

We’ve written a few posts about how quality improvement can enhance implementation science efforts, and about the synergies between quality improvement and implementation science. There are also amazing resources you can find online. Our go-to place to start is the Institute for Healthcare Improvement. If you are already working directly with someone with background or training in quality improvement, you could ask them for recommendations of articles or resources (this will also help in trust building, setting you up for Tip #2).

Tip #2: Build trust with your potential collaborators and partners

Before rushing in to recommend alternative approaches and tools, you’ll want to start by establishing and building a trusting relationship. This is particularly important if you’ll be continuing to work with these collaborators and partners over time.?

We know that many implementation support practitioners are so excited and passionate about using implementation science to transform how we implement (we’re very excited about this, too!), but it’s so much more important to start with building a trusting relationship rather than coming in with suggestions for how to change the way things are done. Because building trust is so important and sometimes challenging in implementation work, we have lots of resources to support this process. Here’s a post where we describe the three core components of building a trusting relationship, and if you’re ready for a deeper dive, we have an entire course about Cultivating Trust and Navigating Power.?

Tip #3: Recognize and acknowledge the expertise and experience of others

Something we see often in implementation efforts, particularly on implementation teams, is that people can be dismissive or fail to recognize the unique experiences and expertise each team member brings. If you’ve ever been in the position where people devalue your unique experience or expertise, you know that it can feel very deflating, and doesn’t breed trust. It also doesn’t set you up to be open to learning about new and alternative approaches. The reality is that everyone on an implementation team is bringing something valuable to the table. Identify what that is (it might be quality improvement skills, but it might be many other things). No matter your role on the team (i.e., whether you feel like you have more or less power), make sure to recognize and acknowledge what others are bringing to the team.?

Tip #4: Create a plan to integrate implementation science and quality improvement approaches??

Getting engagement for using implementation science to inform implementation practice is such a common problem that we created a 3-minute video on exactly this topic. In this video, we highlight five steps to build momentum for using implementation approaches. These steps aren’t specific to getting buy-in for implementation among quality improvement professionals, which is why it’s so important to first learn a little more about quality improvement and build a trusting relationship.

Below, we've listed the steps and added some considerations for quality improvement to get you started.

1. Ask questions and listen to what team members describe as their biggest implementation challenges

When thinking specifically about quality improvement, actively listen to people’s descriptions about using quality improvement methods and where they feel like quality improvement approaches or tools are not helping solve a challenge they are facing.

2. Pick one of these implementation challenges to address people’s immediate questions and concerns.

If people on the implementation team or those delivering the change initiative are already familiar with and comfortable with quality improvement, we recommend adopting an integrated approach, which will you take the best of both worlds and integrate them together. It means you don’t have to release the existing approaches that people are using. Instead, you can integrate additional elements from implementation science to enhance how they are already planning for implementation.

Using implementation science approaches that address people’s own self-expressed gaps in using quality improvement can help them see it as a value-add rather than a cumbersome replacement.

3. Choose one video from the Inspiring Change 2.0 mini-course that speaks to this challenge.

Common challenges people have shared with us include mapping barriers and facilitators, discussing roles in the system, and planning for sustainability.

4. If any team members seem reluctant, hesitant, or seem to have questions, have a one-on-one conversation with them.

It can be really valuable to have a one-on-one conversation with people who are reluctant to embrace implementation science. This can help you build trust, better understand their perspective, and identify possible barriers and facilitators to adopting the approaches that you are suggesting.

5. Identify champions — people on your team who immediately embrace the idea of using implementation science.

Often, we’ve seen quality improvement experts be reluctant to embrace implementation science approaches at first, but then later become huge champions (particularly for specific aspects of implementation, like mapping barriers and facilitators to select strategies). When a respected quality improvement expert suggests using implementation frameworks, it’s often much more influential than when others suggest the same thing.

We hope this provided some helpful ideas for how to engage differently with?quality improvement experts you might be working with now or in the future.

Want to dive further into implementation quality and different types of evaluation at various stages of the implementation process? Our course Implementation, Spread, and Scale is officially open for enrollment until April 25, 2023!

Note: An earlier version of this article originally appeared in the August 2022 issue of our Implementation in Action bulletin. Subscribe here to receive our next issue.