Lecture 10 & 11 Implementation Flashcards
What is implementation
A specified set of activities designed to put an activity or program of known dimensions into practice.
What is the sum of successfulness used for implementation?
Effective intervention x enabling context x effective implementation methods = socially significant outcomes.
Explain the model of Fleuren about the enabling context which is part of the successful implementation equation.
Facilitators or barriers have four different levels:
1. innovation
2. user
3. organization
4. social-political context.
- They can span more of these levels or just one of them.
With use of an implementation strategy, you can come to the dissemination phases, which are:
- adoption
- implementation
- and then maintenance
in that specific order.
Explain the four different levels of facilitators and barriers of the Fleuren model in keywords.
- Innovation: Proven effectiveness, complexity, adaptable to context, access, ownership and maintenance.
- Users: motivation, involvement, perceived relevance, knowledge, skills, self-efficacy, confirmation to social norms, habits.
- Organization: commitment top, culture and leadership, multidisciplinary teams, resources.
- Social-political context: legal and justice factors, policy of professions, national policy, finances, reimbursement.
What are implementation strategies?
It is the how of implementation.
Methods or techniques are used to enhance adoption, implementation, and sustainability of a program or practice.
It is a systematic intervention process to adopt and integrate evidence based innovations into usual care.
Do you need one or more of implementation strategies in an implementation plan?
Multiple strategies are combined in an implementation plan. One activity can contain more strategies and can thus address different barriers. Or one barrier can be tackled by different strategies.
What are the most used implementation strategies. Give another five examples of strategies.
Most used:
- development of clear and useful materials
- mass media and personal training about the intervention.
- training / coaching at the start and during implementation
- Feedback on implementation / share experiences
- support, coordinator, helpdesk.
Providing information motivation and support Education Feedback Modelling
What is the focus of an implementation plan?
For new programs, demonstration, and research projects:
- to ensure the program is used as intended during the evaluation trial.
For programs that have already been implemented and evaluated:
- to enhance dissemination or ‘scale-up’ for widespread use.
What are the tasks of an implementation plan?
- identify potential program implementers
- state outcomes and performance objectives for program use
- construct matrices of change objectives for program use
- design implementation intervention.
What are recipes for a successful implementation?
- tackle mismatch between programme and implementers
- Use process evaluation as input for implementation plan
- involve implementation stakeholders
- involve potential roll out stakeholders
- think of practical implications.
What is implementation science?
Scientific study of methods that promotes the systematic uptake of research findings and other EBP into routine practice. It includes the study of influences on healthcare professionals and organisational behaviour.
What is a voltage drop?
A drop in the effect of an intervention in the time between the efficacy trial and the implementation trial.
What is a program drift?
- The people who use the program drift from the original protocol and thus affect the results.
- (in real life -> people can change the program alittle -> influences the effect)
What are the five levels of stakeholders?
- target population
- Implementer / user / provider
- organisation
- socio political context
- sustainability
