Change is constant in healthcare. Nurses are often asked to incorporate changes into their work, and the pace of change can make it difficult to know what’s truly improving patient care. Some changes are straightforward, while others require considerable planning and continue to evolve after they’re introduced.Taking time to understand how change is implemented can help organizations learn from each initiative and make more informed decisions about what comes next.

Implementation science provides a systematic way to do that. While the field has been developing for decades, it complements approaches already familiar in nursing, including evidence-based practice and quality improvement. Its focus is on understanding how evidence and innovations are implemented in routine practice.¹

An important part of learning from implementation is planning for evaluation from the beginning. Organizations already devote considerable attention to preparing for new initiatives, and incorporating evaluation into that planning provides an opportunity to decide what success will look like, how it will be measured, and what the organization hopes to learn. Implementation outcomes provide a way to evaluate how well implementation is occurring, separate from the clinical or service outcomes an innovation is intended to influence.² Thoughtful evaluation takes time to plan and may begin months before implementation, allowing organizations to ask and answer important questions throughout the process and use what they learn along the way.

Implementation also extends beyond the day a new initiative is launched, with go-live representing one milestone in an iterative process. Understanding the impact of an initiative often takes time, and some important questions can’t be answered until implementation is underway. Is the innovation working as intended? What can we learn from the people experiencing it? If nurses report that a new process is difficult to use or doesn’t fit naturally within existing workflows, their experiences can provide important insight into how the innovation is working in practice.

While existing frameworks and lessons learned from other organizations can provide valuable guidance, studying implementation can help identify what supports or challenges an innovation as it moves into practice.³ Nurses have an essential role in this work because they understand clinical practice in ways that few others can. They know where workflows fit naturally into patient care and where they create unnecessary burden. Their perspective can help organizations interpret what they’re seeing and make practical improvements along the way.

As healthcare continues to evolve, that perspective will remain important. Nurses will continue to experience and lead change, and implementation science provides a systematic way to learn from those changes and understand how they become part of practice. With time, a change can stop feeling like another initiative or task and simply become part of routine nursing care. n

References

1. Curran GM. Implementation science made too simple: a teaching tool. Implement Sci Commun. 2020;1:27. Published 2020 Feb 25. doi:10.1186/s43058-020-00001-z
2. Proctor E, Silmere H, Raghavan R, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38(2):65-76. doi:10.1007/s10488-010-0319-7
3. Damschroder LJ, Reardon CM, Widerquist MAO, Lowery J. The updated Consolidated Framework for Implementation Research based on user feedback. Implement Sci. 2022;17(1):75. Published 2022 Oct 29. doi:10.1186/s13012-022-01245-0