IT AIN’T WHAT YOU DO, IT’S THE WAY THAT YOU DO IT!
Implementation science and practice, effectiveness and the SDGs
The UN’s 17 Sustainable Development Goals (SDGs) give us a blueprint for social action and investment as well as a framework for thinking about and measuring impact. But try Googling or searching for ‘implementation’ on the SDG website and you won’t get far.
For us as implementation professionals, this feels familiar. Most people have an intuitive understanding that ‘implementation’ is about making things happen – translating high-level goals into something workable and effective. Yet we’re often struck by how few of those working in social change make reference in their work to implementation science and practice (ISP). Yet ISP is incredibly relevant. A thriving and growing field, ISP is the science (or more properly, sciences) of delivering effective and sustainable social initiatives. ISP is a rigorous multi-disciplinary field of academic and practice enquiry that tests and analyses implementation methods, techniques and strategies, and builds theory and evidence about how we can implement services for people and communities right, first time and repeatedly.
“THE FIELD WE PERSONALLY KNOW BEST (SOCIAL, HEALTH AND COMMUNITY SERVICES), IS LITTERED WITH EXAMPLES OF APPARENTLY WELL-DESIGNED PROGRAMMES THAT HAVE FALTERED.”
We all know that achieving impact requires more than well-directed funding. Experienced people working in the delivery of social programmes will tell you that of course there is a core set of principles that make for effective (and cost-effective) implementation. These include consultation, planning, monitoring, evaluation and so on. Some will speak of logic models, theories of change, monitoring systems, randomised controlled trials. It sounds like we all know what we are doing. But do we? A favourite saying of implementation professionals is that the effort of implementing effective interventions far outweighs the effort of designing them.
The field we personally know best (social, health and community services), is littered with examples of apparently well-designed programmes that have faltered. Good programmes are built and tested and show good results. But when transported to new settings, often they disappoint – sometimes very expensively. For example, a few years ago an evidence-based parenting support programme for vulnerable first-time mothers known as NurseFamily Partnership in the US was introduced to England by central government at considerable expense and with considerable fanfare. After an expensive trial, it failed to demonstrate better outcomes than the usual services provided by local primary health care workers. This wasn’t the first time this had happened, nor was it the last.
So widespread is this phenomenon that there’s even a formal name for it, the ‘crisis of replication’. The reason – as implementation studies have shown repeatedly – is that although successful projects may well have become part of the local scene and the bandwidth of the local service offer, that didn’t happen by magic, and it didn’t happen fast. It is often only after years of struggle, hard won arguments, shifts in the local politics and determined, value-driven leadership. They may have rooted their success in specific local circumstances, serendipity, a meeting of minds and common values. It turns out that disassembling, rebuilding and managing a new project in the image of the original in a new setting isn’t that easy. Understanding the limits of how far a ‘proven’ model can be adapted to a new setting without corrupting the core elements or active ingredients that made it effective and functional in the first place is a significant test for implementers.
“FOCUSING ON LOCAL MARKETS ENABLED A REDUCTION IN TRANSPORTATION COSTS AND ENSURING LONG-TERM PARTNERSHIPS BETWEEN PRODUCERS AND VENDORS.”
And that’s before we even talk about the explicit and implicit ‘resistance to change’ often found within the existing systems into which innovations are introduced. Human and community services are not like the McDonald’s restaurant that arrives on a low loader to be plumbed-in on a pre-cast concrete base. You might think, “We already know this!” But how often do we see funded initiatives that assume they can just slot into an existing system and then find themselves struggling to gain traction? To reach full potential, even manualised ‘off the shelf’ programmes require craft, core skills and a facilitative environment, supported by skilled systems leadership. These factors – especially the facilitative environment – vary significantly from one setting to another. This has been shown repeatedly by studies of the transportation of juvenile justice programmes from the US into the UK and Northern Europe, for example.
BRIDGING THE GAP
Formal implementation knowledge and evidence, applied in practice, gives us a bridge across the gap from ideas to outcomes. This can help avoid waste and can accelerate impact. Yet in our experience, surprisingly few organisations (or funders) have thought about how this learning can be blended with existing experience to support effectiveness and sustainment of new initiatives. Still fewer have taken steps to employ implementation (not management) professionals to stand shoulder to shoulder with providers to use this learning for support and troubleshooting in real time.
“IMPLEMENTATION INSIGHTS HELP US UNDERSTAND WHY
WELL-INTENTIONED AND WELL-RESOURCED CHANGE INITIATIVES MISFIRE.”
The implementation sciences are centrally concerned with sustainability. Over time, a combination of careful independent, interdisciplinary and multi-method research blended with practice wisdom acquired in the course of ‘doing’ social change are clarifying the principles of lasting effectiveness across widely varying contexts and sectors. These principles are critically relevant to the SDGs, as they are to any social change effort, and are also deeply salient for anyone advising or supporting impact investors. Drawing from health and social sciences, community development, environmental sciences, psychology, economics, behavioural science, complexity and systems science, and from business and management studies, they can provide the solid foundations to buttress investment and innovation.
For example, some of the insights talked about most at the moment include:
The importance of systems thinking at all times. ISP is helping us to think about the outer context for social change initiatives, how it can block or enable success, and how it can be leveraged for impact.
Understanding that implementation is a complex process, not a single event. ISP has clarified the stages that characterise the typical trajectory of change initiatives. It has emphasised how the stages are recursive, how interactions and emergence in complex systems affect planning and management, and is refining tools for rapid cycle testing to help keep up forward momentum.
Co-create and co-design wherever possible, and privilege local cultural, social and political intelligence at all times. That innovation can go against the grain or disturb existing patterns, but this has to be done intelligently, sensitively and with preparedness to go back to the drawing board if things start to falter badly. Humility is the watchword.
Observe and test repeatedly, throughout the process, even when resources are tight, and use data intelligently. Measure implementation outcomes (what’s changed in systems, organisations and teams) as well as outcomes for beneficiaries so that whether ‘it’ works or not, we’ll understand why.
And perhaps most importantly, the vital importance of supporting the implementation process with more than money. Effective implementation needs active, sleeves-rolled-up support from people on the ground who both understand implementation evidence and principles, and who know the work in hand. For change initiatives at scale, the gold standard must be training up such teams at the local level. Not only can they provide that magic ingredient that makes change happen, but when they move on, they take those skills and apply them in new roles and new initiatives, building local capacity.
INVESTING IN ISP
Of course, there is much more to be said. Implementation studies and their findings have proliferated in the past decade and cover a huge range of factors that influence the effectiveness of programmes. There are now numerous frameworks and models, although still a relatively small supply of those trained active support professionals we’d like to see spread through every system in every country. For that, the field of ISP itself needs more investment.
Implementation insights help us understand why well-intentioned and well-resourced change initiatives misfire. They help us to be more explicit about what goes on in the black box of a complex social change process. Paying attention to ISP when investing effort or funds in any kind of social change initiative is the scientific equivalent of financial or legal due diligence – without it, claims to future effectiveness and sustainability are just claims. At the UK Implementation Society, we’d like an 18th SDG to be added to the list: Effective, evidence-informed implementation for every new initiative.
Published in Philanthropy Impact Magazine - Summer 2021
© UK Implementation Society, 2021
All views expressed are the author's own and not those of The UK Implementation Society.