A Social Networked Approach to Implementation: Questions, Methods, and Interventions

Alicia Bunger, MSW, PhD
The Ohio State University

Reza Yousefi-Nooraie, PhD
University of Rochester

ABSTRACT:
Social networks are channels for transmitting knowledge, influence, and resources among patients, professionals, and organizations. These relationships are at the heart of all dissemination and implementation efforts. Examining implementation from a social network perspective has potential to help us better understand the complex social contexts of implementation, their dynamic evolution over time, and implementation success. Networks can also be altered or leveraged deliberately to facilitate and sustain implementation. In this talk, we will introduce terminology and assumptions underlying social network analysis and illustrate how social network analysis can be used to address a range of implementation research questions. We will also introduce a new typology of network interventions (interventions that deliberately alter network structures) that have potential to be used as implementation strategies.

To request powerpoint slides, please email psmg@northwestern.edu

Racial Microaggressions in Patient-Provider Interactions

Kacey Eichelberger, MD
University of South Carolina School of Medicine Greenville

Jonathan Kanter, PhD
University of Washington

ABSTRACT:
For several years, our team has been working closely with leaders at the University of Washington Medical Center to develop, scientifically evaluate, and implement interventions to address racial bias in medical care and improve provider’s capacity for more flexible, empathic, and connected antiracist responses to their patients. We have focused in particular on inter-racial provider-patient interactions and highly charged moments in medical exams when providers are likely to microaggress against patients. We have identified four key psychological processes that fuel microaggressions and other acts of bias in these moments and target these processes with contextual-behavioral science interventions that emphasize mindfulness and acceptance, rather than avoidance or suppression, to create behavior change. Embracing an antiracism agenda, we are particularly interested in addressing the processes that often frustrate diversity trainers, such as defensiveness, anxiety, passivity, and entrenchment in unhelpful behavior that are often observed even during anti-bias trainings. Overall, our research provides important scientific foundations that racial microaggressions are real and harmful; they must be understood as important determinants of the health and well-being of our patients and it is crucial to identify effective strategies to address them and improve inter-racial provider-patient interactions and relationships.

To request Dr. Kanter’s powerpoint slides, please email psmg@northwestern.edu

The Implementation and Sustainment Facilitation (ISF) Strategy A promising strategy for improving implementation climate, implementation effectiveness, and intervention effectiveness.

Bryan Garner, Ph.D.
RTI International

ABSTRACT:
Over at least the past 15 years, implementation research has been defined as the scientific study of the use of strategies to adopt and integrate evidence-based health interventions into clinical and community settings in order to improve patient outcomes and benefit population health. Notwithstanding the significant progress that has been made to date, there remains a significant need for implementation research to identify effective and cost-effective strategies for improving the implementation and sustainment of evidence-based health interventions into clinical and community settings. In 2014, the National Institute on Drug Abuse funded a dual-randomized type 2 hybrid trial that focused on experimentally testing the Implementation and Sustainment Facilitation (ISF) Strategy as an adjunct to a staff-focused Addiction Technology Transfer Center (ATTC) Strategy. After providing a brief overview of the ATTC Strategy, this presentation will focus on describing the ISF Strategy, with emphasis on: (a) its guiding theory, framework, and principles, (b) its standardized tools/exercise, (c) study results that support its effectiveness and cost-effectiveness as an adjunct to the ATTC strategy, and (d) how it is currently being tested as part of several on-going implementation research experiments.

Bridging the Gap: Implementation Science as an Implementation Strategy for EHE

Sarit Golub, PhD, MPH
Hunter College

ABSTRACT:
This talk will discuss the role of implementation science in Ending the HIV Epidemic (EHE) goals at both the national and local levels. Not only can implementation science inform EHE investments, its tools, models and frameworks are critical to supporting and enhancing successful EHE programs and strategies. Practice-driven, collaborative implementation science research that focuses on mechanisms, intervention specification, and all four levels of strategies and outcomes will have the greatest impact.

