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9 Using implementation levers to translate evidence into practice
  1. Niamh O’Rourke1,
  2. Eve O’Toole2
  1. 1Health Information and Quality Authority, Dublin, Ireland
  2. 2NCCP, Health Service Executive, Dublin, Ireland


Objectives Evidence-based medicine should be complemented by evidence-based implementation (Grol & Grimshaw 1999). This project sought to combine these two disciplines to leverage and enable sustainable evidence-based interventions in our health system. Implementation science is the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice to improve the quality and effectiveness of services (Bauer et al., 2015). We adopted a multifaceted approach of implementation drivers, across health and social care, education and regulation.

Our objectives were:

  • To achieve successful adoption of research evidence, through establishing a strategic and systematic approach to support implementation of evidence-based practice in Ireland.

  • To integrate implementation science into our teaching and practice of evidence based practice by focussing on the ‘apply’ domain.

  • To support the translation of research evidence into practice, through communication of evidence, knowledge translation and exchange.

Methods The ‘implementation gap’ refers to the difference between the evidence of what works in theory and what is actually delivered in practice. A suite of integrated implementation measures was introduced into the Irish healthcare system to support the translation of research evidence into practice. Implementation levers such as legislation, ministerial endorsement, implementation mandate, accountability frameworks, regulation, capacity building and a competency framework were introduced. As part of the suite of interventions, a competency framework was developed to enhance the teaching and practice of clinical effectiveness, which included evidence based practice, implementation science, quality improvement processes and collaborative practice. Training courses on Evidence-based Practice were also designed and delivered, which included a specific focus on the ‘apply’ domain, using an implementation science approach.

Results Ireland has introduced a suite of implementation levers at national level to support an integrated sustainable approach for improving implementation of evidence-based practice in the Irish health services. This approach has addressed the ‘implementation gap’ between theory and practice, by creating effective bridges between policy and practice. An EBP training module on ‘evidence into practice’ has been developed, with very positive evaluation. Participants cited the most useful parts of the course as ‘Practical aspects of bringing EBP to patients’, ‘Connection of theory to real world practice’ and ‘Applying information in practice’. The synergy of implementation levers across systems, such as legislation, regulation and education has highlighted the importance of integrating implementation science into all of our evidence-based interventions, throughout the design and development process. Using implementation strategies, we can actively disseminate and translate evidence, to drive innovation in Healthcare.

Conclusion Traditionally, the approach to EBP has focussed primarily on asking answerable questions, searching the available literature and appraising the literature for its quality and applicability. However, there has been less focus on how to apply EBP in practice. By developing an ‘evidence into practice’ module we are addressing the curriculum gap in how to teach the ‘apply’ domain of EBP. Through the identification of barriers and facilitators, assessment of implementation readiness and tailored implementation strategies, the successful adoption and sustainability of evidence-based healthcare can be optimised. Implementation levers form part of a suite of national integrated implementation measures introduced in the Irish healthcare system to support the application of research evidence into practice, reducing waste, and translating knowledge for better quality health services.

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