Implementation Science: Improving adoption of medical advances in routine care

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Studies suggest that new practices can take years to be implemented and only one-fifth achieve routine use in care.^1,2,3 This impacts all stakeholders involved in EBP delivery, including manufacturers, payers and physicians, and can affect patient care and caregiver support.

One proven way to bridge the “evidence-to-practice” gap, ensuring all stakeholders benefit from the latest medical advancements is through implementation science. This approach applies scientific discipline and collaboration among stakeholders to identify factors that inhibit or enable adoption. With the support of leaders who value continuous improvement, it can help address implementation issues and improve adoption.⁴

Identifying EBP adoption challenges through scientific rigor

While organizations often follow standardized processes or industry guidelines to implement new practices, they may lack insight into factors that impede their adoption. Efforts to understand implementation challenges are often reactive, rather than proactive, and lack a systematic approach for identification and documentation. This leads to inefficiencies, increased costs, delays in fully successful implementation or possible failure to adopt.

Organizations can use the following implementation science approaches to help understand and overcome adoption challenges:

Conducting contextualization research

To fully understand stakeholder needs and behaviors that impact EBP adoption, it’s necessary to gain insight into the context around them. Contextualization research uses a data-driven approach that clearly links context with action, helping uncover factors that influence  behaviors. To support the development, deployment and monitoring of EBP implementation, establishing a guiding framework to structure and interpret findings of a contextual assessment is important.

Healthcare organizations can use a range of study methods to conduct this research. For example, surveys or interviews with healthcare staff and patients in an environment where a new practice or program will be implemented can provide insights into potential barriers and enablers. This can help determine what factors might challenge successful adoption, such as reluctance to change an established practice, even when the change is supported by evidence.

A recent case study illustrated how contextualization research helped reveal and correct information issues that impacted the adoption of a cardiovascular product within a hospital system.

• Product information was added to electronic health record (EHR) systems with order set errors that caused confusion for prescribers and posed information gaps that led to inefficient workflows.
• This lack of parity to other established products impeded the product’s adoption into practice. A review to find a cause identified the information errors, which were shared with institutional clinical decision makers.
• Steps taken to resolve these errors significantly decreased barriers to the product’s adoption; the identification of workflow gaps resulted in a 38% reduction in hospital system errors from the previous year.

Developing and delivering an implementation strategy

Contextualized research helps reveal factors impacting implementation. It also serves as guidance for developing a well-defined implementation strategy with clear goals and metrics, as well as methods for measuring and monitoring progress. Two key areas of focus include:

• Structured design and testing of interventions: The complex nature of an intervention can make it difficult to determine what is most important to test and measure. Gaining clarity and consensus around this provides more effective information for decision-making. Identifying key metrics during deployment and limiting measurements to essential metrics helps organizations stay focused on monitoring and sustaining their interventions.Actionable insights from testing should be added to the guiding framework, as they are crucial in determining the best ways to support future implementation efforts, ensuring long-term sustainability and scaling across an organization.
• Intervention deployment and monitoring: Continued monitoring can show where adaptations to an intervention or strategy are needed and help determine the best methods for implementation when adaptations are appropriate.For example, an intervention requiring training and education can be adapted within the implementation context. However, if specific equipment is involved — such as a treatment requiring a ventilator with precise technical standards and specifications to ensure patient safety and efficacy — it cannot be modified. In this case, a different approach to the issue will be required.

Again, the guiding framework can track these adaptations and monitor impacts on the strategy’s goals. This can provide insight to possible changes for future efforts, as well as how the implementation program aligns with the organization’s goals.

Change begins at the top

One of the strongest predictors of success in an EBP implementation is a supportive culture. Individuals who support the evaluation of their current practices and promote continuous improvement will inherently be more likely to advocate for change and actively champion it. This is vital to a successful implementation and realization of benefits, including optimized spending and maximized effort to deliver the best care while enhancing patient outcomes.

Bios:

Jennifer Hill, Director of Scientific Services, Patient Centered Solutions, IQVIA:
As a Director and Implementation Science Practice Lead in IQVIA’s Patient Centered Solutions team, Jenn provides strategic and scientific leadership in the conceptualization and operationalization of implementation science studies to generate insights within clinical trials to support optimization prior to launch and within real-world studies to enhance uptake, scaling and sustainability in routine practice.

Sam Foster, Senior Director, Evidence Generation Medical Affairs, IQVIA:
As a Senior Director in IQVIA’s Evidence Generation for Medical Affairs team, Sam works to develop real-world studies that will successfully inform and enhance the development and implementation of new treatments for patients.

References:

1. Balas EA, Weingarten S, Garb CT, Blumenthal D, Boren SA, Brown GD. Improving Preventive Care by Prompting Physicians. Arch Intern Med. 2000 Feb 14;160(3):301-8. doi: 10.1001/archinte.160.3.301.
2.  Morris ZS, Wooding S, Grant J. The Answer is 17 Years, What is the Question: Understanding Time Lags in Translational Research. J R Soc Med. 2011 Dec;104(12):510-20. doi: 10.1258/jrsm.2011.110180.
3. Reis SE, McDonald MC, Byers SJ. Crossing the Research Valleys of Death: The University of Pittsburgh Approach. Clinical and translational science. 2008 May;1(1):9.
4. Foster S, Hill J. Implementation Science: The Art of Intended Consequences. IQVIA. 2025.