More than 300 people attended the second annual Implementation Science Health Conference Australia
(ISHCA 23) in Sydney.


With the theme “Scale, sustain, success,” ISHCA 23 was headlined by international leaders in the fast-developing discipline of implementation science.


Associate Professor Rachel Shelton from Columbia University in New York presented on the importance of sustaining evidence-based interventions after they have been implemented in health service settings.


Professor Jeremy Grimshaw from the University of Ottowa, Canada described the establishment of implementation “laboratories” which use new audit and feedback methods to enhance quality improvement activities in hospitals.


ISHCA 23 also featured a dozen invited speakers from around Australia, 30 abstract presentations, 18 rapid-fire presentations and 43 posters.


Organisation of the two-day conference was led by Sydney Health Partners, with support from Maridulu Budyari Gumal SPHERE, the National Centre Of Implementation Science, NSW Agency for Clinical Innovation, Health Translation South Australia, NSW Regional Health Partners, South Australian Health and Medical Research Institute, Melbourne Academic Centre for Health and Monash Partners.



Columbia University Associate Professor, Rachel Shelton has called for sustainability to be given greater consideration when investing in the implementation of health and medical research.

In an interview previewing her presentation at ISHCA 23, Associate Professor Shelton makes the case for investment in the research, the science and the practice of how to sustain interventions.

“I love the fact that the focus of the ISHCA conference is sustainability and scale-up. There are people in Australia doing great work on this, and at an amazing scale. So, I feel like sustainability is the next frontier of implementation and there’s a real opportunity to advance some of the science. I’m excited!”


I am really going to focus on all the reasons why we should think about investing in sustainability of evidence-based interventions, programs and practices, why that investment matters and why we can’t really wait to think about that until the end of our invention or implementation efforts. I will make the case as to why we have to invest in the research, the science and the practice of how to sustain our interventions if we really want to have impact.

And especially equitable impact. In a lot of the work we do, we exacerbate and worsen the gaps in healthcare, because if a lot of the population is in settings where we can’t reach them with our interventions, we certainly aren’t going to be able to sustain them, especially if we haven’t been thinking about and engaging with those partners, settings and populations up front.

So having people think about sustainability early and making those connections between engagement, equity and long-term sustainability will build our programs and their impact on health.


Sustainability for me is really a multi-dimensional construct. I think a lot of times in implementation science research and practice we have focused on that early phase of “how do we get an evidence-based intervention into practice in public health and community settings?” We concentrate on what training the providers need, what is the technical assistance, how can we support and facilitate delivery in that initial phase. But we often don’t think about what happens after a year, two years or five years in terms of continued delivery of that program, and its continued impact. What are the health benefits that the intervention continues to deliver and, maybe, what are some of the unintended consequences of that over time?

What I love about the work with sustainability is that it recognises that health, and context in which we have our health, are not static. The context changes, the population needs change, the systems change, and the evidence changes. And so, we have to be thinking about sustainability in a dynamic way, really from a learning health systems model or a dynamic systems approach. So that’s why I think it’s exciting but also really challenging. It’s not like there’s this static end goal that we’re going to reach and go “oh, it’s sustained.” It is much more complex than that.



Oh, there are so many reasons! First of all, I think often in our systems and our settings, we work within a short-term time frame. We often have some initial leadership buy-in, some initial champions, but then there are all these unexpected and competing demands that come in. Maybe the leadership shifts or their priorities shift, maybe policies change and there’s no longer the same alignment to support that intervention. Maybe there are competing health issues. In the context of COVID-19 we saw that people had to shift priorities. So, I think it’s just the reality of the complex and changing systems that we work in.

But I think it’s important that we think about this upfront so that we can track the return on our investment in implementing research. Because if we don’t understand that, we can never make the case for why it’s important.

And it’s also important because if we are translating a piece of research over and over again, because the implementation efforts stop or discontinue, practitioners and partners will become frustrated with that. They will probably be wary about engaging with the next implementation effort – and especially community partners, which have limited resources, might become mistrustful of research institutions.

I think the other reason it can be so difficult to do is that often when we test an intervention, we test it in isolation, in our academic silos or our perfectly resourced settings, without all those other complex factors. It’s rare that we’re testing in these larger dynamic settings. So, I think that often there are a lot of unanticipated issues that arise.



That’s a good question. It’s not only people like us asking that question, not only funders, but it’s the public asking that question. There’s such tremendous investment that goes into developing new interventions but where is the evidence in terms of impact? As we’re deciding what we are sustaining and scaling we really need to consider which interventions are likely to be more generalizable and impactful.

Often what we try to implement and sustain might be in populations and settings which are more resourced, motivated and organizationally ready for the intervention. I think the interventions which we prioritise for implementation and sustainability should be those which are more scalable, simple and adaptable. We should prioritise those where there is some evidence that they are more likely to be implemented and sustained in populations that suffer, for example, poverty or food insecurity – because they are the ones that need better health care the most.

As researchers we really need to be consulting with stakeholders and groups from the beginning because they are the ones who are going to know what will be more sustainable. So, we should make sure we are partnering with policymakers, health administrators and practitioners in those settings, and that we are not just by ourselves, trying to do this one-way dissemination and implementation.

We should also think about interventions that might be more synergistic, that might be able to impact multiple chronic diseases, or might be able to be embedded or institutionalized in community settings like faith-based organisations or schools that already have a lot of reach at a population health level.



In my opinion yes, and rightfully so! I think I started teaching a class in this area about ten or 12 years ago when there was a lot less interest. And now it is growing globally and so many people –researchers, health service leaders, administrators, government – see the value in it. It is not the answer to everything but it’s a set of tools and resources for approaching the challenge of bridging the evidence-to-practice gap in a way that’s systematic and that really supports thinking in terms of multi-disciplinary teams.

I love the fact that the focus of the ISHCA conference is sustainability and scale-up. I think one of the frustrations I have is that there has been so much investment in the implementation piece but that’s just one piece of the puzzle. And I think that if we are all fully investing in the science of implementation, sustainability needs to be considered as its own domain. We need to be building the science of sustainability in terms of what factors and strategies matter, how do we plan early for sustainability, and what are sustainability strategies.

The sustainability field is ready, and especially because we have done so much great work on implementation. There are these people in Australia doing great work on this and at an amazing scale. So, I feel like sustainability is the next frontier of implementation and there’s a real opportunity to advance some of the science. I’m excited! 

Prof Rachel Shelton

Columbia University