JCPSLP Vol 23 Issue 2 2021

research studies, as it provides a highly structured and systematic process to translate the evidence based new ways of working into routine care. Although it has been around for more than 15 years, ImpSci as a science and specific type of research is not well understood. From the perspective of the practitioner workforce who strive to read and apply research into their own practice, there are particular aspects of ImpSci that are likely to have constrained familiarity and confidence in understanding of ImpSci principles and methodologies. The first is the large number of distinctive frameworks that sit under the ImpSci umbrella. ImpSci methodologies comprise a range of sophisticated frameworks, incorporating a toolkit of specific and sensitive evaluation approaches. The Consolidated Framework for Implementation of Research (Damschroder et al., 2009) provides a highly practical and accessible guide that relates theoretical ImpSci constructs into pragmatic real-world scenarios. The behaviour change model (Michie et al., 2011) has also been widely used over the past decade. This model was developed from a purposeful selection of directly relevant components of other approaches to social behaviour change, specifically focused on capability, opportunity and motivation (COM-B model). The second barrier to understanding ImpSci is the plethora of terminology that has been associated with ImpSci; with terms often appearing to be used interchangeably, such as knowledge management, knowledge exchange, knowledge transfer, knowledge translation, dissemination, diffusion, implementation and research utilisation. Within our own professional community, Douglas et al. (2015) have warned that ImpSci terminology was beginning to be used as a “buzzword”; like other buzzwords before it, it devalues ImpSci if the result is a tokenism where almost anything may be called ImpSci. Thus, we recommend a helpful primer by Bauer et al. (2015) to help orientate clinical practitioners to more meaningfully understand these aspects. There are also a range of ImpSci focused websites that provide helpful overviews for interested researchers and practitioners- including the University of Washington Implementation Science Hub (https://impsciuw.org/), the Sydney Health Partners Implementation Science Community of Practice (https://implementationscience.com.au/), and the American Institutes for Research Centre on Knowledge Translation for Disability and Rehabilitation Research (https://ktdrr.org/ products/kt-implementation/introduction.html). How does implementation science differ from evidence-based practice and quality improvement? From the outset, the fundamental philosophy of evidence- based practice (EBP) has been to promote a culture of critical reflection on practice, guiding sound and explicit decision making based (McCurtin & Roddam, 2012). EBP was driven by an agenda to assure greater consistency and continuity of best practice and effective health care treatments, after a growing awareness that there was immense variability in the way that patients were treated in medical practice (Greenhalgh, 1997). The general public were beginning to question why ‘expert’ clinical wisdom differed so widely. Alongside this, government and health care insurance agencies started to increasingly demand factual evidence for medical treatments, so that they could have a more objective basis for procuring the most clinically and economically effective health care available. Moving

beyond medicine over time, the EBP movement in nursing and the allied health professions emphasised that clinical decision-making should focus more clearly on high quality scientific evidence, rather than on clinical intuition (Reilly et al., 2004). Professional associations now almost universally actively promote the EBP agenda, and link this with regulatory requirements for individuals to undertake continuing professional development (CPD) and for services to be accountable for clinical effectiveness. While the EBP model establishes accountability for individual health care professionals to be aware of the most recent evidence for assessment and intervention approaches in their own field of practice, there is also the imperative for person-centred and values-based care, involving the patient and their family in care planning in the context of their own priority concerns (Greenhalgh et al., 2014). Above all, EBP is “a way of thinking”—a practice of clinicians reflecting on what they are doing (e.g., in assessment and in intervention) and why (McCurtin & Roddam, 2012, p. 21). Despite the attention paid to EBP, it has been recognised that this has not secured the anticipated significant impact to accelerate research findings into practice. Three decades of “barriers’ studies” have shown that individual clinical practitioners still continue to report their perceptions of facing the same inherent challenges of EBP; resoundingly highlighting the factors of time (to locate and read research), skills and confidence (to critically judge research publications), and autonomy (to make changes in work practices). The last of these is closest to what we would consider under ImpSci. While all health care practitioners need to be equipped to find and appraise the literature, when required—for example when faced with an unusual case, or when the usual therapy does not seem to be working well (Roddam & Skeat, 2010)—the implementation part does not rest solely on the individual. The context, which may include not just practical considerations (such as training and resources to use a new intervention), but policy and cultural factors (such as directives or historical use of an established intervention), play a critical role. ImpSci provides a means of exploring these influences on implementing evidence. ImpSci does not substitute for EBP: each has its distinctive philosophy. Embracing EBP as an integral facet of professionalism enhances engagement by practitioners with the research landscape in their own field of practice. This active level of engagement has been robustly demonstrated to significantly improve evidence-based processes of care and patient reported experiences of care, plus some gains in clinical outcomes of care (Boaz et al., 2015). The further contribution of ImpSci is to provide a systematic way of getting those research-based interventions into best clinical practice. ImpSci is also distinct from quality improvement (QI) approaches and methodologies (Jones et al., 2019). There are naturally some aspects of similarity between the two, and the overarching aim of both ImpSci and QI is to improve quality standards in health care. However, QI projects are generally triggered by a focus on patients’ experiences of current service delivery. In contrast, ImpSci is typically initiated by the identification of a robustly validated intervention or treatment that has not yet been introduced, or fully adopted, into routine practice (Bauer et al., 2015). After identifying a specific problem in a health care system, QI approaches lead to the development and trial of strategies to improve the quality standards of that

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JCPSLP Volume 23, Number 2 2021

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