Active Implementation can bring about lasting change
New strategies, new action plans, new legislation, new funding, new training…. all approaches that are widely used to bring about changes in education, health and social work systems. Yet evidence and experiences teach us that we are only rarely successful. Dispiriting? Alex McTier, Evidence and Evaluation Specialist at CELCIS, University of Strathclyde, Scotland, finds the silver lining in Scottish investment in active implementation.
New strategies, new action plans, new legislation, new funding, new training….These are all approaches that are widely used to bring about changes in our education, health and social work systems to improve the lives of those supported by these services. Yet despite the time and resources allocated to these well-intentioned approaches, how successful have we been at achieving the transformational changes to which we aspire?
Evidence and experiences teach us that we have only rarely been successful.
As someone who previously worked on developing new strategies and action plans, it is somewhat dispiriting to look back and accept that these were unlikely on their own to have ever brought about the positive changes that colleagues and I had hoped for.
There is however a silver lining.
The Scottish Government has funded a team to deliver on an improvement programme to address neglect and enhance well-being. Since joining this team, I have been exposed to the science and practice of implementation, and I've been encouraged by the way in which it supports the articulated aspirations to 'come off the page' and actually be delivered.
So what does the science and practice offer us, and in what ways does it transform our understanding of how to bring about change to public sector systems?
These are big questions that undoubtedly extend beyond a blog. Yet, what I offer here are my reflections on what the Active Implementation approach is and isn't, drawing on my past consultancy experience and my current post as a member of the ‘addressing neglect and enhancing well-being’ team. This dual perspective provides, I hope, a useful insight for those who are new to and intrigued by the science and practice of implementation.
What Active Implementation is not
Flipping the order and beginning with the 'what Active Implementation is not', I feel useful distinctions can be made between Active Implementation and other consultancy work. Key differences of Active Implementation that I have seen are that:
It is not a short, sharp research exercise where, for example, external consultants come in for 3-4 months, consult with key staff and stakeholders, review the available data, and produce a final report or strategy before moving on to the next research contract.
The scope of its work cannot be clearly defined up front in a research brief with pre-determined research questions, as the scope only becomes apparent when the current system is explored in depth and key issues identified.
The end outcome is not the production of a final report or strategy and accompanying recommendations, which organisations are then left with to take forward and implement as best they can.
It does not revolve around expert external consultants coming in and using their ‘expert skills’, while the existing, internal staff and skills are overlooked.
What Active Implementation is
So if we have a better understanding of what Active Implementation is not, then what is it?
Active Implementation provides a framework that helps organisations to respond to all factors, including those that are often overlooked, required to successfully implement an approach. Examples of its use can be found in the implementation of evidence-based programmes and evidence-informed approaches in the fields of child welfare, education and mental health. The University of North Carolina's National Implementation Research Network (NIRN) and its Active Implementation Hub also offer a wide range of publicly available resources.
Learning from these and drawing on the early experiences of using Active Implementation in Scotland, my thoughts are that:
It is a long-term relationship that supports organisations to understand what needs to change and then guides them through the change process. For the ‘addressing neglect and enhancing well-being’ team, this means we will be working alongside colleagues in local areas for three or more years to support the work of their local implementation teams to deliver on this aspiration.
The emphasis is on implementation. Beginning with a thorough exploration of what needs to change and/or continue, Active Implementation's long-term engagement aligns with the evidence to support the work as it continues into the detailed planning and evaluation of the delivery to ensure the activities and approaches are implemented as intended. It also ensures that sufficient infrastructure is in place to support change.
It builds implementation capacity within organisations, which can then be applied by organisations across other small and large improvement efforts. By working with staff, using the science and practice of implementation, they themselves can design, implement and oversee their own activities and approaches, and not rely on external experts.
Strategies, action plans, legislation, funding and training all have a place, but we also have to recognise the limitations of these approaches to change.
If we are serious about achieving transformational changes in our systems, such as ensuring that all children's needs are truly met in the right way at the right time so that we 'get it right for every child', then we must devote more time and effort into the 'how we do it' as opposed to the 'what we should do'.
Active Implementation provides the tools to do just that, which makes it a very exciting time to be part of Scotland’s implementation journey.
Alex McTier is Evidence and Evaluation Specialist at CELCIS, University of Strathclyde, Scotland
© UK Implementation Society, 2018
All views expressed are the author's own and not those of the UK Implementation Society.