Shifting Implementation Science Theory to Empower Primary Care Practices.

Area of Science:

• Health Services Research
• Implementation Science
• Primary Care Practice Transformation

Background:

• The field of dissemination and implementation science (D&I) has grown alongside significant changes in primary care.
• Current D&I research often assumes primary care practices require external support to meet predefined standards.
• Stakeholder investments in D&I initiatives have yielded less-than-anticipated improvements in quality metrics, cost savings, and patient experience.

Purpose of the Study:

• To challenge existing D&I assumptions by exploring practice-led change.
• To propose a new theoretical framework for D&I science rooted in internal practice drivers.
• To inform health policy by empowering primary care practices.

Main Methods:

• Qualitative discovery research within three primary care practices exhibiting unique change dynamics.
• Integration of systems thinking, complexity theory, action research, and community-based participatory research principles.
• Conceptual framework development based on observed practice-led transformations.

Main Results:

• Identification of three primary care practices that demonstrated profound internal capacity for change.
• Observation of change originating from within practices, challenging the predominant "outside-in" D&I model.
• Evidence suggesting an "inside-out" approach can be a powerful driver of practice improvement.

Conclusions:

• Reimagining D&I theory to emphasize an "inside-out" model empowers primary care practices.
• This paradigm shift has the potential to create a new frontier in D&I science.
• An inside-out approach can lead to more effective and sustainable improvements in primary care.
• Findings can inform health policy to better support practice-led innovation.