Implementation Science Expert

Her career path is anything but straightforward. However, she has landed precisely where her wide-ranging knowledge can shine. Lauren Clack initially studied biology, French, and international studies in the USA. She later focused on the question of how to prevent hospital infections at the University Hospital in Geneva. This question also became the subject of her doctoral thesis in psychology at the University of Zurich, where she investigated facilitating and inhibiting factors on both the individual and organizational levels. Three years ago, Lauren Clack was appointed assistant professor at the newly established Institute for Implementation Science in Health Care at the University of Zurich (see below). "Here, everything I’ve learned on my winding path comes together," Clack says.

Benefiting from the 'Cantonal Spirit' 

Upon taking her position, she deliberately sought to expand her activities beyond infection prevention, says the expert in implementation. The funding from the Swiss Cancer Research Foundation for projects in healthcare was a "stroke of luck" for Clack. She reached out to some specialists in colorectal cancer screening and, together with them, developed the idea of comparing the different cantonal screening programs. "Since such programs are already established in some cantons, like Vaud, but are still being developed in others, our project came at just the right time," Clack says.

For her, it’s clear that such a project would be unthinkable in the USA: "A single state like Michigan is already four times the size of Switzerland." Unlike many others who complain about the 'cantonal spirit' in the healthcare system, Clack appreciates the small-scale federal structure. "Despite the short geographical distances, there is a great variety of different approaches here, which is exciting and interesting for our research," says Clack.

Coherent Strategies

Together with postdoctoral researcher Bianca Albers from her team, Clack analyzed the literature on screening programs, conducted interviews with those involved, and organized several discussion meetings. The goal was twofold: first, to understand the different approaches to organized colorectal cancer screening. And second, to check the coherence of the implementation strategies.

But what does coherence mean? "We call a strategy coherent if it is adapted to the context in which it is implemented," Clack explains. "The context in densely populated Geneva with its large foreign resident population is very different from the context in Jura, where many people live in small, scattered villages." While the canton of Geneva offers its residents the choice between a stool blood test or a colonoscopy, the canton of Jura only provides the stool blood test for colorectal cancer screening. A colonoscopy is only offered as a follow-up if blood is found in the stool.

Taking Gastroenterologists' Workload into Account

However, precisely because the contexts differ, it makes sense that the cantonal screening programs are structured differently, Clack explains. "In most cases, the differences are justified," Clack says, adding: "All of the implementation strategies examined in the project are coherent, as our investigations have shown."

What would an incoherent strategy look like? A strategy is incoherent if it fails to correctly assess the situation, Clack replies. For instance, if a strategy assumes that a low colonoscopy rate is due to a lack of public knowledge, rather than considering that local gastroenterologists are already overburdened and cannot perform additional colonoscopies. In such a situation, launching an awareness campaign would not be a productive use of resources.

An Opportunity to Reflect on Their Own Practice

Clack found the collaboration with those involved in the various cantonal screening programs to be very pleasant and fruitful. People were not only willing to provide her and her team with information during the interviews, but "many also took the questions as an opportunity to reflect on and question their own practices," Clack notes.

In her research project, Clack encountered many innovative approaches. While, for example, personalized recommendations for early detection exams are being developed and tested in the canton of Vaud, the canton of Lucerne follows a model where pharmacies play a key role in colorectal cancer screening. Clack and her team also participated in networking events, where she noticed "the great thirst of people to learn from each other." Clack remains motivated to continue quenching this thirst with her research.