Marjon Borgert

13 General introduction and outline of the thesis ndings. 18 In the literature, this gap is called the ‘quality chasm’, and the IHI has captured it perfectly in a quote borrowed from the German poet Goethe:‘Knowing is not enough; we must apply. Willing is not enough; we must do’. 20 Implementation of quality improvement interventions Even though there might be strong evidence and high-quality clinical guidelines, it is a real challenge to actually implement new ndings. This is especially true if this requires changes to behaviour, clinical practices, the organization, or how professionals collaborate. 17 To improve patient safety and the quality of care provided to critically ill patients, we need to understand those factors that facilitate or hamper successful implementation of evidence-based practices and guidelines. 21 According to Cabana et al., implementation can be a ected by multiple barriers related to professionals’ knowledge, attitudes, and behaviour. 22 Examples from the literature show that the professionals themselves can form a barrier to implementation: sometimes they are not aware of clinical guidelines or are not familiar with evidence-based recommendations; they do not agreewith the recommendations or the evidence; they believe the guideline is too di cult to use in their own hospital or that patient-related factors may interfere; or they are not motivated to change their practices. 23 However, patient-related factors, organizational factors, and economic factors have also been shown to be important barriers to implementation. 17,24 To select strategies for successful implementation, it is important to understand the barriers and facilitators to implementation. 25 Implementation science has therefore becomemore important over the years, especially for implementing quality improvement projects in hospitals. Implementation science can be de ned as ‘the scienti c study of methods to promote the systematic uptake of research ndings and other evidence-based practices into routine practice to improve the quality and e ectiveness of health care’. 26,27 Model for translating evidence into practice Various models, frameworks, and theories have been developed to understand and explain why implementation of quality improvement initiatives succeeds or fails. 25,26 Pronovost et al. developed a useful model for translating research ndings into daily practice in the ICU. 28 This model sets out the phases of the process of translating research into practice; it also includes how research ndings are implemented. The model, which consists of four steps, can be used to guide the process of translating research into clinical practices, and is shown in Figure 1.