- So today we'd like to talk about the introduction to implementation, a little bit about where implementation has come from what it is, and what we see as the next steps. So we all are familiar now with the no-do gap, the quality chasm how do we get science into service? How do we get science into practice? And this has been a problem now for several decades and we are learning that the to in science to service is really implementation. There's a whole new field that's being developed to make sure that the science that's being developed is actually used in service and used as intended. So implementation is the missing link, this is the part that we are focused on and so implementation though, this no-do gap, the quality chasm has many sources of information. There's bench to bedside from medicine. There's policy to practice that has come from our colleagues in policy analysis. Innovation to manufacture in business, how do you take an idea and actually produce a product that's usable by many people. On the business side as well how do you take strategies business strategies, leadership strategies and help to assure outcome. But in all these cases it is implementation that ties these things together, innovations and new learning that is being used then in actual practice in hospitals, clinics, and community medical centers. So out of this then, implementation we are learning is universal, it applies to all of these fields and it's trans-disciplinary, it borrows from many many disciplines and many many professional domains in order to inform what is implementation. But keep in mind, implementation now is a thing unto itself, this is not a new problem, there's an Italian poem and an Irish proverb and I'm sorry to say I grew up in western Kansas so I can't read either one of these, but I can tell you what the translations are. For the Italian poem, that poem means between saying and doing is half a sea. We can say one thing, but to actually accomplish that, mm there's a lot that goes on in between those two. The Irish proverb, you'll never plow the field by turning it over in your mind, yes knowing something, thinking about something does not equate though to accomplishing what it is you set out to do. So that, these proverbs have been around for a long time so we understand now that the implementation gap that we were talking about in implementation to fill that gap has a history, but it's starting to take on definition. And that's really what we want to talk about. So for implementation practice in science, what is implementation? Implementation means to use, if you look it up in the dictionary as I did, you'll find that that's the basic meaning behind implementation. And we know that people cannot benefit from innovations that are not used as intended in practice. So to do implementation in practice really relies on having the behavior change at the practice level so that people are making use of research in sci-- in service. They are making use of the innovations and building that in to the manufacturing process. So that is part of the practice piece of this. Implementation science then is the study of factors that influence the full and effective use of innovations in practice, so what is it then that affects our ability to do that? And that's what we will talk about here in a minute. There are three things that are in the history of implementation, that we need to clarify up front. Diffusion, Everett Rogers the work that he did for many decades in agriculture and communication. How do you get the word out, how do you have people understand things so that they are aware that here's a new hybrid corn seed? He's a new way of going about doing something in the agriculture field, and so getting, it's like advertising you know? It's making people aware, dissemination was the next thing awareness is good but it's insufficient. So now we have websites, we have manuals we have all kinds of things that are being developed, things like this video, for example to have people understand a bit better. What it is that we're trying to help them do, but dissemination just means that we are supporting people learning what needs to be done. Implementation is the actual doing of it, closing that no-do gap crossing that quality chasm so that people can actually benefit from these innovations once they're put into practice. Implementation includes dissemination, implementation includes diffusion, we want people to know about stuff so that is the diffusion part, we want them to know more about the details and of it and what it is and how to do it. That's the dissemination part, and we also want them to be actually able to do it in practice and with good effect and that's the implementation part. But those three things work together, so hopefully this will clear up a little confusion that is still out in the field of implementation. Those three things correspond with some levels of action. And these are things Hall and Hord back in 1987, Green Hall and colleagues and their wonderful summary of the literature they talked about these things. Letting it happen, helping it happen, making it happen. And that letting it happen is really the diffusion part helping it happen is where we have the websites and the other manuals and things to help people understand it better, we're gonna focus it on the practitioners, we're gonna get policy makers to understand things better. And so those are important endeavors but it's the making it happen category this is the new thing and this is really what defines our work in implementation, again relying on diffusion relying on dissemination but focusing on implementation. But it's a purposeful proactive use of implementation practice in science as we're learning how to do things better we now are doing these things on purpose we're assessing our progress and doing it and unlike the first two categories where I'm giving you information in a journal article or in a manual and you're going off and doing whatever you're going to do with it, we're gonna give you websites we're gonna have web based courses and so on. But you the recipient are still accountable for taking that information and somehow or the other making use of it. In the making it happen category where we're making good use of implementation and practice in science, it's the expert implementation teams. You have support to do this and these implementation teams, they persist until the job is done. Keep in mind diffusion, dissemination, implementation, that roughly corresponds with letting it happen, helping it happen, and then making it happen. So implementation as I just mentioned is mission driven. For example when for the eradication of Small Pox. Small Pox in the 1950s, there were 50 million people in the world who had Small Pox there were millions of