Joining the Forces of Implementation

In May 2018, four of the CES team presented at and attended the 2018 Nordic Implementation Conference (NIC) held in Copenhagen, Denmark.

The theme for the conference was ‘Joining the Forces of Implementation’, with the aim of advancing the field of implementation science and practice, and effectively integrating research into practice and policy. From the variety of keynote speeches, panel discussions, workshops and presentations we attended, here are some of the key things we picked up over the 3 days:

There is a huge amount of evidence at our fingertips

An impressive volume of research and evidence is being produced to support and inform the development of Implementation Science as a field. The importance of using this evidence to inform decisions and meet needs at every level of a system can’t be overstated.

We took note of a couple of really useful (and free!) evidence repositories curated by McMaster University and focusing on health systems (available here) and social systems (available here).

We need to better support practitioners to use evidence

Despite producing such a volume of evidence, it does not always filter down in an accessible and practical way to the people who need it most. There was a lot of debate during NIC about how to support practitioners to use evidence more effectively. Some of the suggestions included increasing practitioners’ capacity and skills to find and engage with evidence, using the power of positive peer pressure by creating social norms around using evidence, creating spaces to support learning among practitioners and developing the right incentives (or ‘implementation climate’) to support use of evidence by rewarding those using evidence effectively.

One way to involve knowledge users is by using Integrated Knowledge Translation

Integrated Knowledge Translation (IKT) was one method put forward at NIC as a way to get knowledge users (practitioners, policymakers or others who could usefully use evidence) involved in the research process.

The idea is popular in Canada and essentially involves collaborating and partnering with people who could benefit most from research, so that it becomes more relevant, inspires more confidence and ultimately increases impact. It also has the potential to produce research findings in formats that are more immediately accessible and digestible for knowledge users.

Watch a great example of IKT in practice below.

The way feedback is given makes a difference to outcomes

In her keynote, Dr Kim de Jong from Leiden University discussed routine monitoring of patient outcomes from clinical psychology interventions, and how feeding this information back to practitioners can improve end results for patients. Interestingly, however, she highlighted that feedback is not equally effective under all circumstances.

Feedback theory tells us there are three key elements when providing feedback — the source, the message and the recipient. Failure to pay equal attention to all three elements can undermine the positive impact of feedback.

Click here to access Dr. Kim de Jong’s slides.

It’s important to keep working with people over time and overcome resistance to change

Resistance to change is a natural and expected part of implementing any initiative. We collected some of the experts’ tips for effectively working with resistant stakeholders:

· Find out the reason for resistance to change — you can then determine if it is worth putting in the effort to overcome it (the answer isn’t always yes…)

· Recognise that change often involves a loss of job, responsibility, role etc., and work to compensate for this loss in some way

· Keep talking to people — sometimes people who are very critical at the beginning of implementation are the ones who end up being very engaged at the end (and vice versa)

· Resistance to change can be a numbers game — if 5% of stakeholders are resistant, you can probably overcome this; but if 50% are resistant, you have a huge problem

· When implementing a new initiative, consider if other things need to be de-implemented to free up time and resources.

The development of new frameworks and theories continues

The number of frameworks, models and theories in Implementation Science has grown to over 100 in recent years and drawing out common elements is an important exercise for the field.

NIC highlighted the value of new and improved theoretical developments to inform the practical nature of implementation. During the conference it was argued convincingly that theory contributes to: explaining how and why certain results are achieved; identifying ‘core components’ or ‘active ingredients’ that improve the likelihood of implementation success; and developing improved implementation strategies and methods.

One example of a recently developed framework that was discussed at NIC is:

The Context and Implementation of Complex Interventions (CICI) Framework (Pfadenhauer et al., 2017)

Implementation may be difficult, but there is great cause for optimism!

The title for one of the pre-conference workshops at NIC was The application of Murphy’s law in implementation science…if anything can go wrong it will!’ and much of the discussion over the following days centred around implementation challenges.

However, the tone wasn’t disheartening — quite the opposite. A variety of useful solutions and suggestions were put forward by those attending, such as spending time anticipating potential problems before/early in implementation, allowing adequate time to deal with implementation barriers, and investing in more than one leader, as leadership change will happen and must be mitigated against.

Many people at the conference spoke about the importance of learning from both implementation successes and failures to make successful implementation ever more attainable.

For more implementation resources, check out our resource library. Read more about the Implementation Network of Ireland here.

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