TR Talks: Implementation In Clinics And Community

A good idea is about only about ten percent, the remaining ninety is implementation.

Zoya Retiwalla| TRP | March 21, 2020

In the words of Guy Kawasaki, “Ideas are easy. Implementation is hard.” This understanding formed the core of our February TR Talk where our panelists had an engaging and invaluable discussion on their experiences around the importance of implementation of innovations in clinics and the community. Furthermore, they shared the hurdles they faced while translating transformation and spoke about how they surpassed the issues.
As is customary at the TR series, we hosted a diverse group of driven researchers, clinicians, health practitioners, and students. Facilitated by the Translational Research Program, the “Implementation In Clinics And Community” TR Talk featured a panel discussion followed by a Q & A round and ended with an engaging networking evening.
The panelists for the Talk were Roland Cohn, Monika Kastner, and Gilbert Sharpe. The panel was led by Allan Kaplan and the discussion offered diverse perspectives on the issues faced in the implementation of novel ideas. They began the discussion by noting that healthcare is changing rapidly and we, as translators, need to keep abreast of the changing pace.
“Writing law tends to get stuck in the sand unfortunately and in healthcare, it takes particularly long to bring change.” Gilbert Sharpe, Canadian Health Lawyer, Strategic Advisor and adjunct professor at the Faculty of Law, started the discussion by acknowledging that law takes time to accept change. He went on to explain that even though great ideas are the key, it is the implementation that finally opens the door. In healthcare, it takes longer and in the case of mental health, change is even harder to incorporate.
Gilbert particularly focuses on mental health because he finds the field to be extremely siloed. “Mental health is the orphan of the health systems.” He further explained that “the laws for children are different than those for the elderly.” He believes this greatly affects how healthcare and resources are delivered. He would like to bring about judicial changes that would allow for equal distribution of resources among people who need it, irrespective of their age.
Another pressing matter he brought to the fore was the imbalance of resource allocation in urban populations and indigenous communities. Gilbert pushes for centralization and shared systems that would assure that breakthrough innovation would reach every community. This would require strategic, integrated frameworks. “We need to break silos and build bridges rather than walls to build patient-centered frameworks that would help bring change to healthcare.”
Monika Kastner, Research Chair Knowledge Translation at North York General and Associate Professor at Dalla Lana School of Public Health started her talk using a fact. “Knowledge translation takes an average of five years, that’s five years too long.” She’s a strong advocate of swiftly bringing interventions and making things happen in healthcare.
She agreed with Gilbert in that with healthcare, implementation takes painfully long. “No matter how great an innovation is, if there is no sustainability – the implementation is flawed.” In addition to the pace, Monika took our focus towards sustainability, in the absence of which she says implementation and its impact would fail. An idea needs to be impactful but it also needs to fit a longevity model.
Her advice to make interventions sustainable was to make care models integrated. “Patient engagement is tokenistic and we need to move towards an integrated approach concerning care models, recognizing the patient as the central human if we are to improve sustainability.”
Bringing in a different perspective, Ronal Cohn, President, and CEO of SickKids spoke about diagnostics, precision medicine, and artificial intelligence. A shift in the healthcare paradigm has three pillars as Dr. Cohn explained – a. Moving away from conventional methods to AI, b. Proactivity in medicine rather than reactivity and lastly, c. Moving away from one size fits all.
“AI will not take over human capacity,” he stated supporting his first point. The example he used was that of a stethoscope. AI is like a stethoscope in that it will help doctors in diagnosis and providing treatment but it will not take over the role of medical professionals. However, he cautioned that AI needs to be tested thoroughly to assure it is effective and safe.
Talking about a proactive model, he stated that, “people have to accept change, learn and incorporate innovations. Until the change in thinking comes in, healthcare change cannot be achieved.” He firmly believes that comprehension and knowledge are the first steps in moving towards a proactive model. Once people understand, infrastructure and funding would follow.
Lastly, throwing light on the third pillar, Ronald began by explaining precision medicine and touched upon the misconceptions that surround it. “Patients who have non-common pathologies are biological gems,” he stated adding furthermore that at the very core, each patient is different. If that truly is the case, he fails to understand why each patient should be treated similarly. He recognizes that a change in control and a change in thinking would help shape a precision-centered approach to healthcare and hopes to help spearhead that change.
This TR Talk was one of a series of sessions hosted by the Translational Research Program in collaboration with the Health Innovation Hub (H2i). These Talks are open to the public and are geared towards interprofessional clinicians, researchers, and trainees to provoke discussion and community building. To learn more about the future TR Talks, please visit our website.