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Implementation Science

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 health services [155].

The fact that it takes on average 17 years for Evidence-Based Practices (EBP) to become routine [156] is a widely cited driver for the development of Learning Health Systems. Discourse on Learning Health Systems often assumes that knowledge delivered to the point of care – such as through a decision support system – will actually change practice. Despite positive efforts to integrate knowledge delivery with clinical workflow [62], previous sections of this report have shown that this is slow and variable, something that is supported by the literature [157]. Indeed, the Learning Health System concept itself is approaching the 17-year milestone without becoming routine practice.

Traditionally, the efficacy of individual interventions has been studied in isolation in a controlled environment. As discussed in previous sections, Learning Health Systems are complex, rather than controlled environments. It can be more important to optimise their real-world effectiveness by ensuring that they are used correctly, rather than seeking to understand their efficacy in a lab.

Learning Health Systems are likely to require an implementation strategy: an integrated package of discrete approaches ideally selected to address identified barriers to implementation success [156]. For example, these might include behaviour change, training, feedback, incentives, learning collaboratives and community engagement. The focus is on the successful integration and use of the Learning Health System elements, rather than their individual efficacy.

Implementation Science is a common source of failure for Learning Health Systems. However, there are many guides available [156] and an extensive academic literature [158]. Large Learning Health Systems will benefit from a team of Implementation Scientists, but even smaller Learning Health Systems would profit from tapping at least some external expertise.