Looking back at 'Knowing HOW: 25 Years of Implementation Science and Practice'

ZonMw celebrates her 25th birthday. In those 25 years we have built up extensive knowledge of implementation. During our symposium 'Knowing HOW: 25 Years of Implementation Science and Practice' we reflected on that period. This article provides you with an overview of that day.

This was ZonMw’s anniversary conference

‘Does your meal look like the picture in the recipe?’ On September 26th ZonMw celebrated its 25th anniversary with a conference in The Hague. Implementation is about opening up black boxes, working very hard to make even more impact – and having fun.

ZonMw’s anniversary conference was attended by people around the globe: 62 % were present in person, 25 % followed it online from home, 13 % did so from their office. According to a Slido question, ‘inspiration’ was what people hoped to take from this congress. ZonMw’s chairman Arfan Ikram felt a ‘very positive buzz and energy. I hope we can take it forward to the rest of the day. ZonMw started from scratch, now implementation is becoming a professional science.’ Ikram proudly announced the establishment of the association of the Dutch Implementation Collective (NIC, only available in Dutch) and the opportunity to become a member of this association in the making for free until December 2024. 'Our goal is a national infrastructure for implementation and change.'

Stop low value care

We have to stop doing things that have no added value for patients – also known as ‘inappropriate’ or ‘low value care’. Tijn Kool – professor of Appropriate Care at Radboudumc in Nijmegen – had a very clear message: ‘de-implement’ care that has no value regarding effectivity, costs, alternatives, side effects, treatment effects and patient preferences. But can we de-implement? ‘Yes, we can!’ Kool exclaimed. ‘But don’t expect miracles and be patient.’ Take for instance hernia: it took thirty years to reach the insight that patients have to be activated and to implement it. Kool concluded that evidence-based practice should be complemented by evidence-based de-implementation. And he addressed the audience when he said: ‘I see a lot of young people, I hope you are inspired here today!’ Judging by the applause he received, his own contribution succeeded in doing just that.

  • All presentations and parts of the program can be viewed on this page.
  • You can also view business drawings from the symposium presentations and workshops.

Surprise and delight

‘Surprise and delight’: with that approach Femke van Nassau started one of two parallel sessions. Van Nassau – a human movement scientist ­­– asked the audience to stand up and asked them four questions. If your answer was no, you had to sit down. The questions provided much hilarity: Do you like to cook? Do you use a recipe? Do you stick to the recipe? And does your prepared meal look like the picture in the recipe? In the end, few people were still standing. Then Van Nassau linked cooking to implementing: ‘Traditional research focuses on a before-and-after-comparison. And then we say: “Oops! It does not work!” But have we researched if a recipe was used? If the intervention group sticked to the recipe? What the context was?’ Implementation science investigates this black box: ‘What we already know, is that implementing is all about describing, refining, evaluating and reporting. Our research helps us to know how to define successful implementation.’

‘It’s in the law!’

In the second parallel session, Barbara van der Linden talked about 25 years of implementation by ZonMw. Why is implementation so important for ZonMw? ‘Well, it’s in the law!’ This law (passed in February 1998) says that ZonMw must ‘finance research’ and ‘promote the use of results’. Back then, nobody knew how to do that. ‘So we have come a long way!’ Van der Linden happily quoted from the four external evaluation reports in those 25 years. One of the findings is that ZonMw uses a mix of strategies and activities, ‘but we need to improve our knowledge of the effectiveness’. She added: 'Like Tijn Kool said: there is no magic bullet, but we are moving towards more standardization and measuring what we achieve. We are incorporating data in our system – and there is a lot of it.’

Great ice breaker

Time for interaction, time for four workshops. They all started with a ‘Get To Know You Bingo’. That turned out to be a great ice breaker. Every person was handed a pen and bingo card (an A4 paper) with 24 boxes and 24 traits: ‘Has been to Asia’, ‘Has moved more than seven times’, ‘Been actively involved in implementation’, et cetera. The workshop participants talked to each other in duo’s and asked each other three questions. The person with the most boxes circled was the winner. ‘I am going to use this myself to energize a meeting and get people to connect!’ was just one of many enthusiastic reactions.

Pictures Symposium Knowing HOW

Logo op pilaar met ballonnen 25 jaar ZonMw
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Arfan Ikram op het podium met de dagvoorzitter
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Arfan Ikram on stage with moderator Milou Dijkman

Keynote speaker Tijn Kool
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Tijn Kool

Spreker Barbara van der Linden
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Barbara van der Linden

Spreker Femke van Nassau
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Femke van Nassau

Zakelijk tekenaar aan het werk
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Business drawing being made

Aan de slag tijdens een van de sessies over implementatie
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One of the live workshops

Feestelijke afsluiting plenair gedeelte
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Festive conclusion of the symposium

Getting serious

After that, things got serious with one profound question per workshop (policy, research, education, practice) about the future of implementation. How can we ensure that knowledge will be used in policy? (‘Create knowledge questions in co-creation with stakeholders’). As an (implementation) researcher, how can you facilitate knowledge utilization? (‘Match needs of end users’.) How can we improve knowledge transfer to learning and development? (‘Ask: what do you want to learn and how?’) How can we ensure that knowledge reaches the heads, hearts and hands of those on the work floor? (‘Involve the patients from the start’.) These workshops were very lively, the participants were very involved. Here are some of the reactions: ‘Talking to different research perspectives was fun.’ ‘It was wonderful, I learned a lot, got new ideas to work with.’ ‘The network is really important.’ There was also an online international workshop with best practices and about the role of funders: ‘We had a lot of great interaction and a lot of splendid suggestions in our chat,’ the host said.

Knowing what, knowing how

Speaking of global: ZonMw works together with sister organizations abroad, united within the Ensuring Value In Research (EViR) Funders’ Forum. Chairman Michael Bowdery had ‘a really good day’ with ZonMw, he disclosed: ‘I liked today’s emphasis on de-implementation. It goes right to the heart of our organization, which is to fight waste in research. I also like “sustainable implementation”.’ ZonMw-director Veronique Timmerhuis replied to that: ‘Today is input for our next strategic plan. I can assure you sustainability will be very prominent. Our next step is to work very hard to make more impact. And keep having fun!’

Fun is what the conference ended with. Much to their surprise the visitors were asked to… sing! Although just 13 % of them qualified their own singing abilities as ‘excellent or good’, the song ‘Knowing me, knowing you’-made-ZonMw-proof sounded like a bell:

Implementation is never easy we know
But we have to show
Knowing what knowing HOW
Is the best we can do


Text: Stan Verhaag
Photographer: Hans Tak
Video credits: Live Online Events
Business drawings: Sandra Mesman, Stefanie Jansen, Frances Blomberg, Ellie Polfliet and Claartje van Tiel.