Implementing Change

Translating research evidence into practice requires deliberate and planned effort. Simply generating and disseminating new research evidence is rarely sufficient to successfully change practice. Implementation research is "the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice". [1]

Worldwide interest has seen the publication of Implementation Science, a free Open Access journal in this field, in 2006.

What is the range of implementation strategies?

The Cochrane Collaboration's Review Group on Effective Practice and Organisation of Care has identified five broad categories of implementation strategies: professional, financial, consumer, organisational or regulatory interventions. Many of these are widely used in practice, and a large number of systematic reviews have examined their effectiveness. The Rx for Change Interventions Database (Canadian Agency for Drugs and Technologies in Health) identifies a staggering body of literature that attempts to identify what interventions work and in what circumstances.

Which strategies work best?

There is no strategy for all circumstances, and there is unclear evidence about whether it is more effective to use a single or multi-faceted intervention. Grol recommends working creatively to plan a cost-effective approach, relying where possible on methods that have worked elsewhere in similar situations. [2]

If you want to change drug prescribing patterns, for example, over 120 systematic reviews have examined interventions targeting the individual professional. The strongest research evidence supports educational outreach, audit and feedback, use of local opinion leaders and reminders (for drug dosing) as generally effective. There are mixed effects or insufficient evidence for the other interventions. [3]

Where do I start?

Plan the implementation! Possibly the most important element of implementing change is to actually plan the implementation, rather than assume it will automatically happen on the strength of the identified need or the evidence alone.

Grol [2] emphasises this need for planning. First, there should be a good basis for change. This could be new scientific knowledge, or perhaps a particular problem or best practice is identified. Second, the implementation should be planned (when, where, how, and by whom the implementation will occur). A diagnostic analysis can reveal the target group and behaviours, and identify barriers and facilitators to change. The general principles of planning are similar across different projects and circumstances but include plan development, testing, adapting and scheduling, and evaluation and organisation of the implementation. [2]

Tools such as Identifying Barriers to Evidence Uptake (NICS) and How To: Implement Change Successfully (113kb pdf) (University Hospitals Bristol, UK) may be useful in your implementation project.

Relevant organisations

Recommended reading

  • Grol R, Wensing M, Eccles M Editors. Improving patient care: the implementation of change in clinical practice. Oxford: Elsevier; 2005.
  1. Eccles M, Miiman B. Welcome to Implementation Science [editorial]. Implement Sci. 2006;1:1.
  2. Grol R, Wensing M, Eccles M, Editors. Improving patient care: the implementation of change in clinical practice. Oxford: Elsevier; 2005.
  3. Canadian Agency for Drugs and Technology in Health. Rx for Change Interventions Database [Internet]. 2008 [updated Sep 2011; cited 23 Jan 2012].
Last updated 18 January 2017