Implementation for a
Change
RtI Best
Practices
Institute
Barbara Sims
Dean L. Fixsen
Karen A. Blase
Michelle A. Duda
Wrightsville
Beach, NC
October 2012
Complex Problems
 Human services involve
interaction-based sciences
 Inherently more complex than
atom-based sciences
 E.g., atom-based ingredients
don’t refuse to be ingested, talk
back, or run away
Ineffective Approaches
Best data show these methods, when used alone,
Do Not result in uses of innovations as intended:

Diffusion/ Dissemination of information

Training

Passing laws/ mandates/ regulations

Providing funding/ incentives

Organization change/ reorganization
5 to 10% return on investment
NECESSARY BUT NOT SUFFICIENT
System Change
EXISTING SYSTEM
EXISTING SYSTEM IS
CHANGED TO SUPPORT
THE EFFECTIVENESS OF
THE INNOVATION
EFFECTIVE INNOVATIONS
ARE CHANGED TO
FIT THE SYSTEM
EFFECTIVE INNOVATION
Implementation Gap
Implementation is defined as a specified set of activities
designed to put into practice an activity or program of
known dimensions.
RESEARCH
PRACTICE
GAP
IMPLEMENTATION
Why Focus on Implementation?
“Students cannot benefit from
interventions they do not experience.”
Developing the Capacity
to Implement Well
“A serious deficiency is the
lack of expertise to
implement best practices and
innovations effectively and
efficiently to improve student
outcomes.”
Rhim, Kowal, Hassel, & Hassel (2007)
Implementation Science
Implementation science is the scientific study
of variables and conditions that impact
changes at practice, organization, and
systems levels; changes that are required to
promote the systematic uptake, sustainability
and effective use of evidence-based
programs and practices in typical service and
social settings.
~Blase and Fixsen, 2010
National Implementation Research Network
Implementation Science
IMPLEMENTATION
INTERVENTION
Effective
Effective
NOT Effective
from Mark Lipsey’s 2009 MetaanalyticInconsistent;
overview of the primary
factors that
effective
Notcharacterize
Sustainable;
juvenile offender interventions –
Actual
outcomes
Benefits“. . . inPoor
some analyses, the
quality with which the
intervention is implemented
Unpredictable or
Poor outcomes;
has been as strongly related
NOT Effective
poor outcomes; to recidivism
Sometimes
effects harmful
as the
type of program, so much so
that a well-implemented
intervention
ofon
an inherently
(Institute of Medicine, 2000; 2001; 2009; New Freedom
Commission
Mental Health, 2003; National Commission on Excellence
in Education,
less efficacious
type can
1983; Department of Health and Human Services, 1999)
outperform a more efficacious
one that is poorly
implemented.”
Formula for Success
Effective Intervention practices
X
1.0
X
Effective Implementation practices 0.0
=
Improved Outcomes
=
0.0
Plan for Change

District is the point of entry for systemic
support of school improvement
 Use short-term infusion of resources
 Establish long-term, district-based
capacity for quality
Shifting Accountability
Student
SISEP 2012
Practitioner
System
Cascading Logic Model

Improve student outcomes

Improve teacher instruction




Improve school supports for teachers
Improve district supports for schools
Improve regional supports for districts
Improve State supports for outcomes
Re-define relationships among system components
Focus fully on student outcomes
Active Implementation
Frameworks
 Implementation Drivers
 Implementation Stages
 Implementation Teams
 Improvement Cycles
Active Implementation Frameworks

Successful implementation on a useful scale
requires. . .
 Active use of implementation core components
“best practices”– “IMPLEMENTATION
DRIVERS”
 Purposeful matching of critical implementation
activities to the stage of the process –
“STAGES OF IMPLEMENTATION”
 Organized, expert assistance –
“IMPLEMENTATION TEAMS”
 A focus on continuous, purposeful
improvement – “IMPROVEMENT CYCLES”
IMPLEMENTATION DRIVERS
Common features of successful
supports to help make full and
effective use of a wide variety of
innovations
Improved educational outcomes
Consistent Use of
Educational Innovations
Interventions
meet
Implementation
Performance Assessment
(Fidelity)
Systems
Intervention
Coaching
Facilitative
Administration
Training
Selection
Integrated &
Compensatory
Decision Support
Data System
Leadership
Adaptive
Technical
© Fixsen & Blase, 2008
Performance Assessment
(Fidelity)
Coaching
Training
Selection
Technical
© Fixsen & Blase, 2008
© Fixsen & Blase, 2008
Competency Drivers
Build Competency and Confidence

Develop, improve, and sustain competent
& confident use of innovations
Performance Assessment




Measure fidelity
Ensure implementation
Reinforce staff and build on strengths
Feedback to agency on functioning of
 Recruitment and Selection Practices
 Training Programs (pre and in-service)
 Supervision and Coaching Systems
 Interpretation of Outcome Data
Selection
 Select for the “unteachables”
 Screen for pre-requisites
 Set expectations
 Allow for mutual selection
 Improve likelihood of retention after

“investment”
Improve likelihood that training, coaching,
and supervision will result in
implementation
Training






Develop Training Plan
Define critical components
Aspects requiring new knowledge
Aspects requiring new skills
Prioritize training topics
Identify or develop fidelity measures
Coaching




