METHODS FOR CARE INNOVATION
SESSIE 1 – 2 ARTIKELS + LESOPNAMES
DE GEEST ET AL: POWERING SWISS HEALTH CARE FOR THE FUTURE:
IMPLEMENTATION SCIENCE TO BRIDGE “THE VALLEY OF
DEATH”
- 2019 SAMS or Swiss Academy of Medical science bulletin addressed the rift between basic
scientific discoveries and their clinical use.
o “Valley of death” = distance between both.
§ Consists of well-researched, EB programmes, practices, procedures, products
and policies developed by health scientists that are now waiting on bookshelves
to be translated into real world settings.
§ 30 – 40% of patients do not receive treatments of proven efficacy, 20 – 25%
receive unnecessary or potentially harmful treatments.
o Same rift between clinical research and implementation of related health policies or
innovations in health services.
- 2019: report on improving patient safety and quality of care called for investment in
implementation science.
- Balas and Boren: 14% of published evidence is translated into clinical practice.
o Mean wait between innovation and application = 17 years.
o Implementation deficits contribute to excess research waste.
- 2 types of research waste:
o Research waste 1: results in a low proportion of the research initiated eventually
resulting in high-quality scientific evidence.
§ Research designed without reference to systematic reviews of the existing
evidence.
§ Research not published in full.
§ Studies with avoidable research flaws
§ Studies that are unusable, incompletely reported or both
§ Various measures have been implemented to reduce this type of waste, with
some success.
• Examples: obligation to register studies, widespread investment in
clinical research infrastructures for example clinical trial units,
guidelines supporting the quality of scientific reporting.
• But more measures are needed.
o Research waste 2: lack of effective and sustainable translation and implementation of
EB innovations from the trial word into daily clinical practice.
§ To guide the translation of well-conducted, well-reported studies into real-word
settings, an increased focus on “implementation science’ is needed and should
be added early in the research process.
• Implementation science = “the scientific study of methods to promote
the systematic uptake of research findings and other EB practices into
1
, routine practice, and, hence, to improve the quality and effectiveness of
health services and care”.
• Conducting and implementation science study implies not only a
scientific evaluation of effectiveness of an intervention in a real-world
setting, but also an evaluation of how and why it either works or fails in
the specific context in which it was tried.
• Evidence generated on effectiveness outcomes and from evaluation of
implementation pathways can subsequently be transferred to other
contexts to suport a more efficient implemenations and/or scaling up of
an intervention.
• Implementation science builds on existing research principles and
methods, but its focus is on external validity à it is attentitive to the
additional complexities that characterise real world contexts.
• Requires the integration of 7 specific considerations.
o Patient and public involvement: involving all relevant
stakeholders in all stages of the project.
o Contextual analysis: allows researchers to better understand
and map relevant characteristics of the setting in which the
intervention will be implemented. The information contributes
to effective intervention co-design and informs the choice of
contextually relevant implementation strategies.
o Implementation science-specific theoretical frameworks:
Guide parts or all of an implementation science sudy.
o Implementation strategies: facilitate adoption,
implementation, sustainability and scaling up of specific
interventions, programmes or practices.
o Effectiveness and implementation outcomes: concurrently
measured.
o Implementation sciencespecific designs: combine evaluation
of an intervention’s effectiveness and outcomes of
implementation efforts.
o Transdisciplinary research teams: complementary skill sets of
implementation scientists are aligned with the knowledge and
skills of other team members, incl. policy- and decisionmakers.
• To strengthen recognition of implementation science in Switzerland,
IMPACT was recently launched and pursues 4 major claims.
o To showcase implementation science healthcare projects
conducted by swiss healthcare researchers and institutions.
o To provide networking opportunities for implementation
science researchers and other interested stakeholders in
Switzerland.
o To provide implementation science training opportunities
o To leverage funding options for implementation science in
Switzerland.
- According to De Geest et al boosting the performance of the Swiss healthcare system requires
bridging ‘the valley of death’, which will involve increasing the research capacity for
implementational science.
o Implementation science needs to be recognised as an essential part of a high-
performing research enterprice, with high societal returns on investment.
2
, o As implementation science projects require competencies beyond the traditional
clinical research methods, researchers need opportunities both to develop
competencies and to learn the principles of implementation science.
o Implementation scientists should be involved early on in the design of clinical research
projects à potentially shorten not only the time to routine use of EB interventions, but
also enhance their sustainability after succesful implementation.
o Rigorous methods of attracting and developing stakeholder involvement in projects can
be fostered through the Swiss EUPATI National platform.
o Adequate funding mechanisms must be established to help fund implementation
science projects.
