Taking the Lead in Implementation Science

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As a geriatrician and neuroscientist, I am committed to protect the brain of every person including my own family. There is no health without a healthy brain. For example, Alzheimer disease and other neurodegenerative brain disorders take away a person’s ability to maintain independence, relationships and even enjoyment of life. Over the past two decades, my research focus has been on developing a personalized brain care support system to optimize the quality of life for both the patients and their family members living with these devastating brain disorders.  

Along with my mentor, Dr. Chris Callahan, we came up with a brain care model called the Aging Brain Care Medical Home. The model brought community resources into the primary care setting and reorganized dementia care by creating collaborative network of brain care. Included in the model is a tool to monitor the complex biopsychosocial needs of the patient and the family, an algorithm that connect such needs with evidence-based care protocols, and a care team that coach the patient and their families in problem solving strategies and the effective execution of personalized brain care plan.

Several studies conducted by our research team and others in the United States and the world provided evidence supporting the impact of our care model. The Aging Brain Care Medical Home reduced the behavioral and psychological symptoms for Alzheimer’s patients, decreased the stress of their family caregivers, kept the patients in their own homes longer and saved million of dollars. Yet, even after publishing and speaking globally, the solution stayed on the bookshelf. The translation cycle, from discovery of the solution to implementing the solution is simply terrible. It would take 17 years and billions of dollars for 14% of the medical discoveries to reach less than 3% of the world. As a matter of fact, my family member residing less than 200 miles away from Indianapolis could not receive the services of the Aging Brain Care Medical Home.

Wanting to solve this translation problem, I looked at common change methodologies used by other industries such as LEAN and Six Sigma. I was not satisfied. Both Lean and Six Sigma assume that humans are rational decision makers. Yet even our statisticians, neuroscientists and economists make decisions based on emotion. This led me to dive into two relatively emerging theories. The first, called behavioral economics, provides insights on human decision-making process. It explains how human brains falsely identify noise as a signal, quickly convert the noise into a story, then use the story to make decisions, and overtime several decisions become a mindset.

The second, called complex adaptive system theory, explains the emerging characteristics of social organizations such as companies, cities, and universities. This complexity theory explains the frailty of publically traded companies with 50% of them dies within 10.5 years and the resiliency of cities. I integrated the insights and frameworks from these theories to develop a human centric process to select, adapt, implement, evaluate, and scale evidence based solutions within local context of social organizations such as the healthcare delivery organizations. I called this process, Agile Implementation.  

In 2008 I used Agile Implementation to translate the Aging Brain Care Medical Home into a clinical program serving the residents of central Indiana. In 2011, my mentor and dean of research at Indiana University School of Medicine, Dr. Anantha Shekhar, guided me to use the Agile Implementation process to transform not only brain care in Indianapolis but also the entire healthcare system. Moving from the vertical of brain care horizontally to all of healthcare resulted in the creation of the Health Innovation and Implementation Science Graduate Certificate program offered by the Center for Health Innovation and Implementation Science through Indiana University School of Medicine. Program graduates are passionate about making significant and lasting change in healthcare.

We need to start sharing with the world how Indiana is becoming the hub for healthcare transformation and continue working towards creating agile smart adaptive healthcare organizations. Indiana is producing passionate change agents set out to disrupt healthcare in a positive manner. Focusing on solutions for a better system, with increased consumer satisfaction, lower provider burnout, and better enhanced clinical experiences for patients, their families and clinicians. Most importantly better outcomes at lower costs. The next vision is to spread these innovators not only across the United States but also throughout the world.

Malaz Boustani, MD, MPH, is Founding Director and Chief Innovation & Implementation Officer, Center for Health Innovation & Implementation Science; Research Scientist, Indiana University Center for Aging Research at Regenstrief Institute; and a Richard M. Fairbanks Professor in Aging Research, Indiana University School of Medicine.