Since the 1999 landmark publication To Err Is Human1 was published, which found that 98 000 deaths occur because of medical error, quality of care has been a major focus for health care systems. Nurses make a tremendous impact on the quality of care provided to patients, as they are the largest health care discipline and spend the most time in direct care of patients. Indeed, nurses' efforts have been highlighted in the pages of the Journal of Nursing Care Quality. We have had the opportunity to publish innovative work that nurses have led to improve the quality of care. Articles published in this journal have described nurses' innovations in reducing falls and infection rates to improving patient satisfaction and have examined the important role of nurses in quality and patient safety.

Multiple project and study designs are used to improve quality of nursing care, from using evidence-based practice (EBP) and quality improvement (QI) models (eg, the Iowa Model of Evidence-Based Practice, Plan-Do-Study-Act, DMAIC) to research designs, such as descriptive studies, to randomized controlled trials. Regardless of the design used, the success of an intervention or a practice change is dependent on how well it was implemented. This leads us into the exciting world of implementation science.

Implementation science is defined as the "study of methods to promote the systematic uptake of research findings and other EBPs into routine practice ... to improve the quality and effectiveness of health services."2^(p1) Implementation science focuses on the processes and methods for how interventions and changes are implemented into practice. While individuals often consider implementation science separate from other methods (EBP, QI, research), I argue that strong projects incorporate implementation science methods and strategies into projects and research. For example, the Iowa Model of Evidence-Based Practice3 provides a comprehensive overview of how to conduct an EBP project. Under the step to "Design and pilot the practice change," clinicians are directed to create an implementation plan. This is an ideal place to bring in implementation science methods to bolster the effectiveness of the project.

Using implementation science methods allows clinicians and researchers to use evidence-based strategies to implement evidence-based interventions-helping to increase the success of implementation. Deciding on which strategies to include depends on the barriers to the practice change and understanding which ones would be feasible and supported by the local institution. There are several evidence-based implementation strategies available (https://epoc.cochrane.org/our-reviews). Brief descriptions of several common strategies follow. Evidence has shown that the first 2, educational outreach visits and audit and feedback strategies, are the most effective in changing practice4:

* Educational outreach visits-previously called "academic detailing," are visits whereby an expert physically goes into the clinician's workspace to provide tailored education to individuals (or a very small group) in an effort to change their practices.4,5

* Audit and feedback is a strategy that entails completing practice audits (either through documentation or process observations) and giving this information back to clinicians, often in the form of run charts, so they can see their progress over time. This strategy is helpful when clinicians are not compliant with a practice to begin with and allows them to see a goal.6,7

* Printed educational materials-often referred to as "flyers" or "handouts," comprise a strategy that provides information about the practice change as a printed resource. While many projects include this type of strategy, this is passive and should not be used alone; it should be used in combination with other, more effective strategies.8

* Educational meetings, categorized as small (<25 people) or large (>25 people), are meetings that present new information to clinicians, often referred to as "courses" or "lectures." Large educational meetings can reach a wide group of people; however, small educational meetings may be more interactive and allow clinicians to be more engaged.9

* e-Learning is a strategy that uses information technology to disseminate information through online modules or self-learning exercises.10

* Other strategies allow clinicians to be creative with implementation methods that may help increase engagement of staff. Previous research has used games and memes as implementation strategies to help improve clinicians' compliance with EBPs.11,12

There are several implementation science frameworks and models that can help guide clinicians and researchers, such as the Consolidated Framework of Implementation Research, the Grol and Wensing Model of Implementation, and the RE-AIM Framework (https://www.fic.nih.gov/About/center-global-health-studies/neuroscience-implemen). An implementation science tool kit for clinicians also provides helpful information for how to utilize these strategies in clinical settings.13 When reporting on implementation strategies, it is important to thoroughly describe them. For example, if using a small educational meeting, include the following: Who was responsible for delivering content? How was it implemented (in person, online, with a PowerPoint Presentation)? When and where did the meeting occur? How frequently did it occur? What was the length of time of the meeting? Who attended the meeting? This is important for readers to implement the strategies in their own settings and improve practice.

For the Journal of Nursing Care Quality, we urge authors to incorporate and provide detailed information on implementation science frameworks, methods, and strategies into their projects and publications. This will not only help with the success of the project but also assist others in replicating your project. We are seeking articles that use implementation science models/frameworks, methods, and/or strategies in nursing.

-Staci S. Reynolds, PhD, RN, ACNS-BC, CCRN, CNRN, SCRN, CPHQ

Editor-in-Chief

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