December Lunchtime Talk with Allison Metz

1. Implementation Science
below the Waterline
The Role of Trust and Psychological Safety in
Use of Evidence
Allison Metz
Professor of the Practice and Director of Implementation Practice
December 2021

2. Objectives
• Define implementation science and its goal to improve outcomes and
advance for people and communities
• Describe how implementation science could be strengthened by
recognizing the roles of trust, power, and psychological safety
• Provide a case example
• Examine and reflect on the roles of professionals who support
implementation efforts

3. Check-in
In the chat, please share:
• Name, affiliation, pronouns
• How are you today?
• What is one thing that comes to
mind when you think about what it
takes to implement something?

4. Defining Implementation Science

5. Implementation Science
Estabrooks and colleagues 2018
Implementation science is the study of the factors that lead to uptake,
scale and sustainability of practices, programs and policies with evidence
behind them.
The purpose of implementation science is to create a bridge between
research evidence and the real-world settings of service delivery to
improve outcomes for those being served.

6. Implementation Science
Implementation science includes research and practice
Seeks to understand the approaches that work
best to translate research to the real world
(Ramaswamy, et al., 2019)
Seeks to apply and adapt these approaches in
different contexts settings to achieve outcomes
Implementation
Research
Implementation
Practice

7. The Future of Implementation
While the field of
implementation science
includes many frameworks,
theories, models, and
strategies, a blueprint for
the real work that needs to
happen to support people
and organizations to change
does not exist.
(Powell et al., 2015)

8. Mechanisms of Change
(Lewis et al., 2018)
Implementation
Strategies
Mechanism Moderator
Proximal
Outcome
Distal
Outcome

9. What’s Missing?
Centering the Human Experience in Implementation
The truth is that the deeper work of supporting organizational
and social change happens below the surface where there is little
light, and we strain to see what is actually happening and what
people are actually feeling.

10. The Role of Psychological Safety in
Implementation Science

11. The Role of Psychological Safety in Implementation Science
Implementation relies on collaborative learning, taking
risks, and failures. At the center of this is vulnerability,
trust and psychological safety.

12. Characteristics of a Safety Culture
• Staff feel valued and appreciated for their contributions
• Staff have the tools and resources to work effectively
• “Learning Organization” where staff are encouraged to try new things, ask “what went
wrong?” and learn from mistakes
• Agency where the physical and emotional well-being of staff is nurtured and protected
• Prioritizes racial equity and inclusivity
• Support from leadership, supervisors and peers
• Job is understood and valued by the community

13. Why this Matters in our Implementation Work
If psychological safety – and more
broadly a culture of safety – does not
exist, implementation efforts will be
challenged. We believe that assessing
and building a culture of safety should be
centered in our implementation practice.
Here are just a handful of ways that it
could be helpful, but the list is endless!
• Readiness Assessments
• Team Development
• Communication and Feedback Loops
• Training and Coaching
• Leadership
• Champion Development
• Using Data for Improvement

14. Case Example

15. Case Example
from Public
Child Welfare
• Case Management
• Evidence-Based Practices
• Systems Chance
Develop and implement a prevention
practice model aligned with the
Family First Prevention Services Act

16. Child Welfare Organizational Data
Turnover rates ranged from 20% to 40% annually across the agencies
All staff reported experiencing high job stress and some amount of work-related
burnout (feeling worn out at the end of the workday and being emotionally
exhausted from work)
- 49% of caseworkers and 63% of supervisors
- 50% report workload is too high
46% of staff reported PTSD-level symptoms of secondary traumatic stress
symptoms

17. Low psychological safety (feeling unsafe to take risks, undermined,
afraid to disagree)
Over 60% of staff experienced Moral Distress
• This job requires action against their better judgement
Physical safety:
• 73% of staff have been yelled out, or sworn at by a client
• 37% have been physically threatened
Staff report more organizational bias and prejudice and
discrimination in the workplace compared to white staff
Child Welfare Organizational Data

18. Implementation Considerations
Utilize safety strategies to support implementation:
• Take time to understand organizational climate
• Create teaming structures for safe participation
• Foster distributive and inclusive leadership opportunities
• Listen to stakeholder voices
• Attend to racial equity issues in the organization
• Allow for staff to try new things, make mistakes and avoid blaming and shaming

19. Transformational Change
Implementation efforts often focus on what we can see – tangible events
such as trainings, data collection activities, and meetings – and pay less
attention to the “mental models” of leaders, team members, and
community stakeholders.
Mental models affect the structures we put in place, the way we interpret
information and interact with others, and how we make decisions.

