Implementation Science

​​​

​Background 

Research in clinical practice is often suggested as a mechanism to enhance transparency in decision- making, to overcome unwanted variation and to improve patient and system outcomes. However, most research-based knowledge fails to translate into practice. The result is that patients do not benefit optimally from research and are therefore exposed to unnecessary risks. 

There are a lot of reasons why these evidence-practice gaps occur; one is that researchers rarely cooperate with the practitioners. Researchers and practitioners speak different languages. Many practitioners do not have the knowledge, skills or time to implement the evidence-based research. 

Many programs and clinical guidelines are designed in optimal circumstances and not in the complex everyday life of clinical practice. This factor especially applies to elderly medical patients.

We work with the Knowledge To Action (KTO) model. KTO is a theoretic model developed to support the ‘black box’ call knowledge translation or implementation. The model contains two phases - a Knowledge creation phase and an Action cycle phase. The core principle of this model is continuous exchange of information between the two phases. 

Our focus 

  • To generate knowledge about implementation of clinical guidelines and evidence-based programs, for elderly medical patients.
  • How to incorporate knowledge about the organisation’s local culture and learning processes, during implementation of clinical guidelines and evidence based health care programs.
  • How to incorporate implementation science when designing evidence-based studies.

On-going studies 

Action - Implementation of screening and brief intervention. This project is a health promoting mixed-methods implementation research project that examines the conditions for - and the implementation of an alcohol screening and brief intervention (SBI) adapted to the local context to optimize care and treatment for patients with alcohol problems. The project consists of three studies: 1) Explorative ethnographic studies consisting of field observations and interviews in two different emergency departments, 2) Tailoring of the intervention and implementation strategies and 3) the tailored version is fidelity tested to ensure successful implementation and sustainability. Project leader: Ditte Maria Sivertsen.

Cross-border transfer of healthcare.
Productive frictions and comparisons making the Danish Fast-track surgery approach transportable through awkward engagements. The project tells the story of how the Danish evidence-based Fast-Track Surgery (FTS) approach travels from Hvidovre Hospital in Denmark to provincial hospitals in Gansu province in China. With the FTS approach serving as an example, I explore the arduous work and efforts that are required for health-related standards, protocols, technologies, procedures, and regulations, or what colleagues and I term health-promoting infrastructures (HPIs) to travel cross-border. Thereby, I problematize the tendency to overstate the fluidity, abstractability and movement of global forms in global health research by analytically and empirically emphasizing the very work often necessary to enable HPIs to travel. First, I apply concepts of productive friction and comparison to unravel how the FTS approach is made transportable through awkward engagements. Second, I unfold the work of Chinese delegates making FTS compatible and acceptable for Chinese health staff, patients, and relatives as FTS moves into a Chinese setting. Project leader: Signe Lindgård Andersen.

Screening for nutritional barriers.
A qualitative study using focus groups interviews to explore the barriers for nutritional care as perceived by nursing staff at an acute orthopedic ward, aiming to implement evidence-based nutritional care. The interview guide was designed according to the Theoretical Domains Framework. The interviews are analyzed using Qualitative Content Analysis. Project leader: Pia Søe Jensen.

WALK-Cph. WALK-Cph is an implementation project aiming at investigating to what extend a patient intervention (WALK-Cph, aimed at increasing 24-hour activity in older medical patients) is implemented as planned. We will investigate which factors influence implementation both on an individual, a collective and an organizational level. This is done via implementation outcomes: implementations strategies, fidelity and adoption. The project consists of three studies: 1) Selection of implementation strategies, 2) fidelity of intervention and implementation strategies, 3) Evaluation of the implementation process. The project is based on qualitative methods such as work shops, observations and interviews. The project is inspired by various theories and "rammeværktøjer", e.g. Quality Implementation Framework, Theoretical Domain Framework and cultural theory. Project leaders: Jeanette Wassar Kirk and Mette Merete Pedersen.

Publications

Stuck in tradition-A qualitative study on barriers for implementation of evidence-based nutritional care perceived by nursing staff (2018). O Connell MB, Jensen PS, Andersen SL, Fernbrant C, Nørholm V, Petersen HV. J Clin Nurs 27:705-714.

A tailored strategy for designing the WALK-Copenhagen (WALK-Cph) intervention to increase mobility in hospitalized older medical patients: A protocol for the qualitative part of the WALK-Cph project. Kirk J., Bodilsen A.C., Tjørnhøj-Thomsen T., Pedersen M.M., Bandholm T., Husted R., Poulsen L., Petersen J., Andersen O., Nilsen P.. BMJ Open 2018;8:e020272.doi: :10.1136/bmjopen-2017-020272.

Barriers and facilitators for implementing a new screening tool in an emergency department: a qualitative study applying the Theoretical Domains Framework. Kirk JW, Sivertsen DM, Petersen J, Nilsen P, Petersen HV. J Clin Nurs .

Redaktør