implementation science and organizational...

IMPLEMENTATION SCIENCE AND ORGANIZATIONAL READINESS: BRIDGING RESEARCH AND PRACTICE UNC-CHAPEL HILL APRIL 2016 Abraham Wandersman U. of South Carolina [email protected]

GTO

mailto:[email protected]

Readiness Team Person Institution Projects (s)

Abe Wandersman University of South Carolina All

Andrea Lamont University of South Carolina

Ariel Domlyn

Brittany Cook, MA University of South Carolina SCALE

Drew Gadaire University of North Carolina-Charlotte Morehouse

Erin Godley-Reynolds University of North Carolina-Charlotte Morehouse

Gareth Parry Institute for Healthcare Improvement SCALE

Jonathan Scaccia Independent SCALE

Kassy Alia University of South Carolina SCALE

Maria Fernandez University of Texas

Paul Flaspohler Miami of Ohio

Rohit Ramaswamy University of North Carolina SCALE

Sami Hartley University of South Carolina SCALE

Tara Kenworthy University of South Carolina Morehouse

Victoria Scott University of North Carolina-Charlotte Morehouse

OVERVIEW

•Bridging Research and Practice

•The Interactive Systems Framework for Dissemination and Implementation

•Readiness (R=MC2)

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RESEARCH PRACTICE

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Interactive Systems Framework for Dissemination and Implementation

Delivery System

General Capacity

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General Capacities Types of General Capacities

(non-exhaustive) Authors

Culture Drzensky et al., 2012; Glisson, 2007; Glisson & Schoenwald, 2005; Hemmelgarn et al., 2006

Climate Aarons et al., 2011; Beidas et al., 2013; Damschroder et al., 2009; Glisson, 2007; Greenhalgh et al., 2004, Hall & Hord, 2010; Lehman et al., 2002

Organizational

Innovativeness

Damschroder et al., 2009; Fetterman & Wandersman, 2005; Greenhalgh et al., 2004; Klein & Knight, 2005; Rafferty et al., 2013; Rogers, 2003

Resource Utilization Armstrong et al., 2006; Greenhalgh et al., 2004; Klein et al., 2001; Rogers, 2003; Simpson, 2002

Leadership Aarons & Sommerfield, 2012; Becan, Knight, & Flynn, 2012; Beidas et al., 2013; Fixsen et al., 2005; Grant, 2013; Rafferty et al., 2013; Simpson et al., 2002

Structure Damschroder et al., 2009; Flaspohler et al., 2008; Greenhalgh et al., 2004, Lehman et al., 2002; Rafferty et al., 2013; Rogers, 2003

Staff Capacity Flaspohler et al., 2008; McShane & Van Glinow, 2009; Simpson et al., 2002

General Capacities

• Culture

• Climate

• Openness to change

• Use of Resources

• Leadership

• Structure

• Staff Capacity

• Process Capacities

General Capacity

Ready to Implement

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GC Components are “Normal”

High Medium Low

Leadership

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Delivery System

General Capacity

Innovation-Specific Capacity

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An Innovation

•Any policy, program, or process that is new to a setting

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Innovation-Specific Capacities Types of Innovation-Specific Capacities;

(non-exhaustive) Authors

Innovation-Specific

knowledge, skills, and

abilities

Wandersman, Chien, & Katz, 2012; Fixsen et al., 2005; Greenhalgh et al., 2004; Simpson, 2002

Program Champion Atkins et al., 2008; Damshroder et al., 2009; Greenhalgh et al., 2004; Gladwell, 2002; Grant, 2013; Rafferty et al., 2013; Rogers, 2003

Specific Implementation

Supports

Aarons et al., 2011; Beidas et al., 2013; Damshroder et al., 2009; Fetterman & Wandersman, 2005; Greenhalgh et al., 2004; Hall & Hord, 2010; Rogers, 2003; Schoenwald & Hoagwood, 2001; Weiner et al., 2008.

