With Cati Brown-Johnson, Sonia Rose Harris & Lisa Goldthwaite
In the February issue of the journal, Hofmeyr and colleagues describe an initiative to improve the quality of postpartum family planning at a large public hospital in Botswana. Their initiative aimed to improve postpartum contraceptive counseling and provision, particularly efforts to integrate IUD services into clinical practice, while monitoring patient experience. Their efforts take into account that even with best practice recommendations, the transition from evidence to practice must be shaped by local contexts and reflect real-life experiences.
In our article, we commend the authors for reporting this study, especially given the focus on quality improvement and implementation, which can advance the growing field of implementation science. While quality improvement is relatively straightforward—improving the quality of care—implementation science goes a step further. Implementation science is the science represented by generalizable knowledge, principles, frameworks, theories, and tools for implementing interventions in real-world settings. Implementation science, like quality improvement, is about how. How is this intervention best done locally?
While Hofmeyr et al only mention ‘implementation’ a few times in their article, we see principles throughout, which begs the question – what benefit do we, as researchers and clinicians, get if we call this quality improvement or implementation science? What is the advantage of using frameworks and theories described in implementation science?
Here’s what we recommend in our editorial:
- Reflect: Understand what you’ve done and how it relates to other successful and failed efforts.
- Gaps and Opportunities: Consider gaps and opportunities in the work you’ve done. Using an implementation framework, you can see opportunities that are not currently being reported on — for example, patient engagement.
- Your contribution: Think about details of your setting that are not represented in the framework, this could be your contribution to an evolution of the framework.
Another success we note – Hofmeyr et al include patient satisfaction as an aspect of program analysis, as talking to people can help ensure that changes are appropriate for the local context. Patient input can be gathered at many points in improvement work, including program evaluation, as we see in this example. We encourage those doing improvement work to consider inviting patient representatives to project teams early in project development in order to incorporate their constructive ideas from the outset, thereby centralizing patient voices during design and implementation.
From our perspective, whether we call it quality improvement, implementation science – or something else – whether patients’ views are included in the initial or final assessment – ultimately what matters is improving the quality of care and communicating between us for these efforts.
So forget the labels! At the end of the day, we just want to read about your efforts to improve care.
Reading the paper by Hofmeyr and colleagues here.
Reading the editorial here.
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About the authors
Cati Brown Johnson PhD is a founding member of the Stanford Evaluation Sciences Unit. In her role as a researcher, she developed the Stanford Lightning Report, a rapid assessment tool based on principles of applied science. For the past 10 years, he has focused on health care delivery, innovation in preventive medicine, and scientific direction for health equity research. Her approach includes methods from qualitative research, quality improvement, behavior change, and linguistics, including lean management, the Quadruple Aim of healthcare, and design thinking/user experience. Dr. Brown-Johnson believes in the value of Learning Healthcare systems and is deeply committed to continuous learning and maintaining a curious mindset. Committed to identifying what is working and what needs improvement to improve systems and deliver patient-centered care.
Dr. Lisa Goldthwaite is a board certified Obstetrician Gynecologist and Subspecialty in Integrated Family Planning. He completed medical school and residency at Oregon Health & Science University. She then completed a Fellowship in Integrated Family Planning at the University of Colorado while simultaneously earning a Masters in Public Health from the Colorado School of Public Health. From 2015-2022 she was a Clinical Assistant Professor at Stanford University School of Medicine, where she also served as a consultant through the Stanford Program on International Reproductive Education and Services (SPIRES) to provide clinical family planning medical education and quality assurance services internationally. Dr. Goldthwaite currently lives and works as a Gynecologist in Minneapolis, Minnesota and serves as the Immediate Postpartum Contraceptive Care Clinical Consultant for Upstream USA. Her professional interests include patient-centered reproductive health care, immediate postpartum contraception, medical education, and health care quality improvement.
Sonia Rose Harris, MPH is a qualitative research and project manager with Stanford University’s Evaluation Sciences Unit. Sonia earned her bachelor’s degree in social policy and her master’s degree in public health from Northwestern University, where she focused on child and adolescent injury and violence prevention. After graduation, Sonia worked for multiple non-profit organizations as a sexual health and sexual assault prevention educator. Her professional interests include violence prevention, trauma-informed care, and quality improvement in mental health.
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