The findings from clinical and health services research can not change population health outcomes unless health care systems, organizations, and professionals adopt them in practice . A consistent finding is that the transfer of research findings into practice is unpredictable and can be a slow and haphazard process. The relative inattention to implementing what we know is costing lives. There is an imbalance between investment in the development of new drugs and technologies versus improving the fidelity with which care is delivered.
In a structured review of healthcare professionals views on clinician engagement in quality improvement, Davies et al. identified 86 empirical reports relevant to the review . They report that the literature suggests: healthcare professionals are heterogeneous in relation to their definition of quality; their perception of the need for quality improvement; their attitudes to quality improvement initiatives; their attitudes to clinical guidelines and evidence-based practice. In addition, they have a limited understanding of the concepts and methods of quality improvement, and quality improvement is often the scene of turf battles. Under the heading of perceived barriers, they also stated that 'many of the identified barriers arise from the well-documented problems of working effectively between and across health professions. This means that although more time and more resources may be necessary or helpful (directly and in their explicit recognition of healthcare professionals' concerns), they are unlikely to be sufficient on their own to overcome the substantial barriers to clinicians' active engagement in successful quality improvement'. Healthcare professionals are an important part of the organisation in which they work (and are subject to organisational policies, procedures, and cultures); this review offers a partial explanation for the persistent quality gaps and also supports the contention that it is unlikely that this will change spontaneously.
Recognition of quality gaps has led to increased interest in more active implementation strategies. Over the past 10 years, a body of Implementation Research has developed [5–7]. This demonstrates that interventions can be effective, but provides less information to guide the choice or optimise the components of such complex interventions in practice . While the effectiveness of interventions varies across different clinical problems, contexts, and organizations, studies provide scant theoretical or conceptual rationale for their choice of intervention , and only limited descriptions of the interventions and contextual data . Research on economic and political approaches to change is scarce , and it is therefore not surprising that little is known about how best to integrate disease and case management interventions into existing healthcare at the system level. Thus, the science of Implementation Research is still a work in progress, largely due to the fact that it is a relatively young science.
Internationally, Implementation Research is a recognised area of funding within other healthcare systems; this is not the case in the UK. The Cooksey Report  suggested a UK annual research budget (Public sector and major charities) of just over £2 billion. The proportion spent on health services (as opposed to biomedical or clinical) research in general is small. While there have been a number of previous funding programmes for Implementation Research within the UK, none are current. The proportion of annual research money devoted to Implementation Research is impossible to quantify; it is likely to be of the order of a maximum of a few millions pounds per year.
The Cooksey Report , having identified the need for implementation and Implementation Research, offers a sound basis on which to elaborate the Implementation Research agenda as a core part of a research agenda of key relevance to the NHS.
One of the major problems with not having a clearly identified, named Implementation Research funding stream is that the whole area loses 'profile'; the issues become blurred and the central focus of the routine uptake of findings, from clinical research programmes into routine care, becomes lost to research enquiry. In countries where there is a named, dedicated, funding stream (e.g., Canada, Australia) the research area has a higher profile with both researchers and with clinicians. There is the potential for senior researchers to establish programmes of research (rather than doing one-off studies), junior researchers to make it a career choice, and clinicians to become willing collaborators, thereby facilitating the spread of knowledge and the improvement of methods.