Interorganizational Relationships

Aarons et al., 2011; Flaspohler et al., 2004; Powell et al., 2012

Innovation-Specific Capacities

• Knowledge, skills, and abilities

• Champion

• Supportive climate

• Inter-organizational Relationships


Ready to Implement

General Capacity

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Delivery System

General Capacity

Innovation-Specific Capacity Motivation

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Motivation for Innovation

Types of Motivations (non-exhaustive)

Authors

Relative Advantage Armenakis et al., 1993; Damschroder et al., 2009; Hall & Hord, 2010; Rafferty et al., 2013; Rogers, 2003; Weiner, 2009

Compatibility Chinman et al., 2004; Durlak & Dupre, 2008; Fetterman & Wandersman, 2005; Greenhalgh et al., 2004; Rogers, 2003; Simpson, 2002

Complexity Damschroder & Hagedorn, 2011; Fixsen et al., 2005; Greenhalgh et al., 2004; Meyers, Durlak & Wandersman, 2012; Wandersman et al., 2008.

Trialability Armenakis et al., 1993; Greenhalgh et al., 2004; Rapkin et al., 2012; Rogers, 2003

Observability Beutler, 2001; Chinman et al., 2004; Damschroder et al., 2009; Ford et al., 2008; Rossi, Lipsey, & Freeman, 2004

Priority Armenakis & Harris, 2009; Greenhalgh et al., 2004; Flaspohler et al., 2008

Factors that Influence Motivation

• Relative Advantage

• Fit

• Complexity

• Ability to pilot

• Visibility

• Priority

• Joy

Ready to Implement

Motivation Innovation-Specific Capacity

General Capacity

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A Heuristic

Readinessi = Motivationi x General Capacity x

Innovation-Specific Capacityi

R = MC 2

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Delivery System

General Capacity


Support System

General Capacity


Readiness Building Strategies

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Readiness: Facilitating Innovation Use

•Organizational readiness is important if we want to help organizations put an innovation into place •Flaspohler et al. (2008), Scaccia et al. (2015),

Weiner et al. (2008)

•Assessment of organizational readiness is important: • Before an innovation is selected (adoption) • Before the innovation is put into place • During implementation

• During sustainability planning

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Building Readiness Broad Strategies

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Ways to support an Innovation

Evidence-Based System for Innovation Support (EBSIS)

(Wandersman, Chien, & Katz, 2012)

Tools Training

Technical Assistance

Quality Assurance/

Quality Improvement

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Testing out systems to help assess and develop readiness and capability:

Building Readiness Through an Evidence-Based System for Implementation Support (EBSIS)

To Achieve Desired Outcomes

Initial Readiness

• General Capacities

• Innovation-Specific Capacities

• Motivation

Readiness Outcomes Improved:

• General

Capacity • Innovation

- Specific Capacity

• Motivation

Relationships

Training

Quality Assurance Quality Improvement

Tools Technical

Assistance

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Led by the Institute for Healthcare Improvement An unprecedented collaboration of change agents pursuing an unprecedented result: 100 million people living healthier lives by 2020 Vision: to change the way we think and act to improve health, wellbeing and equity

Unprecedented collaboration

Innovative improvement

System transformation

100 Million People Living

Healthier Lives by 2020

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100 Million Healthier Lives Overview

Spreading Community Accelerators through Learning and Evaluation - SCALE

Vital Village Community Engagement Network Boston Medical Center

Boston, MA

Support System Resources • CHILA

• includes content taught at CHILA • Webinars • Coaches • Peer Community Team Meetings • Improvement Advisors meetings • Healthdoers

Increasing the effectiveness and efficiency of the SCALE model Utility of Support System

Aims and Driver

diagrams

Community Health Plan

Implementation

Outputs and

Outcomes (metrics)

Q1. How did the support system contribute to progress on tasks?

Onboarding

Support System

Resources

Support System

Resources

Support System

Resources

Support System

Resources

Support System

Resources

Partner Organizations

• Boston Local Initiatives Support Corporation

• Child Witness to Violence Project

• Dudley Street Neighborhood Initiative

• Medical-Legal Partnership | Boston

• Orchard Gardens Pilot School

The Vital Village Network SCALE Team

Renee Boynton-Jarrett Founding Director, Vital Village Network

Kymberly Byrd Project Manager, Vital Village Network

Josette Williams Program Manager, Boston Public Schools/Countdown to Kindergarten

Coalition Leader

Local Improvement Advisor

Community Champion

Natanya Behrmann Research Assistant, Vital Village Network

Trauma-Informed K-3rd Grade Classroom Pilot Year completed at Orchard Gardens Pilot School

5.18 5.47

1.72

6.13 6.09

2.46

0

1

2

3

4

5

6

7

Emotional Support Classroom Organization Instructional support

CLA

SS S

core

Changes in Classroom Climate

Baseline Follow-Up

p < 0.05

p < 0.001

p < 0.001

A story about something we learned since CHILA1….

