NOVEMBER – DECEMBER 2021
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Evidence-based medicine has been proven to be very valuable, but putting the findings into practice takes between 15 and 17 years.
The statistician, mathematician and consultant William Deming (1900-1993), who disseminated methods and principles of quality management that promoted Japan's post-war economic recovery, popularized the PDCA improvement cycle in the 50s: plan, do, measure and act. A conceptual framework and process model initially conceived for the industry, but which can also be applied to improve service quality in any area of the health sector. The key is knowing what to look for, defining the problem and addressing it methodologically, involving staff to implement subsequent changes and adjustments.
Implementation science seeks to put scientific evidence into practice. Geoffrey Curran, a professor at the University of Arkansas for Medical Sciences, in Little Rock, United States, has proposed a simple way to define the concept: if the intervention, practice or innovation is “the thing,” effectiveness research examines whether “the thing” works; and implementation research seeks to determine the best way to help people or places do “the thing.”
Implementation science is not new, because most of its theories are 30 or more years old. Its conjugation with the science of quality improvement applied to health services is a catalyst for reducing the temporal gap that exists between the discovery of evidence and clinical practice. Scientific findings can take 15 to 17 years to reach the patient as a standard of care. And more and better tools are needed to try to narrow that gap between what is known to do well and what is applied.
We must consider all those aspects that are not studied in clinical trials. Because it is not only about finding the best vaccine, chemotherapy or antimicrobial treatment, but also about driving the management of behavior change so that this intervention achieves its goal. At the level of professionals and also patients. Despite all the information available, why do so many people smoke, suffer from nutritional imbalances or do not wear seat belts?
Thus, implementation science seeks to identify the problem, understand the reasons, act on the causes and find the solution together. It aims to ensure that improvement actions (from the prevention of bedsores to the reduction in the incidence of nosocomial infections or adherence to standards for COVID-19 care) have greater results and impact on a broader scale. Transcend “good intentions” and more effectively translate the stated objectives of public health interventions into concrete and tangible benefits.
By Dr. Viviana Rodríguez, coordinator of the Department of Quality, Patient Safety and Clinical Management of the IECS.