September always brings that feeling of a new season full of fresh starts that come with the new school year. To take advantage of the energy that Fall creates, EvidenceConneKTion is bringing you a series of blog posts about a fresh approach to knowledge translation (KT): implementation science laboratories (IS labs).
What are IS labs? What can they do? Why might one be beneficial for Alberta? Don’t worry, we’ll get to all your IS lab questions between now and first semester finals. But in honour of the first day of class, let’s start with the fundamentals: What are IS labs?
Last October, we posted about our event called “Advancing Implementation Science Alberta.” This event brought together members of the province’s health systems and research communities to explore the potential and feasibility of creating an IS lab in Alberta. As is always the case when someone introduces a new concept to the field, such as an IS lab, attendees at AISA asked, “what exactly does an IS lab do?”
In a nutshell, IS labs are teams of academics that help people working in health systems to plan and evaluate implementation projects using theory. Implementation projects aim to take proven health interventions and implement them into real-world settings. IS lab members help to plan and build evaluation measurements for implementation projects then follow the progress of these implementation projects to learn what worked, what didn’t, why, and how.
Academics connect to implementation project teams through IS labs to help systematically measure the outcomes of implementation projects. By providing very explicit theory-based project plans with associated measurements, teams are better equipped to learn why projects succeed or fail. Health system folk still measure how innovations impact health outcomes, but by embedding IS lab team members into implementation projects, the implementation processes can also be evaluated. Understanding these processes shows what works for who, when, why and how – essential knowledge for scaling up pilot projects into regular clinical practice province-wide. This system of collecting implementation process data is useful to share within the health system, so that teams can learn from each other’s work. Furthermore, academics can share the lessons for what they are: scientific findings. So not only are IS labs able to contribute to the uptake of evidence-based practices, they can contribute to and advance our knowledge of evidence-based implementation processes.
Effectively implementing the most advanced health research evidence is a priority of Alberta health researchers and administration. Indeed integrating health research evidence into clinical practice is a fundamental element of KT. As the KT community knows though, the mere existence of evidence does not guarantee that it will be taken up in practice. To move evidence into action, academics need to work closely with the health care system.
Folks working in the health care system who are tasked to implement new evidence are often working under short deadlines and face unexpected and quick shifts within the system. Thus, while implementation projects may start with an evidence-based innovation, workplace demands limit the ability to study and choose evidence-based implementation methods. Instead employees plan based on what has worked in the past or trying new ideas until something works.
There’s nothing actually wrong about this approach – that’s why it is so common! – but this style of implementation limits our ability to learn WHY something worked (or not!). While a team might improve health outcomes eventually using the common approach, they may have to try a few different strategies before something sticks. Furthermore, without understanding how or why their method worked, it’s difficult to scale or spread a new innovation to different contexts. If the innovation does not improve outcomes, it’s hard to tell if the innovation itself didn’t work or if something in the implementation process caused the innovation to fail.
The common approach to implementation leads to many missed learning opportunities, both practical and scientific. IS labs are made up of academics who study theories of change for a living. Having academics embedding into the project allows for quick access to implementation theories that can improve the likelihood of success for implementation project. However, academics do not necessarily have the intimate knowledge of the context to identify barriers to implementation alone. Thus, the work of IS labs is fundamentally collaborative and creates various benefits for all the stakeholders:
· The health systems continually learns from its own work to improve implementation methods and increase the likelihood of fast, scalable, and sustainable uptake of evidence-based practices.
· Patients receive evidence-based health care.
· Researchers learn from the tacit knowledge of the health system partners and can direct high quality implementation science that can lead directly to policy changes.
· Funders see higher return on investment with lower trial and error rates that come from the common approach to implementation.
Mutually beneficial collaborations are truly beautiful so it is easy to understand our interest in IS labs. But is this really different than other high quality implementation work? How do you get an IS lab off the ground? How do you find the right partners and know that you’ve met with all the stakeholders involved? How do you decide what projects are suited to IS lab activities? What do IS labs cost? What are some examples of IS labs? All very good questions! All very good reasons to keep your eye on EvidenceConneKTion throughout the Fall as we’ll be writing about these topics and more throughout the season. For now, we hope you’ve learned a little something about the potential of this different approach to implementation.
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The Alberta SPOR SUPPORT Unit operates on and acknowledges the lands that are the traditional and ancestral territory of many peoples, presently subject to Treaties 6, 7, and 8. Namely: the Blackfoot Confederacy – Kainai, Piikani, and Siksika – the Cree, Dene, Saulteaux, Nakota Sioux, Stoney Nakoda, and the Tsuu T’ina Nation and the Métis People of Alberta. This includes the Métis Settlements and the Métis Nation of Alberta. We acknowledge the many First Nations, Métis and Inuit who have lived in and cared for these lands for generations. We make this acknowledgment as a reaffirmation of our shared commitment towards reconciliation, and as part of AbSPORU’s mandate towards fostering health system transformation.