Dr Hossai Gul
Dr Hossai Gul is a transdisciplinary (TD) implementation scientist and practitioner, specialising in leading TD teams to implement evidence-based innovations into practice within complex systems. Hossai has worked within the Australian health and medical sector for over 10 years in health services, biomedical research, and health system and implementation science research. Hossai has a Bachelor of Advanced Science, an Honours by thesis in cancer drug discovery, a Master of Research by thesis in bioinformatic analysis, and a PhD in Implementation Science and Complexity Science. She is currently a Lecturer and the Head of Implementation Lab at TD School, University of Technology Sydney.
Implementation needs assessments are a critical first stage in implementation research and can consist of mapping target behaviours, processes, and barriers and facilitators. These barriers and facilitators are often reported as discrete lists despite the complex, interrelated, and dynamic reality that shapes implementation determinants. The aim of this body of work was to conduct an implementation needs assessment that provided a holistic view of implementation determinants to guide the development of evidence-informed implementation strategies in support of real-world genomic implementation efforts.
The model of care being implemented combined specialist clinical genetics services with nongenetic primary paediatric services. The implementation needs assessment began within genetics services via qualitative semi-structured interviews (n=14 participants, clinical genetics professionals) and continued within paediatrics via a cross-sectional survey (n=114 respondents, paediatricians) and semi-structured interviews (n=22, paediatricians). The resultant data were analysed using: (1) the Interactive Systems Framework (ISF) for mapping the implementation system; (2) pathway mapping techniques to visualise changes required in processes and practices; (3) Implementation Mapping to identify target behaviours; (4) mapping of implementation barriers and facilitators using the Consolidated Framework for Implementation Research (CFIR) (within genetic services) and the TDF in combination with descriptive statistics (within paediatric services); and (5) to integrate all findings a rich picture was developed using soft system methodology.
A systems science approach to implementation needs assessment revealed the specific relationships between barriers and facilitators that informed strategy design, bundling, and sequence of deployment. A rich picture view of implementation needs within a system also provided clear leverage points and areas within the system that change was not feasible, ethical, or outside of the sphere of influence of implementation teams – enabling better resource utilisation.
Integrating implementation science tools with systems science tools allows for a more effective implementation needs assessments rooted in truer depictions of complex realities