Bridging the Silos: A Comparative Analysis of Implementation Science and Improvement Science

Abstract

BackgroundImplementation science and improvement science have similar goals of improving health care services for better patient and population outcomes, yet historically there has been limited exchange between the two fields. Implementation science was born out of the recognition that research findings and effective practices should be more systematically disseminated and applied in various settings to achieve improved health and welfare of populations. Improvement science has grown out of the wider quality improvement movement, but a fundamental difference between quality improvement and improvement science is that the former generates knowledge for local improvement, whereas the latter is aimed at producing generalizable scientific knowledge.ObjectivesThe first objective of this paper is to characterise and contrast implementation science and improvement science. The second objective, building on the first, is to highlight aspects of improvement science that potentially could inform implementation science and vice versa.MethodsWe used a critical literature review approach. Search methods included systematic literature searches in PubMed, CINAHL, and PsycINFO until October 2021; reviewing references in identified articles and books; and the authors' own cross-disciplinary knowledge of key literature.FindingsThe comparative analysis of the fields of implementation science and improvement science centred on six categories: (1) influences; (2) ontology, epistemology and methodology; (3) identified problem; (4) potential solutions; (5) analytical tools; and (6) knowledge production and use. The two fields have different origins and draw mostly on different sources of knowledge, but they have a shared goal of using scientific methods to understand and explain how health care services can be improved for their users. Both describe problems in terms of a gap or chasm between current and optimal care delivery and consider similar strategies to address the problems. Both apply a range of analytical tools to analyse problems and facilitate appropriate solutions.ConclusionsImplementation science and improvement science have similar endpoints but different starting points and academic perspectives. To bridge the silos between the fields, increased collaboration between implementation and improvement scholars will help to clarify the differences and connections between the science and practice of improvement, to expand scientific application of quality improvement tools, to further address contextual influences on implementation and improvement efforts, and to share and use theory to support strategy development, delivery and evaluation.

Co-designing, measuring, and optimizing innovations and solutions within complex adaptive health systems

“…The KT-cnm (31) brings the ecologic basis of PROLIFERATE (defined in Table 1 and illustrated in Figure 3). Having the KT-cnm as a foundational component of PROLIFERATE is of interest to the field of IS because it means operationalizing a novel way of considering the evolving and emergent properties of the health systems and developing, identifying, implementing, and evaluating solutions that attempt to respond to the challenges presented in the introduction (22,31,37).…”

Perspectives on the future of dissemination and implementation research in oral and craniofacial sciences

“…What happens in a dental practice, or any clinical service delivery system organization, is not simply a function of an individual's behavior. Those familiar with quality improvement and systems engineering will recognize that the performance of the system is a function of the design of the system itself 7,8 . Exhorting people to change their behavior in the context of a system that is not designed to support and promote the behavior is likely to be a fruitless and futile exercise 8 .…”

“…If you are familiar with the quality improvement approach, you will find the general process steps of implementation research to be familiar 7 . There are interesting similarities and differences between quality improvement research and implementation science, but in general if you are comfortable with quality improvement, you will find it easy to work with implementation scientists or dip your toe into doing some of it yourself.…”

“…Those familiar with quality improvement and systems engineering will recognize that the performance of the system is a function of the design of the system itself. 7,8 Exhorting people to change their behavior in the context of a system that is not designed to support and promote the behavior is likely to be a fruitless and futile exercise. 8 The practice environment-what we call the inner setting in implementation science-is very important in dental practice and all clinical practice more generally.…”

Let's Talk

“…The Deming (1986) Cycle principles are at the foundation of improvement science as it is referred to in education research. Although Shewhart's PDSA Model was largely ignored by educators during his lifetime, the learning and improvement tools are at the center of what has been adopted as IS-GR in education (Moen & Norman, 2010;Nilsen et al, 2022) and have also found traction in Japanese business and American manufacturing (Add Source).…”