Reflections on Equity and Justice in Implementation Science and Practice
By Dr. Sobia Khan, Director of Implementation
The events of this past year have led to a massive upheaval of our norms. Many have already reflected on the world we leave behind and have ruminated on the world we have the potential to walk into – more equitable, just and fair – if we are ready and willing to make it so. Upheaval can be painful while at the same time it can be a powerful agent of change.
As 2020 comes to a close, myself and others at The Center for Implementation have thought a lot about our roles and what we believe in, not only as implementation scientists and practitioners, but as citizens of the world. How are we positioned to contribute to positive change during this uncertain time? What are we ready and willing to say and do to question unfair systems, to shine a light on injustices, and to support equity to the best of our capacities?
Strengths of implementation science and practice
Let’s start with what we’re doing right as a field. Everyone everywhere will implement something in their lives, whether it’s a personal change or system-wide transformation. Our jobs are to figure out the best and most impactful ways of making that change. People in our field are problem solvers, are wired to wade through uncertainty and manage complexity. We want to bring everyone along on this crazy journey, to give them the tools and methods to be problem solvers too, because we inherently want to do good. We want to make a real difference in outcomes, and ultimately, in people’s lives.
Reflections on equity and implementation practice
While our intentions are good, the systems within which we work - and more importantly, within which we allow ourselves to work – can be better. For example, evidence on the best methods of implementation can only usually be found in academic journals. Academic journals are cost-prohibitive to access and to contribute to, which poses an unjust barrier to those who want to be part of the discussion. Moreover, most implementation occurs outside of research, and so the greatest beneficiaries and contributors to these findings are implementation practitioners. It is important that practitioners create and demand spaces for knowledge exchange and dialogue about how best to apply implementation science. These spaces should be inclusive, should enable practitioners to tell their stories, and should be as equitable as possible to ensure that different types of knowledge are shared.
Another area where we can make positive change is in our ability to assess, reflect, and take action on inequities in organizations and systems. While many have made strides in terms of emphasizing participatory approaches and inclusiveness, there is still more work to be done. Understanding how things like classism, racism and patriarchy are embedded in systems can help identify levers for change. Not just inviting people to the table, but meeting them where they are is vital. Ensuring that we aren’t just trying to aim for “diversity”, but are questioning governance structures and distributing power is important when thinking about how we can make meaningful change.
Finally, the mental models through which we have constructed the theories, models, frameworks and approaches of implementation science could be adjusted to enable us to better see the world with an equity and social justice lens. In doing so, we can ensure that equity and social justice are also part of implementation in practice. An action that implementation practitioners can take is reviewing and revising their implementation processes and identifying when and how to incorporate an equity lens and approaches into those processes. Overall, it is important, as we aim to restructure our systems of knowledge to reflect our values and principles as citizens of the world, that we reshape this knowledge to reflect the experience of many and not just a few.
The Center for Implementation’s 2021 goals: A call to action and invitation to collaborate
With that being said, we at TCI have committed to new goals in 2021.
First, we are launching an implementation practice community in January 2021 to help build alternate spaces for learning and discussion on implementation.
Second, we want to facilitate a shift in mental models that will make implementation science theories, models, frameworks and approaches more relevant to all. We want to connect with collaborators to work alongside us to integrate social justice, equity, and implementation science principles.
Third, we are launching pro-bono services for grassroots community organizations that need implementation support to meet their goals. We are looking to connect with collaborators here as well to work with us to build a well-informed support model.
If you are thinking about your own goals for 2021, consider connectivity. We would love to hear from you on Twitter or reach out to us by email. We also strongly encourage joining others’ calls to action to move this field towards more equitable and just ways of being and doing. In this bulletin, Ana Baumann, Cory Bradley, Sarabeth Broder-Fingert, Nadine McCleary, Pamela Denise Long, Rachel Shelton, and Atia Thurman have penned a letter to you all, our bulletin readers, to be allies against anti-Black racism in implementation science. We are part of their Collaborative of Practice, and we hope you will consider joining too.
Have a wonderful and safe holiday. We are excited to connect with you again in the new year.
Project Spotlight: An Invitation for an Antiracist Implementation Science Field
By Ana A. Baumann, Research Assistant Faculty, Washington University in St. Louis, Cory Bradley, Postdoctoral Research Associate, Washington University in St. Louis, Sarabeth Broder-Fingert, Associate Professor of Pediatrics, Boston University School of Medicine, Nadine J. McCleary, Assistant Professor of Medicine, Dana-Farber Cancer Institute, Pamela Denise Long, Adjunct Faculty, Southern Illinois University, Rachel C. Shelton, Associate Professor, Columbia University, Atia Thurman, Associate Director of the Clark-Fox Policy Institute, Washington University in St. Louis.
Dear Readers,
Consider this as an invitation to join a grassroots movement that we hope will make an impact in the field of implementation science research and practice – and consequently on the lives of Black scholars and the broader Black community.
It all started on June 4th of 2020, when Drs. Ana Baumann and Rebecka Lengnick-Hall were scheduled to talk about the basics of implementation science in a Zoom classroom hosted by the Brown School of Social Work at Washington University in St. Louis. That week George Floyd was murdered, and several protests were happening around the world. We could not stay silent – because silence in the context of injustice is perpetrating the racial injustices that we see and live.
The short story of this group, with now more than 200 stakeholders from diverse backgrounds (students, postdocs, junior and senior faculty, and program officers) is that we are a group in light of the striking racial inequities in COVID-19 experienced by Black Americans and the racial injustices, violence, and police brutality amplified through the deaths of Breonna Taylor, Ahmaud Arbery, and George Floyd.
The group has now hosted five meetings, including two with Black stakeholders only. We have also launched six surveys. In the spirit of transparency, all collected data is anonymous and available here. We asked stakeholders which action items they think we should act on to address racism in the field of implementation science, what would be key measurable outcomes for these items, and what type of infrastructure would be needed to achieve them. Nine items were identified, including: identify anti-racists frameworks, disseminate antiracist practices/policies, identify/create equity-focused methods (including grant reviews, examining editorial boards of our journals), and apply de-implementation approaches to racism practices.
We are currently drafting our Mission Statement with the input of everyone and gaining feedback into the process by which we will achieve these goals. Currently, we see this group as a Collaborative of Practice group, whereby we aim to share a purpose, have this group as a space for personal and professional growth, and develop practice tools for knowledge sharing and creation.
The explicit focus of this group in its initial efforts is a focus on anti-black racism in the US in light of the urgency of addressing the social and health inequities experienced by this group historically and on an ongoing basis. We recognize that there are other groups that focus on equity and implementation science, and we welcome everyone to join as allies in this space. We base our work on movements such as #anti-blackness, #blackintheivory, feminist/women’s rights movements, and the Movement for Black Lives, among many. We hope to learn from the rich history of Black activists and engage our work to act and think collectively in terms of social movements to make a difference in our field.
We hope you will join us. To do so, please add your information here.
You can also follow us in our twitter handles: @BaumannAna @1stluvd @DrRachelShelton @sbroderfingert @Pdeniselong
These articles were featured in our monthly Implementation in Action bulletin! Want to receive our next issue? Subscribe here.