PT - JOURNAL ARTICLE AU - JM Grimshaw AU - Noah Ivers AU - Stefanie Linklater AU - Robbie Foy AU - Jill J Francis AU - Wouter T Gude AU - Sylvia J Hysong ED - , TI - Reinvigorating stagnant science: implementation laboratories and a meta-laboratory to efficiently advance the science of audit and feedback AID - 10.1136/bmjqs-2018-008355 DP - 2019 May 01 TA - BMJ Quality & Safety PG - 416--423 VI - 28 IP - 5 4099 - http://qualitysafety.bmj.com/content/28/5/416.short 4100 - http://qualitysafety.bmj.com/content/28/5/416.full SO - BMJ Qual Saf2019 May 01; 28 AB - Audit and feedback (A&F) is a commonly used quality improvement (QI) approach. A Cochrane review indicates that A&F is generally effective and leads to modest improvements in professional practice but with considerable variation in the observed effects. While we have some understanding of factors that enhance the effects of A&F, further research needs to explore when A&F is most likely to be effective and how to optimise it. To do this, we need to move away from two-arm trials of A&F compared with control in favour of head-to-head trials of different ways of providing A&F. This paper describes implementation laboratories involving collaborations between healthcare organisations providing A&F at scale, and researchers, to embed head-to-head trials into routine QI programmes. This can improve effectiveness while producing generalisable knowledge about how to optimise A&F. We also describe an international meta-laboratory that aims to maximise cross-laboratory learning and facilitate coordination of A&F research.