Engaging Hospitals in Research:
Implementation Science
Jose Azar, MD
Medical Director, Quality Improvement. Patient safety
and Inpatient Hematology/Oncology Unit
IU Health Simon Cancer Center
ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH
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Bridging Healthcare Discovery and Delivery:
Implementation Science
Implementa
tion
Science
Clinical
Trials
Learning
Health
System
Better Care
at Lower
Cost
Health
Services
Research Fast Adoption of Proven
Interventions In Everyday Practice
ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH
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Bridging Healthcare Discovery and Delivery:
Implementation Science
Implementation research is the scientific study of
methods to promote the systematic uptake of research
findings and other evidence-based practices into
routine practice, and, hence, to improve the quality and
effectiveness of health services and care.
Implementation Science 2006; 1:1
ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH
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Consolidated Framework for Implementation
Science
Implementation Science, 2009; 4:50
Individuals
Involved
Inner Setting
Adapted
Intervention
Adaptable Periphery
Core Components
Outer Setting
Core Components
Adaptable Periphery
Un-adapted
Intervention
Process
ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH
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Implementation Science:
Sources of Variation in Healthcare Delivery
Implementation
Science
Professional
Informed
Clinical Decision
Making
Lean/Six Sigma
Patient Centered
Systems and
Processes
Personalized
Medicine
• Patient Response
• Effectiveness of Care
• Zero Error
• Zero Waste
Boustani and Azar, 2012
ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH
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Health Care System:
Complex Adaptive System (CAS)
• Open, dynamic, flexible, adaptive and complex network
• Complex due to:
– Numerous interconnected, semi-autonomous,
collaborating professional members
competing,
and
• Adaptive due to:
– Ability to learn from prior experiences
– Dynamic and flexible connecting patterns among its members
• The performance of a CAS fluctuates over time due to:
– Response to the external pressure or stressors
– Resiliency of its internal network
ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH
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Discovering solutions in a CAS:
Reflective Adaptive Process (RAP)
• Process:
–
–
–
–
–
–
Shared Vision, Mission, and Values
Protected Time and Space
Safe Environment
Value Tension and Discomfort
Seek Diversity and Different Perspectives
Timely and ongoing feedback
• Accomplishments:
–
–
–
–
Critical Evaluation of Opportunities
Identification the Optimal Interventions
Scalability of positive solutions
Discontinuation of negative solutions
ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH
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Application: Group-based Problem Solving
Indianapolis Discovery Network for Dementia
• Group-based problem solving and solution generation forum
• Includes stakeholders from all five major health systems in
Indianapolis
• Mission:
– Conduct implementation science research activities
– Provide a culture of discovery, cooperation and team work
– Disseminate knowledge and innovations
• Outcome:
– ROI of $32M in grant funding (NIH, CMS, PCORI)
ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH
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Application: Group-based Problem Solving
Hospital Unit-Based Innovation Team:
• Innovation team assembled to create resiliency/adaptability
• Engage with respect, purpose, empowerment
• Principles:
– Innovation
– Lean Methodology
– Complexity Science
• Outcomes:
– Rapid Cycle Improvement board – 18 projects in 6 months
– Inpatient Relational Coordination based inter-professional daily care
rounds
ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH
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Inpatient Relational Coordination based
Inter-professional Daily Care Rounds
Coaching to
Enhance
non-MD
participation
Team:
?
Relational
Coordination
?
MD
Fellows
Residents
Bedside RNs
PharmDs
Care Coordinators
Case Managers
Social Workers
Outcomes:
Care
Delivery
Process
•
•
•
•
•
LOS
Readmissions
Discharge efficiency
Falls
Patient experience
Role
Definition
to highlight
expertise of
each role
ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH
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Engaging Hospitals in Research:
• Find mutual goals and interest between healthcare research and
delivery
• Focus on patient relevant outcomes in the clinical study design
• Factor optimal implementation / dissemination into clinical study
design
• Consider economic and financial implications of the clinical study
design
• Remember that healthcare systems are complex adaptive systems
rather than linear hierarchical systems
ACCELERATING CLINICAL AND TRANSLATIONAL RESEARCH
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