Table 1 Challenges in research on how to improve healthcare practice

Fit between problems and approaches to address these

Approach depends on the professional background of the practitioner, researcher or advisor

Approach depends on what fits best with the problem in healthcare practice

Researchers and advisors are trained in a variety of scientific disciplines and work in multidisciplinary teams

Concepts, frameworks and theories for implementation, transfer and improvement

Proliferation of proposals; many are descriptive lists of items; testing and validation strictly within paradigms

Emphasis on testing, integration and refinement of middle-range theories

Better recognition of published work; funding of comparison across paradigms

Stakeholder involvement in design and conduct of programs

Considered to be the single most important determinant of successful implementation, but most methods are loosely defined

Integration of evidence and theory with of stakeholder involvement, using well-specified approaches

Validation of structured approaches for stakeholder involvement

Evaluation of outcomes of implementation programs

Decreased interest in rigorous effect evaluations of implementation interventions, such as randomized trials

Rigorous outcomes evaluation remain part of broader research programs, which likely comprise a variety of study designs and methods

Nurture knowledge and appreciation of rigorous evaluation of practices among healthcare practitioners, managers and policy makers

Measurement of outcomes of improvement, transfer, and implementation

Descriptive documentation of professional practice, provider perceptions, or health outcomes

Advanced measures of rapid uptake of valuable practices, and rapid reduction of non-valuable practices

Design and validation of a new generation of outcome measures