20. Example: Jamboard Activity and Discussion
• What do we need to do as a team to focus on the the
bottom of the triangle (mental models) and achieve
transformational change?
• What might hinder our ability to focus on the bottom of
the triangle (mental models)?

21. Example:
Jamboard
Activity
and
Discussion

22. Example:
Jamboard
Activity
and
Discussion

23. Check-in
How do you support teams to
achieve psychological safety,
while simultaneously meeting
funder and agency demands for
deliverables that fall above the
water line?

24. Implementation Support Practitioner
Principles and Competencies

25. Who Are Implementation Support Practitioners?
Implementation support practitioners are professionals
who support organisations, leaders and staff in their
implementation of evidence-informed practices and
policies. They identify, contextualise and improve the use
of evidenced implementation strategies in a range of
settings. They also build implementation capacity among
teams, organisations and systems.

26. Background
• There is an increasing call for the advancement of a workforce capable of integrating
implementation research into practice to support evidence use, advance equity, and
achieve improved population outcomes.
• The shortage of individuals trained in the practice of implementation has been cited
as a reason for our failure to optimize the use of evidence.
• This William T. Grant funded study explored the use of competencies by
professionals who support evidence use in human service systems and the
conditions under which specific implementation strategies were perceived as most
effective.

27. Principles
and
Competencies
Grow and sustain relationships
Develop teams
Build capacity
Cultivate leaders and champions
Co-learning
Brokering
Address power differentials
Co-design
Tailor support
Assess needs and assets
Understand context
Apply and integrate
implementation frameworks,
strategies, and approaches
Facilitation
Communication
Conduct improvement cycles
SUSTAINING
CHANGE
ONGOING
IMPROVEMENT
CO-CREATION
AND
ENGAGEMENT
Be empathetic
Be curious
Be committed
Embrace cross-disciplinary
approaches
Advance equity
Use critical thinking
(Metz et al., 2020)

28. Findings
• Respondents reported using strategies across domains to support evidence-use,
including co-creation and engagement, ongoing improvement, and sustaining
change.
• Trusting relationships emerged as a ubiquitous fixture of the implementation
support process.
Respondents described trusting relationships as directly associated with
successful implementation and use of evidence and bidirectionally associated
with (and reinforcing of) all other implementation strategies

29. Relevance
• Findings reflect that implementation support is a multi-faceted endeavor that requires
a broad range of skills.
§ Respondents enacted technical strategies (e.g., supporting data use), while simultaneously
carrying out relational strategies (e.g., building trusting relationship, addressing power
differentials).
• Relationships appear to be as important as technical strategies and may explain why
perfectly offered implementation support at times remains unsuccessful in leading to
sustained evidence use.
• Building a workforce capable of supporting evidence-use will require developing skills
for building trusting relationships.

30. Research
on
Relationships
Implementation Support
Authenticity, vulnerability, and empathy
Building relationships through:
• Humility
• Honesty
• Credibility
• Responsiveness
• Commitment

31. Research
on
Relationships
Implementation Support
Evidence of a good relationship:
• Transparency
• Mutuality
• Comfort asking for help
• Sharing information
• Capacity to stay in difficult situations
Authenticity, vulnerability, and empathy

32. Check-in
How can we reconcile gaps in
implementation science
approaches related to the human
experience and group dynamics?

33. Thank you!
Allison Metz, Ph.D. (she/her/hers)
Professor of the Practice and Director of Implementation Practice, School of Social Work
Faculty Fellow, FPG Child Development Institute
UNC Chapel Hill
202-714-4576
Allison.metz@unc.edu
@allisonjmetz @imppractice
www.implementationpractice.org