Implementation science and translating evidence into practice — formative SAQs

SAQ 1 — Diagnosing and closing a paediatric evidence-practice gap (10 marks)

A paediatric emergency department has a sepsis guideline endorsed by the college, yet only 52% of eligible children receive the first antibiotic within the recommended hour. The department has emailed the guideline to all staff and posted it on the intranet, with no measurable change over a year. The head of department has asked you to lead a proper implementation effort. ^{[1] [3]}

Questions

1. Define implementation science and explain why the email-and-intranet approach failed, naming the distinction that matters most. (3 marks) ^{[1] [9]}
2. Using the Cabana framework, describe how you would diagnose why the guideline is not followed, and state at least one barrier from each of the three tiers. (4 marks) ^[3]
3. Outline how you would select implementation strategies matched to the diagnosed barriers, and name the resource you would use. (3 marks) ^[8]

Model answer

Definition and why it failed (3). Implementation science is the scientific study of methods to promote the systematic uptake of research findings into routine care. The email-and-intranet approach is dissemination — the passive spread of information — and dissemination alone changes behaviour almost nothing. The problem was one of implementation: active, tailored strategies to change the behaviour that delivers the bundle. Dissemination is not implementation; that distinction is the single most tested idea on the topic. ^{[1] [9]}

Cabana diagnosis (4). Cabana's framework decomposes non-adherence into three tiers, and I would assess each with structured staff interviews and a short survey. Knowledge: clinicians may lack awareness the guideline exists or familiarity with its hour-one target. Attitudes: some may disagree that it applies to febrile infants, lack self-efficacy in escalation, or be caught in the inertia of previous practice. Behaviour/external: the workflow may lack pre-mixed weight-based antibiotics, clear escalation triggers, or decision support in the record. Each tier calls for a different strategy, which is the whole point of the diagnosis. ^[3]

Strategy selection (3). I would map each diagnosed barrier to a strategy from the Expert Recommendations for Implementing Change (ERIC) compilation — seventy-three discrete strategies clustered into families. An awareness barrier calls for educational strategies and clinical opinion leaders; an attitude barrier for local champions and consensus; an environmental barrier for a sepsis trolley, an opinion-led escalation pathway and visible decision-support reminders. I would build a parsimonious bundle of two or three matched strategies rather than an untargeted pile, because Grimshaw's synthesis shows tailored strategies outperform untargeted ones. ^{[8] [9]}