MIND THE IMPLEMENTATION GAP
How implementation science helps get research into practice
SRA annual conference 9 December 2013
Jane Lewis Director of Implementation Support
The Colebrooke Centre for Evidence and Implementation
About the Colebrooke Centre
• first and only UK centre specialising in implementation science and practice in child and family services
• social enterprise, not-for-profit
• services
– design and selection of interventions
– implementation strategies and support
– implementation evaluation
• for local government, voluntary sector, central government, philanthropies, improvement bodies
• leading application and development of implementation theory, evidence and frameworks for UK context
© Colebrooke Centre for Evidence and Implementation 2013
© Colebrooke Centre for Evidence and Implementation 2013
Evaluation of My Baby’s Brain – Hertfordshire County Council
© Colebrooke Centre for Evidence and Implementation 2013
Let Teachers Shine – Shine Foundation
The science-practice gap
© Colebrooke Centre for Evidence and Implementation 2013
Research
dissemination
and translation
initiatives
The science-practice gap
© Colebrooke Centre for Evidence and Implementation 2013
Blank slide for charts etc.
© Colebrooke Centre for Evidence and Implementation 2013
Research
dissemination
and translation
initiatives
The science-practice gap
© Colebrooke Centre for Evidence and Implementation 2013
Research
dissemination
and translation
initiatives
The science-practice gap
Implementation
© Colebrooke Centre for Evidence and Implementation 2013
The implementation gap
• what is known is not adopted by policy / practice but also …
• what is adopted is not operationalised as intended
• what is operationalised as intended is not sustained
• what is operationalised as intended is not used at scale
© Colebrooke Centre for Evidence and Implementation 2013
Implementation
• active and planned efforts to identify approaches that (will) work and to deliver them sustainably and at scale in ways that maximise their effectiveness
• from letting it happen to helping it happen to making it happen (Greenhalgh et al, 2004)
• ‘the nexus between research and practice’ (Chaudoir et al, 2013)
© Colebrooke Centre for Evidence and Implementation 2013
© Colebrooke Centre for Evidence and Implementation 2013
The emergence of implementation science
• systematic study of implementation informed by theory
– processes, strategies, contexts – to produce evidenced and replicable methods,
frameworks and systems
• draws on all research methods
• beyond evidence-based programmes and narrow questions of fidelity (Ghate, 2013)
© Colebrooke Centre for Evidence and Implementation 2013
© Colebrooke Centre for Evidence and Implementation 2013
Implementation matters!
“The level of implementation achieved is an important determinant of programme
outcomes. Achieving good implementation … can lead to much stronger benefits for
participants.”
Durlak and Dupre, 2008 – review of over 500 quantitative studies
Anything times zero is zero
effective
practices
effective
implementation
enabling
contexts
intended
outcomes
Used with permission of NIRN
© Colebrooke Centre for Evidence and Implementation 2013
What doesn’t work
• disseminating research and good practice
© Colebrooke Centre for Evidence and Implementation 2013
© Colebrooke Centre for Evidence and Implementation 2013
What doesn’t work
• disseminating research and good practice
• Just Do It
© Colebrooke Centre for Evidence and Implementation 2013
What doesn’t work
• disseminating research and good practice
• Just Do It
• training
• guidelines
© Colebrooke Centre for Evidence and Implementation 2013
© Colebrooke Centre for Evidence and Implementation 2013
© Colebrooke Centre for Evidence and Implementation 2013
we need to get better at turning research into something that can
be implemented
principles
populations
implementation supports
practices
© Colebrooke Centre for Evidence and Implementation 2013
© Colebrooke Centre for Evidence and Implementation 2013
what is the ‘it’ in ‘does it work?’ or
‘should it be rolled out?’
