Washington People: Enola Proctor

Faculty; Research

Enola K. Proctor has spent her academic career focused on one central question: How can we ensure the highest quality of care for all individuals in need?

More recently, that pursuit has led Proctor, PhD, the Shanti K. Khinduka Distinguished Professor at the Brown School at Washington University in St. Louis and director of the Center for Mental Health Services Research, to tackle the challenges associated with learning how to implement high quality care in hospital, clinic and community based settings.

As such, Proctor directs the Center for Dissemination and Implementation at the university’s Institute for Public Health, which seeks to ensure that the most effective services are delivered in health and public health settings.

She also co-authored the seminal 2012 book, “Dissemination and Implementation Research in Health: Translating Science to Practice​” with Ross Brownson, PhD, the Bernard Becker Professor at the Brown School and director of the Prevention Research Center; and Graham Colditz, MD, PhD, deputy director of the Institute for Public Health, chief of the division of public health sciences and Niess-Gain Professor of Surgery at Washington University School of Medicine in St. Louis.

Although the phrase “dissemination and implementation” doesn’t quite roll off the tongue, the work is hugely important in speeding the adoption and delivery of critical medical care and in reducing disparities in health care.

Here, Proctor discusses the field and how she became interested in it.

What exactly is dissemination and implementation science?

“We have in the United States a terrific research enterprise for all academic fields. The National Institutes of Health (NIH) and others are continually investing in discoveries related to how we can deliver better care. However, all too often, those discoveries happen without a distribution system to ensure they get carried out in the real world.

“There’s a huge lag, a backlog, of effective programs, services and interventions that we could all be benefitting from. But to get them adopted, delivered and sustained in real-world service delivery systems takes time and it often happens with only partial success.

“Through the study of dissemination and implementation science, we are trying to figure how to help people deliver better services.”

How did you get interested in this field?

“Before I came to Washington University for my doctorate, I was a social worker in mental health and I saw firsthand the huge problems in delivery of services. Too few people were getting services and what they were getting wasn’t good enough.

“I realized that getting better care for people takes more than publishing the research. We must look at system barriers and ways to retrain organizations. So I started looking for colleagues who shared my vision.

“Implementation science was in its true infancy. Working with leaders at the NIH, I began to work on ways to grow the field. And I’m proud to say that today, Washington University has both of the NIH grants given to train researchers for this work. At the university, we have a critical mass of faculty interested in tackling this issue from a variety of angles, including a network of more than 80 people from all across the campus — through the Institute for Public Health and Institute for Clinical and Translational Sciences — who meet regularly to discuss strategies. It’s very exciting.”

Where is the field of dissemination and implementation headed?

“One of the key questions we have yet to answer is what change strategies are most effective in particular situations and contexts. We’ve studied the barriers, and why things take so long to get from research to the real world, but the next breakthrough will come from discoveries of what kinds of strategies lead to faster adoption and more sustained delivery once strategies are adopted.

“We’re doing much of that work here at the university. Ross Brownson and Doug Luke (PhD, professor at the Brown School and director of Center for Public Health Systems Science) study the policy angle. Doug has developed tools to measure the sustainability of these strategies. Graham Colditz brings expertise in guideline and clinical decision supports. Matt Kreuter (PhD, associate dean for Public Health at the Brown School, the Kahn Family Professor of Public Health and senior scientist at the Health Communication Research Laboratory) is looking at the communications messaging we need to develop. I think all of these strategies will come together to help form the next breakthroughs in dissemination and implementation.”

What does success look like?

“First of all, success includes increasing the proportion of people who receive the very best care. That ranges widely now. In medicine, about 50 percent of people get evidence-based care. But in mental health, that number is around 15 percent. Success will look like 70-80 percent of people receiving high-quality care.

“Success will also look like smoothing out some of the variation we have right now. Many low-resourced service providers have a tougher time bringing in new discoveries, which contributes to a host of health disparities. Low-income communities may be lagging in terms of the quality of care. We need to reduce those health disparities.

Why is a school of social work leading the charge on this issue?

“I am often asked about my role as a social worker, leading a field that engages medicine, psychology, business, engineering, public health and nursing. I respond that social workers are naturals for implementation science. We understand the complexities of change at the community, organizational, provider, and client levels, and we know how to bring people together to solve hard problems.

“This year, I am teaching a new course I developed on implementing evidence-based practice for the Brown School’s master of social work and master of public health programs. I am passionate about helping to shape new roles of social workers as implementation facilitators in community agencies, clinics and hospitals.”