Implementation Research Logic Model: A Method for Planning, Executing, Reporting and Synthesizing Implementation Projects

JD Smith, PhD
University of Utah School of Medicine

Dennis Li, PhD, MPH
Northwestern University

Miriam Rafferty, PT, DPT, PhD
Northwestern University

ABSTRACT:
Background: Numerous models, frameworks, and theories exist for specific aspects of implementation research, including for determinants, strategies, and outcomes. However, implementation research projects often fail to provide a coherent rationale or justification for how these aspects are selected and tested in relation to one another. Despite this need to better specify the conceptual linkages between the core elements involved in projects, few tools or methods have been developed to aid in this task. The Implementation Research Logic Model (IRLM) was created for this purpose and to enhance the rigor and transparency of describing the often-complex processes of improving the adoption of evidence-based practices in healthcare delivery systems.

Methods: The IRLM structure and guiding principles were developed through a series of preliminary activities with multiple investigators representing diverse implementation research projects in terms of contexts, research designs, and implementation strategies being evaluated. The utility of the IRLM was evaluated in the course of a two-day training to over 130 implementation researchers and healthcare delivery system partners.

Results: Preliminary work with the IRLM produced a core structure and multiple variations for common implementation research designs and situations, as well as guiding principles and suggestions for use. Results of the survey indicated high utility of the IRLM for multiple purposes, such as improving rigor and reproducibility of projects; serving as a “roadmap” for how the project is to be carried out; clearly reporting and specifying how the project is to be conducted; and understanding the connections between determinants, strategies, mechanisms, and outcomes for their project. 

Conclusions: The IRLM is a semi-structured, principles-guided tool designed to improve the specification, rigor, reproducibility, and testable causal pathways involved in implementation research projects. The IRLM can also aid implementation researchers and implementation partners in the planning and execution of practice change initiatives. Adaptation and refinement of the IRLM is ongoing, as is the development of resources for use and applications to diverse projects, to address the challenges of this complex scientific field. This presentation will cover the primary elements and use of the IRLM, review evidence of its utility, and present multiple completed examples.

Organizational Mechanisms of Change in Implementation Science

Mark G. Ehrhart, PhD
University of Central Florida

ABSTRACT:
With the increased recognition of the importance of effective implementation of evidence-based practice (EBP) in health and health services organizations, the role of the organizational context has emerged as a critical area of study in implementation science. This presentation will give an overview of relevant literature from organizational psychology and management on multilevel factors relevant for implementation effectiveness. In addition, it will provide examples of recent applications of organizational research in implementation science, in addition to highlighting directions for future research that can deepen our understanding of how organizations can most effectively implement EBPs.

Individual-level mechanisms of behavior change across implementation stakeholders

Clayton Cook, PhD
University of Minnesota

ABSTRACT:
This webinar will discuss the importance of attending to individual-level mechanisms of behavior change across a range of key implementation stakeholders. Whether it is to increase clients pull (I.e., requests) for EBPs, policymakers translation of research into policy, administrators use of implementation strategies, or implementer uptake and use of EBPs, there is evidence suggesting the existence of universal individual-level mechanisms that are applicable to all humans and represent the specific targets of behavior change strategies. This webinar will also discuss methods of adapting and tailoring strategies to the specific stakeholders and the context in which they operate

Implementation Mechanisms: The Next Frontier

Cara C. Lewis, PhD
Kaiser Permanente
Washington Health Research Institute

ABSTRACT:
Implementation mechanisms are the processes through which strategies work, or how strategies achieve their effect. Without knowing implementation mechanisms, one cannot effectively or efficiently select, match, tailor, or optimize implementation strategies. Recent systematic reviews suggest that few researchers attempt to explore implementation mechanisms given theoretical, conceptual, and methodological issues. This talk will describe the current state of implementation mechanisms evaluation, an approach to articulating implementation mechanisms through causal pathway diagrams, and early learnings from an attempt to develop an implementation mechanisms research agenda.

Conceptualizing and Testing Multilevel Mechanisms of Change in Implementation Science

Nathaniel J. Williams, PhD., LCSW
Boise State University

ABSTRACT:
An important step toward the development and targeting of optimally effective, efficient, and feasible implementation strategies involves identification of the mechanisms through which these strategies influence implementation and clinical outcomes. This presentation will provide an overview of the conceptualization, measurement, and analysis of multilevel mechanisms in implementation science with an emphasis on the application of multilevel mediation analysis. Dr. Williams will review the state-of-the-science on testing implementation mechanisms and will illustrate a highly general mediation approach for testing multilevel mechanisms, using as examples studies focused on organizational leadership and organizational social context.