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Article
Publication date: 21 July 2021

Mitchell Sarkies, Suzanne Robinson, Teralynn Ludwick, Jeffrey Braithwaite, Per Nilsen, Gregory Aarons, Bryan J. Weiner and Joanna Moullin

As a discipline, health organisation and management is focused on health-specific, collective behaviours and activities, whose empirical and theoretical scholarship…

Abstract

Purpose

As a discipline, health organisation and management is focused on health-specific, collective behaviours and activities, whose empirical and theoretical scholarship remains under-utilised in the field of implementation science. This under-engagement between fields potentially constrains the understanding of mechanisms influencing the implementation of evidence-based innovations in health care. The aim of this viewpoint article is to examine how a selection of theories, models and frameworks (theoretical approaches) have been applied to better understand phenomena at the micro, meso and macro systems levels for the implementation of health care innovations. The purpose of which is to illustrate the potential applicability and complementarity of embedding health organisation and management scholarship within the study of implementation science.

Design/methodology/approach

The authors begin by introducing the two fields, before exploring how exemplary theories, models and frameworks have been applied to study the implementation of innovations in the health organisation and management literature. In this viewpoint article, the authors briefly reviewed a targeted collection of articles published in the Journal of Health Organization and Management (as a proxy for the broader literature) and identified the theories, models and frameworks they applied in implementation studies. The authors then present a more detailed exploration of three interdisciplinary theories and how they were applied across three different levels of health systems: normalization process theory (NPT) at the micro individual and interpersonal level; institutional logics at the meso organisational level; and complexity theory at the macro policy level. These examples are used to illustrate practical considerations when implementing change in health care organisations that can and have been used across various levels of the health system beyond these presented examples.

Findings

Within the Journal of Health Organization and Management, the authors identified 31 implementation articles, utilising 34 theories, models or frameworks published in the last five years. As an example of how theories, models and frameworks can be applied at the micro individual and interpersonal levels, behavioural theories originating from psychology and sociology (e.g. NPT) were used to guide the selection of appropriate implementation strategies or explain implementation outcomes based on identified barriers and enablers to implementing innovations of interest. Projects aiming to implement change at the meso organisational level can learn from the application of theories such as institutional logics, which help elucidate how relationships at the macro and micro-level have a powerful influence on successful or unsuccessful organisational action. At the macro policy level, complexity theory represented a promising direction for implementation science by considering health care organisations as complex adaptive systems.

Originality/value

This paper illustrates the utility of a range of theories, models and frameworks for implementation science, from a health organisation and management standpoint. The authors’ viewpoint article suggests that increased crossovers could contribute to strengthening both disciplines and our understanding of how to support the implementation of evidence-based innovations in health care.

Open Access
Article
Publication date: 24 October 2018

Euan Sadler, Jane Sandall, Nick Sevdalis and Dan Wilson

The purpose of this paper is to discuss three potential contributions from implementation science that can help clinicians and researchers to design and evaluate more…

1387

Abstract

Purpose

The purpose of this paper is to discuss three potential contributions from implementation science that can help clinicians and researchers to design and evaluate more effective integrated care programmes for older people with frailty.

Design/methodology/approach

This viewpoint paper focuses on three contributions: stakeholder engagement, using implementation science frameworks, and assessment of implementation strategies and outcomes.

Findings

Stakeholder engagement enhances the acceptability of interventions to recipients and providers and improves reach and sustainability. Implementation science frameworks assess provider, recipient and wider context factors enabling and hindering implementation, and guide selection and tailoring of appropriate implementation strategies. The assessment of implementation strategies and outcomes enables the evaluation of the effectiveness and implementation of integrated care programmes for this population.

Research limitations/implications

Implementation science provides a systematic way to think about why integrated care programmes for older people with frailty are not implemented successfully. The field has an evidence base, including how to tailor implementation science strategies to the local setting, and assess implementation outcomes to provide clinicians and researchers with an understanding of how their programme is working. The authors draw out implications for policy, practice and future research.

Originality/value

Different models to deliver integrated care to support older people with frailty exist, but it is not known which is most effective, for which individuals and in which clinical or psychosocial circumstances. Implementation science can play a valuable role in designing and evaluating more effective integrated care programmes for this population.

