Implementation Quality: The difference between doing and achieving.

Are you truly achieving results, or just doing stuff?  There is a growing body of evidence that how we implement a new practice, program, or strategy affects the outcomes we see as a result. In other words, the way you do it impacts what you get out of it.  

Implementation science offers evidenced-based methods that help us to better ensure we get results from the new practices we implement. Although often focused on healthcare, education or child development, learning from implementation science can be successfully adapted to support the adoption of all sorts of innovations— policies, strategies, practices, processes, technologies — within all sorts of organizations 

Unfortunately, it’s easy to get lost in the nuances and inconsistencies in the research.  This is a relatively new field, so there are still many unknowns. However, there are also some big picture ideas from this field of study that are likely to benefit to everyone, regardless of what or where you are implementing. I summarize some of them below. 

There is a difference between doing and achieving.

Implementation science provides strategies that support the achievement of the intended outcomes of a practice, which is different from just putting a practice in place.  This difference may seem obvious, but if you've worked in implementation, you know it's easy to claim success when something new simply exists in your organization..."Look —people are using the process!"...without ensuring it's actually performing well.

Joanna Meyers and her co-authors define this as the difference between “quality implementation” and implementation; quality sets a higher bar. In their work, Dean Fixsen and Karen Blase provide a helpful differentiation between paper, process and performance implementation, with performance being the level of implementation that actually measures achievement of intended outcomes.

Achieving requires specific effort.

The second idea relates to the actual “stuff” that makes up an implementation effort.  Called various things — strategies, elements, factors, drivers — you can think of this "stuff" as an integrated system of actions and supports through which the work of quality implementation is done.  It may include implementation teams, coaching as well as training, data support systems, and leadership actions, among other things.  As Fixsen and Blase note in their work, it's important to your success to ensure you have all aspects of this system in place, and that they are working effectively as a system...even if each individual part of the system is not perfect.  The key is to have all the bases covered in some way and to know your strengths and weaknesses, so you can compensate as needed.  

Use a framework to help you get it right. 

There are a lot of pieces and parts to a successful implementation "system". You can use a framework as a checklist to ensure you have all relevant aspects of your effort covered.  The trick for the general practitioner is that there are MANY different frameworks offered from researchers in this field —and they aren’t all consistent. Wading through them can be a chore.  For that reason, I’ve created an easy-to-use summary framework, based on areas of consistency in the research and my own experience over the last 20 years.

 
 

If you are interested in applying findings from implementation science in your project, strategy or other implementation efforts, you may find some of the articles in the reference section below useful.  Reading journal articles not your thing?  Then check out my free Implementation Playbook and checklist, which provides practical detail on this framework and key ideas from implementation science. 

 


References

Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M. and Wallace, F.  “Implementation Research: A synthesis of the literature.” 2005.  See here. Note: This is quite lengthy, but provides in-depth information on many aspects of implementation. 

Meyers D., Durlak, J. Wandersman, A. “The quality implementation framework: a synthesis of critical steps in the implementation process.”  Am J Community Psychol. Dec 2012.  See here.   Note: The researchers outline 14 steps to implementation that are consistently found across frameworks.

Moullin, J. et al.  “A systematic review of implementation framework innovations in healthcare and resulting generic implementation framework.   Health Research and Policy Systems.  2015. See here. These researchers offer a generic implementation framework, which can be used as a mental checklist when designing an implementation effort. There is also a helpful appendix that provides information on all the frameworks that were reviewed in the research.