Implementation Science

Vision 21: Linking Systems of CareJune 2015

Lyman Legters

Using Implementation Science• What is implementation science?

• What are the science-based implementation frameworks that will inform our work?

• How will these frameworks be incorporated into our strategies and approaches?

Science “to” Service

SCIENCE SERVICEGAPIMPLEMENTATION

IMPLEMENTATION: the process of incorporating effective practices into typical human service settings to benefit children and families.

Implementation Gap

IMPLEMENTATION

• NOT a passive process of “diffusion” and “dissemination of information”

Business As Usual - Impact

Best data show these methods, when used alone Do not Result in Implementation as Intended

• Diffusion/ Dissemination of information• Training

• Passing laws/ mandates/ regulations• Providing funding/ incentives

• Organization change/ reorganization5 to 10% return on investment

NECESSARY BUT NOT SUFFICIENT

Science to Service Gap

• Implementation Gap

– What is adopted is not used with fidelity and good outcomes

– What is used with fidelity is not sustained for a useful period of time

– What is used with fidelity is not used on a scale sufficient to impact social problems

2 Frameworks

• 6 Stages

• Core Components - Drivers

Six Stages

• Exploration• Installation• Initial Implementation• Full Implementation• Innovation• Sustainability

Exploration

What happens during Exploration Stage?• Determine Need and Identify Options• Assess “Fit” and Feasibility• Structural and functional changes identified• Promote “Buy in” for the innovation and for

implementation supports• Make recommendations (go/no go)• Implementation “Team” identified

InstallationGoals• Structural and functional changes are made to

support implementation• Staff selection protocols developed• First ‘practitioners’ selected• Define and initiate training of first cohort of

practitioners• Develop coaching system and plans• Evaluate readiness and sustainability of data systems

(e.g. fidelity, outcomes)

Initial Implementation• Work through the Awkwardness• New skills are fragile and uncomfortable• Implementation supports require new thinking/doing• Organization/system change is scary• Provide training and coaching on the evidence-based

practice, re-organization of organization’s roles, functions and structures

• Make use of improvement cycles to resolve systems issues• Learn from mistakes (detect and correct)• Celebrate participation and progress• Continue “buy-in” efforts

Full Implementation

Goals• Maintaining and improving skills and activities

throughout the system• Components integrated, fully functioning• Skillful practices by front line staff, supervisors,

administrators (50% meet performance criteria)• Changes in policy are reflected in practice at all

levels• Ready to be evaluated for expected outcomes

Innovation

• Improvement Cycles• PDSA’s• Spread• Scale

Sustainability

• Organizational Culture• Purveyors• Implementation Teams• Motivators

Stages AND Drivers

Implementation Takes

Time: 2 – 4 Years

EXPLORATIO

N

IN

STALL

ATION

INIT

IAL

IMPLE

MENTA

TION

FULL

IMPLE

MENTA

TIONDrivers

Drivers

Drivers

“DRIVERS”

Drivers• Competency Drivers–develop, improve and

sustain ability to implement an intervention as intended.

• Organization Drivers–create and sustain hospitable organizational and system environments for effective services

• Leadership Drivers–providing the right leadership strategies for change management process needed to make decisions, provide guidance, and support organization functioning.

Implementation Drivers

• VisualPerformance Assessment

(fidelity)

Coaching

Training

Selection

Integrated & Compensatory

Systems Intervention

Facilitative Administration

Decision Support Data System

Adaptive Technical

Com

pete

ncy

Driv

ers Organization D

rivers

Leadership Drivers

Consistent Uses of InnovationsReliable Benefits

Integrated & Compensatory

Drivers

• Are interactive processes

• Integrated

• Influence staff and organizational behavior

Implementation Driver: Training and Coaching

Reflection• What are the implications for the

Vision 21 Demonstration Sites?• How do these concepts inform the

Steering Committee, the TA Providers and the OVC Grant/Program Staff?

• Can we see how IS applies at both program and systems levels?

Implementation Science Resources

• NIRN http://nirn.fpg.unc.edu/• http://

implementation.fpg.unc.edu/sites/implementation.fpg.unc.edu/files/resources/AIHub-SISEP-StagesOfImplementationAnalysisWhereAreWe.pdf

• Lyman Legters, Senior Fellowlyman.legters@usdoj.gov