sraconf plenary: mind the implementation gap, jane lewis

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


Evaluation of My Baby’s Brain – Hertfordshire County Council


Let Teachers Shine – Shine Foundation

The science-practice gap


Research

dissemination

and translation

initiatives



Blank slide for charts etc.


Research

dissemination

and translation

initiatives



Research

dissemination

and translation

initiatives


Implementation


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


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)


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)



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


What doesn’t work

• disseminating research and good practice


What doesn’t work


• Just Do It


What doesn’t work


• Just Do It

• training

• guidelines



we need to get better at turning research into something that can

be implemented

principles

populations

implementation supports

practices



what is the ‘it’ in ‘does it work?’ or

‘should it be rolled out?’


we need to get better at researching implementation


Implementation stages

exploration

installation

initial implement’n

full implement’n

sustained implement’n

Fixsen et al, 2005; Metz and Barclay, 2012


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


“All organizations [and systems] are designed, intentionally or unwittingly,

to achieve precisely the results they get”

R Spencer Darling

A very chilling thought!


Systems support for innovation

Prism Prison


Where implementation outcomes fit in –expanding the ‘logic model’


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


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


http://www.cevi.org.uk/docs/Good_Enough_Ghate_2013.pdf



The Colebrooke Centre for Evidence and Implementation

55 St John Street London EC1M 4AN

0203 551 7666

[email protected]

www.cevi.org.uk


mailto:[email protected]

mailto:[email protected]

sraconf plenary: mind the implementation gap, jane lewis

Documents