The difference between 'doing' and 'achieving'.

There is a growing body of evidence that how we implement a new practice, or program, 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 methods that help us to better ensure we get the intended results from the new practices we adopt.  Although often focused on healthcare, education or child development, I’ve found that learning from implementation science can be successfully adapted to support the adoption of all sorts of innovations within organizations. 

Those leading broad implementation efforts in organizations may find the frameworks offered by implementation science most useful. You can use a framework as a checklist to ensure you have all relevant aspects of your effort covered.  There are MANY frameworks – but recent literature reviews have found areas of consistency across many of them.

Below, I broadly summarize three concepts from implementation science that I have found useful in my work implementing enterprise-wide programs and processes.  To go deeper, check out the sources at the end of this post or the resources section of my site.

1.  Implementation involves multiple phases.   Contrary to popular belief these phases are not 1) Start and 2) Finish! A fully implemented, sustainable process or program can take years of continuous effort to achieve. This is a particularly important concept for both stakeholders and organizational leaders to understand.

Phases cover everything from initial investigation on whether or not to implement, to setting up the infrastructure to support the implementation effort, to measuring effectiveness and making ongoing improvements.  Importantly, these phases are more cyclical than linear.  Different frameworks offer a varying number and definition of phases.  I’ll generalize them here as:  

  • Deciding
  • Preparing
  • Doing
  • Improving
  • Sustaining

2. Be clear about what you are implementing.  This sounds pretty obvious; however, it’s important to recognize that there will always be some holes in a new practice or program during initial implementation efforts.  The key is to ensure that these are holes you are aware of – not craters that you didn’t know were there, or just expect people to work around.  Feedback loops with those who are using the new practice is essential – they will help you find the gaps and work to fill them. 

3.  Quality implementation takes specific effort.  There are two ideas here.  The first is about quality.  Implementation science provides strategies that support the achievement of the intended outcomes of a practice, which is different than simply putting a practice in place.  This difference should be top of mind for those leading implementation efforts.  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 differentiate between paper, process and performance implementation.

The second idea is about the actual “stuff” of implementation.  Sometimes called strategies, elements, factors, or 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 others.   Fixsen and Blase offer a clarification about this that I’ve found particularly useful as a practitioner:   All of these strategies don’t have to be perfect.  Strengths in some areas make up for weaknesses in others.  The key is to have all the bases covered in some way and to know your strengths and weaknesses.  

Sources

Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M. and Wallace, F.  “Implementation Research: A synthesis of the literature.” 2005.  See hereNote: 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.