The Mechanisms of Implementation Support - Findings from a Systematic Integrative Review

Abstract

Purpose: Mechanisms of Change (MoC) explain how strategies used to enhance the uptake of evidence in social and human services enable change in the behaviors of individual practitioners, organizational leaders or entire organizations, and systems. One such strategy is the use of implementation support practitioner (ISPs). This study examines the mechanisms through which ISPs facilitate behavior supportive of the implementation of research-supported interventions. Methods: A systematic, integrative review was conducted. The conceptualization of MoCs built on a model by Dalkin and colleagues. Results: Based on a unique combination of knowledge, skills, and attitudes, ISPs install trust in and among their stakeholders and utilize this trust to promote meaningful and relevant learning; provide ongoing opportunities for learning, reflection, and support; help to span boundaries; and positively motivate stakeholders. Discussion: ISPs do not represent a short cut to better implementation. They represent an additional implementation challenge that requires dedicated attention and resources.

Knowledge and attitudes of Implementation Support Practitioners—Findings from a systematic integrative review

“…This may also ease the flexible tailoring of ISP offerings to different projects, settings and stakeholder groups, because there is higher probability for a greater bandwidth of knowledge and attitudes across multiple individuals. The findings from this review and related results from the project into which it is embedded [ 6 , 36 , 37 ] provides a knowledge base for setting up implementation support teams representing the relevant complementary knowledge, attitudes, and skills needed to enable and facilitate implementation processes.…”

“…This research is part of an ongoing international collaborative program of work on implementation support practice and practitioners involving the National Implementation Research Network (NIRN) , University of North Carolina, the European Implementation Collaborative (EIC) and the Centre for Effective Services (Ireland). This collaboration involved the conduct of a systematic integrative review of studies reporting on multiple aspects of the work of ISPs, including ISP skills [ 36 ] and the mechanisms of change that may explain how ISP efforts generate change in others [ 37 ]. The present article reports on ISP knowledge and attitudes .…”

Implementing a complex hospital innovation: conceptual underpinnings, program design and implementation of a complex innovation in an international multi-site hospital trial

“…This fifth design principle acknowledges the important impact of social processes such as role modelling and opinion leader support within an organization to galvanize support for the desired change(s) [ 34 ]. Explicit exploration and leveraging of the supportive social process specific to each implementation hospital provided a vital connection between implementation leaders and end-user, facilitated communication about the innovation and the implementation process, legitimized the innovation, and assisted end-user to ‘let go’ (unlearning) of existing practices in favour of the new ‘preferred’ behaviours [ 35 ].…”

“…Implementation program evaluation measures were modified in this stage to be incorporated with ongoing hospital evaluation plans and priorities. Implementation teams in this phase capitalized on opportunities to solidify the social mechanism(s) that supported the implementation in the activation phase, for example formalizing champion roles or continued participation in communities of practice [ 34 , 40 ].…”

Intervening for sustainable change: Tailoring strategies to align with values and principles of communities

“…Metz and colleagues (31) have reported a range of strategies that are used to build relationships including engagement, facilitation, collaboration, and consensus building. Trust has also been identified as a critical relationship quality for implementation success (31,34,70). There are several implementation strategies that have described as both a contributor to and an outcome of trust including collaboration (71), communication (38), empathy (39), and sensitivity (42).…”