Implementation or execution of programs for transp

An adaptable tool that describes the theory of change underpinning an intervention, a programme or a policy. It allows the user to systematically work through the connections between the components of an intervention or process, usually in graphical format on a single page. A formal or informal arrangement which typically involves an ongoing relationship of support for significant transitions in knowledge, thinking and skills.

A deliberate simplification of a phenomenon. Models are intended to be descriptive and need not be a completely accurate representation of reality to have value. The routine and systematic collection of information against a plan. It makes use of existing data and information about inputs, outputs, outcomes, or about outside factors affecting an organisation or project, with a view to ongoing cycles of improvement.

A process which clarifies the extent to which needs, as well as enablers and barriers to meeting those needs, are accurately known and prioritised by an organisation or group of people. Intended or unintended changes that occur as a result of implementing interventions. These changes can occur at the level of individuals, groups, organisations or population, and can occur in the short-, medium- or long-term. A stock or supply of money, materials, staff, and other assets that can be drawn on by a person or organisation in order to effectively implement an intervention.

Anyone who is affected by or is involved in the intervention being implemented. This includes staff, public, clients, managers, professional bodies, unions, educators, policy-makers and funders.

Methods or actions that aim to overcome barriers, increase the pace and effectiveness of implementation, and sustain interventions over time.

An intervention can be considered to be sustainable when not only have the process and outcomes changed, but the thinking and attitudes behind them are fundamentally altered and the systems surrounding them are transformed as well. A structured process where relevant information and evidence on a topic is gathered, reviewed, assessed and brought together to support decision making.

A set of analytical principles or statements designed to structure our observation, understanding and explanation of the world. An explicit, step-by-step statement of the expected relationship between the intervention and the outcome, i. A special interest in maintaining or controlling an intervention, arrangement or institution, usually for personal gain. Implementation Stages Here we look at implementation stage by stage, and the outcomes or changes related specifically to the implementation process.

The stages of Implementation Implementation in the real world rarely follows a linear path from one step to the next, but research indicates that there are generally four stages in implementing any intervention.

Stage Activities during this stage include: Assessing needs and the evidence base for the intervention Assessing fit, feasibility and appropriateness Assessing implementation readiness Developing leadership for implementation Stakeholder engagement planning Selecting or designing the intervention Identifying outcomes Developing a theory of change and logic model. Activities during this stage include: Assessing enablers and barriers for implementation Developing an implementation plan Establishing implementation team s and other structures to support implementation Securing resources Identifying champions to support implementation Designing monitoring, evaluation and feedback systems Determining and delivering staff training, capacity building and support requirements Planning for sustainability.

Activities during this stage include: Maintaining ongoing communication with key stakeholders, explaining why the intervention is necessary and securing continued buy in Providing ongoing professional development opportunities, coaching and mentoring for stakeholders implementing and delivering the intervention Monitoring implementation, service and client outcomes Using data and feedback to inform ongoing improvements Adapting for local context where appropriate.

Full Implementation During this stage, the intervention is fully operational and integrated into the setting. Activities during this stage include: Maintaining skilful practice Developing more efficient and effective structures Evaluating implementation, service and client outcomes Engaging in continuous improvement cycles.

What is Implementation? The A—Z of Implementation There are a range of terms used when writing or talking about implementation and in implementation science. Adaptable components Elements of an intervention which may be tailored to local settings during implementation without undermining the integrity of the intervention itself.

Barriers Factors which hinder the implementation process and reduce the probability of successful implementation. Capacity The ability or power to do, understand or absorb something.

Coaching A formal, typically short-term, arrangement between a coach and an individual focused on developing work-related skills or behaviours.

Community A group of people living in an area or having characteristics in common e. Consultation The action or process of formally discussing something with stakeholders, generally asking stakeholders a relevant question and receiving answers to that question. Context The set of circumstances or unique factors in which implementation takes place. Continuous Improvement Cycles Ongoing use of emerging data and evidence on outcomes and implementation, and using that information to learn from experience, inform future implementation and improve outcomes.

Core Components Indispensable elements of an intervention or implementation plan, which cannot be changed without undermining it. Data-Based Decision Making Using processes for collecting and analysing different types of data to guide decisions with the aim of improving outcomes on an ongoing basis. Diffusion A process by which an intervention is communicated through certain channels over time. Dissemination An active, negotiated and influenced means of spreading an intervention or information about an intervention to relevant target groups.