© Colebrooke Centre for Evidence and Implementation 2013
we need to get better at researching implementation
© Colebrooke Centre for Evidence and Implementation 2013
Implementation stages
exploration
installation
initial implement’n
full implement’n
sustained implement’n
Fixsen et al, 2005; Metz and Barclay, 2012
© Colebrooke Centre for Evidence and Implementation 2013
Implementation stages
exploration
installation
initial implement’n
full implement’n
sustained implement’n
Fixsen et al, 2005; Metz and Barclay, 2012
© Colebrooke Centre for Evidence and Implementation 2013
Implementation stages
exploration
installation
initial implement’n
full implement’n
sustained implement’n
Fixsen et al, 2005; Metz and Barclay, 2012
Substantive innovations take 2-4 years to full implementation
Implementation strategies
Powell et al, 2012
planning
policy context educating
financing quality
management
infrastructure
© Colebrooke Centre for Evidence and Implementation 2013
Implementation drivers
© Fixsen & Blasé, 2008
Leadership
Integrated &
Compensatory
“All organizations [and systems] are designed, intentionally or unwittingly,
to achieve precisely the results they get”
R Spencer Darling
A very chilling thought!
© Colebrooke Centre for Evidence and Implementation 2013
Systems support for innovation
Prism Prison
© Colebrooke Centre for Evidence and Implementation 2013
Where implementation outcomes fit in –expanding the ‘logic model’
© Colebrooke Centre for Evidence and Implementation 2013
Impact
Service or treatment outcomes
Implementation
Outcomes
Outputs
Inputs
Key messages • implementation matters – it’s key to getting
research into policy and practice
• moving forward requires partnerships
• get better at turning research into something that can be implemented
• get better at researching implementation
• get better at implementation
© Colebrooke Centre for Evidence and Implementation 2013
References Chaudoir S, Dugan A and Barr C (2013) ‘Measuring factors affecting implementation of health innovations: a systematic review of structural, organizational, provider, patient, and innovation level measures’ Implementation Science 8:22
Durlak J and DuPre E (2008) ‘Implementation Matters: ‘A Review of Research on the Influence of Implementation on Program Outcomes and the Factors Affecting Implementation’ American Journal of Community Psychology 41: 327:350
Fixsen D, Naoom S, Blasé K, Friedman R and Wallace F (2005) Implementation Research: A synthesis of the literature National Implementation Research Network Tampa FL: University of South Florida
Ghate D (2013) ‘Good enough: when is evidence-based intervention ready for dissemination?’ Pre-conference discussion paper for Jacobs Foundation conference London: The Colebrooke Centre for Evidence and Implementation http://www.cevi.org.uk/docs/Good_Enough_Ghate_2013.pdf
Greenhalgh T, Robert G, MacFarlane F, Bate P and Kyriakidou O (2004) ‘Diffusion of Innovations in Service Organizations: Systematic Review and Recommendations’ Milbank Quarterly vol 82 (4) 582-629
Lipsey M (2009) ‘The primary factors that characterise effective interventions with juvenile offenders: a meta-analytic overview’ Victims and Offenders 4: 124-147
McIntosh K, Martinez R, Ty S and McClain M (2013) ‘Scientific research in school psychology: leading researchers weight in on its past, present and future’ Journal of School Psychology 51 267-318
Metz and Barclay (2012) ‘Active implementation frameworks for program success’ Zero to 3 March 2012 11-18
Meyers D, Durlak J and Wandersman A (2012) ‘The Quality Implementation Framework: A synthesis of critical steps in the implementation process’ American Journal of Community Psychology 50:462-480
Powell B, McMillen J, Proctor E, Carpenter C, Griffey R, Bunger A, Glass J and York J (2012) ‘A Compilation of Strategies for Implementing Clinical Innovations in Health and Mental Health’ Medical Care Research and Review 69(2) 123-157
© Colebrooke Centre for Evidence and Implementation 2013
The Colebrooke Centre for Evidence and Implementation
55 St John Street London EC1M 4AN
0203 551 7666
www.cevi.org.uk
© Colebrooke Centre for Evidence and Implementation 2013