- Implementation science already promises to make clinical research far more cost-effective (by
shortening the time to routine use of results), the complexities of implementation science studies
need to be reflected in the fundin mechanisms.
- Strategies to apply implementation science methods to Swiss health research offer an excellent
return on investment. Designing studies to overcome translation barriers promises to remove
years from the current research process.
o In turn, this will maximise the entire Swiss research enterprise’s value for patients and
populations.
o In effect, it will bridge the valley of death.
ARTIKEL WHAT CAN IMPLEMENTATION SCIENCE DO FOR YOU? KEY SUCCESS
STORIES FROM THE FIELD”
- It explores how implementation science helps bridge the gap between research and practice by
ensuring that evidence-based health interventions are adopted, scaled, and sustained in real-
world care.
- Key examples of success:
o Chronic Disease Self-Management Programs (CDSMP): Empower patients to manage
long-term illnesses, spreading widely across the U.S. through community partnerships.
o Primary Care–Mental Health Integration: Collaborative care models for depression
improved outcomes and reduced suicide risk, especially in the U.S. Veterans Affairs
system.
o HIV Prevention (DEBI): Effective interventions were packaged and disseminated
nationwide, though sometimes criticized for being too top-down.
o Patient Safety Checklists: Reduced hospital-acquired infections significantly, saving
lives and costs when combined with leadership support and monitoring.
o Diabetes Prevention Program (DPP): Lifestyle interventions were successfully adapted
for community use, showing large-scale health benefits though with some challenges in
inclusivity.
- Lessons learned:
o A shared agenda among stakeholders and leadership support is essential.
o Conceptual frameworks (e.g., RE-AIM, REP) help guide implementation.
o Ongoing evaluation builds a strong case for sustaining interventions.
o Operational experts and frontline provider input ensure real-world fit.
o Adaptations are necessary while maintaining core intervention elements.
- Conclusion: Implementation science has strong potential to transform healthcare by improving
the uptake and sustainability of effective interventions, policies, and programs.
3
, RECORDING 1: IMPLEMENTATION SCIENCE – MAKING RESEARCH FINDINGS
MORE POWERFUL FOR CLINICAL USE
THE PROBLEM
- The leaky research pipeline: there is a lot of research waste.
o Research waste 1 à well described and existing measures against them.
§ If a project is done there is >50% designed without reference to systematic
reviews or existing evidence à projects being done that aren’t necessary or
aren’t embedded in literature.
§ >50% of publications have avoidable research flaws or biases à poor
methodologie.
§ 50% of research is never published in full.
§ 50% of the published papers are unusable or incompletely reported or both for
instance not enough information to replicate the research.
o Research waste 2:
§ If you have evidence, only a fraction of that evidence is implemented in the
clinical practice
§ Implementation science studies how to reduce research waste 2.
o It takes a mean of 17 years to get research evidence implemented.
- Increasing value and reducing research waste is an important goal in the scientific world.
- A lot of innovation is happening, not all of it is useful for implementation.
o “The best big idea is only going to be as good as its implementation”.
- “The valleys of death” = the gap between research and develepmoment and the trial world and
the real clinical world.
o 1 valley of death between university research institute and inddustry technology transfer.
o Another, even bigger valley of death is between industry technology transfer and the
clinical implementation.
o A lot of innovation takes place for example in biology, prevention, detection and
diagnosis, treatment, public health, if we then move into the real world we can see that
only a fraction (14%) ever arrives. The sustainability is even less.
o In the US: 85% of biomedical research is wasted and this implias a considerable
financial los that sum up to $268.4 billion US dollars.
§ This is a big problem.
- Tackling the valleys of death and the leaky research pipeline (both research waste 1 & 2) calls for
investment in better research infrastructure and also calls for new types of methodology à
implementation of implementation science.
o Example: innovation to reduce non-adherence to medications.
§ Patients not taking their medication results in 200.000 premature deaths a year
in Europe.
§ In Europe there are around 125 billion avoidable hospitalisations, emergency
care and outpation visits a year.
§ In research there have been investmensts done to tackle medication non-
adherence. A intervention namely ‘new medicine services’ has been done in the
UK. However the moment that this new service had been transfered to other
setting (being scaled up) à the effect waived.
§ In Switzerland there is a project called ‘myCare Start’, this starts from evidence
developped in ‘new medicine services’ and changing the intervention to work in
farmacies in Switzerland.
