Understanding Implementation and Sustaining Change October 23, 2007

Thoughts on Implementation It is one thing to say with the prophet Amos, “Let justice roll down like mighty waters,” and quite another to work out the irrigation system. -William Sloane Coffin -William Sloane Coffin

Thoughts on Implementation I have not failed. I've just found 10,000 ways that won't work. -Thomas A. Edison -Thomas A. Edison

What Doesn’t Work Implementation: The Missing Link Between Research and Practice, Fixsen et al.  Dissemination of information by itself  Training alone, no matter how well done  Implementation by edict  Following the money  Implementation without changing supporting roles and functions

Stages of Implementation Implementation: The Missing Link Between Research and Practice, Fixsen et al.  Take 2-4 years  Often non-linear  Stages impact each other  Staff turnover impacts implementation

Stages of Implementation Implementation: The Missing Link Between Research and Practice, Fixsen et al.  Exploration  Installation  Initial Implementation  Full Implementation  Innovation  Sustainability

Exploration (6-15 months) Implementation: The Missing Link Between Research and Practice, Fixsen et al.  Also called “pre-contemplation”  Dissemination of information  Question generating:  What problem exists?  What innovations exist?  What changes must be made?  Implementation team formed  Purveyor group formed

Installation (2-6 months) Implementation: The Missing Link Between Research and Practice, Fixsen et al.  Begins with decision to implement  Ends when innovation is used for first time  May require new staff  Takes cash

Initial Implementation (9-24 months) Implementation: The Missing Link Between Research and Practice, Fixsen et al.  Where the rubber meets the road  Bumps expected  Stage when innovation often falls apart  Experience of purveyor group may be helpful

Full Implementation (2-4 years) Implementation: The Missing Link Between Research and Practice, Fixsen et al.  Reached when 50% of practitioners perform their new functions w/ fidelity  Impacted by turnover of practitioners, administrators, and purveyor group  New staff must be trained, coached, and checked for fidelity  Often Utopian

Innovation Implementation: The Missing Link Between Research and Practice, Fixsen et al.  First do it right, then do it differently  Learn the system  Do it with fidelity  Sustain it long enough to learn the nuances  Make it better

Sustainability Implementation: The Missing Link Between Research and Practice, Fixsen et al.  Fidelity!  Must build local capacity  Never-ending

Stages of Implementation Implementation: The Missing Link Between Research and Practice, Fixsen et al.  Exploration  Installation  Initial Implementation  Full Implementation  Innovation  Sustainability

Life is a process of becoming, a combination of states we have to go through. Where people fail is that they wish to elect a state and remain in it. This is a kind of death. -Anais Nin