Agile Implementation: Reengineering dissemination of healthcare in the US
INDIANAPOLIS — In a study published in the Journal of the American Geriatrics Society, clinician-researchers and implementation scientists from the Regenstrief Institute, Eskenazi Health, and Indiana University address the escalating need for faster implementation of healthcare innovation. The authors present Agile Implementation, a simple new methodology which they designed, developed, embedded and tested. Agile Implementation enables fast, efficient, scalable, sustainable and effective dissemination of evidence-based healthcare solutions.
The need is great. For example, as the ratio of older to younger Americans increases, older adults will struggle to find family and professional providers to support their care, especially the care of the approximately one in five older adults with a mental health or substance abuse problems — including lifelong conditions and late life onset illnesses such as Alzheimer's disease. But evidence-based models of care developed to serve these older adults have inadequately spread to caregivers, healthcare systems and the older adults themselves according to the study authors.
To support the spread of innovation, Agile Implementation reorders and reprioritizes the implementation steps so that the families of older adults, their caregivers, primary care physician, healthcare system or other large or small organization pulls the solution rather than the innovator pushing it forward. End-users — in this case those providing various aspects of care to older adults — apply their own criteria to determine an innovation's value and thus Agile Implementation recognizes end-users as the informed customer.
"We created Agile Implementation because we saw a huge need for rapid diffusion of evidence-based solutions to pressing problems in the healthcare delivery system," said Regenstrief Institute and IU Center for Aging Research scientist Malaz Boustani, MD, MPH, senior author of the new study and the founding director of the IU Center for Health Innovation and Implementation Science. "While our initial focus has been on older adults, a vulnerable population, Agile Implementation methodology provides a universal platform to implement any evidence-based innovation in any environment in which humans are the major players from all aspects of healthcare to such areas as finance or technology."
The eight steps of the Agile Implementation methodology are: 1) identify opportunities; 2) identify evidence-based healthcare services; 3) develop evaluation and termination plans; 4) assemble a team to develop a minimally viable service; 5) perform implementation sprints; 6) monitor implementation performance; 7) monitor whole system performance; and 8) develop a minimally standardized operating procedure.
"Demonstrating effective model of care through rigorous research is important," said study corresponding author Christopher M. Callahan, MD, founding director of the IU Center for Aging Research and a Regenstrief Institute investigator. "But data alone will not lead to rapid diffusion of innovation. We need to recognize the importance of social networking, the barriers of competing priorities, and the opportunities within complex systems to facilitate implementation."
Authors of "A State of Science: Bridging the Science-Practice Gap in Aging, Dementia and Mental Health" in addition to Dr. Boustani, who is the Richard M. Fairbanks Professor of Aging Research at IU School of Medicine and founding director and chief innovation and implementation officer of the Sandra Eskenazi Center for Brain Care Innovation at Eskenazi Health, and Dr. Callahan, who is the chief research and development officer with Eskenazi Health and Cornelius and Yvonne Pettinga Professor of Medicine at IU School of Medicine, are Daniel R. Bateman, MD of the Regenstrief Institute and IU Center for Aging Research and Sophia Wang, MD of the IU Center for Health Innovation and Implementation Science.
In the paper, they identify a number of compelling evidence-based solutions to problems faced by older adults and analyzed their failure to be disseminated. They found that these solutions typically fail to incorporate three important factors in their design — the complexities of health systems, the barriers to diffusion, and the role of human emotion, all of which are taken into account by Agile Implementation.
This work was supported by the Agency for Healthcare Research and Quality Patient Safety Learning Laboratories Program (P30HS024384).
Earlier this year, Dr. Boustani and colleagues published "Agile Implementation: A Blueprint for Implementing Evidence-Based Healthcare Solutions" in the Journal of the American Geriatrics Society.
Agile Implementation is based on the complex adaptive system and social cognitive theories. Those interested in applying Agile Implementation methodology to their healthcare system or medical practice can participate in the IU Center for Health Innovation and Implementation Science's unique training opportunities through workshops, short courses, boot camps or graduate certificate programs. Information is available on the center's website.
Cindy Fox Aisen