The Centre for Implementation Science at the King’s College London hosted the 2nd Annual UK Implementation Science Research Conference on July 19th, 2019 which was supported by BMC, the UK Implementation Society, and King’s Health Partners. This year the conference’s theme was ‘Advancing the science of scaling up: Improving efficiency and effectiveness of implementation strategies in healthcare’. It attracted around 145 delegates that comprised applied health and social researchers, health and social professionals, policymakers, and service user researchers from across the globe.
The conference kicked off with a service user perspective where Josephine Tapper, a health advocate and expert patient, reminded delegates about a key purpose of any scale-up effort – to benefit the people who use the health and social care services. In her talk ‘Scaling up without leaving behind: A perspective from the ‘shop-floor’, Josephine described her experience of being involved in the scale up of a number of interventions through voluntary work as an expert patient and offered a service user perspective on the importance of scale up and what it looks like from the ‘doing’ side.
The conference then broke into four parallel sessions with presentations and discussions on:
- Understanding complexity
- Realist and qualitative evaluation
- Maternity care
- Structure, products, and exchange
I attended the session on ‘Structure, products, and exchange’ where I and colleagues from Wessex Academic Health Science Network presented on our work on scaling-up innovations across local regional systems. Following the presentations, we had a lively Q&A session and discussion about the emotional labor involved in scaling-up effort and how an evidence-base of an intervention’s clinical and cost-effectiveness is just the starting point in any scale-up process.
At lunch we had the opportunity to look at the poster presentations, which spanned an array of clinical specialties, interventions, and settings. For example, there was work looking at scaling up guidance documents on dementia palliative care; measuring success of quality improvement in a mental health NHS Foundation Trust; lessons learnt from a novel HIV care and treatment funding model for health facilities in Nigeria; and impact of evidence-based healthcare education for Chinese medicine practitioners.
In the first of two afternoon plenaries, Prof Annette Boaz from Kingston University and St George’s, University of London gave a provocative session asking us to consider the distinction (or not) between implementation and scale-up; i.e., is scale-up simply more implementation or does it require a different set of approaches? Prof Boaz also challenged us to think about the ethnocentric bias in implementation studies and the risk of scaling-up as a new form of ‘colonialism’. Just because an intervention is effective for a population in a certain setting does not necessarily mean it’s suitable for all populations.
In the afternoon, I attended an excellent session called ‘Scale-up 2: clinical considerations’, which was chaired by Prof Geoff Curran and Prof Greg Aarons as lead discussant. Elena Pallari (King’s College London, UK) talked about scaling up a QI training with urology registrar training and Posy Bidwell (Royal College of Obstetricians and Gynaecologists, UK) described the implementation of national QI project to reduce perineal trauma during childbirth. Rohina Joshi (The George Institute for Global Health, Australia) gave an elegantly simple presentation on a hugely complex implementation change on scaling up the use of verbal autopsy technology (SmartVA) to improve cause of death certification in The Philippines across over 700 islands and 1,400 municipalities. Despite the many challenges (not least the geographical barriers), Dr Joshi and colleagues have achieved amazing outcomes. When any of us feel we’re having a challenging day, I’d suggest looking at Dr Joshi’s work to help put the complexity of our problems into perspective!
The day closed with a plenary by Prof Geoff Curran, a medical sociologist and professor of pharmacy practice and psychiatry at the University of Arkansas for Medical Sciences, USA. Prof Curran started his presentation with a quote from Greenhalgh and Papousti who said “…there is no simple or universally replicable way of implementing change at scale in a complex system”. Rising to the challenge, he saw this as a call to action to design strong scale-up studies to understand what does and does not work. For a comprehensive overview of the range of designs and methods for studying scale-up, check out his presentation slides.
If you couldn’t make this year, the 2020 conference looks to be a date not to be missed. The 3rd Annual UK Implementation Science Research Conference hosted by the NIHR Applied Research Collaboration (ARC) South London follows on from the Implementation Science Masterclass (15-16 July)