Challenges such as decreases in clinical placement sites and increased student enrollment, indicate a need for improvements in implementation of SBL for student observers.
Improvements in implementation need to be matched by investments in communication and affordable transportation networks.
Therefore, an important issue to be considered is the distinction between successful practice change and clinical outcome improvements in implementation research.
Evaluation may demonstrate that none of the options is superior or optimal, and so fail to contribute to improvements in implementation, particularly as the context is constantly changing.
We need to improve how we commission, conduct, consume, and convert evaluation findings from complex global health initiatives to improvements in implementation and impact.
Indeed, without necessarily changing grand policies, local, small – but cumulative – improvements in implementation can contribute to a pattern of successive adaptation spreading within its viable niche, ultimately providing locally derived, long-term improvements in health systems.
Although researchers have succeeded in identifying barriers preventing the use of guidelines, and have recommended improvements in implementation strategies, the adherence level of physicians to guidelines often remains low [ 1, 16- 18].
Without necessarily changing or challenging grand policies, extending this idea to health systems innovation can facilitate thinking around how local, small – but cumulative – improvements in implementation potentially contribute to a pattern of successive adaptation spreading within its viable niche and ultimately providing locally-derived, long-term improvements in health systems.