Details

Journal of Integrated Care, vol. 27 no. 3
Type: Research Article
ISSN: 1476-9018

Keywords

Article
Publication date: 6 February 2017

Lee E. Nordstrum, Paul G. LeMahieu and Elaine Berrena

This paper is one of seven in this volume elaborating upon different approaches to quality improvement in education. This paper aims to delineate a methodology called…

1172

Abstract

Purpose

This paper is one of seven in this volume elaborating upon different approaches to quality improvement in education. This paper aims to delineate a methodology called Implementation Science, focusing on methods to enhance the reach, adoption, use and maintenance of innovations and discoveries in diverse education contexts.

Design/methodology/approach

The paper presents the origins, theoretical foundations, core principles and a case study showing an application of Implementation Science in education, namely, in promoting school–community–university partnerships to enhance resilience (PROSPER).

Findings

Implementation Science is concerned with understanding and finding solutions to the causes of variation in a program’s outcomes relating to its implementation. The core phases are: initial considerations about the host context; creating an implementation structure; sustaining the structure during implementation; and improving future applications.

Originality/value

Few theoretical treatments and demonstration cases are currently available on commonly used models of quality improvement in other fields that might have potential value in improving education systems internationally. This paper fills this gap by elucidating one promising approach. The paper also derives value, as it permits a comparison of the Implementation Science approach with other quality improvement approaches treated in this volume.

Details

Quality Assurance in Education, vol. 25 no. 1
Type: Research Article
ISSN: 0968-4883

Keywords

Article
Publication date: 22 July 2021

Stephanie Best, Janet C. Long, Clara Gaff, Jeffrey Braithwaite and Natalie Taylor

Clinical genomics is a complex, innovative medical speciality requiring clinical and organizational engagement to fulfil the clinical reward promised to date. Focus thus…

Abstract

Purpose

Clinical genomics is a complex, innovative medical speciality requiring clinical and organizational engagement to fulfil the clinical reward promised to date. Focus thus far has been on gene discovery and clinicians’ perspectives. The purpose of this study was to use implementation science theory to identify organizational barriers and enablers to implementation of clinical genomics along an organizations’ implementation journey from Preadoption through to Adoption and Implementation.

Design/methodology/approach

We used a deductive qualitative approach study design drawing on implementation science theory - (1) Translation Science to Population Impact Framework, to inform semi structured interviews with organizational decision-makers collaborating with Australian and Melbourne Genomics, alongside and (2) Theoretical Domains Framework (TDF), to guide data analysis.

Findings

We identified evolving organizational barriers across the implementation journey from Preadoption to Implementation. Initially the organizational focus is on understanding the value of clinical genomics (TDF code: belief about consequences) and setting the scene (TDF code: goals) before organizational (TDF codes: knowledge and belief about consequences) and clinician (TDF codes: belief about capability and intentions) willingness to adopt is apparent. Once at the stage of Implementation, leadership and clarity in organizational priorities (TDF codes: intentions, professional identity and emotion) that include clinical genomics are essential prerequisites to implementing clinical genomics in practice. Intuitive enablers were identified (e.g. ‘providing multiple opportunities for people to come on board) and mapped hypothetically to barriers.

Originality/value

Attention to date has centred on the barriers facing clinicians when introducing clinical genomics into practice. This paper uses a combination of implementation science theories to begin to unravel the organizational perspectives of implementing this complex health intervention.

Details

Journal of Health Organization and Management, vol. 35 no. 7
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 9 October 2017

John Ovretveit, Brian Mittman, Lisa Rubenstein and David A. Ganz

The purpose of this paper is to enable improvers to use recent knowledge from implementation science to carry out improvement changes more effectively. It also highlights…

1582

Abstract

Purpose

The purpose of this paper is to enable improvers to use recent knowledge from implementation science to carry out improvement changes more effectively. It also highlights the importance of converting research findings into practical tools and guidance for improvers so as to make research easier to apply in practice.

Design/methodology/approach

This study provides an illustration of how a quality improvement (QI) team project can make use of recent findings from implementation research so as to make their improvement changes more effective and sustainable. The guidance is based on a review and synthesis of improvement and implementation methods.

Findings

The paper illustrates how research can help a quality project team in the phases of problem definition and preparation, in design and planning, in implementation, and in sustaining and spreading a QI. Examples of the use of different ideas and methods are cited where they exist.

Research limitations/implications

The example is illustrative and there is little limited experimental evidence of whether using all the steps and tools in the one approach proposed do enable a quality team to be more effective. Evidence supporting individual guidance proposals is cited where it exists.

