Post on 29-Dec-2015
transcript
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