← Implementation Enablers — Implementation Teams

The development of an implementation team is a key step for successful implementation.

Dedicated People

Implementation requires dedicated people who can provide direction and support. The development of an implementation team is a key step for successful implementation.

Implementation teams oversee, support and attend to implementation. They lead change and provide guidance to others who will be impacted by it (Hirsch, 2017). They are accountable for change and progress, and can also hold others to account. They should not be confused with other groups or structures such as governance groups or steering committees. They are different in that they are actively involved in overseeing and managing the implementation process. They typically have some decision-making authority but rely on other governance structures for major decisions.

What implementation teams do

  • Moving an innovation through the stages of implementation
  • Identifying barriers and finding solutions where needed
  • Identifying enablers and leveraging them for successful implementation
  • Securing resources to support implementation
  • Putting in place infrastructure to support implementation
  • Engaging stakeholders and communities
  • Building cross-sector collaboration and alignment between relevant agencies
  • Monitoring and evaluating progress
  • Using data to make decisions and support implementation
  • Ensuring decisions are purposeful and planned
  • Ensuring that the innovation is being implemented as intended (fidelity).

Skills and competencies needed by implementation teams

Implementation teams need a range of skills and competencies to oversee, support and attend to the implementation of interventions. Teams need a mix of skills, including content knowledge and expertise developing teams, implementation, improvement cycles and systems change.

External expertise may be needed to support implementation teams, to complement existing skills and competencies. There is increasing interest in the field of implementation science about what is needed to facilitate change in complex systems. ‘Implementation Specialists’ can provide skills and competencies to support large scale interventions.

Putting together an implementation team

Implementation teams are typically made up of 3-12 people. The composition of this group is important, and should address the following needs:

  • Diversity – does the team have an appropriate balance of perspectives, training and expertise, experience, relationships and priorities?
  • Decision-making authority – the team should include members who have decision-making authority or have direct access to decision-making authority, so that timely decisions can be made
  • Knowledge – the team should include members who have a range of relevant skills and expertise.

Documents which set out the position, expertise and rationale for including members can help to ensure that a team has the right balance of diversity, authority and knowledge.

It may be possible to repurpose an existing team to work on implementation, but the team needs to reflect these needs. Additional members may need to be recruited to address any imbalance.

Linked teams

Teams can be established at local, regional or national levels and should be linked. One implementation team may not be enough to implement an initiative at national level. Additional teams may be required, but will need to be linked, with two way communication between them. Linked implementation teams can help to drive change and ensure a coherent and consistent approach.

Implementation teams in action

The Health Services Executive (HSE) Nurture Programme – Infant Health and Wellbeing, aims to improve the health and wellbeing for infants under the age of two and their parents. The HSE has established six national implementation teams. Each team has specific roles and responsibilities and communication protocols for communicating between teams and governance structures.

A wide range of stakeholders are represented on the teams, including representatives from public health nursing, public health medicine, practice nursing, midwifery, speech and language therapy, health promotion, training and development, ICT, academia, administration, and community and voluntary organisations. A full-time programme manager sits on each of the teams. Project support and implementation support is also provided to each team.

Implementation plans guide the work of the teams, which are monitored and updated over time. Whilst the team do not have control over budgets, they regularly inform budgetary decisions made by governance structures.

Tips for effective implementation teams

  • Appoint a chair that is skilled in group facilitation and has credibility and respect from a broad range of stakeholders. They do not necessarily need to be an expert in the subject matter.
  • Try to keep the size of the team manageable (i.e. less than 12), but ensure that the range of perspectives needed are included.
  • Clarify the role, scope and mandate of the team in the Terms of Reference, and in how the team relates to any other teams and structures.
  • Develop an implementation plan for the team and monitor progress and update it on an ongoing basis.
  • Create sub-groups for specific tasks that cannot be completed within the teams. Consider including other stakeholders, who are not part of the team, but who have specific expertise that would be helpful.
  • Use evidence to inform decisions made. If evidence is not available, collect it through, literature reviews, surveys, focus groups and interviews.

The A—Z of Implementation

There are a range of terms used when writing or talking about implementation and in implementation science. This glossary provides a short definition for each of these terms.

Adaptable components

Elements of an intervention which may be tailored to local settings during implementation without undermining the integrity of the intervention itself.

Barriers

Factors which hinder the implementation process and reduce the probability of successful implementation.

Capacity

The ability or power to do, understand or absorb something. This can apply to an individual, a team, an organisation or a whole system.

Coaching

A formal, typically short-term, arrangement between a coach and an individual focused on developing work-related skills or behaviours.

Community

A group of people living in an area or having characteristics in common (e.g. city, neighbourhood, organisation, service, business, professional association); the larger socio-political-cultural context in which an intervention is intended to operate.

Consultation

The action or process of formally discussing something with stakeholders, generally asking stakeholders a relevant question and receiving answers to that question. While the views of stakeholders may then be used to influence decisions, there is no commitment or requirement to do so.

