January 2019 Bulletin
Welcome to Implementation in Action, a monthly bulletin for implementers and intermediary organizations who are seeking to apply implementation science in a thoughtful and systematic way. Implementation in Action includes an overview of the issue's theme, a Project Spotlight, and links to two resources - one from the foundational literature on the topic and another more recently published resource.
What theory are you using to create change?
By Julia E Moore
Senior Director, The Center for Implementation
The foundations of applying implementation science involve using theories, models, and frameworks. These are developed in implementation science, but are extremely useful for implementation practice. By using theories, models, and frameworks to guide our implementation activities, we are setting ourselves up for the best chance of success. Process models provide the steps or stages in putting evidence into practice. Theories describe the mechanism of change, how we will create the change we are looking for. Frameworks present factors that affect different aspects of implementation, for example the context or sustainability.
People implementing gravitate towards using process models, as they provide a roadmap for where the implementation project is going. For example, people might use the quality implementation framework, active implementation, or the knowledge to action. Frameworks also have a lot of appeal; people naturally think about barriers and facilitators or aspects of the context, and frameworks give them away to organize their thoughts.
People are most reluctant to use theories, although theories are the most integral component to implementation success. All programs have a theory, whether it is stated or not, because all of the strategies we select are expected to impact change in some way – the theory is how we assume that change is occurring. Not having an explicit theory is a barrier to effective implementation and it’s happening all the time. There’s lots of research to show that people are developing and implementing evidence without using an explicit theory up front (Davies, Walker & Grimshaw, 2010, Davidoff et al., 2015., and Colquhoun et al., 2013).
Theories can be confusing, because they exist at multiple different levels. Imagine you want to change the public, patients, or providers (e.g., doctors, nurses, teachers, social workers). In this situation you would need an individual theory of change. For example the trans-theoretical model or the theory of planned behavior. If you are looking to create organization-level change, then you would need an organization-level theory. For example organizational learning theory or institutional theory. If you want to create system-level change, then you will need a system-level theory of change. A commonly used system theory is Roger’s diffusion of innovation, which describes how the innovations spread.
In the Project Spotlight this month, Jennifer Schroeder illustrates how she uses a theory of change at the system level. Jennifer Schroeder uses a theory of change to support early childhood systems building in Colorado.
Depending on the project, you may need an individual, and organizational, and a system-level theory of change. What level are you trying to produce change? Do you have a theory of change to describe how you will create the change you’re looking for? Thinking early on about how change will be created, and using a theory of change up front, can improve how you plan for and action implementation.
Project Spotlight: using a theory of change tool to support effective and sustainable implementation
By Jennifer Schroeder
President, The Implementation Group
In 2011 I launched The Implementation Group to provide planning, implementation capacity building, and evaluation support to organizations seeking to effectively implement programs and practices. As an implementation consultant, I am often involved in the planning process at the beginning of implementation or to revisit alignment of vision, goals, and activities midway through implementation.
I utilize implementation frameworks to support this work, including the National Implementation Research Network Active Implementation Framework (AIF) (referenced in the TCI November 2018 bulletin), to support implementation planning and tracking. A large proportion of my work, however, often occurs during the Exploration stages of implementation facilitating the development or refinement of a Theory of Change to identify the non-negotiable sequence of steps that must be achieved to meet an organization’s goals. This early conceptual work is foundational to ensuring success and sustainability for effective implementation.
A Theory of Change is a map of steps or pre-conditions required to achieve a desired goal. Put simply, it is your theory of how change will occur. It can be either simple or complex and the steps must all logically follow in sequence. The Implementation Group developed the following framework to help facilitate Theory of Change development and provide anchors for the sequence of necessary steps required to achieve outcomes.
This template has been used with many of our project partners with positive results, including LAUNCH Together in Colorado. A Theory of Change planning process was facilitated with four local grantees in Colorado to plan activities and goals for a 4-year Early Childhood Systems Building grant. Systems-building work can be complex and involves multiple partners. Each grantee used this framework to map out the systems-building activities and outcomes necessary to achieve success in their community. Their resulting Theory of Change roadmaps have continued to be used as a blueprint for development of related implementation activities as well as any course corrections needed during the grant. Because they had vetted the necessary steps for success early in the process, each grantee could more easily adapt and negotiate implementation changes while staying aligned with their overall Theory of Change. This organizational Theory of Change is adaptable to multiple contexts, guiding the process of understanding how organizations change.
Implementation Resources - January Picks
Classic Literature: Demystifying theory and its use in improvement
This paper really lays out the foundations of using a theory in an applied way, essentially demystifying how people not trained in psychology can explicitly use theory to improve how the develop and implement programs.
New Literature: Leading large scale change: a practical guide
The National Health Service in the UK just released a guide to support large scale change efforts. This document presents ways to create system-level change in a transformative way.