Implementation in Healthcare: Boosting Compliance by Promoting Uptake of Evidence-Based Principles and Practices

By Kelly M. Pyrek

Implementation science, viewed through the lens of infection prevention and control, can boost compliance, and is a viable approach for improving outcomes. At its essence, it focuses on factors that promote the systematic uptake of research findings and implementation of evidence-based practices into routine care.

Using broad behavioral and socio-adaptive concepts can help deliver high-quality care is the conclusion of the new SHEA/IDSA/APIC practice recommendation Implementing strategies to prevent infections in acute-care settings, which introduces and explains common implementation concepts and frameworks relevant to healthcare epidemiology and infection prevention and control.

Joshua Schaffzin, MD, a pediatric infectious disease physician at the Children’s Hospital of Eastern Ontario, in Ottawa, Ontario, Canada, and co-author of the SHEA/IDSA/APIC practice recommendation, says infection prevention and control teams, healthcare epidemiologists, infection preventionists, and specialty groups may address the challenges at hand through strategies for implementation such as identifying determinants of adherence and proper measures and utilizing frameworks such as the 4Es, CUSP, and others that are a good fit for the institution.

Implementation Science in Healthcare

Eccles and Mittman (2006) define implementation science as “the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice.”

As Geerligs, et al. (2018) observe, “Health service interventions that are effectively implemented are associated with improved patient and staff outcomes and increased cost-effectiveness of care. However, despite sound theoretical basis and empirical support, many interventions do not produce real-world change, as few are successfully implemented, and fewer still are sustained long-term. The ramifications of failed implementation efforts can be serious and far-reaching; the additional workload required by implementation efforts can add significant staff burden, which can reduce the quality of patient care and may even impact treatment efficacy if interventions disrupt workflow. Additionally, staff who bear the burden of implementing new interventions may be reluctant to try alternatives if their first experience was unsuccessful. A thorough understanding of the barriers and facilitators to implementation, as well as an ongoing assessment of the process of implementation, is therefore crucial to increase the likelihood that the process of change is smooth, sustainable, and cost-effective.”

Hospitals are unique microcosms, with their specialized populations, processes and microsystems, which may encounter unique barriers to implementation science. Geerligs, et al. (2018) assert that, “Translation of evidence-based interventions into hospital systems can provide immediate and substantial benefits to patient care and outcomes, but successful implementation is often not achieved.”

They point to various determinants (barriers and facilitators) of the implementation process, and in their systematic review, they identified relationships between these barriers and facilitators to highlight key domains that need to be addressed by researchers and clinicians seeking to implement hospital-based, patient-focused interventions. The researchers grouped staff-identified barriers and facilitators to implementation into three main domains: system, staff, and intervention. Barriers identified by Geerligs, et al. (2018) directly related to the hospital environment and included workload and workflow, physical structure, and resources: “Staff workload and lack of time for implementation were the most commonly cited barriers. Staff shortages, high staff turnover, or changes in roster compounded this issue, resulting in burden for implementation falling on small numbers of staff who were most interested, rather than generating change at the institution level. Several studies targeted this issue by hiring additional staff, such as a research coordinator, or delegating parts of the intervention to the research team. In contrast, support provided at the institutional level for staff to have time for implementation was believed to be a more sustainable facilitator.”

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