Implementation science and quality improvement in neonatology: complementary approaches to accelerating evidence-based care

Quality improvement (QI) has transformed neonatal care, yet evidence-based practices may still be delivered inconsistently, reach some infants and families more reliably than others, or decline after active improvement support ends. QI projects typically target improvement in a clinical outcome, care process, or service outcome and often rely on evidence-based practices to achieve it. Implementation science (IS) offers complementary methods by making more explicit how local barriers and facilitators, implementation strategies, and context influence whether an evidence-based practice is adopted, delivered, and sustained in routine care. In this narrative review, we use the term implementation-enhanced QI to describe QI that intentionally incorporates selected IS concepts and methods while retaining the QI approach used locally. We distinguish the improvement target from the evidence-based practice intended to influence it and from the implementation strategies used to promote its reliable delivery. We then describe how IS can strengthen determinant assessment, strategy selection, implementation measurement, adaptation, sustainment, and spread. Using a neonatal intraventricular hemorrhage example, we illustrate a practical sequence from defining the improvement target to identifying evidence-based practices, assessing implementation gaps and determinants, selecting and testing matched strategies, and evaluating implementation alongside the improvement target. We also describe when selected IS tools may add value to traditional QI, and when formal implementation research is warranted. The goal is not to replace QI with IS, but to make improvement efforts more systematic, explainable, equitable, sustainable, and transferable across neonatal settings.