Enablers Factors which increase the probability of successful implementation. Evaluation A planned investigation of a project, programme, or policy used to answer specific questions. Evidence-Based Interventions Practices, programmes, policies, strategies or other activities that have been empirically shown through scientific research and evaluation processes to improve outcomes to some degree. Fidelity Delivering an evidence-based intervention exactly as intended by those who developed it.

Framework A structure, overview, outline, or system consisting of various descriptive categories and the presumed relationships between them. Dose Once per week for 15 minutes for 12 weeks, plus follow-up booster sessions at 20 and 36 weeks. Once monthly for one hour for the first six months. Justification Research that suggests that post-training coaching is more important than quality or type of training received [ 70 ].

Cooperative learning theory [ 71 ]. Existing reporting guidelines and suggested extensions We suggest that journals that routinely publish implementation studies could advance knowledge about strategies by formally adopting reporting guidelines and providing them to authors and reviewers. Competing interests The authors declare that they have no competing interests.

Acknowledgements The authors acknowledge their colleagues in the practice community who ask important and provocative questions about how to improve care, the kind of questions that simulated this work.

References Lomas J. Diffusion, dissemination, and implementation: who should do what? Ann N Y Acad Sci. What implementation efforts increase cancer screening rates? An implementation research agenda. Initial national priorities for comparative effectiveness research. Knowledge translation of research findings. Specifying and reporting complex behaviour change interventions: the need for a scientific method.

A systematic review of the use of theory in the design of guideline dissemination and implementation strategies and interpretation of the results of rigorous evaluations. A systematic review of the use of theory in randomized controlled trials of audit and feedback. Methods and metrics challenges of delivery-systems research. A cross-sectional study of the number and frequency of terms used to refer to knowledge translation in a body of health literature in a tower of Babel?

Developing and evaluating complex interventions: new guidance. London: Medical Research Council; Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care. Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges.

Adm Policy Ment Health. Out of the crisis. Lean thinking in healthcare: a realist review of the literature. Qual Saf Health Care. The impact of evidence-based guideline dissemination for the assessment and treatment of major depression in a managed behavioral health care organization.

J Behav Health Serv Res. A compilation of strategies for implementing clinical innovations in health and mental health. Med Care Res Rev. Innovations in mental health services implementation: a report on state-level data from the U. Implementation research: a synthesis of the literature No. Refining a taxonomy for guideline implementation: results of an exercise in abstract classification. Data Collection Checklist. The behavior change technique taxonomy v1 of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions.

Ann Behav Med. Randomized trial of the availability, responsiveness, and continuity ARC organizational intervention with community-based mental health programs and clinicians serving youth. J Consult Clin Psychol. Cambridge, Massachusetts: Institute for Healthcare Improvement; A framework for spread: from local improvements to system-wide change. Institute for Healthcare Improvement: Cambridge, Massachusetts; Getting to outcomes promoting accountability through methods and tools for planning, implementation, and evaluation.

From science to application: the development of an intervention package. Implementing evidence-based interventions in health care: application of the replicating effective programs framework. Child Abuse Negl. Randomized trial of the availability, responsiveness and continuity ARC organizational intervention for improving youth outcomes in community mental health programs.

Specifying the treatment process: the basis for effective research. J Soc Serv Res. A taxonomy of behavior change techniques used in interventions. Health Psychol. Employing external facilitation to implement cognitive behavioral therapy in VA clinics: a pilot study. Evidence-based practice implementation strategies: results from a qualitative study.

Community Ment Health J. Bridging research and practice: models for dissemination and implementation research. Am J Prev Med. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science.

A checklist for identifying determinants of practice: a systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice. Validation of the theoretical domains framework for use in behaviour change and implementation research. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. In: Dissemination and implementation research in health. New York: Oxford University Press; Design and analysis in dissemination and implementation research; pp.

Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Teacher key opinion leaders and mental health consultation in low-income urban schools. In: Dissemination and implementation research in health: translating science to practice. Measurement issues in dissemination and implementation research; pp.

In: Child and adolescent therapy: dissemination and implementation of empirically supported treatments. In Press. Changing the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings. J Clin Epidemiol. Planning and studying improvement in patient care: the use of theoretical perspectives. Milbank Q. The OFF theory of research utilization. Tailored implementation for chronic diseases TICD : a project protocol.

Developing and evaluating complex interventions: the new medical research council guidance. Implementation science in health care; pp. Towards a general theory of implementation. Barriers to adoption of new treatments: an internet study of practicing community psychotherapists. Social science methodology: a criterial framework. Cambridge: Cambridge University Press; Advancing the application, quality and harmonization of implementation science measures. A glossary of dissemination and implementation research in health.

