Implementation science in maternity care

Since its inception, ‘evidence-based healthcare’ has attempted to provide a scientific justification for the treatments and care provided within healthcare systems (Haynes, 2006). This approach has been guided by a traditional view of the hierarchy of evidence, culminating with meta-analyses and randomised controlled trials (Evans, 2003). However, despite the near-complete respect for evidence-based healthcare that is routinely expressed by healthcare agencies and practitioners, many practices and procedures followed in healthcare services lack, or are actively contrary to, the actual evidence base (Lau, Stevenson, Ong et al, 2014). At times this is because the evidence does not yet exist and researchers are yet to ask and/or answer questions about certain practices. However, even where the evidence does exist, practice often directly contravenes the relevant research findings.

Implementation science aims to address this evidence to practice gap through ‘the scientific study of methods to promote the uptake of research findings into routine healthcare in clinical, organisational or policy contexts’ (Eccles, Foy, Sales, Wensing and Mittman, 2012). Implementation science studies differ from clinical research in many ways (Figure 1). It can take as long as 17 years for a piece of research evidence to directly impact patient care (Morris, Wooding and Grant, 2011). The evidence-translation gap is influenced by a multitude of interrelated factors, which can arise from individuals, organizations, and/or society. Implementation scientists aim to develop innovative approaches to identifying, understanding and overcoming barriers to the adoption, adaption, integration, scale-up and sustainability of evidence-based interventions, tools, policies and guidelines (Brownson, Colditz and Proctor, 2012). This chapter will provide a practical guide to some of these approaches, using the example of midwifery-led continuity of care (MLCC) as an illustration.