Table 1.

Challenges in research on how to improve healthcare practice

Issue	Current practice	Desired practice	Possible strategies
Fit between problems and approaches to address these	Approach depends on the professional background of the practitioner, researcher or advisor	Approach depends on what fits best with the problem in healthcare practice	Researchers and advisors are trained in a variety of scientific disciplines and work in multidisciplinary teams
Concepts, frameworks and theories for implementation, transfer and improvement	Proliferation of proposals; many are descriptive lists of items; testing and validation strictly within paradigms	Emphasis on testing, integration and refinement of middle-range theories	Better recognition of published work; funding of comparison across paradigms
Stakeholder involvement in design and conduct of programs	Considered to be the single most important determinant of successful implementation, but most methods are loosely defined	Integration of evidence and theory with of stakeholder involvement, using well-specified approaches	Validation of structured approaches for stakeholder involvement
Evaluation of outcomes of implementation programs	Decreased interest in rigorous effect evaluations of implementation interventions, such as randomized trials	Rigorous outcomes evaluation remain part of broader research programs, which likely comprise a variety of study designs and methods	Nurture knowledge and appreciation of rigorous evaluation of practices among healthcare practitioners, managers and policy makers
Measurement of outcomes of improvement, transfer, and implementation	Descriptive documentation of professional practice, provider perceptions, or health outcomes	Advanced measures of rapid uptake of valuable practices, and rapid reduction of non-valuable practices	Design and validation of a new generation of outcome measures