Relationships Incorporating CHILA1 tools into network meetings improve relationships among partners CHILA1 Skillsmatch technique participation in 7 childhood SEL* community events

Process PDSA Cycle to improve community outreach (Love Bank Activity & Neighborhood Survey). UFO Exercise to facilitate collective problem-solving among innovation pilots.

Results Community survey results have helped frame our next steps. Shared data dashboard success has helped deepen shared investment in metrics. Evaluation support approach development of 2 survey instruments for partners

*SEL=socio-emotional learning

Vital Village Network

• Building community capacity to promote healthy social and emotional development in early childhood.

• Integrating a trauma-informed framework for preventing childhood adversity into the context of existing systems and community-based efforts for early childhood health and education.

Health Systems Early Childhood

Education

Community Initiatives &

Advocacy Organizations

Legal Advocates

www.vitalvillage.org

Vital Village Network

1. To cultivate community settings that protect children from violence and optimally support their well-being.

2. Improve the quality of data and tools to promote family and community safety.

3. Support social emotional learning, protective factors

4. Support geography of opportunity


Driver Diagram

By December 2016, we will increase socio-

emotional wellbeing for children ages 0-8 in

Dudley Square, Codman Square, and Mattapan

by 30%.

Access to reliable, regularly updated

indicators and data to inform collaboration

Shared existing data from multiple sources and agreed upon indicators

Socially connected caregivers

Disseminate peer advocacy curriculum and meeting model

Peer to Peer Advocacy workshops, clinics

Improve neighborhood social cohesion

Improved classroom climates

Systematic implementation of trauma-informed models in school settings

Integrated neighborhood child

opportunity structure

Develop local community of practice

Network of engaged residents, stakeholders, and organizations

Build family protective factors

Financial opportunity centers in health centers to reduce material hardships

Improved understanding of child development by parents

Build community

capacity, improve social cohesion, and

strengthen family

protective factors and

neighborhood opportunity

structures to maximize

social-emotional

competence and wellbeing

for children and families.

Vision: Aim:

Outcomes Primary Drivers Secondary Drivers


Since the last CHILA, we are most proud of our progress with trauma-informed classrooms

2013

Curriculum and toolkit co-designed with educators

2014 First pilot in 2nd grade class at Orchard Gardens Pilot School.

2014-2015 Full pilot with K-3rd grade at Orchard Gardens Pilot School

August 2015

Curriculum guide finalized and Teacher champion designated

September 2015

Expansion from one to four schools schools. Children’s Services of Roxbury( CSR), Haynes Early Education Center, and Lee Academy Pilot School

OGPS

CSR

Haynes

Lee Academy


Infusing Trauma-Informed Practices into Classrooms

• Students Obtain knowledge on socio-emotional regulation

• Teachers Partner with Vital Village Network (VVN) and Child Witness to Violence Project (CWTVP) to design a trauma-informed curriculum and support students exposed to trauma

• Administrators Partner with VVN and CWTVP to offer professional development on trauma-informed approaches


Metrics

Classroom Assessment

Scoring System

1. % increase in

emotional support

2. % increase in

classroom

organization

3. % increase in

instructional

support

Neighborhood Measures

1. Social Cohesion

2. Civic Engagement

3. Collective Efficacy

Parents’ Assessment of

Protective Factors

1. % increase in parental

resilience

2. % increase in social

connections

3. % increase in concrete

support in times of

need

4. % increase in social

and emotional

competence of

children


Support System Resources • CHILA

• includes content taught at CHILA • Webinars • Coaches • Peer Community Team Meetings • Improvement Advisors meetings • Healthdoers

Increasing the effectiveness and efficiency of the SCALE model Utility of Support System

Aims and Driver

diagrams

Community Health Plan

Implementation

Outputs and

Outcomes (metrics)

Q1. How did the support system contribute to progress on tasks?

