Reflections on a Canadian adventure by @jog13 (Part One)
Having been buried in the midst of several systematic reviews of implementation evidence for what feels like most of a lifetime it was time to shake things up a bit, get out there and talk (and listen) to people involved in real life implementation. Cue much discussion, the hatching of a plan, and a funding application to the University of Exeter Medical School Internationalisation Fund. Fast forward to June 2017, and the unfolding of a two-part Canadian adventure connected by the most beautiful train journey. This blog post reflects on part one of the adventure – three days in Toronto at the Global Implementation Conference.
It was with more than a little trepidation that I sat down for the opening keynote – I didn’t recognise anyone in the room, the conference programme appeared to be a collection of random words and name badges were decorated with coloured stars to signify how many previous conferences delegates had been to… eek! But this is what this adventure was meant to be about right? Mixing it up… doing things differently…
I need not have worried – what followed was two days of inspiring keynotes, a long list of interesting papers to read and much conversation and laughter (all helping to achieve the five doses of fun a day that Dr Phil Hammond recommended in our previous blog).
So in a nutshell – these are some the things I’ll be thinking about some more…
- Systems thinking in implementation science ~ the subject of a keynote delivered by Diane Finegood in which she proposed that systems thinking is needed to improve implementation and implementation science. In a later panel session led by Annette Boaz, Deborah Ghate, Louise Brown and Melissa Van Dyke we were asked to think about the following questions:
- How does expanding the view to system-wide issues change implementation evaluation planning and design?
- What tools and methods have been found to be most (and least) useful for widening the perspective to embrace a system perspective?
- What special considerations apply when innovations are being transported to a new systems context? and
- What recommendations are there for commissioners/funders of implementation (and outcomes) evaluation?
- Rutter H, Savona N, Glonti K, Bibby J, Cummins S, Finegood DT, Greaves F, Harper L, Hawe P, Moore L, Petticrew M, Rehfuess E, Shiell A, Thomas J, White M. The need for a complex systems model of evidence for public health. Lancet. 2017 Jun 13. pii: S0140-6736(17)31267-9.
- Riley BL, Robinson KL, Gamble J, Finegood DT, Sheppard D, Penney TL, Best A. Knowledge to action for solving complex problems: insights from a review of nine international cases. Health Promot Chronic Dis Prev Can. 2015 May;35(3):47-53.
- Co-design and building partnerships ~ the subject of a fascinating keynote delivered by Annette Boaz in which she demonstrated the enormous benefits of partnerships with patients and the public in the design of implementation programmes. However, Annette then went on to highlight the fine line between involving patients as research partners and research subjects, questioned whether academics are really ready to share the power and observed that we are often quick to retreat to our academic safe places where co-creation becomes consultation.
- Boaz A, Biri D, McKevitt C. Rethinking the relationship between science and society: Has there been a shift in attitudes to Patient and Public Involvement and Public Engagement in Science in the United Kingdom? Health Expect. 2016 Jun;19(3):592-601.
- Boaz A, Robert G, Locock L, Sturmey G, Gager M, Vougioukalou S, Ziebland S, Fielden J. What patients do and their impact on implementation. J Health Organ Manag. 2016;30(2):258-78.
- Evidence ~ how do we find ways to value evidence at the bottom of the evidence pyramid? Yes we need to know whether things work but we also need to understand the local context. This was a theme discussed in a number of sessions and served as a reminder to re-visit these papers:
- Petticrew M. Time to rethink the systematic review catechism? Moving from ‘what works’ to ‘what happens’. Syst Rev. 2015 Mar 28;4:36.
- Petticrew M, Roberts H. Evidence, hierarchies, and typologies: horses for
courses. J Epidemiol Community Health. 2003 Jul;57(7):527-9.
- Implementation failure ~ it is so important to be able to learn from failure as Einstein observed in this quote ‘Failure is success in progress’. This was a key message from Conor Owens who had the unenviable task of delivering a keynote whilst we all ate a three-course meal. He also underlined the importance of ‘writing it down’.
The final session was in many ways my favourite. A series of 11 Ignite presentations in which presenters spoke for five minutes to a backdrop of 18 automatically advancing slides – a format apparently known as PechaKucha – completely new to me but what a fabulous idea. A great addition to the presentation formats available to conference organisers – much more satisfying than endless poster boards so often crammed into lunch and coffee breaks where they (and their presenters) don’t get the attention they deserve.
The winning Ignite presentation was given by Christine Ackerley – a captivating and expertly delivered journey through the metaphors used in implementation science -across boundary spanning bridges, down two-way streets and via ivory castles and silos. Martin Davoren (‘Who should fund implementation research?’), Travis Sztainert (‘From sustainability to evolution-ability’) and Mark Pearson (‘How should we approach evidence synthesis in implementation science?’) also gave really thought provoking presentations.
I’m full of admiration for the brave folk that took on the challenge of an Ignite presentation – and it set me thinking about what I would present in five minutes given the opportunity. Having spent much of the last six weeks reading almost 300 reviews of implementation evidence it would be a plea for better reporting, better description of methods and more and better reporting of the detail. There is so much great work going on in implementation research and practice but if it isn’t reported well – no-one knows what you did and no-one can learn from it.
I’m still not 100% sure I understand all the words in the conference programme or how to make informed decisions about which session to go to – but I met and listened to lots of people from different and varied perspectives and have come away with much food for thought. Hopefully, there will be time in Part Two of this adventure to do some reading and thinking. Watch this space.