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SISC Implementation Science Simcoe Muskoka Kathy Simpson. Agenda. Introduction Implementation Science Overview Stages Drivers Teams (SISC Implementation Team) Improvement Cycles (Use of QI) Learnings Questions & Discussion Installation/Implementation Planning. 2.
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Agenda • Introduction • Implementation Science Overview • Stages • Drivers • Teams (SISC Implementation Team) • Improvement Cycles (Use of QI) • Learnings • Questions & Discussion • Installation/Implementation Planning 2
Implementation Science Implementation Research: A Synthesis of the Literature Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M. & Wallace, F. (2005). Implementation Research: A Synthesis of the Literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231). Download all or part of the monograph at: http://www.fpg.unc.edu/~nirn/resources/detail.cfm?resourceID=31 or Google National Implementation Research Network
Today’s Objectives Deepen your understanding of implementation science as it is being applied in the Service Collaborative project Understand the drivers critical to successful implementation Understand Implementation Planning context and content 4
What is implementation? “A specified set of purposeful activities at the practice, program, and system level designed to put into place a program or intervention of known dimensions with fidelity.” 6
Implementation Science • An intervention is one thing (Serum, software) • Implementation is something else altogether (Syringe, hardware) • Neither one is useful without the other 7
Getting results IMPLEMENTATION Effective NOT Effective Actual Benefits Inconsistent; Not Sustainable; Poor outcomes Effective INTERVENTION Poor outcomes; Sometimes harmful NOT Effective Poor outcomes (Institute of Medicine, 2000; 2001; 2009; New Freedom Commission on Mental Health, 2003; National Commission on Excellence in Education,1983; Department of Health and Human Services, 1999)
Active Implementation’s Four Frameworks (“make it happen”) • Implementation Stages • Implementation Drivers • Implementation Teams • Improvement Cycles 9
ImplementationStages Conducting stage-appropriate implementation activities is necessary for successful service and system change (Metz & Bartley, 2012)
Stages of Implementation • Stages are not linear, overlap occurs • Sustainability planning is important at all stages • Exploration • Installation (Implementation Planning) • Initial Implementation • Full Implementation Decide What to adopt and implement How will it happen. Plan what needs to be in place to implement the What Put the plan on the ground and implement the What Make sure it works, then do it better (PDSA) and make it “business as usual” 11
Cluster 1: Milestones Exploration Initial Implementation March-October 2012 November-March 2013 April-July 2013 August 2013 Installation Full Implementation 12
Implementation Drivers Developing implementation components (a.k.a. Drivers) results in an implementation infrastructure that supports competent and sustainable service delivery (Metz & Bartley, 2012)
Competency Drivers • Recruitment and Selection • Identify roles and responsibilities for all participants • Organizations select knowledgeable and appropriate staff to deliver intervention • Training • Participants acquire knowledge and skills necessary to support implementation • Practitioners must acquire the necessary skills to use the intervention • Consultation and coaching • Successful implementation requires ongoing guidance for participants (supervision, teaching, assessment/feedback, and emotional support) • Performance assessment (fidelity) • Is the intervention being implemented as intended? (evaluation question) • Frequent performance reviews and feedback on adherence to the core intervention components (fidelity) are important for continued success
Organization Drivers • 5. Systems Intervention • Internal and External leadership is in place to support ongoing implementation and sustainability (e.g. funding, human resources) • Facilitative Administration • Internal leadership at agency/regional/ systems level is in place and using data to inform their decisions and support necessary infrastructure for ongoing implementation and sustainability • There is a strong leadership “connection” to external partners to promote the use of this initiative. • 7. Decision Support Data Systems • Program evaluation and process data are routinely collected, analyzed and shared • Overall assessment of the initiative assures continuing implementation and outcomes of core components over time 16
Leadership Drivers Effective Implementation requires Leadership at all levels and for all drivers. 8. Technical – to support ‘technical’ changes e.g. management sign off to include 5 additional questions on intake form 9. Adaptive – to support changes in the way work is done e.g. reduce office based time and increase time mental health worker is allocated to be in school to implement a school-based program. Identifying champions at all levels!
Implementation Teams Creating Implementation Teams that actively work to implement interventions results in quicker, higher-quality implementation (Metz & Bartley, 2012)
SISC Project:SC Implementation Team • Develop project charter • Develop the implementation plan • Develop evaluation and communication plans • Consult with larger SC as needed • Execute implementation plan • Develop and execute sustainability plan 20
The use of QI and IS in SISC Implementation Science is an approach that uses QI tools and processes where appropriate (at any stage). Example, fishbone can be used in Exploration but also Initial implementation, etc…. To evaluate the success of implementation, PDSA cycles will be critical throughout the process but especially at initial implementation 22
NIRN has advocated for QI approaches as a way to help with continuous decision making and to better understand the core intervention components. PDSA cycles can be included at a number of NIRN’s stages. Continuous Improvement Cycles: Rapid Cycle Improvement (PDSA)
Policy-practice feedback loops: A Quality Improvement Method Organized, Expert Assistance Policy Practice Feedback Loops Policy Enabled Practices Policy Policy Practice Informed Policy Structure Procedure Practice Practice 24 Metz & Bartley, 2012
Lessons Learned • In the exploration phases, securing funding is crucial. • In the later phases, fidelity monitoring and feedback is essential. • Committed leaders who motivate and inspire participants are beneficial at all stages. 25
Lessons Learned Competency Drivers: • Tailor materials to the specific needs of users • Match engagement method to user’s “stage of change” • Involve practitioners that are receptive to using the new practice • Reduce the lag time between training and implementation • Offer opportunities to trial the intervention on a small scale • Connect users with peers who may have been through a similar implementation initiative, or who are using the EBP already • Balance negative feedback • Share successes! (of all sizes) 26
Lessons Learned Organization Supports: • Get buy-in from key influencers (e.g. formal and informal) • Tap into existing communication pathways • Alter the workflow to support the EBP • Encourage organizational structures that support the EBP & an EBP that is adaptable to such structures Leadership: • Have onsite leaders at all levels in organizations • Support an organizational culture that is motivated towards improvement • Advocate for changes needed 27
INSTALLATION From Practice Profile to Implementation Drivers to Implementation Plan
Installation: Active implementation planning • Determining the composition of the implementation team • Establishing the resources needed to carry out the intervention with fidelity • Identifying structural, functional changes and work flow processes • Address barriers and propose system solutions (MACRO) • Planning for each implementation driver
Installation: SISC activities Develop the project charter Identify structural and functional changes needed Develop implementation plan Develop evaluation plan Develop communication plan Implementation Plan Developed!
Implementation Planning • Practice Profile Part 2 • Identifies, at a high level, the knowledge, skills and abilities needed to execute the practice profile as described in Part 1 as well as the ‘outcome’ ie how we will prove that things have been implemented as planned • Implementation Drivers: A guide to planning • Provides a chart structure and probing questions to develop a detailed plan as to how what’s needed is going to be put in place
