Implementation – getting ‘what works’ into public services

 

 

"If we don’t get the how right, which is implementation, we won’t get the what into practice, which is the effective intervention".

Dr Karen Blase, Co-Director of the National Implementation Research Network, University of North Carolina, Dublin, May 2011.

The need for better implementation of policies and practices to improve results in services is widely acknowledged. There is now a global focus on Implementation – putting ‘what works’ into practice by using effective implementation practices, the “how”. Here in Ireland and Northern Ireland we need to make sure that research findings in public services are actually making a difference in real world settings by making use of the best evidence related to both interventions and to practice and system change. In our current economic climate publically funded initiatives such as education and community and voluntary programmes must be implemented effectively and provide evidence of better outcomes, to support decision making on initiatives that deliver best results to benefit children, families and communities. The aim of this web article is to introduce you to some of the key concepts associated with Implementation science and direct you towards key readings and resources so that you can read further around the issue, if you so desire.

What is Implementation?

Too often ‘science to service’ has involved a passive process, investing millions of Euros into the dissemination of research information. While effort in communicating key messages about effective programmes and practice is necessary - it is not enough to support and solve national social problems. We are now coming to realise that the ‘to’ in ‘science to service’ represents a whole new set of activities known as Implementation.

Implementation has been described by Dr. Dean Fixsen and Dr. Karen Blase, Co-Directors of the National Implementation Research Network, University of North Carolina as, “the art and science of incorporating innovations into typical human service settings to benefit children, families, adults, and communities”(Implementation Brief Number 1, 2009).
The term is increasingly used to refer to frameworks and methods to assure the full and effective use of evidence-based programmes and other innovations in public services.

Implementation ‘stages’

In 2005 an extensive review of implementation evaluation literature and current successful implementation practices was completed by a group of research scientists. A synthesis of their findings resulted in the publication of Implementation Research: A Synthesis of the Literature. This publication provides new ways to view methods needed to make better use of science in typical public service settings. The publication concludes that implementation takes time, and that there are six functional stages of implementation which include: exploration, installation, initial implementation, full implementation, innovation, and sustainability.

In order to keep evidence-based initiatives effective, programmes and policy must be implemented with high fidelity and measures are needed to show crucial stages of the implementation process have been carried out as intended, and elements of the programme or policy have been implemented as planned. Here, Managers and those responsible for outcomes need to show that they engaged in stage-related activities to move the project from a good idea to reality. There are a number of practice and policy implications associated with these stages which include:

• You don’t get to skip any stages!
• If you make a judgment about “effectiveness” too early you might be making a mistake because you might be evaluating a project that is not yet fully implemented
• Activities need to match the stage.
• Stages will need to be “revisited” – this is important! For example, the Exploration Stage is always needed as new providers, new practitioners, new communities, new partners, new government officials, new families join the effort.
• When you have multiple initiatives, each will be on its own ‘schedule’ of progress through the stages of implementation.
• Looking through an ‘implementation lens’ involves considering many aspects of organisational and operating context. (Blase, Fixsen, Naoom, Friedman & Wallace, 2005)

Implementation ‘drivers’

Ultimately, in the context of Ireland and Northern Ireland the objective of implementation is to have practitioners such as foster carers, teachers, and social workers, community development workers using innovative practices effectively. To accomplish this practitioner/service provider ‘behavior’ needs to be created and supported by core implementation ‘drivers’. These drivers include correct staff selection, pre and in-service training, continuous coaching and consultation, staff performance evaluation, decision support data systems, facilitative administrative supports, and system interventions. (Fixsen & Blase, 2009, Implementation Brief Number 1).

 

 

An Implementation Framework

Results from the Synthesis of implementation literature and best practices provide major theoretical frameworks that can guide practice and research efforts to move ‘science to service’ more effectively and efficiently. These frameworks include the aforementioned implementation stages and implementation drivers, but also implementation teams and cycles. Team leadership is crucial in effective implementation and different leadership strategies are needed for different types of challenges. Also, the cyclical approach should involve planning specific targets, carrying out targets, studying what happens, acting on any necessary adjustments, and repeating until the goal is achieved. (Blase, Fixsen, Naoom, Friedman & Wallace, 2005)

Championing Implementation

To date CES has actively supported the Global Implementation Initiative and the first ever Global Implementation Conference (GIC) which took place 15-17 August, 2011, in Washington, DC. The ongoing Initiative will now bring together policy, research experts and practitioners dedicated to building and sharing expertise and research about turning scientific knowledge of ‘what works’ into effective implementation, focusing particularly on the implementation of evidence-based programmes and practices to improve outcomes for people and organisations. CES will now support the development of a network of implementation champions in Ireland and Northern Ireland.

 

Recommended Listening and Reading:

Podcasts: Double click these links to listen

•Title: Implementation Science - how to get best practice into human services
Dr Karen Blase , Co-Director of the National Implementation Research Network and Senior Scientist at the Frank Porter Graham Child Development Institute at the University of North Carolina, Chapel Hill

• Title: An Introduction to The Global Implementation Initiative Conference Washington D.C, August 2011
Dr Dean Fixsen, Co-director of the National Implementation Research Network and of the State Implementation and Scaling up Evidence-based Practices Centre, University of North Carolina, Chapel Hill

 

Reading:

• Fixsen, Naoom, Blase, Friedman, & Wallace, (2005) Implementation Research: A Synthesis of the Literature
http://www.fpg.unc.edu/~nirn/resources/publications/Monograph/

Note: This publication includes an extensive list of published literature on the topic of implementation.

• Fixsen & Blase (2009) Implementation Brief Number 1
http://miblsi.cenmi.org/LinkClick.aspx?fileticket=T6mQAnz5pak%3D&tabid=1194

 

• Blase, K. A., Fixsen, D. L., Naoom, S. F., & Wallace, F. (2005). Operationalizing implementation: Strategies and methods. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute.

• Clancy, C. (2006). The $1.6 trillion question: If we're spending so much on healthcare, why so little improvement in quality? Medscape General Medicine

• Greenhalgh, T., Robert, G., MacFarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. The Milbank Quarterly, 82(4), 581-629.

• Hiss, R. G. (2004). Translational Research – Two Phases of a Continuum. In National Institutes for Health and the Center for Disease Control and Prevention (Ed.), From clinical trials to community: The science of translating diabetes and obesity research (pp. 11-14). Bethesda, MD: National Institutes of Health.

• Ulrich, W. M. (2002). Legacy systems: Transformation strategies. Upper Saddle River, NJ: Prentice Hall PTR.