Onboarding

Support System

Resources

Support System

Resources

Support System

Resources

Support System

Resources

Support System

Resources

Example: Readiness for SCALE Methods for Health

Improvement

• General capacity

• Innovation-specific capacity

• Motivation

-needed to put SCALE Methods for Health Improvement into place

• 64 total responses (~22 communities)

• Scored 1 to 7 (Strongly Disagree = 1, Disagree = 2, Slightly Disagree = 3, Neither Agree nor Disagree = 4; Slightly Agree = 5, Agree = 6, Strongly Agree = 7).

Full Readiness Survey index scores

Community N

General

Capacity Index

Innovation

Index

Motivation

Index

Full

Readiness

index

Community 1 1 6.45 6.85 5.96 6.42

Community 2 2 6.48 6.37 6.25 6.37

Community 3* 9 6.55 6.35 5.64 6.18

Community 4 2 6.48 6.03 6.01 6.18

Community 5 1 6.01 6.41 6.00 6.14

Community 6 2 6.41 6.09 5.59 6.03

Community 7 1 6.18 5.72 5.71 5.87

Community 8 2 5.90 5.55 5.61 5.68

Community 9 4 5.91 5.80 5.33 5.68

Community 10 8 5.70 5.67 5.40 5.59

Community 11 1 5.46 5.51 5.64 5.54

Community 12 3 6.32 4.99 5.15 5.49

Community 13 2 5.27 5.70 5.48 5.48

Community 14* 1 5.61 5.51 5.19 5.44

Community 15 6 5.40 5.52 5.20 5.37

Community 16 5 5.39 5.56 5.07 5.34

Community 17 5 4.97 5.27 5.35 5.20

Community 18 3 5.24 5.47 4.79 5.17

Community 19 2 5.29 4.84 4.60 4.91

Community 20 1 4.18 4.86 5.42 4.82

Community 21 1 5.38 4.64 4.18 4.73

Community 22* 5 5.95 No data No data No data

Subcomponents of General Capacity

Community N Culture Climate Structure Innovate

Resource

Utilization Leadership

Staff

Capacity Process

General

Capacity

Index

Community 3 * 9 6.69 6.73 6.3 6.65 6.56 6.72 6.33 6.44 6.55

Community 4 2 6.75 6.19 6.83 6.75 6.71 6.96 5.67 6 6.48

Community 2 2 6.5 6.19 6.42 6.88 6.17 6.92 6.5 6.27 6.48

Community 1 1 6.83 6.88 6.67 6.88 5.33 7 5.67 6.36 6.45

Community 6 2 7 6.63 6.5 6.88 5.67 6.5 5.83 6.27 6.41

Community 13 1 6.17 6.38 5.83 7 5.67 7 5.67 6.81 6.32

Community 7 1 6.33 6.25 5.83 6.5 6.67 6.38 5.67 5.82 6.18

Community 5 1 6.33 6.5 5.33 6.25 5 6.31 6 6.36 6.01

Community 22* 5 5.75 5.88 5.91 5.69 6.33 6 6 6 5.95

Community 8 2 6.33 5.75 5.58 6.13 5.83 6.27 5.5 5.91 5.91

Community 9 4 6.42 6.47 6.08 6.16 4.17 6.37 5.67 5.82 5.90

Community 10 8 6.15 6.02 5.52 5.94 4.13 6.93 5.25 5.64 5.70

Community 14* 2 6.02 6.72 5.75 6 4 5.88 4.17 6.36 5.61

Community 11 1 5.83 5.75 5.5 5.88 5 5.92 4.33 5.5 5.46

Community 15 6 5.77 5.62 5.58 5.79 4.28 5.94 4.5 5.7 5.40

Community 16 5 5.9 5.75 5.57 5.9 4.07 5.63 5 5.27 5.39

Community 21 1 5.17 5.88 5.17 5.88 4.33 5.61 5.67 5.36 5.38

Community 19 2 5.58 5.5 4.67 5.44 5.17 5.77 4.83 5.36 5.29

Community 12 3 6 5.63 4.94 5.58 4.44 5.74 4.44 5.42 5.27

Community 17 5 5.37 5.48 4.97 5.25 4.47 5.57 5.21 5.62 5.24

Community 18 3 5.72 5.75 4.78 4.88 4.33 5.69 4.11 4.52 4.97

Community 20 1 5.17 5.38 4 3.88 1.67 4.46 4 4.91 4.18

Challenges in Developing and Sustaining a Coalition Identity and Structure

• “We are functioning but fragmentally and the 2 contexts are starting to develop different visions and approaches…”

