Implementationframework



BACKGROUND

THE KNOW-DO GAP

 

Implementation science is a systematic approach to close the gap between what we know and what we do (the know-do gap).

 

Research indicates that it takes approximately 17 years for evidence to be adopted into practice, with only 20% success rate. When applying a proven implementation framework and/or methodology this can be reduced to 2-4 years, with an 80% success rate.

 

The field of Implementation Science has evolved rapidly in the past 30-years, addressing the centuries-old problem of the know-do gap. Implementation Science has a journal; The Journal of Implementation Science (Impact Factor 7.327) which publishes research relevant to the scientific study of methods of implementation. In addition, many prestigious institutions such as University College London, Kings College London, University of Oxford, NIHR, University of Southampton, Washington University, University of Chicago have Centres of Implementation Science.

 

 

IMPLEMENTATION AT SCALE AND PACE

 

Pilot studies are examples of implementing change in a controlled, local environment, and they are usually very successful. Attempts to scale up these pilot studies to a national scale (outside of the controlled environment) usually fail. As a counter approach to trying to scale up a pilot study, Implementation Science methodology allows teams to work on a large-scale, and in an uncontrolled environment, improving success rates significantly.

 

ICST understand the difficulties of disseminating resources and programmes to large, diverse populations, which we call an ‘uncontrolled environment’. This is demonstrated by the vast know-do gap seen in healthcare.

 

ICST has developed an implementation framework to create system-wide readiness and ensure the resources reach the people that need it, when they need it. This is most successful if it is run through an established implementation infrastructure, ensuring the channels for implementation are clear and navigable. ICST have achieved this, after years of close partnership, in organisations such as NHS Wales, and dozens of CCGs in NHS England.

 

 

WHAT IS AN IMPLEMENTATION FRAMEWORK?

 

An implementation framework is a graphical or narrative representation of the factors, concepts, or variables of implementation. Put simply, it is a proven method of turning your vision into a reality, using principles of implementation science.

 

There are hundreds of implementation frameworks, often developed for specific projects, and most feature very similar components. But some are more complex than others. And some of those that are very complex will have little impact on the world because they are only accessible to the expert in implementation science.

 

 

Ironically, most implementation frameworks are failing to be implemented

 

 

There are now so many theoretical approaches to implementation science that some researchers have complained about the difficulties of choosing the most appropriate implementation framework.

 

 

A MORE ACCESSIBLE APPROACH

 

Ensuring that everyone can benefit from the science by making it accessible and useable, the SIMPSI (Simple IMPlementation ScIence) framework was developed by Professor Chris Davies and the team at ICST, drawing on many years of experience implementing high-profile programmes at scale and pace.

 

 

Our vision is to make Implementation Science, implementable

 

 

The SIMPSI framework is a proven implementation framework, which contextualises implementation science, starting from the beginning of implementation, and taking you through each step for successful implementation.

 

The SIMPSI framework aims to make Implementation Science simple and accessible to everyone. Supported by an expert implementation team at ICST who help achieve large scale adoption.

 

 

INTRODUCING SIMPSI

 

 

 

 

VALUE PROPOSITION TO VALUE REALISATION

 

A value proposition is the value of an innovation to an individual or stakeholder group, should they choose to believe in/ buy into this concept. There are different value propositions for each group, for example patients, their healthcare professionals, the healthboard and the commissioners.

 

 

THE INNOVATION

 

The innovation is the product, the initiative, the process, that is going to help realise the value proposition.

 

 

Standard practices are what we do every day; innovations are something new

 

 

Depending on the context, the target audience, the budget, etc. there are many types of innovation, for example:

 

  • Systems, processes, or guidelines
  • Products, initiatives, or campaigns
  • Education packages or apps
  • Posters or leaflets

 

During the four phases of SIMPSI, the development of the innovation and ongoing modification will be more intensive during the early phases of the framework, but monitoring will continue throughout to ensure the innovation remains fit for practice.

 

 

THE IMPLEMENTATION

 

The implementation are the steps taken to implement an innovation into the environment. The implementation comprises four phases

 

 

PHASE 1
Development

During this early phase, the scoping of the programme begins, the innovation(s) are developed and work begins to optimise the implementation enablers ready for launch.

 

 

PHASE 2
Installation

Often called a soft launch, phase two is installing the innovation into the environment, and teasing out any issues that arise.

 

 

PHASE 3
Development

The phase where the innovation is formally introduced into the system and efforts are made to maximise the uptake by the target audience

 

 

PHASE 4
Sustainability

The phase where the innovation becomes part of the system, it is widely adopted and accepted, and it is contributing towards the desired outcomes for this programme.

 

 

THE ENABLERS

 

Within each phase of the framework, there are some key principles, action points that must be completed before progress to the next phase. These steps are called the ‘Enablers’. Examples of Enablers include:

 

  • Implementation team – Those members of the team who have a desire to realise the value proposition, engaged in creating system-wide readiness and achieving the outcome
  • Organisational structure – A view of the organisation that the innovation is being implemented into, from the top (executive/ managerial team) to the target population(s) who are going to be implementing this
  • Target layer – the intended audience which the innovation is aimed at
  • Power layer – the power layer, sometimes called influencers or mentors, are the individuals who have a special interest in making change in this field, and are going to make the most impact on the uptake of this innovation.
  • Alignment – are all the individual and group stakeholders, who have influence in the system, aligned and understand the value of this app and digital infrastructure? Are there any stakeholders or groups with barriers to alignment, and what are their reasons?
  • Readiness and capacity – understanding whether healthcare professionals have the capacity to make changes to their practices? Are they focusing on other initiatives such as flu vaccines? Do they understand the importance of self-management? Do they have the correct toolkit and resources that they need to navigate patient queries and concerns? How receptive are patients to adopt an app?
  • Fidelity – clear and consistent messaging through multi-media channels to the target audience(s), ensuring there is fidelity in message from policy to patient

 

The above examples of Enablers, scientifically proven to optimise implementation, will guide progress through the phases of implementation;

 

If the conditions are right and the analysis suggests that implementation is feasible, the implementation team will progress to the next phase of implementation.

 

If the conditions are not right to move to the next phase, the implementation team will monitor this and optimise the chance of successful implementation before progressing to the next phase.

 

 

SIMPSI SOFTWARE

 

Bringing the SIMPSI framework to life, is the software that documents every step of an implementation project, and guides the team towards successful implementation through the four key phases.

 

In the same way that accountancy software has revolutionised financial management for organisations, SIMPSI implement is revolutionising Implementation Science for teams, adding transparency to projects and bridging the gap between what we know and what we do.