Successful Healthcare Improvements From Translating Evidence in complex systems (SHIFT-Evidence)

Simple rules to guide practice and research

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Published journal: International Journal for Quality in Health Care



Evidence translation and improvement research indicate that healthcare contexts are complex systems, characterized by uncertainty and surprise, which often defy orchestrated intervention attempts. This article reflects on the implications of complexity on attempts to translate evidence, and on a newly published framework for Successful Healthcare Improvements From Translating Evidence in complex systems (SHIFT-Evidence).


SHIFT-Evidence positions the challenge of evidence translation within the complex and evolving context of healthcare, and recognizes the wider issues practitioners routinely face. It is empirically grounded, and designed to be comprehensive, practically relevant and actionable. SHIFT-evidence is summarized by three principles designed to be intuitive and memorable: ‘act scientifically and pragmatically’; ‘embrace complexity’; and ‘engage and empower’. Common challenges and strategies to overcome them are summarized in 12 ‘simple rules’ that provide actionable guidance.


SHIFT-Evidence provides a practical tool to guide practice and research of evidence translation and improvement within complex dynamic healthcare settings. Implications are that improvement initiatives and research study designs need to take into account the unique initial conditions in each local setting; conduct needs to respond to unpredictable effects and address dependent problems; and evaluation needs to be sensitive to evolving priorities and the emergent range of activities required to achieve improvement.


Julie E Reed, Cathy Howe, Cathal Doyle, Derek Bell. International Journal for Quality in Health Care, mzy160,

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