Public sector entities, non-profits, and funders alike want their projects and services to be based in evidence. But the journey from research findings to routine practice can be long and arduous, and people cannot benefit from evidence-based interventions if the interventions never reach them. Research on health care systems and public health has shown that evidence-based practices (EBPs) take an average of 17 years to be incorporated into routine general practice, and only about half of all EBPs actually reach widespread clinical usage.1 As a result, patients often do not receive treatments that have been proven to be effective, and in the worst case, they receive unnecessary or harmful treatments.
The field of implementation science evolved in response to these concerns, and offers key insights into what works — and what doesn’t — when it comes to integrating evidence-based strategies into public and social-sector endeavors. Implementation science research examines “the factors that influence the full and effective use of innovations in practice”2 in order to find ways to bridge the “science-to-service” gap. It takes a multidisciplinary approach, often driven by teams of academic and operational partners, which seeks to understand barriers and design interventions that can be successfully integrated into daily practice.
What’s going wrong along the pathway from science to service? In many cases, ineffective implementation methods are to blame:3 information dissemination alone, training (even high-quality training) alone, funding or incentives alone, compliance requirements alone. The pattern here is clear: these methods are not effective in isolation. They don’t change the roles and functions of service providers, nor do they take a multilevel approach to addressing individual and organizational behavior or systemic change.
Flawed implementations can yield a few common problems. An evidence-based practice may be adopted, but not with fidelity. Or it might be adopted with fidelity, but quickly abandoned, or only used in a fraction of target sites. Depending on whether these problems are recognized and addressed, evaluations of these programs can yield flawed data on the efficacy of a practice.
Successful integration of EBPs requires usable innovations, effective implementation, and enabling contexts. Implementation teams are critical to planning and driving the success of an implementation process, though there is not a one-size-fits-all blueprint for what these teams should look like. Research has identified four common stages present in successful implementation processes:4
- Exploration: Recognizing and assessing the need for resources to help move research into practice.
- Installation: Acquiring or repurposing the resources necessary for implementation, and preparing for new practices. This can include hiring and training activities, as well as setting up tools for assessment.
- Initial Implementation: The innovation/EBP is first put into use, and practitioners/staff attempt to use their skills and training in context.
- Full Implementation: 50% or more of the intended practitioners use the innovation with fidelity and good outcomes; the “new” is now standard.
Work from these stages can overlap or occur somewhat out of sequence. Regardless of how neatly an implementation process fits into this framework, it’s clear that assessing and building readiness, planning carefully, and integrating improvement frameworks are all key to getting evidence into practice.
This post was written by Celeste Middleton, Summer Associate.
Learn more about implementation science by checking out:
- About Dissemination and Implementation Science
- National Implementation Research Network: Learn Implementation
- An Introduction to Implementation Science for the Non-Specialist
You can find information on applying implementation science to early childhood care and education here:
- Implementation Science and its Applications to State-Level Integrated Professional Development Systems for Early Care and Education
- Applying Implementation Science in Early Childhood Programs and Systems
- An Integrated Stage-based Framework for Implementation of Early Childhood Programs and Systems
1. Bauer. M.S., Damschroder, L., Hagedorn, H., Smith, J., and Kilbourne, A.M. (2015). An introduction to implementation science for the non-specialist. BMC Psychology, 3(1). doi:10.1186/s40359-015-0089-9 ↩
2. Implementation Science Defined. (2015). National Implementation Research Network. ↩
3. Fixsen, D.L., Blase, K.A., Duda, M.A., Metz., A.J., Naoom, S.F., and Van Dyke, M.K. (2010). Implementing evidence-based practices: Are we falling down on the job? National Implementation Research Network. ↩
4. Implementation Stages. National Implementation Research Network. ↩