Nothing so practical as a good theory
Although an experienced real world implementer leading a service for young people at Leeds City Council, UK-IS member Lisa Forbes, Rethink Practice Development Facilitator (Lead) at Osmondthorpe OneStop, was a relative newcomer to the formal science of implementation when she joined the UK Implementation Society. She recently attended a two day seminar at Surrey University Using Implementation Science in Practice, led by international experts in the field of implementation science. Lisa was taking up a free place generously donated to UK-IS by the organisers. Here are her reflections and key take-homes.
As Kurt Lewin said over 60 years ago, “There is nothing so practical as a good theory”. When I first arrived at the seminar I suffered an acute attack of imposter syndrome. I’m not an academic and although my back ground is in nursing, I don’t currently work within Health Services. My current role is as a Rethink Practice Development Lead within Leeds City Council Children’s Services. The Rethink Team comprises of six multi-disciplinary professionals tasked with implementing the use of a ‘formulation’ model* to unify and develop practice across children’s services in Leeds. This is an exciting and innovative opportunity to embed formulation and restorative practice principles in order to change the way professionals ‘think and do’ in day to day practice and enable practitioners to reach more sustainable outcomes when working with families.
There were many highlights over the two day conference, which had a great balance of interesting and engaging lectures alongside opportunities to discuss the Rethink Team’s implementation project and the projects being undertaken by others.
Think about Form vs Function. Dr Brian Mittman, Senior Research Scientist at the Kaiser Permanente Southern California Department of Research, US, opened the event by giving an overview of the field of implementation science. It was helpful to consider the different types of implementation studies and consider the difference between efficacy and effectiveness studies as well as the difference between clinical and implementation outcomes. A discussion with Brian about the form and the function of implementation strategies was also incredibly valuable. The main learning point for me was that that manualised interventions often produce different to the expected results when applied to different environments. Therefore, if we focus on the function of intervention, its form can be adapted for different environments so long as it meets the desired functions. Evaluation can then focus on achieving high fidelity for the core functions of an intervention rather than striving to replicate the form.
Prospective not retrospective. Siw Carlfjord, Linköping University, Sweden presented a range of process and determinant models and frameworks for implementation alongside implementation strategies. It was helpful to consider such a range of models and frameworks, some of which I was more familiar with than others. For me, Siw’s key take home message was that ideally the models, frameworks and strategies should be considered prospectively and not retrospectively. Something that our team is trying hard to do.
Professor Carl May from the London School of Hygiene & Tropical Medicine opened day two with a presentation on Normalization Process Theory (NPT) on which he has been working for some years, and offered some great insights into the process of embedding complex interventions in practice. The accessible NPT tool kit will be extremely valuable for our team when considering how we translate implementation theory into practice. We plan to use this to enable us to evaluate the work we have already done and develop our strategy moving forwards. I also found Carl’s explanation of using theories to explain complex, dynamic and emergent phenomena useful in considering how theory can be applied to practice to make sense of the task ahead.
Think about sustainability from the off. Professor Sharon Strauss, University of Toronto, stressed the importance of considering sustainability from the outset of the implementation process. The key learning from this was that sustainability needs to be considered in relation to a number of issues including clinical intervention, impact and intervention strategy. Following on from the conference, as a team, it will be beneficial for us to consider sustainability frameworks in relation to our innovation.
Reflecting back, our team In Rethink is in a unique position, being somewhere between theory and practice. The learning about theory from the two days was (as Lewin predicted) highly practical and invaluable for us as a team. I also learned I wasn’t an imposter at all! The conference helped bridge the often cited gap between theory and practice and the learning from the conference will inform our implementation strategy as we move forward and develop as a team.
Lisa Forbes is Rethink Practice Development Facilitator Lead at Osmondthorpe One Stop, part of Leeds City Council. The two-day seminar, Using Implementation Science in Practice was organised by Dr Nicola Carey and Dr Theti Chrisanthanki at School of Health Sciences, University of Surrey. It was aimed at healthcare professionals, managers, commissioners, researchers and policy makers in public and private sector interested in finding out how to use implementation science in practice. The seminar was structured around four main themes: introduction to implementation science; pre-implementation planning; implementing your project and post-implementation; adoption spread and sustainability comprised lectures, practice examples, and facilitated small group work to support participants to use implementation science more effectively in practice.
© UK Implementation Society, 2018
All views expressed are the author's own and not those of the UK Implementation Society.
*Formulation is the process of making sense of a person’s difficulties in the context of their relationships, social circumstances, life events, and the sense that they have made of them. It is a bit like a personal story or narrative that a psychologist or other professional draws up with an individual and, in some cases, their family and carers. (https://clinpsychthinking.wordpress.com/2012/11/25/formulation-the-psychological-alternative-to-diagnosis/)