JCPSLP Vol 23 Issue 2 2021

Invited commentary

How could implementation science shape the future of SLPs’ professional practice? Hazel Roddam and Jemma Skeat

SLPs are familiar with evidence-based practice, but the implementation of evidence into practice continues to be difficult across all health and care professions, including ours. Implementation science (ImpSci) is a branch of science that focuses how we can encourage and improve this implementation. This commentary will introduce readers to ImpSci and where has it come from. We clarify the distinctive differences between ImpSci and both evidence-based practice (EBP) and quality improvement. We also reflect on how ImpSci addresses complementary and essential issues to our current evidence base of scientific and clinical research. ImpSci is beginning to have an impact within allied health, including research addressing implementation of evidence for speech, hearing, communication, and swallowing disorders. However, as a profession we heavily weigh our research towards demonstrating efficacy and the uptake of ImpSci methodologies has been slow. We argue for a more strategic and systematic adoption of ImpSci, to promote change in the clinical effectiveness, societal impact, and scientific reputation of SLP professional practice. The inaugural issue of Implementation Science launched more than fifteen years ago, (https://implementationscience. biomedcentral.com/). This journal aims to promote methods to increase research use in health and care services, ultimately to improve the quality and effectiveness of services. The seminal definition of implementation science (ImpSci) was coined by Eccles and Mittman in that first issue as “the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice” (Eccles & Mittman, 2006, p. 1). The principles underpinning ImpSci What are the drivers for implementation science?

had, in fact, been promoted for at least a decade before the definition was coined. A key influence was the theory of the diffusion of innovations (Rogers, 1995), highlighting the significance of contextual influences for achieving successful and sustainable changes. The principal focus for ImpSci is thus on the context into which the intervention or new practice is being introduced, as well as the perceptions and responses to the change by all stakeholders—those receiving the intervention and the health care professionals who will deliver the specified new treatment. In this way, ImpSci has a broader scope than traditional clinical intervention research, focusing not only on patient, but also on providers, organisations, and policy makers in health care. A focus on ImpSci is needed because translation of research into practice is slow and requires strategic support for sufficient impact and change to clinical service delivery (Morris et al., 2011). The limited uptake and implementation of research evidence into practice across all health care professions has been well documented (Balas & Boren, 2000). This applies equally in allied health disciplines, as reported in Scott et al.’s (2012) systematic review of 32 studies. The analogy of a “pipeline” in translational research (Lynch et al., 2018) has recently been increasingly used to highlight that in the absence of active facilitation strategies (Morris et al., 2020) empirically supported therapies may not be effectively implemented, if at all. Apart from the unwarranted time lag for the uptake of new and effective evidence-based practices, the consequences of this research-practice or “know-do gap” (Rycroft-Malone et al., 2015, p. 2) comprise the risks of clinical harm from potentially unsafe, non-evidence-based practice; ethical harm from raising unrealistic expectations for ineffective practices; and financial inefficiencies from wasted effort and resources. Without consistent and strategic adoption of the best current research findings into practice, the potential for inequalities in health care outcomes, and of inequalities in access to health care services, is also perpetuated. ImpSci has taken up the challenge of finding proven ways for supporting the rapid implementation of research into practice, considering the complex contexts into which new interventions are being implemented, and take into account the need to change clinician behaviours. A key part of this has been understanding the specific challenges perceived by clinicians in implementing what are often multifaceted novel interventions into practice (Cochrane, 2015; Damschroder et al., 2009). ImpSci goes beyond a simple focus on active dissemination of the findings from

Hazel Roddam (top) and Jemma Skeat

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JCPSLP Volume 23, Number 2 2021

Journal of Clinical Practice in Speech-Language Pathology