Megan Schliep, PhD, CCC-SLP, MPH, an assistant professor in the Department of Communication Sciences and Disorders, completed her PhD in Rehabilitation Sciences at MGH Institute in 2020. Her research focuses on language and cognitive assessment after stroke and explores the implementation of standardized assessment practices across the care continuum. She recently spoke with OSC’s Lisa McEvoy about implementation science for this month’s IHP Interview.
What is implementation science and why is it important?
There is an often-quoted statistic that it takes 17 years for only 14% of research to get into practice. This reflects a significant gap — there is a great deal of work being done that is not making it into clinical or educational practice settings. Often there are contextual considerations or needs within real-world settings that do not fully align with what might be happening in research labs.
Implementation Sciences (IS) is the study of the methods to promote the uptake of research into practice and aims to bridge that gap. It is still a growing field, particularly in health and rehabilitation sciences, as well as in education, and can be applied to a variety of settings. A lot of my work focuses on what we are doing in clinical rehabilitation settings, and I have colleagues, many here at the IHP, who are focusing on implementation in school-based and educational settings.
How does it work?
Within implementation science, there are a great number of what we call theories, models and frameworks that can be used. These provide a guide or a scaffold to implementation efforts. Within these, there are three primary categories or breakdowns: First, there are process frameworks that help to either guide or describe a process. These can be especially useful if you're trying to implement a new intervention or process in clinical care or in schools. The second are determinant frameworks — these aim to understand barriers and facilitators to implementation. For example, what is making this work? What is making it not work? What do we need to understand better from the people who are doing the work? Then the last category includes evaluation frameworks, which help us to evaluate implementation efforts. All of this information can help better guide future implementation efforts, with the goal of ultimately improving care or educational practices.
Next, we have implementation strategies, which are the methods or techniques used to increase the implementation of specific interventions or programs. These are often the things that clinicians or educators may be doing every day, but having defined strategies puts a common language to implementation efforts. Implementation strategies might involve education and training. They could involve identifying champions to lead efforts. Or they might include changing documentation practices. Implementation strategies are the specific things that can be done to support implementation. In fact, there is a curated list of 73 different implementation strategies, called the ERIC (Expert Recommendations for Implementing Change) strategies, that practitioners or researchers may draw from.
Last but not least, there are implementation outcomes to measure implementation. These are things like the acceptability, feasibility, or sustainability of an intervention or practice. These are really important, because no matter how wonderful an intervention is in a lab setting, if it can't be used in clinical practice, it's not going to improve care. If it's not something that clinicians or educators may adopt, it's not going to improve care.
How did you get involved in the field?
I completed my PhD in Rehabilitation Sciences (2020) here at MGH Institute working with Dr. Sofia Vallila-Rohter, who is a researcher as well as a practicing speech-language pathologist at Brigham & Women’s Hospital. I was a PhD student and practicing speech-language pathologist at Spaulding Rehabilitation Hospital. Each of our teams, including SLP clinician Carla Tierney-Hendricks, MS-SLP '10, PhD-RS ’23, who was leading much of the work at Spaulding, were independently looking to implement and streamline a standardized language evaluation process for individuals after experiencing a stroke — a standard core series of assessments so that we could improve consistency between clinicians and also measure patients’ progress between time points.
These projects were initially happening on a smaller scale. We came together — put our brains together with both teams — and really began thinking about how we could use an implementation framework to scaffold and structure what was being done. We identified a framework called the Quality Implementation Framework — this was a process framework that helped to guide our process of implementation. It gave us a road map to our implementation efforts between the sites. Based on these implementation efforts, we were able to see who had received a standardized language evaluation at Brigham and then came to Spaulding to more clearly understand the progress that was being made.
We had a very practical clinical need, and we were able to use an implementation framework to help support our efforts.
How do you see implementation science having an impact in the future?
I think we will get better at including implementation considerations early on in our research and planning so that we're considering some of these important contextual factors earlier on. Then, what is ultimately produced are clinically feasible things that can more effectively be used in clinical or educational settings.
As an example, if an intervention needs to be delivered four hours a day every day, well, that could be hard to implement in most clinical settings where people maybe only have one hour a week for their therapy. Or if an intervention requires materials and resources that aren’t routinely available, that would be a critical barrier to implementation. So, by working with practitioners early on to identify what's feasible in their setting, then an intervention or protocol can be designed that meets the specifications or needs of that setting.
Another part of implementation science that I think we’re seeing more of is bringing people together to work as a team. By putting more of an emphasis on research-practice partnerships, we can develop solid, trusting partnerships between researchers, their clinical or educational team members, patients, and families to create a community of practice with shared goals.
Implementation science includes a number of things that people have been doing, but there was never a common language or systematic way of completing and talking about these things. This impacted how well it could be replicated or evaluated. By having more systematic approaches for this work, we can then evaluate how effective specific strategies or processes are and how they impact outcomes.
How is the MGH Institute contributing to the field?
We have a lot of instrumental people who are doing work in meaningful ways to improve implementation. Many here at the IHP are some of the leaders within implementation science in communication sciences and disorders (CSD), especially within rehabilitation and educational care settings.
Every other year we have an interactive and really engaging implementation science conference, led by Dr. Tiffany Hogan, a leader in implementation in CSD, that brings together researchers, clinicians, educators, and other invested partners. The conference is called “IS is for All” and includes people who are doing this work and sharing what they're doing to build collaborations and to share innovations.
The inaugural conference in 2022 centered on implementation for all and provided foundational knowledge in implementation, “lightning rounds” on current implementation efforts in a variety of CSD settings, as well as collaborative opportunities to work together. The second conference (2023) targeted the power of partnerships. This coming April is our third year, and the focus is on collaborative implementation and practice. A primary goal is to bring people together to collaborate, learn from one another, share ideas, and then work together to generate new knowledge.
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