Implementation Strategies

Implementation strategies are “methods or techniques to enhance the adoption, implementation, and sustainability of a program or practice” (Proctor et al., 2013).

After an extensive literature review, Powell and colleagues (Powell et al., 2012) organized 68 implementation strategies into the following 6 categories:

  1. Plan Strategies: to help stakeholders gather data, select strategies, build buy-in, initiate leadership, and develop the relationships necessary for successful implementation.
  2. Educate Strategies: to inform a range of stakeholders about the innovation and/or implementation effort.
  3. Finance Strategies: to incentivize the use of programs and practices and provide resources for training and ongoing support.
  4. Strategies to Restructure: to facilitate implementation by altering staffing, professional roles, physical structures, equipment, and data systems.
  5. Quality Management Strategies: to put data systems and support networks in place to continually evaluate and enhance quality of care, and to ensure that programs and practices are delivered with fidelity.
  6. Strategies That Attend to the Policy Context: to encourage the promotion of programs and practices through accrediting bodies, licensing boards, and legal systems.

 

Implementation Strategies

This infographic lays out the 6 categories of implementation strategies, explained above. This compilation has been refined and each of the strategies has been categorized and rated according to their feasibility and importance.

Reference: A Compilation of Strategies for Implementing Clinical Innovations in Health and Mental Health

Spotlight on Faciliation as a Key Implementation Strategy

Facilitation is a multi-faceted implementation strategy commonly used across health care organizations. Facilitation has been shown to be effective for the implementation of EBPs (See Kirchner, Ritchie and Harvey references). Thus, we have decided to highlight this strategy. The Agency for Healthcare Research and Quality (AHRQ) and the Veterans Health Administration have both designed excellent manuals and guides for doing facilitation.

Designed to assist in the training of new practice facilitators as they begin to develop the knowledge and skills needed to support meaningful improvement in primary care practices. The manual provides training for implementation, such as assessing readiness for change, preparing a practice to work with a facilitator, holding kickoff meetings, and tracking progress. 

Evolving from the Agency for Healthcare Research and Quality’s Integrating Chronic Care and Business Strategies in the Safety Net toolkit, this was developed to aid safety net practices in implementing the Chronic Care Model, now commonly referred to as the Care Model, in their practices.     

 U.S. Department of Veterans Affairs (VA) Implementation Facilitation Training Manual provides resources and information on how to do Implementation Facilitation with examples from the VAAdditional information about the role of implementation science in the VA has been compiled in this literature summary.

The following academic articles provide further detail about the role of faciliation in implemention in the VA:

Kirchner, J. E., Ritchie, M. J., Pitcock, J. A., Parker, L. E., Curran, G. M., & Fortney, J. C. (2014). Outcomes of a partnered facilitation strategy to implement primary care mental health. Journal of General Internal Medicine, 29(Suppl 4), 904–912.

Ritchie, M.J., Dollar, K.M., Kearney, L.K., & Kirchner, J.E. (2014) Responding to needs of clinical operations partners: Transferring implementation facilitation knowledge and skills. Psychiatric Services, 65(2), 141-143.

Harvey, G., & Kitson, A. (2016). PARIHS revisited: From heuristic to integrated framework for the successful implementation of knowledge into practice. Implementation Science 11, 1–13

Ritchie, M. J., Parker, L. E., & Kirchner, J. E. (2017). Using implementation facilitation to foster clinical practice quality and adherence to evidence in challenged settings: A qualitative study. BMC Health Services Research, 17, 294. Doi: 10.1186/s12913–017–2217–0

Additional Resources that compile evidence for implementation strategies:

Cochrane Effective Practice and Organization of Care Group.

Health Systems Evidence.

Rx for Change.

Methods for tracking implementation strategies:

Bunger et al. (2017).

Reporting guidelines for implementation strategies:

Proctor et al. (2013).

Albrecht et al. (2013).

Implementation Guide on SBIRT

Developed through the Technical Assistance Publication Series, the following SAMHSA techincal resource provides comprehensive instruction on how to implement Screening, Brief, Intervention, and Referral to Treatment (SBIRT) at a systems-level. This document in the TAP series is both a model of how careful consideration of implementation strategies can support program goals and how to best implement SBIRT. 

Last Updated: 09/27/2017