Develop Coaching Plan

Grounded in “Best Practices”
Ensures fidelity
Ensures implementation
Provides feedback to selection and
training processes
Training and Coaching
OUTCOMES
% of Participants who Demonstrate Knowledge, Demonstrate
New Skills in a Training Setting,
and Use new Skills in the Classroom
Knowledge
Skill
Demonstration
Theory and
Discussion
10%
5%
0%
..+Demonstration in
Training
30%
20%
0%
…+ Practice &
Feedback in Training
60%
60%
5%
…+ Coaching in
Classroom
95%
95%
95%
TRAINING
COMPONENTS
Joyce and Showers, 2002
Use in the
Classroom
Performance Assessment
(Fidelity)
Systems
Intervention
Coaching
Training
Facilitative
Administration
Decision Support
Data System
Selection
Leadership
Adaptive
Technical
© Fixsen & Blase, 2008
Reflection
Supporting
New Ways of Work
Implementation Drivers
How do we support the
development of the
infrastructure needed to
implement well?
How do we promote more
hospitable organizational
environments?
How relevant are leadership
issues? What’s our role?
Active Implementation Frameworks

Successful implementation on a useful scale
requires. . .
 Active use of implementation core components
“best practices”– “IMPLEMENTATION
DRIVERS”
 Purposeful matching of critical implementation
activities to the stage of the process –
“STAGES OF IMPLEMENTATION”
 Organized, expert assistance –
“IMPLEMENTATION TEAMS”
 A focus on continuous, purposeful
improvement – “IMPROVEMENT CYCLES”
STAGES OF IMPLEMENTATION
Purposeful matching of critical
implementation activities to the stage of the
process
SISEP 2012
FULL
IMPLEMENTATION
2-4
Years
Integrated &
Compensatory
Leadership
EXPLORATION
Stages of
Implementation
Fixsen, Naoom, Blase, Friedman, & Wallace, 2005
Exploration





Formalize Team Structures
Develop Communication Plan
Determine Need and Identify Options
Assess “Fit” and Feasibility
Promote “Buy in” for the innovation and for
implementation supports
“Pay now or pay later.”
Installation





Structural and functional changes are made

Establish communication links and protocols
First implementers selected
Define and initiate training of first implementers
Develop coaching plans
Evaluate readiness and sustainability of data
systems
Initial Implementation



Initiate training plan
Provide coaching
Make use of improvement cycles
 Communication links and protocols
 PDSA to resolve systems issues
 Usability testing of selection, training and
coaching
Full Implementation




Skillful practices by all staff
Evaluation for expected outcomes
Full use of Implementation Drivers
Policy changes/development for sustainability
“The only thing worse than failing and not
knowing why you failed, is succeeding and not
knowing why you succeeded.”
~ Jane
Timmons-Mitchell
ACTIVITY
Supporting
New Ways of Work
Stages of Implementation
Analysis
•
What are you already doing
that is “stage-based”?
•
What are the facilitators and
barriers to doing stage-based
work?
•
Discuss the Exploration and
Installation Stage indicators.
Active Implementation Frameworks

Successful implementation on a useful scale
requires. . .
 Active use of implementation core components
“best practices”– “IMPLEMENTATION
DRIVERS”
 Purposeful matching of critical implementation
activities to the stage of the process –
“STAGES OF IMPLEMENTATION”
 Organized, expert assistance –
“IMPLEMENTATION TEAMS”
 A focus on continuous, purposeful
improvement – “IMPROVEMENT CYCLES”
IMPLEMENTATION TEAMS
Organized, expert assistance to develop
and sustain an accountable structure
Implementation Team
IMPLEMENTATION
INTERVENTION
Impl. Team
Effective
NO Impl. Team
80%, 3 Yrs
14%, 17 Yrs
Making it Happen
Letting it Happen
Helping it Happen
Fixsen, Blase,
Timbers, & Wolf, 2001
Balas & Boren, 2000
Green & Seifert, 2005
Linked Team Structures
State-based
Implementation
Team
Regionally-based
Implementation
Team
District-based
Implementation
Team
School-based
Implementation
Team
“We tend to focus on snapshots of isolated
parts of the system and wonder why our
deepest problems never seem to get solved.
(Senge, 1990)
ACTIVITY
Supporting
New Ways of Work
Table Talk:
Implementation Teams
•
In your experience, who
supports the change
process?
•
How is the transition made
from external expertise to
building internal capacity?
Active Implementation Frameworks

Successful implementation on a useful scale
requires. . .
 Active use of implementation core components
“best practices”– “IMPLEMENTATION
DRIVERS”
 Purposeful matching of critical implementation
activities to the stage of the process –
“STAGES OF IMPLEMENTATION”
 Organized, expert assistance –
“IMPLEMENTATION TEAMS”
 A focus on continuous, purposeful
improvement – “IMPROVEMENT CYCLES”
IMPROVEMENT CYCLES
Changing on purpose to support the new
way of work
SISEP 2012
Types of Improvement Cycles



Plan-Do-Study-Act Cycles
Usability testing (Neilson; Rubin)
Practice-policy communication loops
PDSA
Usability Testing
Policy
Practice
Feedback Loops
Policy
Policy Enabled Practices
(PEP)
Feedback
Practice Informed Policy
(PIP)
Study - Act
Expert Implementation Support
Policy (Plan)
Structure
Procedure
Practice (Do)
FORM SUPPORTS FUNCTION
Practice
ACTIVITY
Supporting
New Ways of Work
Table Talk:
Improvement Cycles and
Communication Loops
•
How can we make use of
improvement cycles in
developing and implementing
our improvement activities?
•
Linking Communication
Protocols
Summary

Conceptualize a change process so that effective
interventions for children and families can
become embedded and sustained in socially
complex settings



Improvement processes are critical


“stage-matched activities to guide the process
“implementation drivers” to build the
infrastructure
the work is never done because the environment
is in motion
Invest in the development of organized, “expert”
implementation support
Stay
Connected!
www.scalingup.org
@SISEPcenter
SISEP
For more on Implementation Science
http://nirn.fpg.unc.edu
www.implementationconference.org