Trends in Higher Education: Implementation Sciences

As part of our mission to advance the scholarship of teaching and learning, we’re introducing a new type of blog post focused on “Trends in Higher Education.” These will often be topics that have emerged from our SOTL Journal Club readings or from our own research and scholarly interests.

This week’s trend in higher education is: Implementation Sciences (IS).

Implications for Pharmacy Education

Let’s say your school is implementing a new teaching technique.  Maybe it’s team-based learning (TBL).  There’s lots of evidence in the literature about TBL.  But, the first semester goes horribly.  Is it the technique?  Or is it your particular implementation of the technique?

Background

This emerging field grew out of a recognition that research has provided many “evidence based practices,” but there can be a disconnect between research and what actually occurs in practice. Implementation research and implementation sciences aim to better understand this disconnect and to identify the key components of implementation to aid in successful uptake.

Foundational Themes

In a review of the implementation literature, Fixsen, et al. identified common themes of successful implementation:

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In addition to these themes, there are several other takeaway messages that are important to reflect upon as you try and adopt new interventions, policies, or programs:

Key Takeaways

“Implementation occurs in the context of community.”

Community may represent your teaching team, your department, your college, or your University. Before adopting a new practice, recognize that your community is different than the community surrounding the original intervention.  Gauge and measure readiness from your community before attempting to implement a change. Attempting implementation without buy-in and support from the community is likely to be unsuccessful.   

“Implementation is a process, not an event.” 

Implementation of new practices does not happen overnight, and it doesn’t always happen smoothly. It requires testing of small implementations, learning from these experiences,  implementing at a larger scale, and establishing ways to innovate and make a sustainable change. It may take several iterations before full and successful implementation is achieved.

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Image from Fixsen, et al. Implementation Research: A Synthesis of the Literature. Louis de la Parte Florida Mental Health Institute, University of South Florida.

“[T]he more clearly the core components of an intervention program or practice are known and defined, the more readily the program or practice can be implemented successfully.”

As you try new innovations, pay attention to aspects of the innovation that seem essential to its success. When disseminating your research describe the core components of the intervention that others should focus on in implementation. Likewise, when you adopt a practice from research, identify the components that you believe are core to the intervention or program. Also, there may need to be several attempts at implementation before you identify the core components.

Selection of staff is important to having effective practitioners, excellent trainers, effective coaches, skilled evaluators, facilitative administrators, or effective purveyors*.”

Identifying who will be responsible for the oversight, evaluation, and management of the implementation affects the outcome. Individuals should be selected based on skill, expertise, and interest in the implementation. All members involved should have training and receive regular evaluation, feedback, and coaching. As you attempt to implement a new idea, think about not only who is readily available or has the capacity to help, but also who would be best in each role.

*Purveyor is defined as an individual or multiple individuals who are actively working to implement the practice or program with high fidelity. In other papers they are referred to as “change agents” or “linking agents” or “site coordinator”

Putting it in practice

Thinking back to the TBL example from the start of this post, how can we use implementation sciences in the next iteration of this course?  Here are a few questions inspired by IS:

  • Was there buy-in from your teaching team and teaching assistants before this change was implemented? Were they well trained before the intervention? Did they receive feedback and coaching throughout the semester?
  • Were the ‘core components’ of TBL implemented or was the intervention a modification of what was in the literature?
  • Was there support from the larger community from college administrators?

As we continue to incorporate scholarly techniques into the classroom, implementation sciences can be a resource to guide success from research into the real world.

Resources

The National Implementation Research Network: http://nirn.fpg.unc.edu

This network has many resources, tools, and further readings to support those interested in using implementation sciences. The site also provides links to current research about implementation sciences and research of those utilizing implementation sciences.

Or

Fixsen, D.L., Naoom, S.F., Blase, K.A., Friedman, R.M. & Wallace, F. (2005). Implementation Research: A Synthesis of the Literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The national Implementation Research Network (FMHI Publication #231)

This detailed synthesis of the literature was the foundation for much of this blog post. It provides greater background information on implementation research, as well as greater details on the common themes and lessons learned from implementation literature.

Or

An Introduction to implementation science for the non-specialist: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4573926/

This brief review of implementation science, recommended by ACCP, provides a background and history of implementation sciences, and also describes differences between implementation research and clinical trials, as well as the evaluation of implementation sciences.