Background: Despite increasing interest in research on how to translate knowledge into practice and improve\nhealthcare, the accumulation of scientific knowledge in this field is slow. Few substantial new insights have become\navailable in the last decade.\nMain body: Various problems hinder development in this field. There is a frequent misfit between problems and\napproaches to implementation, resulting in the use of implementation strategies that do not match with the\ntargeted problems. The proliferation of concepts, theories and frameworks for knowledge transfer - many of which\nare untested --has not advanced the field. Stakeholder involvement is regarded as crucial for successful knowledge\nimplementation, but many approaches are poorly specified and unvalidated. Despite the apparent decreased\nappreciation of rigorous designs for effect evaluation, such as randomized trials, these should remain within the\nportfolio of implementation research. Outcome measures for knowledge implementation tend to be crude, but it is\nimportant to integrate patient preferences and the increased precision of knowledge.\nConclusions: We suggest that the research enterprise be redesigned in several ways to address these problems\nand enhance scientific progress in the interests of patients and populations. It is crucially important to establish\nsubstantial programmes of research on implementation and improvement in healthcare, and better recognize the\nsocietal and practical benefits of research.
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