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Using Quality Improvement Strategiesto Implement an Intervention
Module Created ByPopulation Health Improvement Partners
www.improvepartners.org
Assessing your
Community
Implementing & Evaluating
Establishing Goals &
Objectives;Planning for Evaluation
Finding Evidence
Selecting Best Fitting EBAs
Adapting
Where do We Stand?
Learning Objectives
• Describe key tasks in planning for and implementing an intervention
• Provide QI tools to help your team plan for and implement selected interventions
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=Positive Outcomes
4Source: State Implementation and Scaling-up of Evidence –based Practices
Effective Strategies & Interventions +
Effective Implementation
•CDC Community Guide•National Cancer Inst•CTRT website•iMAPP•Others?
Tips for Successful Implementation
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• Establish an Implementation Team• Cleary define and communicate how the
intervention will operate • Select “early adopters” to do a small
pilot test to understand and learn how to adapt/adjust implementation efforts
• Use improvement cycles to learn what works, what creates barriers, and what can be improved
Role of an Implementation Team
• Makes the intervention happen• Engages stakeholders• Creates readiness for implementation• Ensures fidelity to the intervention• Provides TA and support to overcome barriers• Monitors outcomes and feedback to improve implementation
of the intervention
Sources: National Implementation Research Network and SAMSHA
Characteristics of Implementation Team
• Content Expertise: implement with fidelity• Program Management: implement on time & under
budget• Quality Improvement: monitor data and
continuously adapt implementation process• “Customer Perspective”: view point of someone
who will be using the intervention in their daily life• Partner Representation-provide resources,
expertise, and staff to help implement
What percent of interventions are effective without an Implementation Team?
Trivia Question
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Tips for Successful Implementation
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• Establish an Implementation Team• Cleary define and communicate how the
intervention will operate • Select “early adopters” to do a small
pilot test to understand and learn how to adapt/adjust implementation efforts
• Use improvement cycles to learn what works, what creates barriers, and what can be improved
Planning Tools for Implementation
• Program Charter• High-level Timeline• Work Plan
Program Charter
Program Overview and Timeline
Content Created by the Center for Public Health Quality
Work Plan
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APPLY IT!
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Think about your intervention:1. How can you use these tools to plan how you
will implement your intervention?2. Share your thoughts with the group
Tips for Successful Implementation
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• Establish an Implementation Team• Cleary define and communicate how the
intervention will operate • Select “early adopters” to do a small
pilot test to understand and learn how to adapt/adjust implementation efforts
• Use improvement cycles to learn what works, what creates barriers, and what can be improved
Identify Early Adopters(Everett Rogers’ work)
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Late Majorit
y
35%
Early Majority
35%
Early Adopters
13%Traditionalists
15%2%
InnovatorsContent Created by the Center for Public Health Quality
APPLY IT!
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Think about your intervention:1. Who might be the “early adopters”?2. What ways might you recruit the “early
adopters”?3. Share your thoughts with the group
Tips for Successful Implementation
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• Establish an Implementation Team• Cleary define and communicate how the
intervention will operate • Select “early adopters” to do a small pilot
test to understand and learn how to adapt/adjust implementation efforts
• Use improvement cycles to learn what works, what creates barriers, and what can be improved
Why Use Improvement Cycles?
Ideal
Reality
Ideal
Reality Reality
Ideal
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Why Use Improvement Cycles?
• Helps adapt good ideas to your specific situation:–Forces us to think small–Forces us to be methodical, make
predictions and learn –Allows rapid adaptation &
implementation of changes
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PDSA Cycle
Act Plan
Study Do
• Objective of cycle• Questions/predictions• Plan to carry out the cycle(who, what, where, when)
• Carry out the plan• Document problems/unexpected observations
• Begin analysis of data
• Complete the analysis of data
• Compare data to predictions
• Summarize what was learned
• What changes are to be made?
• Adapt? Or Abandon?
• Next cycle?
Use the PDSA cycle to test changes and organize feedback
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Rapid Cycles of Change
Hunches Theories
Ideas
Changes That Result in
Improvement
A PS D
APS
D
A PS D
D SP ALearning
Very Small Scale Test
Follow-up Tests
Wide-Scale Tests of Change
Implementation of Change
PDSA Cycle Forms
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PDSA Tip: Scale Down
• Years• Quarters• Months• Weeks• Days• Hours• Minutes• Number of
clients/staff
“Drop 2”
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Meeting Structure
Communication Intervention Component 1
Learning & Improvement in Parallel
A PS D
A PS D
A PS D
D SP A
A PS D
A PS D
A PS D
D SP A
A PS D
A PS D
A PS D
D SP A
A PS D
A PS D
A PS D
D SP A
A PS D
A PS D
A PS D
D SP A
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Coaching & TA
Intervention Component 2
Feedback and Improvement
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• Adapting Intervention Core Elements• Caution: although it is
important to be responsive to feedback you CAN NOT change the core elements of an intervention and expect the intended outcomes
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Activity: Using Improvement Cycles
Intervention Components: Targeting Store Owners– Monetary incentives– Nutrition education session/booklets– Cultural guidelines– Corner store guidelines (e.g. buy, stock,
and purchase)
Intervention Components: Targeting Consumers– In-store intervention materials– In-store promotions (incentive cards, nutrition
sessions)
Your turn!
APPLY IT!
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Think about your intervention: 1. How can your team build in improvement
cycles ?2. Share at least one idea for how you plan
to use improvement cycles.
Sources Referenced for this Module
• National Implementation Research Network• SAMHSA (2012). A Road Map to Implementing
Evidence-based Programs. Retrieved from: http://www.nrepp.samhsa.gov/Courses/Implementations/resources/imp_course.pdf.
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