J Public Health Manag. Developing terminology for dissemination and implementation research; pp. Supported local implementation of clinical guidelines in psychiatry: a two-year follow-up. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. Audit and feedback features impact effectiveness on care quality. Functional Job analysis: a foundation for human resources management.

Training and consultation to promote implementation of an empirically supported treatment: a randomized trial. Psychiatr Serv. Cooperative learning returns to college: what evidence is there that it works? Local opinion leaders: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews. Diffusion of innovations. New York: Free Press; A primer on leading the improvement of systems. Increasing value: a research agenda for addressing the managerial and organizational challenges facing health care delivery in the United States.

Med Care Res. Diffusion of innovations in service organizations: systematic review and recommendations. Developing the mental health workforce: review and application of training approaches from multiple disciplines. Advancing a conceptual model of evidence-based practice implementation in public service sectors.

The quality of work will suffer if supervision is inadequate because corners may be cut, inferior materials used, and safety compromised" DFID The involvement of the designers is also needed during the construction stage, particularly to answer questions and make changes in the design when improvements and adaptations are required. A practical implementation plan should be prepared by the implementation team to define real time schedule of delivery of services, such as NETSSAF :.

Other aspects that have to be taken into account during the construction phase are: sourcing, availability of funds , payment procedures, preparation of contracts, supervision of community labour, division of labour between women and men see also gender issues , regular meetings with actors, etc.

Similarly, local materials and construction methods should be employed wherever possible. This may not always be possible, for example if rotary drilling in rock is required, but the community should be consulted because they may have their own ideas. As mentioned before, social projects are also very common in the water and sanitation field, as they usually target the human factor that is crucial for achieving sustainability of the SSWM measures.

These projects are usually related to the change of behaviours and strengthening of capacities by awareness raising see PPT campaigns, training activities , institutional set-ups, etc. As these projects cover a wide range of activities that are case-specific, how the implementation will take place will vary from case to case. However, the implementation of a project will always be successful if management strategies and coordination guidelines are clearly defined.

Independent of the type of project to be carried out, a work plan is needed indicating the pursued objectives, the expected results, the activities to be developed, as well as the budget available and timeframe given. Each of the activities has to be assigned to a particular individual, department or organisation that should have proven experience and the capacity to achieve the goals.

Local community workers, who can speak the local languages, are the first to integrate in the project, as these types of actions require that the implementers know the culture of the community to gain their trust and achieve a real impact. It is of primordial importance that the financial resources are readily available at the beginning of the action, so the members of the team have the budget to initiate the activities and cover their own expenses.

The management team should look for strategic partnerships with local leaders and spokespersons, giving institutional backup to the actions. Directors and CEOs of the leading organisation should participate in the opening ceremonies or kick-off meeting supporting the local workers, thus facilitating future activities that will be done in the field.

An activity and financial reporting procedure has to be prepared and communicated to the members of the team. It should be clear from the beginning of the action, how all the costs incurred will be reported and reimbursed. It is important to keep procedures as simple as possible, using simple tables and template for reporting costs, field visits , interviews, workshops, meeting minutes, etc. A controlling strategy has to be developed, in order to monitor the work done on the field.

This ladder will allow for immediate correction of actions and efficient use of human resources. Communication channels should be kept open between the field workers and the management team, making use of mobile phones, SMS, E-mails, etc. It is important to avoid overloading the team with bureaucratic procedures that nobody will follow like newsletters, long reports, weekly E-mails, etc. Implementation is the desired step after the carrying out of a participatory planning process, as it represents the realisation of the plans and activities described in the strategy paper.

This manual has been prepared as a tool to help improve DFID's Department for International Developments, United Kingdom support for water supply and sanitation projects and programmes in developing countries. Its particular focus is on how DFID assistance can best meet the needs of the urban and rural poor for water supply and sanitation services.

The guideline provides information necessary to understand the EMPOWERS approach of water governance and explains in details how to use the approach for planning and implementation of water management and related issues. The materials are primarily targeted at local government officials, but are considered equally useful for individuals and organisations that work with local governments in the management of water resources.

This is the actual tutorial of the participative planning approach developed by NETSSAF, containing all the steps, sub-steps and case studies. It is freely available on the internet in French and English. Get the latest updates on trainings, new articles or perspectives related to SSWM delivered directly to your inbox! See our data use policy for details.