Inducting Implementation Science into Integrated Care: A Practical Approach

The field of Integrated Care exists because our current health and social care delivery are too often fragmented and need the integrating. If we have the reality of care that is integrated, we would not need the knowledge and practice of Integrated Care. However, care systems are complex and adaptive and in constant flux and flow. They do not stop or slow down for our efforts at improvement. Rushing into action without sufficient exploration of influencing factors and a solid design, or attempting overly ambitious timelines (perhaps for political effect) lead to ineffective outcomes. On the other hand, targetting too limited an objective or a community means not enough is done for the whole population. A key component of the practice of Integrated Care then is 'making things happen' to improve health outcomes and resource efficiency, which is the essence of Implementation Science. Implementation Science plays a pivotal role in translating research and evidence into practical policies and programmes. The domain has developed tremendous in the recent decades and is now replete with much academic literature. For example, Waltz et al in Implement Sci 2015 enumerated 73 strategies in 9 thematic categories, and acronymed theoretical frameworks of components, factors and processes (like EPIS, CFIR, NIRN, COM-B, TDF, RE-AIM, and PARIHS) abound. There are many available tools but new practitioners find navigating the theory and practice of Implementation Science daunting. Implementors must grasp core concepts (including the fundamentals of policy and programme design, implementation, monitoring and evalaution, or DIME) and acquire a process-oriented approach for immediate application. A balance has to be struck between academic depth and practical action for soonest impact with least dysfunction. This induction to Implementation Science draws inspiration from the simplicity of teaching the 'stakeholder register' in Stakeholder Management, which can take a learner systematically and quickly through the steps of stakeholder identification, consideration of stakeholder power and interest, then the stakeholder grid, strategy and action plan. Learners grasp the process and the limited accompanying concepts and can immediately get to action. Sophistication can come with time. The described curriculum offers a concise and intensive course in Implementation Science for Integrated Care. In a few days, it will empower learners with essential knowledge and practical tools, and guide them in applying core theoretical foundations to real-world scenarios.