What Does it Take for Effective Implementation to Get to Outcomes?

By Renée Boothroyd, Scientist and Senior Implementation Specialist, Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill

Getting to outcomes is not as simple as selecting an effective practice model or strategy (“the WHAT”). The process of supporting use of any practice model or strategy (“the HOW”) is just as, if not more important, for creating supportive systems and improving outcomes. 

Effective Implementation

Effective implementation is a process of building and ensuring the resources and abilities of both people and organizations to support change(1-4). In order for practitioners to deliver the “WHAT” as intended, they need training and ongoing coaching to build competence and confidence. They also need guidance and active support from supervisors, who also need it from managers, who also need it from executive leadership. The environment in which change happens needs to foster the kind of conditions necessary for hosting change. So, paying attention to “HOW” means ensuring deliberate time, effort and processes for adaptive leadership and management strategies for modeling behaviors, eliminating barriers, and creating pathways for change. It is about partnering with communities and systems to identify problems and strategies to address them. And it is about using data to understand and improve the behavior of people and organizations for the benefit of children and families. 

Promising Approaches to Implementation

The most promising approaches to implementation address known challenges (3,5-9). In particular, four common features (10) are key to developing local implementation capacity and effective performance to support use of the practice model for getting to improved outcomes: 

• Linked, local leadership and implementation teams (Organizational Readiness Building). People at multiple levels of an organization are specifically resourced and tasked to come together and attend to the day-to-day and ongoing leadership and management activities necessary for effective implementation. Teams of executive leaders, staff and other partners have functional roles and dedicated, on-the-job resources for implementation. Organizational and system practices facilitate progress and problem-solve implementation challenges (6,11-16). Tools and resources focus on assessing, monitoring, and improving organizational culture, climate, functional structures, and processes to support implementing change.
• Workforce and Professional Development. Ongoing professional development plans and practices (often referred to as training and coaching) for the practice model are in place and build on adult learning best practices. This capacity builds the confidence and skills of staff at all levels—those delivering the practice model and the supervisors, managers, and other leadership who support them. This focus on continuing support to deliver the innovation as intended is another key challenge identified in research and practice (17-19). Tools and resources focus on assessing diverse staff needs, supporting the coaching role of supervisors, and strengthening staff retention.
• Engagement, Relationships and Partnership. Internal stakeholders, community, tribal members and system partners are actively involved in co-creating implementation capacity to support getting the practice model into real-world practice. Partners play active roles in listening to identify strengths/barriers, establishing culturally relevant supports and services, detecting practice changes, addressing system barriers and communication and feedback for improvement (20-22). Tools and resources focus on defining and formalizing partnering roles and the adaptive and other leadership behaviors necessary to support them.
• Quality, Outcome and System Monitoring for Improvement. Information and data about implementation, delivery of the practice model, and outcomes are gathered, shared, reviewed, and used by the right people at the right time in order to address problems and improve practices. Organizational and system practices support this ongoing quality improvement work (14,15,23,24). Tools and resources focus on identifying “What do we want to know? How will we know it?” and using data to understand and reinforce what is going well and to address challenges.

So What Does Paying Deliberate Attention to the Process of Implementing a Strategy Mean to You and Your Agency?

People often get trained in something, and then come back to their same organizational environment and expected to “do it” well and as intended, even though the environment—active support from leadership; resources such as parent partners to help staff engage families; ongoing coaching to help them apply “it” in different situations; and getting and using data to understand and improve “what it takes” for it to work—is not really supporting it. There is no one-size-fits-all approach to the process of implementation. You must make it relevant and feasible based on your own local context. 

What might you take on that could help your county strengthen “what it takes” to effectively support the use of change strategies? Focus deliberately on the four features of effective implementation, and whatever you start on, it will be great!

References

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5.    Aarons GA, Sommerfeld DH. Leadership, innovation climate, and attitudes toward evidence-based practice during a statewide implementation. Journal of American Academy of Child and Adolescent Psychiatry. Apr 2012;51(4):423-431.
6.    Waltz TJ, Powell BJ, Matthieu MM, et al. Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: results from the Expert Recommendations for Implementing Change (ERIC) study. Implementation Sci. 2015;10(1):1.
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