JCPSLP Vol 23 Issue 2 2021

6 Implementation science is about your recordkeeping Many questions about the uptake of practices at scale— that is across an entire school district or health system— requires the ability to examine what is happening in routine visit and determine the effect of those actions on the health outcomes (Morris, et al., 2019). In order to determine, for instance, whether a new protocol for managing blood pressure is being effective, an implementation scientist might examine records for everyone with a blood pressure above a certain value. This requires both that blood pressure is taken and recorded consistently for patient visits and that all clinical actions (counselling, patient education, referrals, prescriptions, follow-up) are documented with some specificity. To improve in this area, we need to keep records that are more specific, focused on the actions we believe are therapeutic, and use consistent terminology for those actions. Electronic medical record systems can assist with this, but as a field we have a ways to go in regards to using consistent terminology to regularly document therapeutic actions (rather than contact minutes) and engaging in rapid, repeated assessment with consistent tools across settings and providers. 7 Implementation science values your thoughts, feelings, and lived experiences A key method of implementation science is stakeholder surveys and focus groups. This is because the quantitative data collected from records and observations are best interpreted through the lens of those people who are trying to do the practice. Common outcomes are increased intent to use a measure after training (Cunningham & Oram Cardy, 2019). Frameworks like the COM-B (capability, opportunity, motivation—behaviour; Michie, et al., 2011) organise researchers’ identification of barriers and help identify solutions. Does a practice have low implementation because it is too time consuming? Or because it requires specialised knowledge? Or because it is easy to forget to do? Eckberg et al. (2020) identified challenges aligned with all three areas when examining what affected the uptake of family-centred care in private audiology practices across Australia. Conversations with you as the provider can make it easier to identify how to help promote uptake of a practice. 8 Implementation science is about your decision-making process Implementation science tries to understand your decision- making process, particularly when information available is inconsistent or imperfect. For instance, when diagnostic information is inconsistent, do standardised tests or informal assessments have more influence (Fulcher-Rood et al., 2018)? The pandemic has highlighted the need to be able to move forward with treatment when we have imperfect access to information. For instance, in the absence of direct comparisons, how do we know if telehealth is as effective as in-person care? Particularly when in-person care includes masking and social distancing, an untested adaptation of that method of delivery. Truthfully, we do not—no one has asked that question quite that way because no one really imagined the current circumstances. But as clinicians who have to treat patients before the results of such trials are “all in”, implementation science can provide principled guidance on

which changes are consistent with the key elements of the treatment and which are not (see Tables 2 and 3 in Aarons et al., 2017). 9 Implementation science asks researchers to design with you in mind Have you ever read a paper and thought “There is no way that I can do that. Only someone superhuman could keep track of all the treatment details described here”. Implementation does not just identify barriers and facilitators to adoption after a treatment is designed, but it also calls on researchers and treatment developers to do better during the design process. A key tenet is that all of the design phases should engage stakeholders—so everything from what are the core outcomes that we should be trying to treat (Wallace et al., 2019) to how to make treatments accessible (Harmon et al., 2018) matter and should be baked in up front. Many early trials of a new intervention involve very small scale studies, because the goal is to develop and refine new ideas through an iterative feedback driven process, well-illustrated in work developing story books to promote vocabulary learning by Soto and colleagues (2020). This process leads to interventions that are more adoptable and adaptable at the outset. 10 Implementation science asks you to keep improving Implementation science—also known as knowledge translation, quality improvement processes, and innovation adoption and diffusion—looks to support you in your professional growth and identify ways to support you in changing your own behaviors (Campbell & Douglas, 2017). These tools look to thought leaders and advanced practitioners to support the organisational culture in bridging the knowledge-to-practice gap. Critically, the individual– you –is the key to success. New effective programs must be identified and begun. As these new initiatives come out and are taken up, older, less efficacious practices will need to be stopped (Niven et al., 2015). When the new thing is no longer new–but still works–we must pay attention to how to maintain that practice. Small goals and steady change in collaborative learning groups can be meaningful. Even reading something like this special issue on implentation science and discussing it with colleagues is a piece of that culture. I encourage you to select one area of practice for examination and identify ways that you can be a part of implementation initiatives in your region. References Aarons, G. A., Ehrhart, M. G., Farahnak, L. R., & Hurlburt, M. S. (2015). Leadership and organizational change for implementation (LOCI): A randomized mixed method pilot study of a leadership and organization development intervention for evidence-based practice implementation. Implementation Science , 10 (1), 1–12. https://doi. org/10.1186/s13012-014-0192-y Aarons, G. A., Sklar, M., Mustanski, B., Benbow, N., & Brown, C. H. (2017). “Scaling-out” evidence-based interventions to new populations or new health care delivery systems. Implementation Science , 12 (1), 111. https://doi. org/10.1186/s13012-017-0640-6 Bauer, M. S., & Kirchner, J. (2020). Implementation science: What is it and why should I care? Psychiatry Research , 283 , 112376. https://doi.org/10.1016/j. psychres.2019.04.025

109

JCPSLP Volume 23, Number 2 2021

www.speechpathologyaustralia.org.au