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Implementation… Is there a silver bullet?

It may appear simple- come up with an idea, put together a plan, relay it to a team and voila! You have successful implementation. Unfortunately, in practice this is a much more complicated endeavour.

 “Organisations are successful because of good implementation, not good business plans”

– Guy Kawasaki

Guy Kawasaki, who was one of Apple’s original marketing specialists, goes on to say that a good idea is 10% inspiration and 90% implementation.

Implementation however, has been deemed a complex and multifaceted challenge by many researchers and practitioners worldwide. During my research, I have come across hundreds of studies trying to address its complexity. This challenge is most likely one of the reasons why 90% of start-up businesses in the USA close their doors within 10 years [1]. One thing that we do know is that simple dissemination of information is no longer effective nor sustainable in implementing innovations in the real world.

The questions is, why is successful implementation so difficult and can it be simplified?

There’s an entire science dedicated to implementation called… well ‘Implementation Science’. ‘Implementation Science looks into different methods to promote the systematic uptake of clinical research findings and other evidence-based practice into routine practice’ [2]. In other words, they investigate the best ways to apply research into the real world.

A framework that was published in the Journal of Implementation Science is the Consolidated Framework for Implementation Research or CFIR [3]. CFIR breaks down implementation into five domains;

1. Intervention characteristics

2. Outer setting

3. Inner setting

4. Characteristics of individuals and

5. Process

The authors of CFIR then delve deeper into these domains to highlight the’ implementation factors’ associated with each domain. To look at a practical way to apply the CFIR domains, let’s imagine a Chief Information Officer (CIO) who wants to implement new computer software in his/her company.

1)     Intervention characteristics

When looking at this domain, the CIO should take into account all stakeholders’ perception of the software, whether they know where it came from and if it is in fact better than other alternatives. Can this software be tailored to suit the needs of the company? Can it be tested in a small trial size setting? How difficult is it perceived to be? How is it presented to its future users and what are all the costs associated with it?

2)     Outer setting

What is the organisation’s external reality? Are they aware of their clients’ needs and how this software will meet these needs? Are they implementing this software to keep up with competitors or are they innovating? What are the external policies or incentives surrounding the implementation of this software- is it mandatory for re-accreditation or is there a pay-for performance incentive?

3)     Inner setting

One must take into account inner settings of the organisation, including; culture, structural characteristics such as its age, level of maturity compared to other organisations within the industry and its size. Is this software compatible with the organisation’s vision, norms, needs and workflow? For example, if it’s a new, small boutique firm with younger employees who have a sound knowledge of up-to date systems, implementation will look different to a much older, larger and more established firm whose employees may be more set in their ways. This leads to the aspect of absorptivity of change within the organisation and the tension for change. Do employees welcome change as a way of enhancing practice or is there a change-averse culture. Is this software coming in as a last resort when everyone is already fed up?

4)     Characteristics of individuals

Here the CIO needs to take into account the employees’ knowledge and beliefs about the intervention as well as their belief in their own self-efficacy. Once everyone is aware that new software is being implemented, the CIO or appointed implementation team need to determine what stage of change each person is at. Some may be at the acceptance stage, whilst others may still be resistant or in denial regarding the changes. The CFIR also poses the question of where each participant see themselves within the organisation and to determine their personal attributes that would help bring this software to life.

5)     Process

In the process domain, one must take into account the planning that has gone behind the implementation of this software. Was it an overnight decision that is rushed into action or was there a meticulous planning process? Was adequate time spent engaging all involved through tailored training, role modelling, bringing in an opinion leader and other similar activities? The CFIR also recommends three parties to be involved in the implementation phase.

  • A formally appointed implementation leader- such as a project manager.
  • Champions- who are the individuals driving the change within each team, ensuring resistance is overcome and
  • External change agents- such as change managers or facilitators who can remain objective whilst steering the change.

The last two implementation factors within this domain are executing the implementation plan and finally reflecting and evaluating through qualitative and quantitative feedback. Many implementation teams underestimate the importance of adequate evaluation and reflection. They forget to ask the questions of;

a) What can we do differently next time?

b) What worked well?

c) What didn’t work so well?

Sending out surveys to employees regarding the way the software was implemented is an ideal way of gathering feedback to enhance the implementation process for the next innovation.

So the question remains- is there a silver bullet to accommodate for all these complex, multi-dimensional implementation factors, whilst bearing in mind the economic impact such a bullet may have on an organisation? I will keep digging to find the best way to practically apply evidence based research into the real world of implementation- stay tuned!

For more information about the Consolidated Framework of Implementation Research, visit http://cfirguide.org/constructs.html

1.      YonkRyan M., Ryan M. Yonk, HarrisKayla, Kayla Harris, MartinR. Chistopher, R. Chistopher Martin, AndersonBarrett, Barrett Anderson. 2017. Exploring the case of The White Moustache. Journal of Entrepreneurship and Public Policy 6:1, 41-59

2.      Eccles MP, Mittman BS: Welcome to implementation science. Implementation Science 2006, 1:1.

3.      Damschroder, L. J., & Hagedorn, H. J. (2011). A guiding framework and approach for implementation research in substance use disorders treatment. Psychology of Addictive Behaviors, 25(2), 194.

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