4
SESSIE 1 – 2 ARTIKELS + LESOPNAMES
DE GEEST ET AL: POWERING SWISS HEALTH CARE FOR THE FUTURE:
IMPLEMENTATION SCIENCE TO BRIDGE “THE VALLEY OF
DEATH”
- 2019 SAMS or Swiss Academy of Medical science bulletin addressed the rift between basic
scientific discoveries and their clinical use.
o “Valley of death” = distance between both.
§ Consists of well-researched, EB programmes, practices, procedures, products
and policies developed by health scientists that are now waiting on bookshelves
to be translated into real world settings.
§ 30 – 40% of patients do not receive treatments of proven efficacy, 20 – 25%
receive unnecessary or potentially harmful treatments.
o Same rift between clinical research and implementation of related health policies or
innovations in health services.
- 2019: report on improving patient safety and quality of care called for investment in
implementation science.
- Balas and Boren: 14% of published evidence is translated into clinical practice.
o Mean wait between innovation and application = 17 years.
o Implementation deficits contribute to excess research waste.
- 2 types of research waste:
o Research waste 1: results in a low proportion of the research initiated eventually
resulting in high-quality scientific evidence.
§ Research designed without reference to systematic reviews of the existing
evidence.
§ Research not published in full.
§ Studies with avoidable research flaws
§ Studies that are unusable, incompletely reported or both
§ Various measures have been implemented to reduce this type of waste, with
some success.
• Examples: obligation to register studies, widespread investment in
clinical research infrastructures for example clinical trial units,
guidelines supporting the quality of scientific reporting.
• But more measures are needed.
o Research waste 2: lack of effective and sustainable translation and implementation of
EB innovations from the trial word into daily clinical practice.
§ To guide the translation of well-conducted, well-reported studies into real-word
settings, an increased focus on “implementation science’ is needed and should
be added early in the research process.
• Implementation science = “the scientific study of methods to promote
the systematic uptake of research findings and other EB practices into
1
, routine practice, and, hence, to improve the quality and effectiveness of
health services and care”.
• Conducting and implementation science study implies not only a
scientific evaluation of effectiveness of an intervention in a real-world
setting, but also an evaluation of how and why it either works or fails in
the specific context in which it was tried.
• Evidence generated on effectiveness outcomes and from evaluation of
implementation pathways can subsequently be transferred to other
contexts to suport a more efficient implemenations and/or scaling up of
an intervention.
• Implementation science builds on existing research principles and
methods, but its focus is on external validity à it is attentitive to the
additional complexities that characterise real world contexts.
• Requires the integration of 7 specific considerations.
o Patient and public involvement: involving all relevant
stakeholders in all stages of the project.
o Contextual analysis: allows researchers to better understand
and map relevant characteristics of the setting in which the
intervention will be implemented. The information contributes
to effective intervention co-design and informs the choice of
contextually relevant implementation strategies.
o Implementation science-specific theoretical frameworks:
Guide parts or all of an implementation science sudy.
o Implementation strategies: facilitate adoption,
implementation, sustainability and scaling up of specific
interventions, programmes or practices.
o Effectiveness and implementation outcomes: concurrently
measured.
o Implementation sciencespecific designs: combine evaluation
of an intervention’s effectiveness and outcomes of
implementation efforts.
o Transdisciplinary research teams: complementary skill sets of
implementation scientists are aligned with the knowledge and
skills of other team members, incl. policy- and decisionmakers.
• To strengthen recognition of implementation science in Switzerland,
IMPACT was recently launched and pursues 4 major claims.
o To showcase implementation science healthcare projects
conducted by swiss healthcare researchers and institutions.
o To provide networking opportunities for implementation
science researchers and other interested stakeholders in
Switzerland.
o To provide implementation science training opportunities
o To leverage funding options for implementation science in
Switzerland.
- According to De Geest et al boosting the performance of the Swiss healthcare system requires
bridging ‘the valley of death’, which will involve increasing the research capacity for
implementational science.
o Implementation science needs to be recognised as an essential part of a high-
performing research enterprice, with high societal returns on investment.
2
, o As implementation science projects require competencies beyond the traditional
clinical research methods, researchers need opportunities both to develop
competencies and to learn the principles of implementation science.
o Implementation scientists should be involved early on in the design of clinical research
projects à potentially shorten not only the time to routine use of EB interventions, but
also enhance their sustainability after succesful implementation.
o Rigorous methods of attracting and developing stakeholder involvement in projects can
be fostered through the Swiss EUPATI National platform.
o Adequate funding mechanisms must be established to help fund implementation
science projects.
