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Implementation Resource Digest 1

Core Implementation Resources

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This Implementation Resource Digest identifies a selection of core implementation texts which together provide a practical and evidence-based introduction to implementation science and practice.   
 
Our selection includes a number of recent implementation frameworks. These are attempts to identify, summarise and integrate the key components of effective implementation, based on reviews of empirical evidence.   
 
Some have been further developed with practical tools and other resources designed to be used in implementation planning and analysis.

This is one of a series of Implementation Resource Digests produced by the UK Implementation Society (formerly Network) exclusively for its members.  Each digest focuses on a core implementation science and practice topic and acts as a guide to useful literature and resources, starting from first principles. 

We aim to cover the key dimensions or aspects of each topic, rather than to provide a comprehensive review of the published literature. We particularly aim to include texts that are available on an open access basis or that showcase the contribution of UK implementation scientists and practitioners.  

Each summary will be reviewed and updated periodically and we welcome suggestions for updates.

This series was edited by Jane Lewis (Director of Implementation Support, The Colebrooke Centre for Evidence and Implementation) and Dr Ann Lendrum (University of Manchester).  We welcome your feedback, suggestions and input.  

Email us at admin@ukimplementation.org.uk

A   INTRODUCTIONS TO IMPLEMENTATION SCIENCE AND PRACTICE

1. Implementation Research:  A Synthesis of the Literature.

The National Implementation Research Network monograph is based on an extensive review of the research on implementation across a wide range of fields and is a very comprehensible introduction to implementation research.  It describes four key models:  the stages of the implementation process, the core components or ‘drivers’ of effective implementation, policy-practice feedback loops, and implementation support through implementation teams.  It also discusses the organisational components and wider influencing factors necessary to support effective implementation.   
 
Available to download
here

 

Fixsen D, Naoom S, Blase K, Friedman R and Wallace F (2005) Implementation Research:  A Synthesis of the Literature National Implementation Research Network, University of Florida. 

2. Diffusion of innovations in service organisations.

Based on an extensive literature review, this paper looks at the factors influencing the spread and sustainment of innovation.  Although the focus is on innovation in health services, it draws on a much wider literature.  It presents a multi-level model of innovation diffusion which includes:  the characteristics of the innovation; adoption by individuals; assimilation by the system; diffusion and dissemination; system contexts and readiness; the outer context of inter-organisational networks; implementation and routinization. 
 
Available to download
here

Greenhalgh T, Robert G, Macfarlane F, Bate P and Kyriakidou O (2004) ‘Diffusion of innovations in service organisations:  systematic review and recommendations’ The Millbank Quarterly 82 (4) 581-629. 

3. Implementation Science: a brief overview and a look ahead.

A brief article summarising key aspects of the developing field of implementation science highlighting ‘central concepts, strategies, frameworks and research outcomes’  

 

Ogden T. and Fixsen D.L (2014) Zeitschrift fur Psychologies 222(1) 4-11   

4. From news to everyday use.

This is a good introduction to implementation, from the Swedish National Institute of Public Health.  It covers definitions, the conditions of successful implementation, the roles of individuals and organisations and capacity for change, and has a useful checklist of criteria for effective implementation.   
 
Available to download
here

 

Guldbradnsson K (2008) From news to everyday use:  the difficult art of implementation  Swedish National Institute of Public Health, Stockholm 

5. Introductory Guide to Implementation.

This short report by CES in Ireland is another good introduction to implementation, looking at what it is and why it matters, stages of implementation (based on the NIRN framework), and enablers and barriers.   
Available to download
here

 

Burke K, Morris K and McGarrigle L (2012)  An Introductory Guide to Implementation:  Terms, Concepts and Frameworks CES, Dublin 

6. Implementation Matters:  a review of research on the influence of implementation on program outcomes and the factors affecting implementation.

This article is key for two reasons.

 

First, based on an extensive evidence synthesis, it sets out the factors identified in research as affecting the implementation process.  These are organised under four headings:  community level factors (eg policy and funding); provider characteristics (eg possession of skills necessary for implementation); the characteristics of the innovation; factors relevant to the delivery system; and the support system for implementation.  

 

Second, it shows that the evidence confirms the powerful impact of the quality of implementation on the outcomes actually achieved.   
 
Abstract

 

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 

7. Fidelity criteria:  development, measurement and validation 

There are a range of implementation resources based on the National Implementation Research Network monograph (item 1 above) and the Active Implementation Frameworks it describes.

 

You can access these, and the group’s continuing work, at the Active Implementation Hub and access their learning modules and materials here 

B   IMPLEMENTATION FRAMEWORKS

C KEY TEXTS ON ADAPTATION

8. Consolidated Framework For Implementation Research (CFIR).

Based on a review of published implementation theories, CFIR is intended as an overarching framework to inform both theory development and research on implementation.  CIFR describes five major domains that should be the concern of implementation research:  intervention characteristics, the outer (systems) setting, the inner (organisational) setting, characteristics of the individuals involved in implementation, and the process of implementation. 
 
Available to download
here

 

Damschroder L, Aron D, Keith R, Kirsh S, Alexander J and Lowery J (2009) ‘Fostering implementation of health services research findings into practice:  a consolidated framework for advancing implementation’  Implementation Science 4:50 1-15 

9. PARiHS:  Promoting Action on Research Implementation in Health Services.  

The PARiHS model – developed by a UK-led team - posits that effective implementation of research is a function of the nature of evidence (research evidence, clinical experience, patient experience and local information and data), the quality of the context for implementation (aspects of organisational context particularly culture, leadership and the role of evaluation), and the way in which change is facilitated (requiring appropriate and enabling approaches).  The model is intended to inform planning for implementation, implementation processes and evaluation of implementation efforts.  The team are developing a series of tools to support diagnostic, facilitation and evaluation activity.   
 
