Barbara Sims

Dean L. Fixsen

Karen A. Blase

Michelle A. DudaWrightsville Beach, NC

October 2012

Implementation for a Change

RtI Best Practices Institute

Complex Problems

Human services involve interaction-based sciences

Inherently more complex than atom-based sciences

E.g., atom-based ingredients don’t refuse to be ingested, talk back, or run away

Ineffective Approaches

Best data show these methods, when used alone, Do Not result in uses of innovations as intended:

Diffusion/ Dissemination of information

Training

Passing laws/ mandates/ regulations

Providing funding/ incentives

Organization change/ reorganization

5 to 10% return on investment

NECESSARY BUT NOT SUFFICIENT

System Change

EXISTING SYSTEM

EFFECTIVE INNOVATIONS

ARE CHANGED TO

FIT THE SYSTEM

EXISTING SYSTEM IS

CHANGED TO SUPPORT

THE EFFECTIVENESS OF

THE INNOVATION

EFFECTIVE INNOVATION

Implementation Gap

RESEARCH PRACTICEGAP

Implementation is defined as a specified set of activities designed to put into practice an activity or program of known dimensions.

IMPLEMENTATION

Why Focus on Implementation?“Students cannot benefit from

interventions they do not experience.”

“A serious deficiency is the lack of expertise to implement best practices and innovations effectively and efficiently to improve student outcomes.”Rhim, Kowal, Hassel, & Hassel (2007)

Developing the Capacity to

Implement Well

Implementation Science

Implementation science is the scientific study of variables and conditions that impact changes at practice, organization, and systems levels; changes that are required to promote the systematic uptake, sustainability and effective use of evidence-based programs and practices in typical service and social settings.

~Blase and Fixsen, 2010 National Implementation Research Network

Implementation Science

Effective NOT Effective

Effective

NOT Effective

IMPLEMENTATION

INT

ER

VE

NT

ION Actual Benefits

(Institute of Medicine, 2000; 2001; 2009; New Freedom Commission on Mental Health, 2003; National Commission on Excellence in Education, 1983; Department of Health and Human Services, 1999)

Inconsistent; Not Sustainable; Poor outcomes

Unpredictable or poor outcomes;

Poor outcomes; Sometimes harmful

from Mark Lipsey’s 2009 Meta-analytic overview of the primary factors that characterize effective juvenile offender interventions – “. . . in some analyses, the quality with which the intervention is implemented has been as strongly related to recidivism effects as the type of program, so much so that a well-implemented intervention of an inherently less efficacious type can outperform a more efficacious one that is poorly implemented.”

Formula for Success

Effective Intervention practices

Effective Implementation practices

Improved Outcomes

X

=

1.0

X

0.0

=

0.0

Plan for Change

District is the point of entry for systemic support of school improvement Use short-term infusion of resources

Establish long-term, district-based capacity for quality

Shifting Accountability

SISEP 2012

Student Practitioner System

Cascading Logic Model

Improve student outcomes Improve teacher instruction

Improve school supports for teachers

Improve district supports for schools

Improve regional supports for districts

Improve State supports for outcomes

Re-define relationships among system componentsFocus fully on student outcomes

Implementation Drivers

Implementation Stages

Implementation Teams

Improvement Cycles

Active Implementation Frameworks

Active Implementation Frameworks

Successful implementation on a useful scale requires. . . Active use of implementation core components

“best practices”– “IMPLEMENTATION DRIVERS” Purposeful matching of critical implementation

activities to the stage of the process – “STAGES OF IMPLEMENTATION”

Organized, expert assistance – “IMPLEMENTATION TEAMS”

A focus on continuous, purposeful improvement – “IMPROVEMENT CYCLES”

IMPLEMENTATION DRIVERS

Common features of successful supports to help make full and effective use of a wide variety of innovations

© Fixsen & Blase, 2008

Performance Assessment(Fidelity)

