Implementing Improvements: Opportunities to Integrate Quality Improvement and Implementation Science

Abstract

In hospitals, improvers and implementers use quality improvement science (QIS) and less frequently implementation research (IR) to improve health care and health outcomes. Narrowly defined quality improvement (QI) guided by QIS focuses on transforming systems of care to improve health care quality and delivery and IR focuses on developing approaches to close the gap between what is known (research findings) and what is practiced (by clinicians). However, QI regularly involves implementing evidence and IR consistently addresses organizational and setting-level factors. The disciplines share a common end goal, namely, to improve health outcomes, and work to understand and change the same actors in the same settings often encountering and addressing the same challenges. QIS has its origins in industry and IR in behavioral science and health services research. Despite overlap in purpose, the 2 sciences have evolved separately. Thought leaders in QIS and IR have argued the need for improved collaboration between the disciplines. The Veterans Health Administration's Quality Enhancement Research Initiative has successfully employed QIS methods to implement evidence-based practices more rapidly into clinical practice, but similar formal collaborations between QIS and IR are not widespread in other health care systems. Acute care teams are well positioned to improve care delivery and implement the latest evidence. We provide an overview of QIS and IR; examine the key characteristics of QIS and IR, including strengths and limitations of each discipline; and present specific recommendations for integration and collaboration between the 2 approaches to improve the impact of QI and implementation efforts in the hospital setting.

FIGURE 1

Venn diagram depicts the overlap among different sectors of delivery science. This diagram reflects how QIS and IR inform the practice of QI and implementation in the acute health care setting.

FIGURE 2

Principal differences and overlap between QI and IR.

FIGURE 3

Institute for Healthcare Improvement (IHI) Model for Improvement versus EPIS implementation science framework.

FIGURE 4

Using the PRISM IR framework to guide the categories of a QI cause-and-effect diagram. The PRISM figure has been reprinted with permission from the re-aim.org Web site developers and host.