Annual Environment Health and Wellbeing Conference - EPA, HSE and ESRI - 21 November 2019, Radisson Blu Royal Hotel, Golden Lane, Dublin

1. The Science of How Best to
Implement Evidence Based
Services
Climate Change, Health and Wellbeing –
Opportunities and Challenges
Dr Aisling Sheehan
Centre for Effective Services
21st November 2019

2. Centre for Effective
Services
2
 Not-for-profit all-island
organisation
 Work with government
departments &
agencies, not-for-profit
& community
organisations
 Work in sectors
including health &
social care, education,
children & families,
public sector innovation
 Aim to improve services
and the lives of people
in Ireland and Northern
Ireland

3. Outline
1. In addition to evidence-informed
innovations, we need evidence-informed
implementation
2. Implementation Science can contribute to
improving the health of our environments
and populations by offering useful
frameworks and tools
3. There are many helpful resources for
those interested in applying
Implementation Science

4. 1. In addition to
evidence-informed
innovations, we need
evidence-informed
implementation

7. Why do we need to focus on implementation?
• Establishing evidence does not mean it will be implemented
• In health, < 50% clinical innovations ever make it into practice (Bauer & Kirchner,
2019)
• Gap between evidence and what’s delivered in practice
• ~ 17-20 years to get innovations used in health
• Global policy action to protect the ozone layer lagged scientific understanding by ~
30 years (U.N. Global Sustainable Development Report, 2015)
• There are multiple determinants of how quickly and how well innovations
are implemented

8. Reasons for sustainable development policy implementation
failure (Howes et al., 2017)

9. Challenges to Whole of Government policy implementation
8
• Absence of joined-up thinking about joined-up working – silos exist everywhere
• Marrying collaboration across boundaries with autonomy of organisations and with vertical
control
• Cultural challenges - “Structural change is less important than overcoming the cultural
barriers to operating across silos” (Whelan et al., 2003)
• Time-consuming
• Requires individuals to put their own agendas aside
• Difficult to measure in terms of its success
• May have poorly defined, incompatible goals and frequently involves competing political
and community agendas
• Lack of incentives
Centre for Effective Services (2014)

10. Successful implementation in Ireland - smoking ban

11. 2. Implementation
Science can contribute to
improving the health of
our environments and
populations by offering
useful frameworks and
tools

12. What is implementation science?
Implementation science is the scientific study of methods to promote the
systematic uptake of research findings and other evidence-based
practices into routine practice to improve the quality and effectiveness of
services (Bauer et al., 2015).

13. Diffusion
“let it happen”
Dissemination
“help it happen”
Implementation
“make it happen”
Greenhalgh et al., 2004

14. Types of Implementation Science Frameworks
5 categories of frameworks in Implementation Science (Nilsen, 2015):
14
Process Models
Guide the translation of
research into practice
Determinant Frameworks
Specify barriers and enablers
that influence
implementation outcomes
Classic Theories
From external fields such as
psychology, sociology and
organisational theory
Implementation Theories
Provide understanding of
aspects of implementation
Evaluation Frameworks
Specify aspects of
implementation that can be
evaluated

15. 15
Interactive Systems
Framework
An Organisational
Theory of Innovation
Implementation
Precede-Proceed Model
More that 100 frameworks
exist, making it difficult to
know where to start
Davis’ Pathman-
PRECEED Model
RE-AIM

16. 16
Powell et al. (2012)

17. • Motivation of target audience is important; role and
motivation of organisation and system is more influential
in supporting successful adoption of innovations
• Describe how the innovation is new and different and
how it is compatible with values and current practices
• State why the innovation is better than before and how it
improves the work and outcomes
• Filter the information to what is most valid and essential
• Use email and social media to build awareness; then talk
to people to tackle confusion or resistance
• Opinion leaders can act as effective sources of
information to disseminate about new ways of working
Example of Implementation Strategy: Communication

18. Why use Implementation Science?
• Aids in:
• Identifying implementation barriers and facilitators
• Assessing readiness for implementation
• Implementation planning and monitoring
• Developing, testing and applying implementation
strategies and approaches
• Useful tools and resources
• Developing implementation evaluation methods and
techniques

19. 3. There are many
helpful resources for
those interested in
applying Implementation
Science

20. NCEC Implementation Resources
CES contracted by the National Patient Safety Office to
develop and provide training and resources in
Implementation Science for National Clinical Guidelines
NCEC Implementation Guide and Toolkit launched in
September 2018
Training videos on NPSO Learning Zone
20

21. Membership of the Implementation Network of Ireland and
Northern Ireland
What does membership involve?
 Opportunities to connect with implementation colleagues by attending Network meetings and
events which feature leading local and international experts in implementation and Implementation
Science
 2 Network meetings a year (Spring, Autumn), plus other events
 3-4 ‘Implementation Update’ emails a year
 Access to up-to-date resources and publications on Implementation Science
 Sharing your name, job title, and organisation, as part of a members list, with other members at
Network meetings
 No fee/charge
How to become a member
• Sign up by emailing snevin@effectiveservices.org
21

22. Useful Links
• CES Guide to Implementation
http://implementation.effectiveservices.org/
• The National Implementation Research
Network’s Active Implementation Hub
https://implementation.fpg.unc.edu/
• The Center for Research in
Implementation Science and Prevention
(CRISP) – interactive website on
dissemination and implementation
models in health research and practice
http://dissemination-implementation.org/
• European Implementation Collaborative
website http://www.implementation.eu/
• Society for Implementation Research
Collaboration
https://societyforimplementationresearchcollabo
ration.org/
• National Cancer Institute Division of Cancer
Control & Population Science –
Implementation Science at a Glance Toolkit
https://www.thecommunityguide.org/resources/i
mplementation-science-glance

23. “A policy may be a beautiful thing to behold in the
isolation of bureaucracy, but what really counts is how
the policy is implemented and how it translates into
service delivery”
(Metcalf, 2011)

24. Thank You!
Aisling Sheehan
asheehan@effectiveservices.org
www.effectiveservices.org
http://implementation.effectiveservices.org
Acknowledgements
CES colleagues: Katie Burke, Sarah Rochford,
Niamh Farren, Chris Minch, Jonathan Barrett