Context

The set of circumstances or unique factors in which implementation takes place. This can refer to both the wider, systemic context, as well as the specific setting in which a specific intervention will be implemented.

Continuous Improvement Cycles

Ongoing use of emerging data and evidence on outcomes and implementation, and using that information to learn from experience, inform future implementation and improve outcomes. Progress is, therefore, achieved in an incremental manner over time.

Core Components

Indispensable elements of an intervention or implementation plan, which cannot be changed without undermining it. All core components should be delivered with fidelity.

Data-Based Decision Making

Using processes for collecting and analysing different types of data to guide decisions with the aim of improving outcomes on an ongoing basis.

Diffusion

A process by which an intervention is communicated through certain channels over time. The spread of ideas through diffusion is generally a passive process, following an unpredictable, unprogrammed, emergent and self-organising path, e.g. word of mouth.

Dissemination

An active, negotiated and influenced means of spreading an intervention or information about an intervention to relevant target groups.

Enablers

Factors which increase the probability of successful implementation.

Evaluation

A planned investigation of a project, programme, or policy used to answer specific questions. It can be related to design, implementation, results, and outcomes (cause and effect) of an intervention.

Evidence-Based Interventions

Practices, programmes, policies, strategies or other activities that have been empirically shown through scientific research and evaluation processes to improve outcomes to some degree.

Fidelity

Delivering an evidence-based intervention exactly as intended by those who developed it.

Framework

A structure, overview, outline, or system consisting of various descriptive categories and the presumed relationships between them.

Implementation

The carrying out of planned, intentional activities that aim to turn evidence and ideas into policies and practices that work for people in the real world. It is about putting a plan into action; the ‘how’ as well as the ‘what’.

Implementation Plan

A plan outlining the key activities, responsibilities, timelines and other important information required to achieve the desired outcomes from implementing an intervention.

Implementation Readiness

The extent to which organisations and individuals are both ‘willing’ to, and ‘capable’ of, implementing any specific intervention.

Implementation Science

The scientific study of how interventions are incorporated into service settings. It seeks to identify activities, contexts and other factors that increase the likelihood of successful implementation and lead to improved outcomes for people.

Implementation Strategy

Any specific method or action aimed at overcoming barriers, increasing the pace and effectiveness of implementation, and sustaining interventions over time.

Implementation Team

A group or structure that oversees, supports and attends to, moving an intervention through the stages of implementation. They actively use strategies to facilitate implementation.

Inputs

Resources needed to carry out activities and outputs.

Intervention

Any policy, practice, service or programme that is being implemented. It can be a change to something already in existence, or an entirely new intervention.

Leadership

The action of leading a group of people, or the ability to do this. This does not just apply to leading a whole organisation or system – leadership can take multiple forms and can occur at any level of an organisation or system.

Logic Model

An adaptable tool that describes the theory of change underpinning an intervention, a programme or a policy. It allows the user to systematically work through the connections between the components of an intervention or process, usually in graphical format on a single page.

Mentoring

A formal or informal arrangement which typically involves an ongoing relationship of support for significant transitions in knowledge, thinking and skills.

Model

A deliberate simplification of a phenomenon. Models are intended to be descriptive and need not be a completely accurate representation of reality to have value.

Monitoring

The routine and systematic collection of information against a plan. It makes use of existing data and information about inputs, outputs, outcomes, or about outside factors affecting an organisation or project, with a view to ongoing cycles of improvement.

Needs Assessment

A process which clarifies the extent to which needs, as well as enablers and barriers to meeting those needs, are accurately known and prioritised by an organisation or group of people.

Outcomes

Intended or unintended changes that occur as a result of implementing interventions. These changes can occur at the level of individuals, groups, organisations or population, and can occur in the short-, medium- or long-term.

Outputs

Key activities and areas of work that will help to achieve the desired outcomes.

Organisational Culture

The norms, values and beliefs that exist and govern behaviour within an organisation.

Resources

A stock or supply of money, materials, staff, and other assets that can be drawn on by a person or organisation in order to effectively implement an intervention.

Stakeholders

Anyone who is affected by or is involved in the intervention being implemented. This includes staff, public, clients, managers, professional bodies, unions, educators, policy-makers and funders.

Strategies

Methods or actions that aim to overcome barriers, increase the pace and effectiveness of implementation, and sustain interventions over time.

Sustainability

An intervention can be considered to be sustainable when not only have the process and outcomes changed, but the thinking and attitudes behind them are fundamentally altered and the systems surrounding them are transformed as well. In other words, the intervention has become an integrated or mainstream way of working rather than something ‘added on’.

Synthesis

A structured process where relevant information and evidence on a topic is gathered, reviewed, assessed and brought together to support decision making.

Theory

A set of analytical principles or statements designed to structure our observation, understanding and explanation of the world.

Theory of Change

An explicit, step-by-step statement of the expected relationship between the intervention and the outcome, i.e. why providing input X should lead to a change in outcome Z, by way of output Y.

Vested Interests

A special interest in maintaining or controlling an intervention, arrangement or institution, usually for personal gain.