Coaching

Training

Selection

Systems Intervention

Facilitative Administration

Decision Support Data System

Adaptive Technical

Integrated & Compensatory

Com

pete

ncy

Driv

ers

Com

pete

ncy

Driv

ers O

rganization Drivers

Organization D

rivers

LeadershipLeadership

Improved educational outcomes

Interventions meetImplementation

Consistent Use of

Educational Innovations

© Fixsen & Blase, 2008

Performance Assessment(Fidelity)

Coaching

Training

Selection

Technical

Com

pete

ncy

Driv

ers

Com

pete

ncy

Driv

ers

© Fixsen & Blase, 2008

Competency Drivers

Build Competency and Confidence

Develop, improve, and sustain competent & confident use of innovations

Performance Assessment

Measure fidelity

Ensure implementation

Reinforce staff and build on strengths

Feedback to agency on functioning of Recruitment and Selection Practices Training Programs (pre and in-service) Supervision and Coaching Systems Interpretation of Outcome Data

Selection

Select for the “unteachables”

Screen for pre-requisites

Set expectations

Allow for mutual selection

Improve likelihood of retention after “investment”

Improve likelihood that training, coaching, and supervision will result in implementation

Training

Develop Training Plan

Define critical components

Aspects requiring new knowledge

Aspects requiring new skills

Prioritize training topics

Identify or develop fidelity measures

Coaching

Develop Coaching Plan

Ensures fidelity

Ensures implementation

Provides feedback to selection and training processes

Grounded in “Best Practices”

Training and Coaching OUTCOMES

% of Participants who Demonstrate Knowledge, Demonstrate New Skills in a Training Setting,

and Use new Skills in the Classroom

TRAINING

COMPONENTSKnowledge Skill

DemonstrationUse in theClassroom

Theory and Discussion

10% 5% 0%

..+Demonstration in Training 30% 20% 0%

…+ Practice & Feedback in Training 60% 60% 5%

…+ Coaching in Classroom

95% 95% 95%

Joyce and Showers, 2002

© Fixsen & Blase, 2008

Performance Assessment(Fidelity)

Coaching

Training

Selection

Systems Intervention

Facilitative Administration

Decision Support Data System

Adaptive Technical

Com

pete

ncy

Driv

ers

Com

pete

ncy

Driv

ers O

rganization Drivers

Organization D

rivers

LeadershipLeadership

Reflection Implementation Drivers

How do we support the development of the infrastructure needed to implement well?How do we promote more hospitable organizational environments? How relevant are leadership issues? What’s our role?

SupportingNew Ways of

Work

Active Implementation Frameworks

Successful implementation on a useful scale requires. . . Active use of implementation core components

“best practices”– “IMPLEMENTATION DRIVERS” Purposeful matching of critical implementation

activities to the stage of the process – “STAGES OF IMPLEMENTATION”

Organized, expert assistance – “IMPLEMENTATION TEAMS”

A focus on continuous, purposeful improvement – “IMPROVEMENT CYCLES”

STAGES OF IMPLEMENTATION

Purposeful matching of critical implementation activities to the stage of the process

SISEP 2012

Stages of Implementation

2 - 4

Years

Fixsen, Naoom, Blase, Friedman, & Wallace, 2005

EXPLORATION

INSTALLATIO

N

INITIA

L

IMPLEMENTATIO

N

FULL

IMPLEMENTATION

Integrated & Compensatory

Com

pete

ncy D

river

s Organization Drivers

Leadership

Exploration

Formalize Team Structures

Develop Communication Plan

Determine Need and Identify Options

Assess “Fit” and Feasibility

Promote “Buy in” for the innovation and for implementation supports

“Pay now or pay later.”

