Inside the Accelerator: How Implementation Science Helps Close the Gap Between Medical Discoveries and Better Patient Care

Nearly every day, researchers make new discoveries that aim to improve medicine and healthcare. And yet, only about 14% of what has been proven to help patients becomes routine care, and it can take up to 17 years for those practices to be widely adopted. 

“Discovering what works is only half the job. The harder question is: how do we make it work for real patients, with real clinicians, in real hospitals — and make it part of everyday care? That is where implementation science comes in,” says Dr. Sevdenur Cizginer, a physician scientist at Harvard Medical School and the director of implementation science research for the West Health Accelerator at Mass General Brigham. “Healthcare organizations often know what works. The challenge is figuring out how to make it work consistently for real people in real-world settings. We bring scientific rigor to that last mile between knowing what works and making it happen.”

What Is Implementation Science?

Implementation science in healthcare studies how to integrate evidence-based practices and research into routine clinical care. Its goal is to close the gap between what has been proven to help patients and the care patients actually receive by addressing real-world barriers. 

Change in a health system is complicated. “Implementation science gives us a structured way, and scientific tools, to understand that complexity: What is getting in the way, what needs to change, and what do we need to learn as we go,” says Dr. Cizginer. “Evidence does not improve care simply because we know it works. It improves care when we can make it happen reliably, for the right patients, in the real world. That is what implementation science is about.”

Dr. Cizginer’s team brings its expertise in implementation science to the West Health Accelerator to improve inpatient care for older adults by determining how to put best practices into place across the entire Mass General Brigham system. 

“We know that older patients have specific needs, and we know a great deal about what better hospital care for older adults should look like. The challenge is making those practices part of everyday care across different hospitals, teams, and workflows. That takes continuous evaluation, learning, and adaptation,” she explains. 

Building Solutions Around Real People and Real Settings

Many healthcare improvement efforts focus on the intervention itself and measuring whether it works. By using implementation science methods, the Accelerator focuses on the conditions that determine whether an intervention can succeed in real-world practice.

 "The best intervention can fail if it adds burden to frontline staff or ignores the reality of the local culture,” says Dr. Cizginer.  “We are not only asking, ‘Does it work?’ We are asking, ‘How can it work here? How can it work for these patients, with this workforce, in this workflow — and how can we make it last? Just as importantly, we evaluate whether they are actually reaching the patients who need them, at the right time, and being delivered the way they were intended.

“In a health system, you cannot wait a year to tell people what you learned,” Dr. Cizginer adds. “The decisions are happening now. Our job is to bring scientific rigor and speed together — to learn quickly enough that the evidence can actually help the people making those decisions.”

This approach involves working closely with frontline staff to gather information about how changes are working for them, in real time. “Our job is to make sure that the intervention works the way it’s intended, that people understand the reason we’re doing it, and that it’s working well within the workflow,” says Joy L. Lee, PhD, MPH, a senior research scientist at the Center for Optimal Aging and Serious Illness at Mass General Hospital who is part of the implementation science team for the Accelerator. “To get this information, we’re making lots of site visits and talking with dozens of frontline staff and site leaders. We ask questions and get their feedback about how these changes are working for them and for their workflows, then we bring their feedback to the leadership team to see what changes need to be made. Throughout the process, we keep extensive notes and make sure every detail is captured. This helps shape our approach and teaches us what’s working well and what we might have to do differently.” 

This is a dynamic process that takes time and patience. “To identify barriers, you need to use different channels, reach different stakeholders, and identify what was preventing the implementation from being effective at that moment or in that particular setting,” says Dr. Cizginer. “Then you create a strategy, move forward, and get more feedback. Then you evaluate the implementation: Did staff actually use the intervention the way we intended? If not, why? Did it reach all the patients who needed it when they needed it? If not, why? Then you get more feedback and adapt. There are many different components and it’s a very interactive and iterative process. This is the nature of implementation. Implementation is messy.”

From Implementation to Scaling

As the West Health Accelerator continues to improve inpatient care for older adults, implementation science will remain central not only to launching and refining the interventions, but also to understanding how they can be sustained, scaled, and spread across different hospital and care settings.

The West Health Accelerator is implementing these interventions across nine hospitals, providing opportunities to evaluate implementation in different settings. As they move ahead, Dr. Cizginer and her team are continuing to learn from frontline staff, patients, caregivers, and leaders along the way, keeping track of every adaptation made in each hospital setting.  

“We want a model that is scalable. So, we are creating a recipe for other hospitals that shows not just what worked, but why it worked, what we changed in different settings and why, and what we learned from every adaptation.”

The long-term goal is for the practices developed and refined through the Accelerator to become part of routine care for older adults well beyond Mass General Brigham. “We are creating a blueprint for other healthcare systems to use, so they don’t have to start from scratch,” says Cizginer. “This is how health care system change becomes lasting and transformative, not only in our local setting but also on a national and international level.”