Practical implications

If the steps proposed and illustrated in the paper were followed, it is possible that quality projects could avoid waste by ensuring the conditions they need for success are in place, and sustain and spread improvement changes more effectively.

Social implications

More patients could benefit more quickly from more effective implementation of proven interventions.

Originality/value

The paper is the first to describe how improvement and implementation science can be combined in a tangible way that practical improvers can use in their projects. It shows how QI project teams can take advantage of recent advances in improvement and implementation science to make their work more effective and sustainable.

Details

International Journal of Health Care Quality Assurance, vol. 30 no. 8
Type: Research Article
ISSN: 0952-6862

Keywords

Book part
Publication date: 15 July 2015

Hewitt B. Clark, Alexia Jaouich and Kim Baker

Youth and young adults with emotional and/or behavioral difficulties (EBD) face particularly difficult challenges in their efforts to fit into adult roles and functions…

Abstract

Youth and young adults with emotional and/or behavioral difficulties (EBD) face particularly difficult challenges in their efforts to fit into adult roles and functions. The purpose of this chapter is to assist providers, educators, and administrators from the mental health, education, child welfare, justice/corrections, and adult service system sectors understand (a) a practice for improving the progress and outcomes for young people in transition, and (b) how this practice model is implemented in communities to impact the lives of youth in transition to adulthood. This is accomplished in two major parts in this chapter. The first part provides an overview of the Transition to Independence Process (TIP) model, a description of its status as an evidence-supported practice, and tools and strategies that support its implementation in communities and regions across North America. The TIP model is further illustrated through a description of how it is applied with a young person. The second part of the chapter provides an overview of implementation science, a description of how its strategies and tools can guide the implementation of an intervention or model; and an illustration of a large-scale TIP implementation initiative with collaboratives of agencies and schools. This chapter concludes with implications regarding the importance of having effective transition-to-adulthood models; and ensuring the implementation and sustainability of these to improve the progress and outcomes of youth and young adults with EBD.

Details

Transition of Youth and Young Adults
Type: Book
ISBN: 978-1-78441-933-2

Book part
Publication date: 28 April 2022

Daryl Mahon

Up to this point, we have examined many components that make up the Trauma Ecology Model (TEM). In this chapter, the implementation of TEM in organisations and healthcare

Abstract

Up to this point, we have examined many components that make up the Trauma Ecology Model (TEM). In this chapter, the implementation of TEM in organisations and healthcare systems is explored. The aim is to guide organisations through the process of implementation completely. Practical strategies will be provided for each of the six stages of the Fixen model of implementation. This chapter also includes discussion of potential challenges as well as suggestions for resolving some common issues faced in the implementation literature. You will find the Trauma Ecology Model Fidelity Measure (TEM-FM) in the Appendix a useful resource. As you navigate through each stage, I discuss how best you can utilise the TEM-FM to assess and monitor your organisations progress against clear objectives. As you read this chapter, think about your individual organisational context, and how best to apply this implementation science approach in a meaningful way. This chapter provides a generic implementation guide based on the implementation science literature, as such, we don’t unpack how to implement each component of TEM as specific and non-specific trauma organisations may have some diverging needs. Rather, I provide a framework which can be used by individual organisations as a guide to support implementation at different points in the TEM.

Details

Trauma-Responsive Organisations: The Trauma Ecology Model
Type: Book
ISBN: 978-1-80382-429-1

Keywords

Open Access
Article
Publication date: 2 September 2021

Heather L. Rogers, Susana Pablo Hernando, Silvia Núñez - Fernández, Alvaro Sanchez, Carlos Martos, Maribel Moreno and Gonzalo Grandes

This study aims to elucidate the health care organization, management and policy barriers and facilitators associated with implementation of an evidence-based health…

1913

Abstract

Purpose

This study aims to elucidate the health care organization, management and policy barriers and facilitators associated with implementation of an evidence-based health promotion intervention in primary care centers in the Basque Country, Spain.

Design/methodology/approach

Seven focus groups were conducted with 49 health professionals from six primary care centers participating in the Prescribing Healthy Life program. Text was analyzed using the Consolidated Framework for Implementation Research (CFIR) focusing on those constructs related to health care organization, management and policy.

Findings

The health promotion intervention was found to be compatible with the values of primary care professionals. However, professionals at all centers reported barriers to implementation related to: (1) external policy and incentives, (2) compatibility with existing workflow and (3) available resources to carry out the program. Specific barriers in these areas related to lack of financial and political support, consultation time constraints and difficulty managing competing day-to-day demands. Other barriers and facilitators were related to the constructs networks and communication, culture, relative priority and leadership engagement. A set of six specific barrier-facilitator pairs emerged.