people dying from Small Pox and the world community, finally in the 1960s and 70s took this on as a, a task that they would put before themselves in order to eradicate Small Pox. And by 1979 Small Pox in the entire world, was eradicated there are no more cases of Small Pox. But William Foege who was a leader of this group with CDC and the United Nations organizations. He said a key to this whole effort was going from asking what could we do with what we have? To asking what will it take to do what needs to be done to eradicate Small Pox? So he was clearly in the making it happen mode, so it was not sufficient just to document barriers, publish papers on the barriers. Isn't it too bad we can't eradicate Small Pox because of these difficulties that we're running into? They encountered the barrier and their task was to find a way to overcome those barriers, what do we need to do instead, who else do we need to bring into this? What can we do to solve this problem? And so in that sense in the making it happen category and it is definitely mission driven. So out of those efforts, surveillance and containment strategies were born. How to mobilize resources they had over 100,000 people just in India at one point who were working on the house to house searches for people who may have Small Pox so that they could, that was the surveillance part and then to contain it with injections of the vaccine. And developing the capacity in each country so that they could go and find the last case. And make sure that no one else in that country or that section of the country then would have Small Pox. But this is the mission driven, this is the making it happen this is implementation work as we envision it. So what will it take to do what needs to be done? What will it take to follow Foege's advice in terms of how to do this kind of work? And this is where synthesis of learning about implementation practice, implementation science, implementation policy that has been going on now for several decades but synthesizing this information has lead us to a conception of implementation that is very important. We want socially significant outcomes we want to eradicate Small Pox, we want every child to have an education, we want everyone to have access to high quality health care and so on. We want socially significant outcomes, well what goes into that, that's a lofty worthy goal to be sure but how to accomplish that with implementation? Well first as we've broken this down and analyzed it you definitely need an effective innovation William Foege and the folks in Small Pox, they had a good vaccine the vaccine had been around for 175 years but they found a way to improve it and then also to manufacture it in each of the countries in which they were working. But the effective innovation, we don't want to be in the business of encouraging people to use things that don't work or that maybe even cause harm. And surveys of the literature say that most standard practices today in almost any human service field fit into those two categories, they don't work very well and some cause harm. So we want effective innovations, and so that's where we start. But those effective innovations need to be used in practice they need to be implemented, we have to use them as intended if in fact we are going to produce the desired results. And that's where all the effective innovation strategies come in to play in that category. And none of those things will happen of course, without an enabling context and this is the more global systems context in which we are all operating. There are policies, there are mandates, there are monitoring criteria that we all have to abide by to what extent do those enable effective innovations to be used? And to what extent do they enable effective implementation strategies to be put into place and actually used as intended to support those innovations. So you see how these things all fit together very nicely? But effective innovations, effective implementation, effect enabling context those are the three things that we find over and over again are critical if we want to achieve those socially significant outcomes and do it on a regular basis. So that, those three things, sometimes called the formula for success they're sometimes called social impact factors, they go by many names but keep in mind those are the three categories after all the meaning that has gone on for many decades and the syntheses of information, this is where we ended up in terms of paying attention, of course there's much detail to all of this that we won't get into today. But we will explore that further in the future. So our next step, so given the fact that we have this history we're learning things, we have frameworks now to put information together where are we? And what do we need to do next? Well right now you know I've been in this field now for over 50 years, but right now for the first time in the last 15, 20 years we have sufficient information to really support a rapidly evolving science of implementation. We know more and more about what to do, how to do it and how to study it so we're on the verge of creating a virtuous cycle this is something the world bank and others named a few decades ago but this is where, better practice if we have better practice, now we can study better implementation practice. That gives us more information then to improve implementation practice the next time which gives us better independent variables to study so that we can learn more. So this is the virtuous cycle where we're learning more and more and more as we go along. But we have to do this in a deliberate way, we have to work together this is really a global strategy because some of this long term learning does not happen in even in a decade, so it's going to take some time for this to happen but we're on the path for this virtuous cycle that we just talked about. And if you're interested in this I would really encourage you to join the Global Implementation Society. You can just Google that phrase, Global Implementation Society or Global Implementation by itself and you will find where to register for this. But the Global Implementation Society is after two things and here we are back to implementation practice and research, the society is intending to help create a professional discipline where, who does implementation work, what are the standards for that, how do people get prepared to meet those standards and so on those are the hallmarks of a professional discipline. And we want to add to the development of the science, so the Global Implementation Society and the scientists who are a part of that, this is a platform then for them to get together to do the kinds of things that we just talked about. So thank you very much for listening, and we look forward to the next episode.