Implementation science—the next frontier

Abstract

The challenge of persisting gaps in the quality and outcomes of health care and public health continues to attract interest from the research, policy and practice communities. Public health programs can only deliver benefits if they are able to sustain activities over time. Implementation science is an emerging field of inquiry drawing from a diverse set of research traditions, methods and sources. This chapter reviews the origins and foundations of implementation science, discusses its strengths and weaknesses relative to closely-related bodies of activity in quality and safety improvement, and identifies opportunities for increased collaboration and mutually beneficial synergy across both fields. Implementation science and improvement science must enhance their attention to the significant levels of heterogeneity inherent in quality problems and their root causes, in the settings and contexts in which these problems occur, and in measuring the effects of strategies deployed to change clinical practices and improve patient outcomes. New research and practice strategies building upon the strengths and complementary perspectives of implementation and improvement sciences represent the “next frontier” in efforts to improve quality, value and outcomes in health. Such strategies offer considerable value if developed with a deep and balanced understanding of the magnitude and unique features of quality gaps, the need for multi-level, multi-component, context-sensitive approaches, and the need for continuous monitoring, evaluation and refinement of improvement approaches.