Implementation

What is implementation science?

Implementation science (IS) is a field of study that seeks to identify optimal methods and strategies for accelerating and facilitating the systematic implementation, sustainability, and scale-up of EBIs into regular use by practitioners and policymakers (Eccles & Mittman, 2006). 

Implementation is very important as the things we implement to help people will not help if they are not implemented well. Most implementation efforts fail, even with a plan in place, due to multi-level contextual factors that act as barriers to implementation.

How do we offer support?

We work with projects to ensure they have an impact. We do this by forming relationships with teams and working with them to find an approach to implementation that works for everyone. Individuals like healthcare workers, teachers, research teams, patients are the experts of their own setting and we believe that when empowered and supported they are the best people to accomplish implementation success.

Implementation science offers a range of theories, models and frameworks that can be useful for researching, planning for, carrying out and evaluating implementation. However, working with the improvement science team, we have found that a combination of IS and quality improvement (QI) practices form the most powerful approach to addressing implementation. 

Quality Improvement (QI) methodology accomplishes change through small tests of change at the local microsystem level using Plan, Do, Study, Act (PDSA) cycles. When tests of change, such as through PDSA cycles, are carried out carefully they can allow for a great deal of learning in regards to the microsystem and local context which can in turn inform the change process.

 Implementation science does not strongly emphasise this use of reporting and recursive change but it does provide methods and approaches to capture, assess and report adaptations and sees them as an essential part of generating knowledge that can be shared with others. QI does not emphasise spread to other contexts as strongly. It can therefore be argued that implementing evidence-based practice requires both QI and IS to promote adoption and sustainability. 

While teams get on with the difficult job of carrying out implementation we provide an evaluative structure to make sure all the workarounds, adaptations, articulations and goal changes are successfully captured in the face of uncertainties, inconsistencies and contextual influences. IS provides frameworks and approaches to capturing and evaluating these learnings and translating them into more generalisable and transportable findings that can be shared with future settings. 

Our objectives

• Form meaningful relationships with stakeholders and work with them to implement interventions effectively

• Offer a range of implementation support 

• Writing and designing implementation work packages for projects starting out

• Carrying out rapid, relevant and responsive evaluations for projects

• Using implementation science frameworks to support projects and their analysis and understanding of implementation

• Provide online training videos for stakeholders across the ARC

• Use a combination of IS and QI approaches to ensure projects have an impact

Current projects

• PRIMROSE - Heart disease prevention for people with Serious Mental Illness

• ADAPT - Trauma focused Cognitive Behavioural Therapy (CBT) for young people in care

• BRUSH - Toothbrushing programmes for children in UK schools

• RAVEN - Independent Domestic Violence Advisors on maternity wards

• COMMUNITY – Community health checks

• NIPP - Unscheduled care coordination hubs

• CONNECT – Patient decision aids and shared decisions making

• ATTEND – Mindfulness based interventions for young people using Child and Adolecscent Health Services

• CHOICES -   CHildren and young people's Options In the Community for Enhancing wellbeing through Social prescribing