We recommend that researchers and their funders use existing implementation science to develop policies and information dissemination methods that promote adoption of research findings in routine care. Policies should recognize that research products have different propensities for being adopted outside of research, and should anticipate basic implementation support needs. We discuss below the kinds of challenges that should be addressed by these policies.
At the simplest level, we know that complex QIIs cannot be applied either in future research or in clinical settings without detailed information about what was done. Researchers should therefore be required to document all information and tools necessary for understanding how the product was developed, applied, and evaluated. This information should be publicly available in enough detail to support replication and diffusion, such as on the web.
Guideline concordant treatment and management strategies can be thought of as products that may or may not diffuse effectively. Greenhalgh et al.14
identified at least 13 different research traditions related to understanding how innovations diffuse. Among these, Rogers'16
theories about which characteristics make an innovation likely to diffuse is one of the most widely used. Innovations with positive diffusion attributes may have sufficient impact on clinical care through routine dissemination activities such as journal publication and commercial marketing, without any additional effort from the research community, while those with negative attributes may require substantial researcher implementation support.
For example, proton pump inhibitors (pills to treat gastro-esophageal reflux and ulcers), are effective, easy to prescribe, and affect bothersome symptoms. Pharmaceutical companies also have financial interests in promoting these products. Not surprisingly, proton pump inhibitors have been widely adopted with little implementation support from researchers. On the other hand, the finding that placing infants on their backs reduces sudden infant death syndrome (SIDS) did not diffuse based on journal articles, despite its low cost and simplicity. It contradicted prior habits and beliefs among many parents and pediatricians about sleeping position, and had no commercial market stakeholders. Successful dissemination required the use of social marketing research and methods39
and the involvement of researchers and community partners in a “Back to Sleep” campaign supported by at least 5 partner organizations, including the National Institutes of Health.40
As evidence of the impact of this campaign, participants cite a 70% decrease in prone sleeping between 1992 and 1996, along with a 38% reduction in SIDS mortality.41
Unfortunately, many research findings in need of implementation require significant behavior change, and provide no compelling financial or other advantages to those who must enact the change. For example, studies have repeatedly shown low adherence to hand washing recommendations. Grol et al.5
predicted, based on implementation science, that a QII approach that targets a variety of specific barriers to change at a variety of different levels (professional, team, patient, and organization) will be required to achieve lasting changes in hand-hygiene routines. Multicomponent organizational interventions, such as the hand washing QII envisioned above, are often the most effective means of achieving quality goals,7
but have negative attributes in terms of ease of diffusion. Interestingly, this issue of the Journal
also contains the description of a successful QII based on the multicomponent organizational Six Sigma approach to implement hand-hygiene guidelines.42
Research organizations must become proactive in anticipating these implementation needs.