Emptying the cup: Taking steps to go from knowledge to practice in health
By Jaime Hernán Rodríguez Moreno, Md. PhDPH, Subdirector of Implementation and Dissemination, Instituto de Evaluación Tecnológica en Salud de Colombia (IETS)
In December 2017, I attended the 10th Annual Conference on Dissemination and Implementation in Health organized by AcademyHealth. The conference’s goal is to share trends in research related to the transfer of knowledge.
Putting in practice what we know isn’t always easy due to internal factors (those of the implementer) and external ones (of the environment or the health system) that can determine for us the way in which we do things. This is much harder when those who are putting new knowledge into practice are complete communities, like hospital workers or a community in a municipality. And it becomes even more complicated when we’re talking about topics like health, where what we do from a clinical standpoint or in our treatment policies can impact a lot of people.
It is important that implementation processes take into account how the expected results will be achieved in the population, if practices really are changing and if these are, in turn, improving behaviors, quality of life and the health of people. And this is not the same for populations in big cities, small towns or those with or without climactic changes.
Strategies for implementation: Lessons learned
During the conference strategies were presented that have been developed in different parts of the world, identifying the characteristics and results of each one and how these can be expanded to other regions. Recognizing that taking knowledge to practice implies necessary and sequential steps that ensure that the person receiving the health services is satisfied with the actions they receive. This includes the following elements:
- Who are the spokesperson and the recipient of what we are going to do?
- Which are the strategies that we have to apply the knowledge?
- What is the context (organizational and social) in which the knowledge translation will take place?
Who are the spokesperson and the recipient of what we are going to do?
When a person or community is going to put a new concept into practice or action, they need to have the capacity to analyze and execute the new actions. Often this requires changing old practices that had been learned before and, even though it’s easy to say, doing it is much harder. You need to “empty the cup” that was full with old knowledge to fill it with new knowledge and establish a process to apply it.
Emptying the cup applies when we’re trying to change how parents feed their children as well as when a doctor with 20 years of experience has to change how they carry out a treatment or deal with a patient. So it is important, from the beginning, taking the knowledge and determining who will apply it (the spokesperson), to whom it will be applied (the audience) and the relationship between them.
Which are the strategies that we have to apply the knowledge?
The approach to the implementation topics during the conference allow us to reflect on a large number of strategies that can be used so that implementation processes are closer to the reality of the implementing individuals and organizations. But above all, so that they can have an impact over the recipients of knowledge, changing their attitudes and practices about the activities.
The implementation of the best actions has to be understood as a process, which means that it is not an isolated event that will disappear as time passes by. On the contrary, putting evidence into practice assumes that this will be sustained over time, and which will determine the resources, the people and the results that they will generate. The strategies depend on the population we want to reach and the resources available.
What is the context (organizational and social) in which the knowledge translation will take place?
The implementation and research into its results and outcomes for the population requires that researchers include four key elements for success of the process:
- Analysis of the context, and strategies about how it should be analyzed and approached
- Elements that facilitate and generate barriers for successful implementation processes
- Possibility for replication of the implementation in other contexts, and
- Conditions that facilitate the sustainability of the implementation processes
Understanding the context allows us to establish the conditions for interaction between the different actors, the capacity to identify threats to the process, and the barriers and facilitators that will favor our actions. Sandro Galea, MD Dr.PH, who is professor and dean at the School of Public Health at the University of Boston expressed that implementation is the application of knowledge in a new scenario, in a new environment and that it can change according to the conditions of the environment (Fig 1).
Figure 1: Summary of the implementation process
In conclusion, implementation processes are built daily. Although it is true that there has been much progress in this process and in our understanding of how things can be done better, it is also true that the history of implementation is built every second and will not stop renewing itself.
——————————
Jaime would like to thank the HSG Translating Evidence into Action Thematic Working Group for supporting her to attend the NIH/AcademyHealth Dissemination and Implementation Science 2017 conference. Special thanks toKarine Gatellier and Daniela C. Rodríguez for editorial contributions to this article.
The call for abstracts for the 11th Annual Conference on the Science of Dissemination and Implementation in Health is now open.
