Lecture 9: Implementation Flashcards
Name two aspects of the research practice gap and it’s consequence
- Translating research findings into practice is slow
- Translating research findings is often not effective
Consequence: Interventions and resources are inaccessible to the general population and patients wil not benefit from te new science
Why is implemention important? Also provide three arguments
Effective intervention will only have real-world impact if the implementation is effective
- Improve quality and safety of healthcare
- Improve effectiveness of healthcare
- Use of new innovation or intervention into routine practice
Implementation can be defined as…
… a specified set of activities designed to put into practice an activity or program
What is implementation science?
The scientific study of methods to promote the systematic uptake of research findings into routine practice
Implementation research involves…
- Theory and empirical research on various factors influencing succesful implementation
- Design and evaluation of strategies to adress barriers or enablers to implementation in a given context
- Understanding the process of implementation itself; what gets implemented, when, why and how?
Name the key elements of the theoretical framework for implementation
Determinants:
- Social-political context
- Organizations
- User
- Innovation
Implementation strategy:
- Should target the determinants, and should be tailored to the target group
Innovation process:
- Adoption
- Implementation
- Continuation
What different models theories and frameworks exist?
1. Process models (knowledge-to-action frameworks)
2. Determinants frameworks (CFIR)
3. Classic theories (Roger’s theory of fiffusion)
4. Implementation theories (COM-B)
5. Evaluation frameworks (RE-AIM)
How to implement? Name the 9 steps
- Identifying the goals and the target groups
- Analyzing the target groups
- Examening the innovation
- Examening the context
- Selecting the strategy
- Planning actions and communicating the approach
- Monitor and evaluation
- Get to work
- Scaling up
Step 1: Identifying the goals and target groups, name the three steps involved
- Formulate SMART goals
- Identifying the target group (organizations, departments, teams, individuals)
- What do the target groups need to know, think and do?
Step 2: Analyzing the target groups
3 steps
- Understand different roles and perspectives
- What is their role?
- What are their interests?
- What do they know about the subject?
- What do they think about the change?
- What info do they need?
- How would they like to be approached?
- How can they be reached?
- Identify innovators, early adopters, early/ late majority, and laggards (Roger’s diffusion theory)
- Use different implementation strategies to target different groups
Step 3: Examening the innovation
- Identify strengths and weaknesses
Strengths: evidence based, aligns with politics, clearly described content
Weaknesses: complicated to implement, time consuming, cost-effectiveness unclear §§
Step 4: Examening the context
Context examples
Examples
Social-political:
- support municipalties?
Organizational context:
- Availability of financial partners?
- Staff turnaround
- Alignment with vision/ mission of organization
Step 5: Selecting the strategy
commenly used strategies
Commenly used strategies:
- Audit feedback
- Computerized reminders
- Educational meetings
- Facilitation
- Educational outreach
- Fanancial incentives
- Local opinion leaders
- Printed educational materials
Step 5: selecting a strategy for early adopters
Motivation, influencing factor, methods
Motivation:
- Intrinsic, they’re up for a change and see advantages
Influencing factor:
- Cognition
Methods:
- Good scientifically valid info from reliable resources
Step 5: selecting a strategy for in-between groups (early/ late majority)
Motivation, influencing factor, methods
Motivation:
- Sensative to social pressure, they want to belong
Influencing factor:
- Attitude
Methods:
- Using key figures
- Peer group activities
- Feedback from collegues
