Don’t scrimp on implementation activity
Gill Parkinson, UK-IS member and practice lead from Leeds City Council’s Children and Family Services is one of a group of UK-IS members in Leeds.
As part of Implementation Week 2019 she attended the 2nd Implementation Science Research Conference - ‘Advancing the science of scaling up’ - hosted by Kings College London on July 18th.
Here are her reflections and key take-homes on some of the sessions she attended.
Coming from a social care background in services for both children and adults over the years, I have witnessed many attempts to roll out new ways of working - with variable success. On reflection, it seems that success was not attributable so much to what was done, or who it was done with, but rather to the quality of the thinking and planning that had taken place in advance.
Inspired by colleagues in Leeds who introduced me to the UK Implementation Society, my interest has been growing in what lies behind achieving successful implementation.
I have been working alongside colleagues over the last few years using implementation science to implement and embed the innovative use of Rethink Formulation (a model of formulation*) across the Leeds children and families workforce and also in seven new Restorative Early Support Teams. I am a key member of a small implementation team testing out, through a prototype project, a new approach to assessments aligning statutory social work functions, robust risk analysis and Rethink Formulation.
I am currently especially interested in how to take the social work assessment project forward on a much larger scale. So I was delighted to be able to attend the conference at KCL on July 18th, focused on scaling up. There was so much to hear from the excellent range of speakers and I have taken a lot back to inform our thinking in Leeds. This is a selection of my personal highlights.
The first plenary session was led by Josephine Tapper, member of King’s College London’s Centre for Implementation Science Patient and Public Participation Advisory and Planning Group. Her session on Scaling up without leaving behind: a perspective from the shop floor was an excellent reminder to be inclusive when designing consultation methods and to consider practical and behavioural barriers to participation and how to mitigate them so that outcomes of consultations give a more complete and accurate picture.
Scaling up with structure: Impact feasibility and theoretical reflections on a practice-informed scale-up template to improve patient safety by Andrew Sibley, Wessex Academic Health Science Network, UK was a paper in one of the parallel sessions. It was helpful in providing an overview of non-linear process elements when scaling up. It was reassuring to hear that a lot of what we are doing in Leeds is on the right lines: we have a programme manager; we have a plan (and are starting to develop our scale up plan); we have an implementation team; we can describe the innovation; we know who our stakeholders are; and we have champions to support us. But I think we need to do more about communicating the benefits of the innovation and about keeping others informed about early wins and the progress we are making. We will review our communication and engagement strategy accordingly!
Andrew Walker, Health Innovation Network UK and St George’s, University of London UK – AW gave an (award-winning best paper) on The role of knowledge exchange in scaling-up a complex intervention for osteoarthritis (ESCAPE-pain) in England. My big takeaway from this session was the absolute need to communicate about the innovation and the scale up by providing a number of places to exchange knowledge such as knowledge sharing events, early adopter sites and a range of communication and engagement methods. It’s not enough that the innovation has been proven to work – hard work needs to take place to engage stakeholders and keep them informed. It’s critical that scale up is underpinned by expanding stakeholder understanding of the intervention and the planned approach to implementation. One good tip was to make the new intervention as similar as possible to the old or previous intervention but to be clear about what is different. Another was to not scrimp on implementation activity.
Professor Annette Boaz, Health and Care research, Kingston University and St George’s University of London led a second plenary session - Scaling up – implementation ‘writ large’ or something distinct and different? This session looked at whether strategies need to be different when implementing ‘one offs’ as opposed to going to scale. There was so much in this session, but a key point of learning for me was that scaling up needs to be considered at all stages of the implementation including at the beginning. Another was that active involvement in the implementation is required at all levels of the system to avoid failure, as “many of the failed programmes in the past have been designed and delivered ‘top down’, through eternal contractors” .**
During the breaks, conference attendees had the chance to review implementation posters of various projects and vote for their favourite ones. I really liked a visual about barriers to implementation on a poster from The University of Sheffield*** –I‘ve adapted it for general use – (with permission) – below:
Barriers to implementation
Leeds is a very large local authority with a large workforce and I am aware that social care culture and practice change management is often highly challenging and could benefit from using implementation science approaches. In future, I would be interested in seeing more social care implementation science projects included in the topics for the 3rd Implementation Research Conference. Maybe by next year, Leeds and other non-health organisations will have attracted academic interest in our implementation science informed innovation work!
The conference has been really useful for me in reiterating the need for outstanding levels of communication and engagement at all levels of the system where implementation needs to take place and I will take this message back to share with colleagues. Thank you so much for enabling me to attend.
Gill Parkinson is the Leeds City Council Children and Families Services lead for Improvement, Innovation and Inspection and the Programme Manager for the Innovations and Partners in Practice Programme.
She has embraced the use of implementation science alongside colleagues in Leeds, and like them is a UK Implementation Society (UK-IS) member. She would however describe herself as being relatively new to formal implementation science. Gill was taking up a free place generously donated to UK-IS members by the organisers at KCL.
*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/)
** Head B and Di Francesco M (2019) Using Evidence in Australia and New Zealand. Chapter 14 in What Works Now? Evidence Informed Policy and Practice Bristol: Policy Press
***Developing an implementation strategy in the use of objective adherence data in routine clinical practice: a case study in cystic fibrosis clinics (Poster, Carla Girling, Daniel Hind, Madelynne A Arden and Martin J Wildman).
© UK Implementation Society, 2019
All views expressed are the author's own and not those of the UK Implementation Society.