Rod McClure - The Science of Implementation

The science of implementation: from "what works" to "how to make it work"

Throughout the world, the challenge for injury prevention researchers, policy makers and practitioners is to shift the population level indicators, which characterize the public health burden of injury, in the appropriate direction.  These indicators, however, are also being powerfully driven by influences, such as demographic, economic and social change, that are beyond the focus of injury prevention practice.  The extent to which we can ascribe changes in the population level indicators to injury prevention policies (and the combined effect of multiple specific injury projects) is unclear.  Current research tends to concentrate on evaluating the efficacy of specific countermeasures using individual level analysis, rather than assessing the effectiveness of injury prevention programs at the population level.  Thus on what basis do we currently claim quality results for injury prevention practice?

As is increasingly being recognised, in the field of injury definitional issues remain at the heart of many of the real questions.  Paradoxically, it might be easier to frame "quality results" in terms of changing the population level indicators than it is to understand what we mean by the term injury prevention.  Classically, assessing quality for injury prevention can be equated to holding the strands up to the light and seeing that they are good.  However, while sound strands may shine on their own, they do not necessarily make good cloth.  Quality cloth is achieved by weaving with skill, an appropriate mix of sound strands, according to an approved pattern in the context of adequate facilities and infrastructure ..... and then the cloth still needs to be marketed.  Quality injury prevention is as much about weaving the strands and selling the product as it is about proving the strands are sound.

As a public health area of interest, injury prevention achieved major successes in the latter half of last century by recognizing the role of energy exchange in the causation of injury.  Further advances can be made now, by better understanding the dynamics of the social context in which energy control activities are implemented.  While we often know "what works" to prevent injury, the science of implementation is still under developed.  To create quality results we need to shift our focus on "how to make it work".