Originality/value

Implementation science and, specifically, the CFIR constructs were used as a guide. Barriers and facilitators related to the implementation of a health promotion program in primary care were identified. Healthcare managers and policy makers can modify these factors to foster a more propitious implementation environment. These factors should be appropriately monitored, both in pre-implementation phases and during the implementation process, in order to ensure effective integration of health promotion into the primary care setting.

Details

Journal of Health Organization and Management, vol. 35 no. 9
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 14 June 2018

Lara M. Gunderson, Cathleen E. Willging, Elise M. Trott Jaramillo, Amy E. Green, Danielle L. Fettes, Debra B. Hecht and Gregory A. Aarons

Evidence-based interventions (EBIs) for human services unfold within complicated social and organizational circumstances and are influenced by the attitudes and behaviors…

Abstract

Purpose

Evidence-based interventions (EBIs) for human services unfold within complicated social and organizational circumstances and are influenced by the attitudes and behaviors of diverse stakeholders situated within these environments. Coaching is commonly regarded as an effective strategy to support service providers in delivering EBIs and attaining high levels of fidelity over time. The purpose of this paper is to address a lacuna in research examining the factors influencing coaching, an important EBI support component.

Design/methodology/approach

The authors use the Exploration, Preparation, Implementation, and Sustainment framework to consider inner- and outer-context factors that affect coaching over time. This case study of coaching draws from a larger qualitative data set from three iterative investigations of implementation and sustainment of a home visitation program, SafeCare®. SafeCare is an EBI designed to reduce child neglect.

Findings

The authors elaborate on six major categories of findings derived from an iterative data coding and analysis process: perceptions of “good” and “bad” coaches by system sustainment status; coach as peer; in-house coaching capacity; intervention developer requirements vs other outer-context needs; outer-context support; and inner-context support.

Practical implications

Coaching is considered a key component for effective implementation of EBIs in public-sector systems, yet is under-studied. Understanding inner- and outer-context factors illuminates the ways they affect the capacity of coaches to support service delivery.

Originality/value

This paper demonstrates that coaching can accomplish more than provision of EBI fidelity support. Stakeholders characterized coaches as operating as boundary spanners who link inner and outer contexts to enable EBI implementation and sustainment.

Details

Journal of Children's Services, vol. 13 no. 1
Type: Research Article
ISSN: 1746-6660

Keywords

Article
Publication date: 17 September 2021

Jodie Shoobridge, Tim Schultz, Gill Harvey and Neil Kirby

The study describes the implementation of a novel strategy, entitled the Action Learning Set Facilitation Model, to develop internal facilitation capability to lead…

Abstract

Purpose

The study describes the implementation of a novel strategy, entitled the Action Learning Set Facilitation Model, to develop internal facilitation capability to lead change. The Model incorporated the Novice-Experienced-Expert pathway, a facilitation development approach underpinning the integrated-Promoting Action on Research Implementation in Health Services Implementation Framework, with action learning methodology.

Design/methodology/approach

A mixed-methods descriptive approach reports the results of 22 interviews, 182 Action Learning Sets and 159 post program survey data sets to explore facilitator experiences, strengths and potential application of the Model.

Findings

At program completion, five novice (of 174) and one experienced (of 27) facilitator transitioned to the next facilitation level. The three groups of facilitators described positive change in confidence and facilitation skill, and experience of action learning sets. Inconsistencies between self-report competence and observed practice amongst novices was reported. Novices had decreasing exposure to the Model due to factors related to ongoing organisational change. Internal facilitators were considered trusted and credible facilitators.

Research limitations/implications

There are practical and resource implications in investing in internal facilitation capability, noting proposed and real benefits of similar development programs may be compromised during, or as a consequence of organisational change. Further research describing application of the facilitation model, strategies to enhance multisystemic support for programs and evaluation support are suggested.

Practical implications

The Action Learning Set Facilitation Model offers promise in developing internal facilitation capability supporting change in organisations. Critical success factors include building broad scale internal capability, stable leadership and longitudinal support to embed practice.

Originality/value

This is the first application of the facilitation component of the integrated-Promoting Action on Research Implementation in Health Services implementation framework embedded to action learning sets as an implementation science strategy for leader development supporting organisational change.

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