Improvement science: getting the evidence into practice

Field: Health Professions (Health Sciences)

Evidence-informed practice is a pressing healthcare issue in all advanced healthcare systems in the developing world and has a direct impact on the quality of care and on improving health outcomes. Using the best available evidence to organise and deliver patient care seems straightforward as a principle of quality but the reality is quite different. Advances have been made in methodologies to synthesise large bodies of evidence to clarify the ‘state of knowledge’ by international groups such as the Cochrane Collaboration and the Joanna Briggs Institute. Furthermore, rigorous processes for the development of knowledge tools by expert panels have resulted in quality practice guidelines for assessment, treatments and supportive care. In spite of these substantive advancements, the experience internationally is that many guidelines are not taken up in day-to-day practice. The implementation of evidence-informed practice through guideline use has, however, proved to be a major challenge at the point of care. Translating evidence into practice is particularly challenging because it often requires investment at both the organisational and practitioner levels and the use of multiple interventions. Evidence on the feasibility, appropriateness and meaningfulness of strategies to facilitate knowledge transfer in healthcare has not been systematically reviewed although work in these areas has occurred through specific implementation projects. The complexity surrounding evidence translation has prompted the emergence of the ‘new’ fields of translation science, implementation science and improvement science. While translation science seeks to move from bench to bedside or from laboratory experiments through clinical trials to actual point-of-care patient applications and implementation science refers to the scientific study of methods to promote the uptake of research findings into routine settings in clinical, community and policy contexts, improvement science seeks to identify improvement strategies and to formally evaluate their effectiveness within health systems. The Improvement Science Summit held in San Antonio, Texas in July 2010 marked the launch of the Improvement Science Research Network in the USA, led by Dr Kathleen Stevens at the University of Texas Health Science Centre, San Antonio. Funded by a substantial grant from the National Institutes of Health, this initiative focuses on developing an evidence base for improvement healthcare through the conduct of large-scale, multisite research and holds out the promise of developing an evidence base that is currently very sparse. Berwick succinctly argues that the development of an evidence base for improvement requires the use of a broad range of scientific methodologies.1 The diverse origins of problems in healthcare require a diversity of research methodologies and, thus, methodological approaches in this area need to be eclectic enough to incorporate classical, medical and scientific designs and the emerging qualitative and action-oriented approaches from the humanities and the social and behavioural sciences. The development of interdisciplinary research and a greater understanding of the relationship between medical, nursing and allied health interventions are also fundamental to the emergence of research methodologies that are relevant and sensitive to improvement. Since its establishment in 1996 the Joanna Briggs Institute has recognised the importance of ensuring that evidence synthesis (i.e. the systematic review) is not limited to the review of the ubiquitous randomised controlled trial and that even the very best systematic reviews are of little use if they are not translated into action within health systems. Until now, it has been rarely possible to identify evidence when systematically reviewing questions related to improvement because of a paucity of high-quality primary research. The emergence of this new field of inquiry – improvement science – may well address the gap in the evidence related to ‘what works’ in improving evidence uptake and improved patient outcomes. Although this issue of the International Journal of Evidence-Based Healthcare focuses on evidence reviews of defined interventions, many previous issues have included systematic reviews of qualitative evidence and reports on practice improvement studies. I am hopeful that, with the investment in the Improvement Science Research Network in the USA, we will begin to see improvement science reports that build an evidence base for improvement in this and other journals. Alan Pearson AM Professor of Evidence Based Healthcare and Executive Director, The Joanna Briggs Institute, The University of Adelaide, Adelaide, South Australia, Australia