Implementation Strategies for Frontline Healthcare Professionals: People, Process Mapping, and Problem Solving
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San Francisco Veterans Affairs Health Care System, San Francisco, USA; 2Department of Medicine, University of California San Francisco, San Francisco, USA; 3Office of Rural Health, Veterans Health Administration, Washington, DC, USA; 4Quality Enhancement Research Initiative, Veterans Health Administration, U.S. Department of Veterans Affairs, Washington, DC, USA; 5Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, USA.
Implementation science is focused on developing and evaluating methods to reduce gaps between research and practice. As healthcare organizations become increasingly accountable for equity, quality, and value, attention has been directed to identifying specific implementation strategies that can accelerate the adoption of evidence-based therapies into clinical practice. In this perspective, we offer three simple, practical strategies that can be used by frontline healthcare providers who are involved in on-the-ground implementation: people (stakeholder) engagement, process mapping, and problem solving. As a use case example, we describe the iterative application of these strategies to the implementation of a new home sleep apnea testing program for patients in the Veterans Health Administration (VA) healthcare system. J Gen Intern Med DOI: 10.1007/s11606-020-06169-3 © Society of General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply) 2020
INTRODUCTION
During the past two decades, implementation science has emerged as a prominent field broadly defined as the “study of methods to promote the adoption and integration of evidence-based practices, interventions, and policies into routine health care and public health settings1.” In practice, implementation science blends theories from sociology and psychology with the methods of traditional research, quality improvement, and business change management2. Much of the existing literature has focused on the development of theories and frameworks to guide the design, evaluation, and dissemination of effective strategies3. However, the evolving theories, constructs, domains, and classification schemes4, 5 can sometimes introduce unintended barriers for practical Received September 3, 2019 Revised March 21, 2020 Accepted August 17, 2020
application by the very individuals (frontline clinicians and staff) who are responsible for day-to-day implementation. As described in the Veterans Health Administration (VA) Quality Enhancement Research Initiative Roadmap,6 implementation involves three phases: (1) pre-implementation, (2) implementation, and (3) sustainment. Pre-implementation consists of defining a quality gap, identifying an evidence-based practice to reduce this gap, selecting local champions to lead implementation at each target site, and planning how to evaluate the impact of these efforts. During this pre-implementation phase, frontline healthcare professionals often serve as valuable opinion leaders and operational stakehold
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