Installation

Structural and functional changes are made

First implementers selected

Define and initiate training of first implementers

Develop coaching plans

Evaluate readiness and sustainability of data systems

Establish communication links and protocols

Initial Implementation

Initiate training plan

Provide coaching

Make use of improvement cycles Communication links and protocols

PDSA to resolve systems issues

Usability testing of selection, training and coaching

Full Implementation

Skillful practices by all staff

Evaluation for expected outcomes

Full use of Implementation Drivers

Policy changes/development for sustainability

“The only thing worse than failing and not knowing why you failed, is succeeding and not

knowing why you succeeded.” ~ Jane Timmons-Mitchell

ACTIVITY Stages of Implementation Analysis

• What are you already doing that is “stage-based”?

• What are the facilitators and barriers to doing stage-based work?

• Discuss the Exploration and Installation Stage indicators.

SupportingNew Ways of

Work

Active Implementation Frameworks

Successful implementation on a useful scale requires. . . Active use of implementation core components

“best practices”– “IMPLEMENTATION DRIVERS” Purposeful matching of critical implementation

activities to the stage of the process – “STAGES OF IMPLEMENTATION”

Organized, expert assistance – “IMPLEMENTATION TEAMS”

A focus on continuous, purposeful improvement – “IMPROVEMENT CYCLES”

IMPLEMENTATION TEAMS

Organized, expert assistance to develop and sustain an accountable structure

Impl. Team NO Impl. Team

Effective

Making it Happen

IMPLEMENTATION

INT

ER

VE

NT

ION

80%, 3 Yrs 14%, 17 Yrs

Balas & Boren, 2000 Green & Seifert, 2005

Fixsen, Blase, Timbers, & Wolf, 2001

Letting it Happen Helping it Happen

Implementation Team

School-basedImplementation

Team

School-basedImplementation

Team

District-basedImplementation

Team

District-basedImplementation

Team

Regionally-basedImplementation

Team

Regionally-basedImplementation

Team

State-basedImplementation

Team

State-basedImplementation

Team

“We tend to focus on snapshots of isolated parts of the system and wonder why our

deepest problems never seem to get solved. (Senge, 1990)

Linked Team Structures

ACTIVITY Table Talk: Implementation Teams

• In your experience, who supports the change process?

• How is the transition made from external expertise to building internal capacity?

SupportingNew Ways of

Work

Active Implementation Frameworks

Successful implementation on a useful scale requires. . . Active use of implementation core components

“best practices”– “IMPLEMENTATION DRIVERS” Purposeful matching of critical implementation

activities to the stage of the process – “STAGES OF IMPLEMENTATION”

Organized, expert assistance – “IMPLEMENTATION TEAMS”

A focus on continuous, purposeful improvement – “IMPROVEMENT CYCLES”

IMPROVEMENT CYCLES

Changing on purpose to support the new way of work

SISEP 2012

Types of Improvement Cycles

Plan-Do-Study-Act Cycles

Usability testing (Neilson; Rubin)

Practice-policy communication loops

PDSA

Usability Testing

Policy Practice Feedback Loops

Policy (Plan)

Practice (Do)

Fee

db

ack

Stu

dy - A

ctP

oli

cy E

nab

led

Pra

ctic

es(P

EP

)

Pra

ctic

e In

form

ed P

oli

cy(P

IP)

Exp

ert

Imp

lem

enta

tio

n S

up

po

rtPolicy

Practice

Structure

Procedure

FORM SUPPORTS FUNCTION

ACTIVITY Table Talk: Improvement Cycles

and Communication Loops

• How can we make use of improvement cycles in developing and implementing our improvement activities?

• Linking Communication Protocols

SupportingNew Ways of

Work

Summary

Conceptualize a change process so that effective interventions for children and families can become embedded and sustained in socially complex settings “stage-matched activities to guide the process

“implementation drivers” to build the infrastructure

Improvement processes are critical the work is never done because the environment is

in motion

Invest in the development of organized, “expert” implementation support

Stay Connected!

www.scalingup.org

SISEP @SISEPcenter

For more on Implementation Sciencehttp://nirn.fpg.unc.edu

www.implementationconference.org