The gap between knowledge and practice is one of those what-keeps-you-awake-at-night topics for many health care professionals. Researchers and practitioners have studied and discussed how to move from knowledge to action or from dissemination to implementation. In fact, implementation science has become a field of study itself. How do we implement evidence-based practices to spread improvement, sustain change and transform health care?
Tools and strategies such as the Plan-Do-Study-Act cycle and Lean Six Sigma can help hospitals test and implement change in one unit, one area or one setting. These strategies are successful in eliminating ventilator-associated pneumonia in the ICU, improving patient flow in the emergency department and streamlining the discharge process across an entire hospital, among many others.
But we are still learning how to take success from one place to another—to implement large-scale improvement. Implementing improvement initiatives in all areas of a hospital can be challenging, and spreading improvement across multiple hospitals and multiple geographic areas is even more difficult.
Effective large-scale implementation calls for:
- A clear aim with goals, measures and target dates. What outcomes are we looking for? How wide are we trying to implement—in one state or across states—and with whom? The aim drives what to do.
- A model that shows the how-to's. What is our specific intervention? What action steps will help us accomplish large-scale implementation? What are our active dissemination strategies—conferences, collaboratives, technical assistance, one-on-one training, webinars or something else?
- Ongoing data collection and feedback. Are we making progress on a large scale? Who has been impacted by the initiative and how many have been impacted? What have we learned? Where are the gaps?
The Comprehensive Unit-based Safety Program is a groundbreaking improvement initiative that aims to reduce the rate of central line-associated bloodstream infections nationwide. Collaborating with state hospital associations and several national partners, the Health Research & Educational Trust is facilitating project kickoffs and supporting implementation steps. CLABSI has been reduced by 35 percent in more than 350 hospitals.The Johns Hopkins Quality & Safety Research Group and the Michigan Health & Hospital Association Keystone Center for Patient Safety & Quality are partners with HRET on this large-scale project.
HRET also is working closely with state hospital associations and national organizations to support the successful implementation of tools and resources from the Agency for Healthcare Research and Quality. More than 850 hospitals have participated in face-to-face training or Web conferences on Quality Indicators, the Door to-Doc toolkit, TeamSTEPPS and other evidence-based resources.
Clear goals and measures, effective models for active dissemination, and ongoing feedback will be keys as we work together to spread improvement.