5th UK Implementation Science Research Conference

Plenary Lectures

Plenary Lecture 1

Why do policymakers not listen to your evidence, and is it their fault?

Professor Paul Cairney

Professor of politics and public policy, University of Stirling

Paul Cairney is Professor of Politics and Public Policy, University of Stirling. His research interests are in comparative public policy, including: comparisons of policy theories (Understanding Public Policy, 2020), methods (Handbook of Complexity and Public Policy, 2015, co-edited with Robert Geyer) and the use of evidence (The Politics of Evidence-Based Policy Making, 2016); policy outcomes in different countries (Global Tobacco Control, 2012 (with Donley Studlar and Hadii Mamudu), Scottish politics (The Scottish Political System Since Devolution, 2011 and Scottish Politics 2nd ed, 2013 with Neil McGarvey), comparisons of UK and devolved policymaking (‘Has Devolution Changed the British Policy Style?’, British Politics, 3, 3, 350-72), and comparisons of policy outcomes across the UK (‘Policy Convergence, Transfer and Learning in the UK under Devolution’, Regional and Federal Studies, 22, 3, 289-307 with Michael Keating and Eve Hepburn). He was funded (October 2013-15) by the Economic and Social Research Council to research the policymaking process in Scotland, focusing on areas such as preventative spending, and is currently funded by Horizon2020 (IMAJINE) to research policies designed to reduce territorial inequalities. He has written multiple articles on COVID-19 policy in the UK: https://paulcairney.wordpress.com/covid-19/

It is common for researchers to complain that policymakers do not pay attention to, or act on, the evidence they give them. In this lecture, Professor Cairney will draw on insights from policy studies to identify three general explanations for this problem: researchers and policymakers often have different ideas about what counts as good evidence; policymakers have to ignore almost all information to make choices; and, they make policy in a political environment of which they have limited knowledge and even less control. In that context, what can be done to address the ’evidence-policy gap’? It is common to simply blame politicians, or encourage researchers to communicate more effectively. However, Professor Cairney will use examples – from public health strategies – to show that this analysis is incomplete without identifying the systemic issues and trade-offs that would arise under any government.

Plenary lecture 2

Implementation of telemental health care during the Covid-19 pandemic

Professor Donald Hilty

Professor and vice-chair of Veterans Affairs, Department of Psychiatry and Behavioural Science, University of California

Dr. Donald Hilty is a scholar in psychiatric and medical education, health services, and telemedicine. He works as a Professor of Psychiatry at the UC Davis School of Medicine, with United Health Services and Heritage Oaks Hospital to develop virtual care and has assisted the Veterans Health Administration to implement technology. He speaks internationally and researches models of care, health services design, health economic outcomes and implementation of video, mobile health, sensors and other technologies. He has obtained 20 grants and 7 contracts from the NIH, AHRQ, California Endowment, and OSHPD, with randomized trials of the treatment of depression in primary care via disease management and an AHRQ comparison of synchronous and asynchronous telepsychiatry. His current research is in implementation and evaluation of video, social media, mobile health and asynchronous competencies for psychiatry, behavioral health and medicine.

Dr. Hilty is active with pedagogy, faculty development and publishing. Dr. Hilty serves as Editor of both the Journal of Technology in Behavioral Science and Psychology and Cognitive Science, and is Editor of the Innovation in Technology Column for Academic Psychiatry. He has led or co-led 8 special editions related to technology, clinical care and professional development, including Psychiatric Clinics of North America, “Professional Development in Psychiatry and Medicine” and for Frontiers in Psychiatry, “Digital Interventions for Mental Health.” He has written 180+ journal articles, 100 chapters and many other publications, including for the APA-IOM and APA-ATA Guideline Writing Groups. His first book is entitled Key Issues in e-Mental Health and a current one in press is Rural Telebehavioral Health: Underserved and Diverse Settings by Springer Nature Publishing.

Dr Samantha Connolly

Assistant professor of psychology, Department of Psychiatry, Harvard Medical School

Dr. Samantha Connolly is an Investigator at the Center for Healthcare Organization and Implementation Research (CHOIR) and a practicing clinical psychologist within the US Department of Veterans Affairs (VA) Boston Healthcare System. She is an Assistant Professor within the Harvard Medical School Department of Psychiatry and an Associate Editor of the Journal of Technology in Behavioral Science.

Dr. Connolly’s research focuses on the implementation of phone and video telehealth. She recently completed a two-year VA Career Development Award studying uptake of telemental health care during the COVID-19 pandemic, and is the incoming recipient of a subsequent five-year national VA Health Services Career Development Award that will focus specifically on quality of telehealth care.

