Getting in on Implementation Science from the Ground Floor

It seems so obvious as to go without saying: The purpose of biomedical discoveries is to improve people’s lives. 

Yet studies show only 14 percent of research makes its way into clinical practice, and even then, only after an average of 17 years. Approximately 85 percent of research funding goes toward findings that effectively sit on a shelf.

Implementation science – the study of how to implement evidence-based practices into routine clinical care such that they’re actually, systemically used – is a relatively new field. The first peer-reviewed journal debuted in 2006, with several professional associations popping up shortly after. 

Elwy encountered implementation science even earlier, in the adolescence of both the field and her career. In 2002, she began her postdoctoral fellowship in health services research at the Veterans Health Administration (VA), which had recently launched one of the nation’s first implementation science programs. There, she realized that implementation science – which grew out of health services and clinical psychology research – addressed the precise problems she studied, namely, access to quality care.

In this field, she could be not just a scientist, but a problem-solver.

“My whole career at the VA, I would meet with a health care system leader, introduce myself, and say, ‘What keeps you up at night? What are your challenges?’” she says. “We’d develop a proposal, get the funding together, and by the end, they’d realize they couldn’t meet their goals without implementation science.”

In 2012, Elwy embarked on a rigorous two-year fellowship in implementation science under Enola Proctor, Ph.D., director of the Implementation Research Institute at Washington University in St. Louis.  

“That training literally changed my life,” said Elwy, who emerged from the experience as part of a vanguard of new implementation scientists. It also forged a connection that would lead her to Brown.

Passing the “Marshmallow Test”

In 2015, the National Institute of Mental Health released a five-year strategic plan that placed new emphasis on translating research into public health impacts. Taking note, DPHB Chair Steven Rasmussen, M.D., decided the department needed an implementation science core. On the suggestion of Professor of Psychiatry and Human Behavior Anthony Spirito, Ph.D., he reached out to Enola Proctor to help draft a job description for a director. Naturally, Proctor thought of Elwy.

“I’d had an excellent vantage point to observe Rani’s work and felt confident she had the vision to build a strong program of research in behavioral health implementation science,” Proctor says. “She’s an inspirational leader and wonderful role model. Everyone wants to work with Rani!”

In fact, at the time, Elwy was busy collaboratively setting up an implementation science center as part of a faculty advisory group at Boston University. The position at DPHB, however, would allow her to not only design a program, but lead it. 

“DPHB has historically been a leader in developing evidence-based treatments for psychiatric conditions, but implementing these treatments into practice has become increasingly challenging in the current health care environment,” Rasmussen says. “The department was very fortunate to recruit Rani, who brings the rigor of an outstanding implementation scientist as well as a highly collaborative nature.”

Rasmussen offered Elwy a five-year budget to get the core started. Shrewdly, she took the job, but not the money – not yet. Instead, she pursued grants so she could keep DPHB’s investment in reserve. Over four years, Elwy said, she was involved in more than100 grant submissions on behalf of Brown or its partner health care systems, bringing in $53 million in funding. 

Even so, she says, “The dedicated funding from the department was essential for this now-growth – I knew I would need that money down the road for capacity building.”

Elwy started her new job by conducting a scoping literature review to determine the elements of a successful program, then set up the core’s consultations and seminars accordingly. To her surprise, they attracted researchers not just at DPHB, but across The Warren Alpert Medical School, the School of Public Health, and beyond. 

Over time, she continuously sought feedback – a key tenet of implementation science – to improve the core’s services. After learning about people’s difficulty attending live seminars, for example, she debuted virtual meetings well before the pandemic.

Elwy also learned that researchers wanted to hear from additional implementation experts. Her immediate solution was to invite national and international colleagues to speak at the core’s Implementation Science Seminar Series, now co-sponsored with Advance RI-CTR and the Brown Alcohol Research Center on HIV (ARCH), groups where she serves as an implementation scientist. 

"I am grateful that collaborators across Brown and its affiliated hospitals – including Advance RI-CTR, ARCH, and the Providence/Boston Center for AIDS Research – have been so excited to embrace implementation science," Elwy says.

But she knew she would need colleagues within the core, as well. After all, there were $53 million in research projects that needed doing. 

Strengthening the Core

Now was the time to tap that investment from DPHB. In 2022, Elwy hired an associate director, Hannah Frank, Ph.D., a mentee who had completed her internship and postdoctoral fellowship at Brown. 

“There are implementation science hubs across the country and Rani’s aspiration was to build something similar,” Frank says. “It was an exciting time to come on board, because she had a clear vision of what she wanted the core to be and was just at the start of really executing it.”

That same spring, Mukesh Jain, M.D., arrived as the new dean of the Division of Biology and Medicine (BioMed) and met with Elwy to discuss the role of implementation science at Brown. Leaders from several departments and centers also joined to attest to the core’s contributions. Rasmussen, who had broken his femur, even hobbled in on a cane to show his support. 

To Jain, the core’s value spoke for itself.

“A robust research enterprise within an academic medical center needs a strong implementation science core that can serve the entire community. To me, it was something we needed to have and Rani was ready to take her core to that next level,” Jain says. “BRIDGE’s work will be essential as we grow our research footprint alongside our hospital partners.”

With an additional investment from BioMed, Elwy was able to expand her team to include not just faculty, but postdoctoral fellows and clinical psychology interns, as well. 

“There aren’t enough implementation scientists to go around, they’re in such high demand,” Elwy said. “That’s why we want to homegrow our own. I want to train loads of people to do this, because it’s not a one-person job.”

The program’s new strength in numbers proved essential this July when the core hosted an inaugural three-day Implementation Science Bootcamp drawing attendees from as far as Texas and Florida. Every team member, whether faculty or trainee, presented and facilitated breakout groups. They also introduced themselves by their new name: BRIDGE.

The Stars, and Research Infrastructure, Align

The rapid rise of the BRIDGE program coincides with the recent launch of the Brown Innovation and Research Collaborative for Health (BIRCH), an alignment of the research infrastructure of Brown University and two of the Medical School’s affiliated  health care systems, Care New England and Lifespan. An explicit goal of this collaboration is to more efficiently translate research into clinical interventions benefiting patients.

Enter Elwy. In August, she joined the newly formed BIRCH clinical trials committee, an opportunity to introduce local health care leaders to implementation science and BRIDGE program services.

“We’re trying to take implementation science into the health system space,” Elwy says. “Say they want to reduce the length of hospital stays or ER visits, increase flu vaccine uptake, reduce sepsis infection – we can help them develop a better system.”

With the BRIDGE program now in a position to effect broader change, Elwy hasn’t paused for congratulations. If anything, she says, she wishes she had built her team sooner.

The team was always the goal.  

“Implementation scientists champion the term ‘team science,’” she says, noting the field depends on collaboration with clinicians and patients. “This idea of the one principal investigator who gets all the glory – that’s not how we operate. I want everyone to feel like they’re contributing to the success of implementation science at Brown.”