- Implementation science already promises to make clinical research far more cost-effective (by
shortening the time to routine use of results), the complexities of implementation science studies
need to be reflected in the fundin mechanisms.
- Strategies to apply implementation science methods to Swiss health research offer an excellent
return on investment. Designing studies to overcome translation barriers promises to remove
years from the current research process.
o In turn, this will maximise the entire Swiss research enterprise’s value for patients and
populations.
o In effect, it will bridge the valley of death.
ARTIKEL WHAT CAN IMPLEMENTATION SCIENCE DO FOR YOU? KEY SUCCESS
STORIES FROM THE FIELD”
- It explores how implementation science helps bridge the gap between research and practice by
ensuring that evidence-based health interventions are adopted, scaled, and sustained in real-
world care.
- Key examples of success:
o Chronic Disease Self-Management Programs (CDSMP): Empower patients to manage
long-term illnesses, spreading widely across the U.S. through community partnerships.
o Primary Care–Mental Health Integration: Collaborative care models for depression
improved outcomes and reduced suicide risk, especially in the U.S. Veterans Affairs
system.
o HIV Prevention (DEBI): Effective interventions were packaged and disseminated
nationwide, though sometimes criticized for being too top-down.
o Patient Safety Checklists: Reduced hospital-acquired infections significantly, saving
lives and costs when combined with leadership support and monitoring.
o Diabetes Prevention Program (DPP): Lifestyle interventions were successfully adapted
for community use, showing large-scale health benefits though with some challenges in
inclusivity.
- Lessons learned:
o A shared agenda among stakeholders and leadership support is essential.
o Conceptual frameworks (e.g., RE-AIM, REP) help guide implementation.
o Ongoing evaluation builds a strong case for sustaining interventions.
o Operational experts and frontline provider input ensure real-world fit.
o Adaptations are necessary while maintaining core intervention elements.
- Conclusion: Implementation science has strong potential to transform healthcare by improving
the uptake and sustainability of effective interventions, policies, and programs.
3
, RECORDING 1: IMPLEMENTATION SCIENCE – MAKING RESEARCH FINDINGS
MORE POWERFUL FOR CLINICAL USE
THE PROBLEM
- The leaky research pipeline: there is a lot of research waste.
o Research waste 1 à well described and existing measures against them.
§ If a project is done there is >50% designed without reference to systematic
reviews or existing evidence à projects being done that aren’t necessary or
aren’t embedded in literature.
§ >50% of publications have avoidable research flaws or biases à poor
methodologie.
§ 50% of research is never published in full.
§ 50% of the published papers are unusable or incompletely reported or both for
instance not enough information to replicate the research.
o Research waste 2:
§ If you have evidence, only a fraction of that evidence is implemented in the
clinical practice
§ Implementation science studies how to reduce research waste 2.
o It takes a mean of 17 years to get research evidence implemented.
- Increasing value and reducing research waste is an important goal in the scientific world.
- A lot of innovation is happening, not all of it is useful for implementation.
o “The best big idea is only going to be as good as its implementation”.
- “The valleys of death” = the gap between research and develepmoment and the trial world and
the real clinical world.
o 1 valley of death between university research institute and inddustry technology transfer.
o Another, even bigger valley of death is between industry technology transfer and the
clinical implementation.
o A lot of innovation takes place for example in biology, prevention, detection and
diagnosis, treatment, public health, if we then move into the real world we can see that
only a fraction (14%) ever arrives. The sustainability is even less.
o In the US: 85% of biomedical research is wasted and this implias a considerable
financial los that sum up to $268.4 billion US dollars.
§ This is a big problem.
- Tackling the valleys of death and the leaky research pipeline (both research waste 1 & 2) calls for
investment in better research infrastructure and also calls for new types of methodology à
implementation of implementation science.
o Example: innovation to reduce non-adherence to medications.
§ Patients not taking their medication results in 200.000 premature deaths a year
in Europe.
§ In Europe there are around 125 billion avoidable hospitalisations, emergency
care and outpation visits a year.
§ In research there have been investmensts done to tackle medication non-
adherence. A intervention namely ‘new medicine services’ has been done in the
UK. However the moment that this new service had been transfered to other
setting (being scaled up) à the effect waived.
§ In Switzerland there is a project called ‘myCare Start’, this starts from evidence
developped in ‘new medicine services’ and changing the intervention to work in
farmacies in Switzerland.
4
