Knowledge implementation in healthcare practice: a view from The Netherlands

In this contribution we discuss some pertinent issues regarding knowledge implementation in the Netherlands, focusing on the largest public funding agency for health research in the Netherlands (ZonMw). The commentary is based on a report, which includes a structured analysis of 79 projects funded by ZonMW, a survey of published implementation research covering 141 systematic reviews, and qualitative study of the implementation infrastructure in the Netherlands. Five themes were identified. First, the term 'knowledge implementation' may be better replaced by more specific terms in some situations. Second, contextual factors need to be taken more systematically into account when planning and evaluating implementation programs. Third, knowledge may change when implemented and this needs to be considered in projects. Fourth, we observed that implementation has developed into a specific world, separated from both healthcare practice and scientific research. It is important to guard against the risk of isolation from the practical and societal needs that the field is meant to address. Finally, we suggest that the strong focus on 'doing projects' and limited opportunities for structural funding may reduce substantial improvement in the field. Many good activities are underway, but the policies regarding knowledge implementation appear to need some adjustment. In its policy plan for the coming years, ZonMW has partly taken up the lessons from our advisory report.