Manchester Business School, University of Manchester, Booth Street West, Manchester M156PB, UK.
Implement Sci. 2011 Aug 23;6:96. doi: 10.1186/1748-5908-6-96.
In response to policy recommendations, nine National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) were established in England in 2008, aiming to create closer working between the health service and higher education and narrow the gap between research and its implementation in practice. The Greater Manchester (GM) CLAHRC is a partnership between the University of Manchester and twenty National Health Service (NHS) trusts, with a five-year mission to improve healthcare and reduce health inequalities for people with cardiovascular conditions. This paper outlines the GM CLAHRC approach to designing and evaluating a large-scale, evidence- and theory-informed, context-sensitive implementation programme.
The paper makes a case for embedding evaluation within the design of the implementation strategy. Empirical, theoretical, and experiential evidence relating to implementation science and methods has been synthesised to formulate eight core principles of the GM CLAHRC implementation strategy, recognising the multi-faceted nature of evidence, the complexity of the implementation process, and the corresponding need to apply approaches that are situationally relevant, responsive, flexible, and collaborative. In turn, these core principles inform the selection of four interrelated building blocks upon which the GM CLAHRC approach to implementation is founded. These determine the organizational processes, structures, and roles utilised by specific GM CLAHRC implementation projects, as well as the approach to researching implementation, and comprise: the Promoting Action on Research Implementation in Health Services (PARIHS) framework; a modified version of the Model for Improvement; multiprofessional teams with designated roles to lead, facilitate, and support the implementation process; and embedded evaluation and learning.
Designing and evaluating a large-scale implementation strategy that can cope with and respond to the local complexities of implementing research evidence into practice is itself complex and challenging. We present an argument for adopting an integrative, co-production approach to planning and evaluating the implementation of research into practice, drawing on an eclectic range of evidence sources.
为响应政策建议，2008 年在英格兰设立了 9 个英国国家卫生研究院（NIHR）应用卫生研究和护理合作组织（CLAHRCs），旨在促进卫生服务与高等教育之间更紧密的合作，并缩小研究与实践应用之间的差距。大曼彻斯特（GM）CLAHRC 是曼彻斯特大学与 20 个国民保健制度（NHS）信托基金之间的合作，其五年使命是改善心血管疾病患者的医疗保健并减少健康不平等。本文概述了 GM CLAHRC 设计和评估大规模、证据和理论驱动、注重背景的实施计划的方法。
本文主张将评估纳入实施策略的设计中。与实施科学和方法相关的实证、理论和经验证据已被综合，以制定 GM CLAHRC 实施策略的八项核心原则，认识到证据的多面性、实施过程的复杂性，以及相应地需要应用与情况相关、响应、灵活和协作的方法。反过来，这些核心原则为 GM CLAHRC 实施方法所依据的四个相互关联的构建块的选择提供了信息。这些构建块决定了 GM CLAHRC 实施项目所使用的组织流程、结构和角色，以及实施研究的方法，包括：促进卫生服务研究实施的行动（PARIHS）框架；改进版的模型改进；具有指定领导、促进和支持实施过程的角色的多专业团队；以及嵌入式评估和学习。
设计和评估能够应对和应对将研究证据付诸实践的地方复杂性的大规模实施策略本身就很复杂和具有挑战性。我们提出了采用综合、共同制定的方法来规划和评估研究向实践的实施，借鉴了广泛的证据来源。
