implementation-planner — Boyce Data Science

Stage 1

Name what you are putting into practice

Implementation science is the study of why good practices do or do not get taken up and kept up. This planner walks you from a one line description of your program to a written plan you can hand to a board, a funder, or a reviewer. Everything you type stays in your browser until you save a file.

The short description

Write this the way you would say it to a family joining your program, not the way you would write it in a grant. If the sentence needs a diagram, it is not short enough yet.

What are you putting into practice?

Organization or program

Target start date

The people and the place

Implementations often stall at a person who was never asked. Name every group whose daily work changes, including the ones you do not employ.

Who has to do something differently?

Where does the work happen?

A year after launch, what would tell you this took hold?

A distinction to hold onto. Whether your program works and whether anyone uses it are separate questions with separate evidence. A registry survey can be well designed, validated, and almost entirely unanswered. The rest of this planner is about the second question.

Stage 2

Choose the frameworks you will use

These are not rival theories you have to choose between on principle. Each one answers a different question, and many programs use more than one. Read what each one can do for you, then check the ones you want. Your choices shape the stages ahead, though every stage stays available.

If you only have time for one. Many teams start with RE-AIM because its questions are answerable without training, then add the Consolidated Framework for Implementation Research when they hit resistance they cannot explain.

Stage 3

Answer the RE-AIM questions in writing

RE-AIM stands for Reach, Effectiveness, Adoption, Implementation, and Maintenance. Answer each one in a few sentences, then rate how solid the answer is. A thin answer is not a failure but the first item on your implementation to-do list.

Stage 4

Map what will help and what will get in the way

The domains below come from the Consolidated Framework for Implementation Research, usually shortened to CFIR. Work through them one at a time and write down what you already know. Something you name here becomes something you can plan against in the next stage.

Stage 5

Pick the strategies that answer your barriers

An implementation strategy is the thing you do to help the program take hold, as distinct from the program itself. The list below is drawn from the Expert Recommendations for Implementing Change compilation, known as ERIC, described here in plain language and grouped the way that project grouped them. Check what you will use, then name an owner and a timeframe so the choice becomes a commitment.

Stage 6

Decide what you will measure about the implementation

Proctor and colleagues separated implementation outcomes from the clinical or service outcomes a program is meant to change. These are the ones that tell you whether the program is being taken up and delivered as designed. Choose the few you can genuinely collect, and name the source for each one before launch.

Stage 7

Place yourself in the arc of the work

The EPIS framework names the phases as Exploration, Preparation, Implementation, and Sustainment. Programs move back and forth between them rather than marching through once. Naming where you are keeps a team from planning a launch while half of it is still deciding what to launch.

Stage 8

Write the plan for after the launch

Sustainment is often the hardest part for a small organization, because the founding energy and the founding grant both run out. Answer these while the program is still being designed, when the answers can still change the design.

Ownership

Who owns this once the launch is over?

Who does it if that person leaves?

Where is it written down?

Money

What does a year of running this cost?

Where does year two money come from?

Ending well

What would tell you to stop or change course?

What happens to the data and the participants if it ends?

Stage 9

See where the plan is thin

This is a check-up of the plan you just wrote, not of your program and not of any patient data. It counts what you answered and how solid you said those answers are. A low bar points at the next conversation to have, not at a verdict.

What to work on next

Stage 10

Take the plan with you

Below is everything you entered, assembled into a document you can paste into a protocol, a board packet, or a grant application. Save the file if you want to come back and revise it.

The papers behind these frameworks

Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science. 2009;4:50. doi:10.1186/1748-5908-4-50
Damschroder LJ, Reardon CM, Widerquist MAO, Lowery J. The updated Consolidated Framework for Implementation Research based on user feedback. Implementation Science. 2022;17(1):75. doi:10.1186/s13012-022-01245-0
Aarons GA, Hurlburt M, Horwitz SM. Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health. 2011;38:4-23. doi:10.1007/s10488-010-0327-7
Moullin JC, Dickson KS, Stadnick NA, Rabin B, Aarons GA. Systematic review of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Implementation Science. 2019;14(1):1. doi:10.1186/s13012-018-0842-6
Proctor E, Silmere H, Raghavan R, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health. 2011;38(2):65-76. doi:10.1007/s10488-010-0319-7
Powell BJ, Waltz TJ, Chinman MJ, et al. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implementation Science. 2015;10:21. doi:10.1186/s13012-015-0209-1
Waltz TJ, Powell BJ, Matthieu MM, et al. Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance. Implementation Science. 2015;10:109. doi:10.1186/s13012-015-0295-0
Harvey G, Kitson A. PARIHS revisited: from heuristic to integrated framework for the successful implementation of knowledge into practice. Implementation Science. 2016;11:33. doi:10.1186/s13012-016-0398-2
RE-AIM planning and evaluation framework: re-aim.org
CFIR guide and construct definitions: cfirguide.org
NIH Pragmatic Trials Collaboratory, Rethinking Clinical Trials, implementation frameworks chapter: rethinkingclinicaltrials.org

Strategy names and groupings in Stage 5 follow the ERIC compilation and the concept mapping that organized it. The descriptions here are written in plain language for this planner rather than reproduced from those papers.

Glossary of terms used in this planner

Adoption: Whether the sites, staff, or families who were supposed to take something up did take it up.
CFIR, the Consolidated Framework for Implementation Research: A catalog of the conditions that help or hinder implementation, organized into domains covering the thing itself, the world around the organization, the organization, the people, and the process.
Determinant: A condition that influences whether implementation goes well. A barrier and a facilitator are both determinants.
EPIS: Exploration, Preparation, Implementation, Sustainment. A description of the phases a program moves through, including moving backward.
ERIC, Expert Recommendations for Implementing Change: A consensus compilation of named implementation strategies with shared definitions, so that teams describing their work use the same words.
Facilitation: A named person or team whose job is to help others make the change, rather than to make it for them. The central element of the integrated PARIHS framework.
Fidelity: Whether the program is being delivered the way it was designed. Drift from the design is normal and is a reason to check rather than a reason to blame.
Implementation outcome: A result about the uptake and delivery of a program, kept separate from whether the program itself improves health.
Implementation strategy: The method used to help a program take hold: training, incentives, a champion, a record system change. The strategy and the program are different things.
IRB, Institutional Review Board: The committee that reviews and oversees research involving people. Changes to what you collect, how you recruit, or what you return to participants usually require its review before you make them.
i-PARIHS: The integrated Promoting Action on Research Implementation in Health Services framework, which treats implementation as facilitation applied to an innovation, its recipients, and their context.
Penetration: How far the program spread through the eligible group or the organization, as distinct from how well it worked for the people it reached.
RE-AIM: Reach, Effectiveness, Adoption, Implementation, Maintenance. A set of planning and evaluation questions written so that a program team can answer them without specialist training.
Sustainment: Continued delivery after the launch period and the launch funding. Sometimes called sustainability.