Patient and public involvement in the implementation of evidence into practice
- 1Patient and Public Involvement and Patient Experiences Programme, RCN Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
- 2Public Involvement Programme, National Institute for Health and Care Excellence, London, UK
- 3RCN Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
- Correspondence to: Dr Sophie Staniszewska
RCN Research Institute, Warwick Medical School, University of Warwick, Warwick CV4 7AL, UK;
Evidence-based healthcare has become a primary focus in many healthcare systems, reflecting concern that practice does not always reflect what evidence suggests is best practice.1 A range of initiatives have been developed to support best practice, such as the development of national guidelines, technology assessment and research on implementation. However, the implementation of evidence is complex and multifaceted, often requiring changes at organisational, team and individual level and this inherent complexity has meant variable success in developing best practices.1–3
Implementation science as an area of research has developed over the last decade. However, less attention has been placed on understanding the role of individual patients, service users, the public and organisations working on their behalf as active collaborators in implementation research and in the development of best practice initiatives. Collaborative involvement has emerged in other areas of research. For example, the POPPY study focused on the experiences of parents of preterm babies. Parents were collaborators in the study, involved in developing the POPPY model of care, in disseminating findings, influencing policymakers and in planning implementation.4 Patients and the public have also become collaborators, involved with many aspects of research, guidance development, publication and dissemination in other studies.5 ,6
The patient and public involvement (PPI) in implementation research is likely to develop further in response to broader trends
within research and society. However, there is also a need to embed PPI into activities that draw on the best evidence to
create best practice, such as the implementation of clinical guidelines. Clinical practice guidelines are:
‘systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific
clinical circumstances’ (Ref. 6, p.38)
Failure to reconcile patient preferences and values with clinical practice guidelines may hamper their implementation in clinical practice.6 The National Institute for Health and Care Excellence provides advice and support on implementation and implementation tools (http://www.nice.org.uk/usingguidance), but its remit does not include active implementation of its guidance into the healthcare system.
In implementing guidelines we encourage those tasked with implementation to consider the importance of PPI in developing their implementation strategies. If we draw on PARIHS, a framework for guiding the implementation of evidence,7 there is a potential role for patients and the public in all three of its dimensions (evidence, context and facilitation). This includes:
The creation of evidence through collaborative PPI in studies that make up an evidence base.
Working collaboratively with patients and the public to provide insight into the contextual factors that need considering for successful implementation.
Patients and the public informing the development of strategies to facilitate effective implementation of guidance.
User-led research, a small but important area of activity in health and social care research, could be utilised in the field of implementation. User-led implementation, appropriately supported, would mean patients and the public could lead on aspects of implementation at an individual and organisational level. Patient organisations could have a particularly important role in developing such strategies and in supporting their membership to enable implementation of guidance. While PPI in the field of implementation is still in its infancy, we hope the impacts and benefits identified more broadly in research3 ,5 will ensure patients and the public are key partners in implementing evidence to enhance the quality of care.