There’s often a disconnect between what we know and what we do in health care. For example, even though we have made unprecedented developments with safe and effective COVID-19 vaccinations, there are still a number of Americans who remain hesitant, and there have been challenges in national distribution and access. This is where a field of study called implementation science becomes a powerful tool — for example, these experts are studying the disconnect between the rigorous evidence for vaccines, and the myriad factors resulting in a research to practice gap.

Gaps between research and practice happen in every setting and disease area. Implementation scientists aim to understand barriers (what makes it harder to implement) and facilitators (what makes it easier to implement), and design and test different strategies to scale evidence-based practices, to ensure that the promise of scientific discovery is realized.

Realizing change can happen

Rinad Beidas, PhD, director of the Penn Implementation Science Center at the Leonard Davis Institute (PISCE@LDI) and the Penn Medicine Nudge Unit, recognized from her early days as a pediatric clinical psychologist, that there was a disconnect and need to get all children inclusive evidence-based psychiatric care. This led her to focus her research on implementation science, to ensure that scientific discoveries were implemented for maximal impact. “What gets me up in the morning is the opportunity to have impact — and to move the needle in health care delivery in order to make sure that evidence-based practices are available to everyone,” said Beidas.

Beidas, who is also an associate professor of Psychiatry, Medical Ethics and Health Policy, and Medicine in the Perelman School of Medicine at the University of Pennsylvania, describes her work as disease and setting agnostic — meaning that she leads implementation research across a variety of topics in health care, including mental health, cancer, HIV, and cardiovascular disease, and across settings, such as in primary care clinics, acute care facilities, community clinics, and schools. Implementation gaps are ubiquitous. 

One specific example of an implementation science challenge emerged from her own personal experience. After losing a family member to suicide by firearm in 2013, Beidas became interested in how to apply implementation science to suicide prevention, given increasing rates in suicide deaths in young people and given that half of suicide deaths in young people are by firearm.

“I had this lightbulb moment when I took my newborn son to a well visit as my pediatrician asked me about how my child slept and whether I had a smoke alarm. Why didn’t she ask me about safe firearm storage? Pediatricians are trusted messengers who can collaborate with parents to maximize the safety of the home environment and can ensure that firearms are stored in such a way that young people cannot gain access to them.” said Beidas.

Beidas dove into the literature and found there was already an evidence-based practice that had been tested in a large trial that was not frequently implemented and was supported by American Academy of Pediatrics guidelines. That evidence-based practice, called Safety Check, included asking parents screening questions about firearms where children live and play, a brief conversation about safe storage, and offering free cable locks while parents are at their child’s appointment. A team of experts from Penn, Henry Ford Health System, and Baylor, Scott, and White Health System interviewed pediatric clinicians, health system leaders, firearm safety experts, and parents who own firearms about what types of changes needed to be made to the existing program to make it more relevant for parents of older children and targeting suicide prevention. They also researched how to implement the program in a sensitive and respectful manner to maximize success — naming their program S.A.F.E Firearm based on parental input.

In doing this work, Beidas and her team were able to dive deep into the barriers surrounding this practice (a hallmark of implementation science is understanding the context in which one is implementing; and the alignment between that context and the program) and came up with some solutions. Supported by a $3.6 million NIH grant, the trial launches in 2022 at Henry Ford Health System and Kaiser Permanente Colorado, and will provide insights for health systems on how best to implement this potentially life-saving approach.

Thanks to Beidas and her team of implementation scientists, this program could become a key component of suicide prevention strategies nationally.

Penn Medicine leads the way

As a learning health care system, Penn Medicine is a pioneer in implementing new practices to transform health care. Beidas has been working for the past decade to bring the implementation science perspective to Penn since she joined the faculty in 2012. Her vision is to make Penn Medicine the leading institution in implementation research, education, and practice. 

The same year Beidas came to Penn, an Implementation Science Working Group launched, led by John Kimberly, PhD, and Karen Glanz, PhD, since so many people were asking what it was, if it was useful, and worth investing in. Efforts have been underway since then including coursework developed in the Perelman School of Medicine’s (PSOM) Master of Science in Health Policy Research (MSHP) program. In 2018, the Penn Implementation Science Center at the Leonard Davis Institute (PISCE@LDI) was officially launched. The leadership team includes Beidas as founding director; Meghan Lane-Fall, MD, MSHP, director of Acute Care Implementation Research for the center and an associate professor of Anesthesiology and Critical Care; Christopher Bonafide, MD, MSCE, associate director and an associate professor of Pediatrics; Katharine Rendle, PhD, MSW, MPH, associate director and an assistant professor of Family Medicine and Community Health; and Courtney Benjamin Wolk, PhD, associate director and an assistant professor of Psychiatry.

Today, Penn is poised to become an international leader in implementation research, education, and practice — consistent with Beidas’s vision. The Implementation Science Center has over 300 members from 10 schools across Penn, and over 50 departments, centers, and institutes. They have trained over 400 individuals in implementation science, and the center has a robust grant portfolio of 39+ NIH grants and a growing cadre of faculty with expertise in this area. The Penn Implementation Science Institute, a one-week training program, has also been featured as an exemplar institute in a recent publication by NIH leaders.

“We have successfully built a strong implementation research and education portfolio at Penn. We have been particularly successful in merging insights from behavioral economics and implementation science given our immense strengths in both areas," shared Beidas.

Beidas continues to find ways to advance the practice of implementation science and find opportunities of growth for Penn to support. She is incredibly excited about her new leadership role as the director of the Penn Medicine Nudge Unit, supported by the Penn Medicine Center for Health Care Innovation and Penn Center for Health Incentives and Behavioral Economics, where she assumes leadership of the world’s first behavioral design team embedded within a health system; along with Sri Adusumalli, MD, MSHP, MBMI, deputy director and an assistant professor of Cardiovascular Medicine; and M. Kit Delgado, MD, MS, deputy director and an assistant professor of Emergency Medicine. She sees this as a tremendous opportunity to bring implementation science to practice within the health system to achieve impact at scale – leading to potential innovations in health care delivery, health outcomes, and health equity.