The model and supporting resources can be accessed
here

10. Getting To Outcomes.

Getting To Outcomes (GTO) is intended to aid the planning, implementation and evaluation of programs.  It is based around 10 steps, also discussed as ‘accountability questions’, which move through needs assessment and identification of goals; identifying programmes and practices; selection based on fit and capacity; planning implementation; evaluating both implementation and outcomes; continuous quality improvement, and strategies for sustaining the new practice or programme. 
 

Available to download here

 

There is also a more detailed manual here

 

Wiseman S, Chinman M, Ebener P, Hunter S, Imm P and Wandersman A (2007) Getting To Outcomes™: 10 Steps for Achieving Results-Based Accountability  Rand:  Santa Monica, California   

11. Quality Implementation Framework.

The Quality Implementation Framework is based on a synthesis of 25 implementation frameworks and identifies 14 critical steps for effective implementation, organised into four phases.  An important point made by the paper is that most of the steps identified need to be addressed before implementation begins.  
 

Abstract

 

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 

12. RE-AIM framework 

The RE-AIM framework is intended to inform programme decision-making to aid the planning of programmes and improve their chances of producing the intended outcomes.  It emphasises the importance of attending to five key elements to improve sustainable implementation:  Reach (to intended service users or beneficiaries); Effectiveness (outcomes to be achieved); Adoption (by settings); Implementation (with a focus on consistency in delivery) and Maintenance (both of the intended outcomes and of high quality implementation). 


Many publications. See for example here and Glasgow GE, T.M Vogt and S.M Boles (2011).  ‘Evaluating the impact of public health promotion interventions: the RE-AIM framework’ American Journal of Public Health, September 1999. Available to download here

13. Conceptual model of evidence-based practice implementation in public services. 

The paper sets out a conceptual model of factors affecting implementation including the ‘inner context’ of service delivery organisations; the ‘outer context’ or wider system; and aspects of the innovation’s characteristics and fit.  It then links these with four phases of the implementation process (exploration, adoption decision/preparation, active implementation and sustainment) highlighting how the focus of attention needs to change over the course of the implementation process.    

 

Abstract

 

Aarons G, Hurlburt M and Horwitz S (2011) ‘Advancing a Conceptual Model of EvidenceBased Practice Implementation in Public Service Sectors’  Administration and Policy in Mental Health and Mental Health Services Research 38(1) 4-23 

14. Normalization Process Theory.

This model, developed by a UK-based team, highlights that new practices become embedded through individual and collective processes and that this requires continuous investment.  Core constructs are coherence (the meaningful qualities of the practice and beliefs about it); cognitive participation (the enrolment and engagement of individuals and groups); collective action (tasks, accountability, resources, policies and procedures that integrate the new practice with existing ways of working); and reflexive monitoring (appraisal, review and reconfiguration).   
 

Abstract

 

May C and Finch T (2009) ‘Implementing, Embedding, and Integrating Practices:  An Outline of Normalization Process Theory’ Sociology 43(3) 535-554.   
 
There are also other resources, including an online tool which is intended to help practitioners and researchers think through the issues involved in implementing, embedding and integrating a new practice, available
here 

C   OTHER CORE IMPLEMENTATION RESOURCES

15. Implementation of policy initiatives.

This document is particularly helpful because it focuses on the implementation of policy initiatives (rather than specific programmes or services), and explores the necessary planning and development processes that make an initiative ready for delivery.  It is aimed at senior policy makers and other public sector leaders.  It covers implementation challenges; governance for implementation; implementation risk management; planning for implementation; procurement and contract management; stakeholder management; resources for implementation and change management; implementation communication strategies, and monitoring and review of implementation.  The report is very practical in its orientation.  Each section poses a set of questions of policy makers and their policy initiative, and there is a set of summary checklists. 

Available to download
here.

CIU/ANAO (2006) Implementation Australian Government Dept of the Prime Minister and Cabinet / Australian National Audit Office.

16. A compilation of implementation strategies

This paper presents a taxonomy of implementation strategies organised around six constructs (planning, educating, financing, restructuring, managing quality, and attending to policy context). It was prompted by the recognition that implementation strategies are rarely defined or well described, and provides helpful guidance both for implementation practice and research.  
 

Abstract

 

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

17. Better reporting of interventions:  template for intervention description and replication (TIDieR) checklist and guide.

This article, by an international team with strong UK representation, sets out a framework for clearer and more comprehensive descriptions of interventions, with the aim of assisting both implementation and replication.  Based on a literature review, Delphi exercise and other consensus-building activity, it identifies 12 items that should be described with an explanation and elaboration of each. 
 
Available to download
here

 

Hoffmann T, Glasziou P, Boutron I, Milne R, Perera R, Moher D, Altman D, Macdonald H, Johnston M, Lamb S, Dixon-Woods M, McCulloch P, Wyatt J, Chan A-W and Michie S (2014) ‘Better reporting of interventions:  template for intervention description and replication (TIDieR) checklist and guide’ British Medical Journal: 348:g1687 

With thanks to Jane Lewis and Ann Lendrum, Editors of the UK-IN Implementation Resource Digest series.  For feedback, suggestions and further information to forward to the editors, please email admin@ukimplementation.org.uk 

How to cite this document:

 

UK Implementation Network (2015) Fidelity and Adaptation:  UK Implementation Network Implementation Resource Digest 2  Ed. Jane Lewis UK Implementation Network www.ukimplementation.org.uk 

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