Disinvesting in Ineffective and Inappropriate Practice: The Neglected Side of Evidence-Based Health Care?

Over recent years, we have become increasingly aware of the challenges of translating research‐based knowledge into practice. At the same time, the evidence base about how to address these challenges has been developing, with focused theoretical and empirical research to build the science of implementation in health care. Theoretical evidence has been examined and synthesised to inform attempts at behavioural change at the individual, team and organisational level (Grol, Bosch, Hulscher, Eccles, & Wensing, 2007), accompanied by a parallel growth in empirical studies to evaluate and compare the effectiveness of different implementation strategies (Grimshaw et al., 2004). Whilst there are still many unknowns in the field of implementation—for example, around the need for single or multifaceted implementation strategies (Squires, Sullivan, Eccles, Worswick, & Grimshaw, 2014) and how to tailor implementation strategies to context (Harvey & Kitson, 2015b)—the emphasis of work to date has tended to be on the implementation of interventions of proven effectiveness. However, what about stopping the implementation of interventions that are known to be ineffective or inappropriate, commonly described as deimplementation or disinvestment? Could we and should we be applying our existing knowledge of implementation and implementation science to address issues relating to the withdrawal of ineffective, inappropriate or unnecessary care?