This is not a sales pitch, instead I am highlighting a different perspective about using research to improve healthcare practice. There is not one best way to explain the complexity of improving healthcare; instead theories are often used to understand the black box of what actually goes on, behind the scenes. The Promoting Action on Research Implementation in Health Services framework has been developed over the last 15 years. It suggests that successful implementation requires an analysis of the nature and type of evidence and the qualities of the context or environment. This analysis emphasises the type of facilitation that is needed to make the change successful. So for a particular intervention it is useful to progress through the following 3 steps;
1.First of all, it is important to understand the types and qualities of evidence; including the best quality research, clinical experience, patient preferences and experiences and any local summaries of what is actually happening. The process of comparing and negotiating these perspectives requires careful management to understand what is working well, and what could be improved.
2. Next, it is important to understand the particular context. Some environments are more conducive to change than others. Careful analysis of the organisational culture and leadership patterns is useful. It is also important to understand what aspects of the context are barriers and facilitators to the particular intervention and whether there are opportunities for monitoring, evaluation and feedback.
3. Finally, an analysis of the type of evidence and the environment will determine the type of facilitation or guidance required to plan and implement the change that is required to improve practice.
This simplified process could be useful to better understand that the inherent complexity is not necessarily totally chaotic – there is some order and like a good game of chess, it is about learning the rules and patterns of engagement!