This plenary lecture will discuss critical components of telemental health implementation during the Covid-19 pandemic from patient, clinician, and system perspectives. Quantitative and qualitative research from the US Department of Veterans Affairs will be presented, including evidence of a digital divide between those with access to video versus audio-only care, as well as key implementation factors that impacted uptake of video telehealth across mental health clinics. Provider attitudes regarding the quality and complexity of telehealth care also have a major impact on telehealth adoption and will be an additional area of focus. An overview of evaluation, process improvement and institutional competencies for technology will be discussed to inform successful integration of telemental health into healthcare systems.

Plenary Lecture 3

Implementation in the wild: three levers to support practice change

Professor Jill Francis

Professor of implementation science, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne

Jill Francis, PhD, is Professor of Implementation Science at the School of Health Sciences, University of Melbourne (Australia), Professor of Health Services Research at the Peter MacCallum Cancer Care Centre (Australia), and a Senior Scientist with the Centre for Implementation Research, Ottawa Hospital Research Institute (Canada); formerly Professor of Health Services Research at City University of London (UK) and Professor of Health Psychology at the University of Aberdeen (Scotland). Jill is known for advancing theoretical and methodological developments in the field of implementation science in a wide range of clinical contexts.

Implementation trials investigate the effects of implementation strategies or techniques on uptake of healthcare interventions, but why do so many effective implementation strategies lose their impact when scaled from a research context to the pragmatic context of health and social care? Our team in Melbourne has proposed that three broad-based, interacting factors will influence the delivery of health and care interventions in practice: implementation strategies; the context in which they are embedded; and the implementability of the intervention itself. Recent literature has increasingly focused on features of interventions and these are brought together in our recent (2022) framework of implementability. This framework proposes that an iterative approach is required to assess implementability as intervention delivery moves from the research context to the more complex context of health care and that implementability includes three key facets. First, acceptability of the intervention (to providers and recipients) is required to enable engagement; second, intervention fidelity is required so that its active components are delivered and received; third, it must be feasible to deliver the intervention consistently in the current context. As the intervention is scaled (to different populations) and sustained (over time), these three factors may change. Hence, acceptability, fidelity and feasibility require re-assessment. Streamlined approaches to assessment and enhancement are therefore essential. Frameworks for efficient assessment of these three factors are discussed and a research agenda is proposed for advancing these aspects of implementation science.

Plenary Lecture 4

Valuing patient engagement to implement meaningful interventions for AMR

Vanessa Carter

AMR patient advocate and consultant

Vanessa became an AMR and One Health advocate after surviving a serious car accident and multidrug-resistant MRSA infection. She is a patient advisor to several organisations including CIDRAP and the WHO Strategic Technical Advisory Group on AMR (STAG-AMR) as well as a civil society champion at the Africa CDC. She has won awards for her advocacy from the Foundation for Innovative New Diagnostics (FINDdx) and Antibiotic Guardian (UK) and further completed an e-Patient Scholarship at Stanford University Medicine X in the USA. She provides consulting services in Patient and Public Involvement and Engagement (PPIE) research such as with the ASPIRES collaborative (Antibiotic use across Surgical Pathways – Investigating, Redesigning and Evaluating Systems). With a professional background in marketing and design, Vanessa has also lectured on various topics including infodemic management in relation to AMR after completing training by the WHO in 2020 as well as effective health communication for patient empowerment. More recently, she was appointed a lay member of the UK’s APRHAI Committee (Advisory Committee on Antimicrobial Prescribing, Resistance and Healthcare-Associated Infection). With her background in design, she has a special interest in human-centered innovation. Originally from Johannesburg, South Africa, she now resides in Devon in the UK.

Patient and public involvement and engagement (PPIE) is a crucial part of the design research process used to create meaningful interventions. Basic principles of effective design balance on an in-depth understanding of the end user’s needs and have proven successful in other fields, such as commercial marketing and sustainable problem-solving challenges. Without understanding the user’s needs, we implement interventions based on assumptions. In addition to user research, and empathising with the target audience to design meaningful solutions, marketing incorporates the use of metrics to monitor and measure data that helps to inform design, such as communication strategies. KPI metrics like social media sentiment or website analytics can also be used to track real-time feedback around existing interventions which are useful for their adaptation or alternatively provide useful insight into the concerns of users. In the area of communication, measuring the impact of an intervention is both equally important in traditional and digital realms, which is why it is important to develop creative strategies that enable us to effectively monitor whether an intervention is working for patients or not.