"MIND THE IMPLEMENTATION GAP: How implementation science helps get research into practice" Jane Lewis, Director of Implementation Support, The Colebrooke Centre for Evidence and Implementation at the SRA annual conference 2013

1. MIND THE IMPLEMENTATION GAP
How implementation science helps get
research into practice
SRA annual conference 9 December 2013
Jane Lewis
Director of Implementation Support
The Colebrooke Centre for Evidence and Implementation

2. About the Colebrooke Centre
• first and only UK centre specialising in implementation
science and practice in child and family services
• social enterprise, not-for-profit
• services
– design and selection of interventions
– implementation strategies and support
– implementation evaluation
• for local government, voluntary sector, central
government, philanthropies, improvement bodies
• leading application and development of implementation
theory, evidence and frameworks for UK context
© Colebrooke Centre for Evidence and Implementation 2013

3. Evaluation of My Baby’s Brain –
Hertfordshire County Council
© Colebrooke Centre for Evidence and
Implementation 2013

4. Let Teachers Shine –
Shine Foundation
© Colebrooke Centre for Evidence and
Implementation 2013

5. The science-practice gap
© Colebrooke Centre for Evidence and Implementation 2013

6. The science-practice gap
Research
dissemination
and translation
initiatives
© Colebrooke Centre for Evidence and Implementation 2013

7. Blank slide for charts etc.
© Colebrooke Centre for Evidence and
Implementation 2013

8. The science-practice gap
Research
dissemination
and translation
initiatives
© Colebrooke Centre for Evidence and Implementation 2013

9. The science-practice gap
Implementation
Research
dissemination
and translation
initiatives
© Colebrooke Centre for Evidence and Implementation 2013

10. The implementation gap
• what is known is not adopted by policy / practice
but also …
• what is adopted is not operationalised as
intended
• what is operationalised as intended is not
sustained
• what is operationalised as intended is not used at
scale
© Colebrooke Centre for Evidence and Implementation 2013

11. Implementation
• active and planned efforts to identify approaches
that (will) work and to deliver them sustainably and
at scale in ways that maximise their effectiveness
• from letting it happen to helping it happen
to making it happen (Greenhalgh et al, 2004)
• ‘the nexus between research and practice’ (Chaudoir
et al, 2013)
© Colebrooke Centre for Evidence and Implementation 2013

12. © Colebrooke Centre for Evidence and Implementation 2013

13. The emergence of implementation science
• systematic study of implementation informed
by theory
– processes, strategies, contexts
– to produce evidenced and replicable methods,
frameworks and systems
• draws on all research methods
• beyond evidence-based programmes and
narrow questions of fidelity (Ghate, 2013)
© Colebrooke Centre for Evidence and Implementation 2013

14. Implementation matters!
“The level of implementation achieved is an
important determinant of programme
outcomes. Achieving good implementation
… can lead to much stronger benefits for
participants.”
Durlak and Dupre, 2008 – review of over 500 quantitative studies
© Colebrooke Centre for Evidence and Implementation 2013

15. Anything times zero is zero
effective
practices
effective
implementation
enabling
contexts
Used with permission of NIRN
© Colebrooke Centre for Evidence and Implementation 2013
intended
outcomes

16. What doesn’t work
• disseminating research and good practice
© Colebrooke Centre for Evidence and Implementation 2013

17. © Colebrooke Centre for Evidence and Implementation 2013

18. What doesn’t work
• disseminating research and good practice
• Just Do It
© Colebrooke Centre for Evidence and Implementation 2013

19. What doesn’t work
•
•
•
•
disseminating research and good practice
Just Do It
training
guidelines
© Colebrooke Centre for Evidence and Implementation 2013

20. © Colebrooke Centre for Evidence and Implementation 2013

21. we need to get better at turning
research into something that can
be implemented
© Colebrooke Centre for Evidence and Implementation 2013

22. principles
populations
practices
implementation
supports
© Colebrooke Centre for Evidence and Implementation 2013

23. what is the ‘it’ in ‘does it work?’ or
‘should it be rolled out?’
© Colebrooke Centre for Evidence and Implementation 2013

24. we need to get better at
researching implementation
© Colebrooke Centre for Evidence and Implementation 2013

25. Implementation stages
installation
initial
implement’n
full
implement’n
exploration
Fixsen et al, 2005; Metz and Barclay, 2012
© Colebrooke Centre for Evidence and Implementation 2013
sustained
implement’n

26. Implementation stages
installation
initial
implement’n
full
implement’n
exploration
Fixsen et al, 2005; Metz and Barclay, 2012
© Colebrooke Centre for Evidence and Implementation 2013
sustained
implement’n

27. Implementation stages
installation
initial
implement’n
full
implement’n
sustained
implement’n
exploration
Substantive innovations take 2-4 years to full implementation
Fixsen et al, 2005; Metz and Barclay, 2012
© Colebrooke Centre for Evidence and Implementation 2013

28. Implementation strategies
planning
policy context
educating
quality
management
financing
infrastructure
Powell et al, 2012
© Colebrooke Centre for Evidence and Implementation 2013

29. Implementation drivers
Integrated &
Compensatory
Leadership
© Fixsen & Blasé, 2008

30. A very chilling thought!
“All organizations
[and systems] are designed,
intentionally or unwittingly,
to achieve precisely the
results they get”
R Spencer Darling
© Colebrooke Centre for Evidence and Implementation 2013

31. Systems support for innovation
Prism
Prison
© Colebrooke Centre for Evidence and Implementation 2013

32. Where implementation outcomes fit in –
expanding the ‘logic model’
Inputs
Outputs
Implemen
tation
Outcomes
Service or
treatment
outcomes
© Colebrooke Centre for Evidence and Implementation 2013
Impact

33. Key messages
• implementation matters – it’s key to getting
research into policy and practice
• moving forward requires partnerships
• get better at turning research into something that
can be implemented
• get better at researching implementation
• get better at implementation
© Colebrooke Centre for Evidence and Implementation 2013

34. References
Chaudoir S, Dugan A and Barr C (2013) ‘Measuring factors affecting implementation of health innovations: a
systematic review of structural, organizational, provider, patient, and innovation level measures’
Implementation Science 8:22
Durlak J and DuPre E (2008) ‘Implementation Matters: ‘A Review of Research on the Influence of
Implementation on Program Outcomes and the Factors Affecting Implementation’ American Journal of
Community Psychology 41: 327:350
Fixsen D, Naoom S, Blasé K, Friedman R and Wallace F (2005) Implementation Research: A synthesis of the
literature National Implementation Research Network Tampa FL: University of South Florida
Ghate D (2013) ‘Good enough: when is evidence-based intervention ready for dissemination?’ Pre-conference
discussion paper for Jacobs Foundation conference London: The Colebrooke Centre for Evidence and
Implementation http://www.cevi.org.uk/docs/Good_Enough_Ghate_2013.pdf
Greenhalgh T, Robert G, MacFarlane F, Bate P and Kyriakidou O (2004) ‘Diffusion of Innovations in Service
Organizations: Systematic Review and Recommendations’ Milbank Quarterly vol 82 (4) 582-629
Lipsey M (2009) ‘The primary factors that characterise effective interventions with juvenile offenders: a metaanalytic overview’ Victims and Offenders 4: 124-147
McIntosh K, Martinez R, Ty S and McClain M (2013) ‘Scientific research in school psychology: leading
researchers weight in on its past, present and future’ Journal of School Psychology 51 267-318
Metz and Barclay (2012) ‘Active implementation frameworks for program success’ Zero to 3 March 2012 11-18
Meyers D, Durlak J and Wandersman A (2012) ‘The Quality Implementation Framework: A synthesis of critical
steps in the implementation process’ American Journal of Community Psychology 50:462-480
Powell B, McMillen J, Proctor E, Carpenter C, Griffey R, Bunger A, Glass J and York J (2012) ‘A Compilation of
Strategies for Implementing Clinical Innovations in Health and Mental Health’ Medical Care Research and
Review 69(2) 123-157
© Colebrooke Centre for Evidence and Implementation 2013

35. The Colebrooke Centre for Evidence and Implementation
55 St John Street
London EC1M 4AN
0203 551 7666
jlewis@cevi.org.uk
www.cevi.org.uk
© Colebrooke Centre for Evidence and
Implementation 2013