• “Even though progress is being made, it's a lot slower than would be possible with more staff. This also means that it's "easier" for people to fall back into the ways we always do our community health improvement work, which is not as effective or impactful as it would be if we could take the time to implement everything we're learning in a high quality way.”

• “It’s one thing to collaborate across different organizations to provide support here and there in specific instances or moments when the need arises. It becomes a whole other challenge to come together as a coalition when not all individual organizations have worked together for a long time or some have and some have not, and one is a larger institution with a different culture and norms and another is a smaller community grassroots organization with a different history and philosophy.”

Subcomponent of Innovation-Specific Capacity

Community N KSA Champion

Supportive

Climate Relationships Innovation Index

Community 1 1 7 7 6.83 6.57 6.85

Community 5 1 6.75 7 6.33 5.57 6.41

Community 2 2 6.38 6.5 6.08 6.5 6.37

Community 3* 9 6.25 6.47 6.33 6.36 6.35

Community 6 2 5.88 6.38 6.25 5.86 6.09

Community 4 2 6 6 5.92 6.21 6.03

Community 8 2 5.88 6 5.67 5.64 5.80

Community 7 1 5.75 6 5.83 5.29 5.72

Community 12 3 6 5.92 5.17 5.71 5.70

Community 10 8 5.88 5.97 5.56 5.27 5.67

Community 16 5 5.95 6.15 5.17 4.97 5.56

Community 9 4 5.75 6.19 5.42 4.82 5.55

Community 15 6 5.46 6 5.11 5.52 5.52

Community 14* 2 6.5 6.13 4.92 4.5 5.51

Community 11 1 6 5.5 4.67 5.86 5.51

Community 17 5 5.7 5.45 5.83 4.91 5.47

Community 18 3 6.13 5.6 4.78 4.57 5.27

Community 13 1 4.75 5 5.33 4.86 4.99

Community 20 1 5.5 5.75 4.33 3.86 4.86

Community 19 2 4.88 5.13 4.42 4.93 4.84

Community 21 1 5 4.75 4.5 4.29 4.64

Challenges developing a supportive climate

• “One of our biggest barriers is the lack of people that know and understand what SCALE is. We also do not have the "decision-makers" at the table, which makes it hard to ensure buy-in from agencies”

• “There are key stakeholders at the table who understand and support SCALE improvement methods and how we are trying to apply them, and many other consortium members do not have a deep understanding of those methods.”

• “The few people working the most with this project are not decision makers in our agencies and the coalition. For some things, we lack the permission to implement SCALE methods in order to create health improvement. “

Subcomponents of Motivation

Community N

Relative

Advantage Compatibility Complexity

Ability to

Pilot Visibility Priority Joy*

Motivation

Index

Community 2 2 6.5 6.5 3.5 5.5 6.75 7 7 6.25

Community 4 2 6 6 1.67 4 6.25 6.5 7 6.01

Community 1 1 6.33 6.25 2.33 5 5.75 6 7 6.00

Community 5 1 6 6 1.33 4.5 5.75 6.33 6.5 5.96

Community 11 1 5 6 2.5 5.5 5.5 6 6.5 5.71

Community 3* 4 5.33 6.25 3 6 5.25 5.67 6 5.64

Community 9 9 5.81 6.25 3.93 5.06 5.75 5.74 6.78 5.64

Community 7 3 6.25 6.25 4.06 5.13 5.44 6 6.25 5.61

Community 12 1 4 6.5 2.17 4.25 6 6.33 6.25 5.59

Community 6 2 5.89 6.5 3.67 5.17 5.33 5.11 6 5.48

Community 8 2 7 6.75 2.67 3.5 4 4.33 7 5.42

Community 20 1 5.48 6.09 3.33 4.88 4.84 5.54 6.31 5.40

Community 10 3 5.33 6.38 4.17 5 5 6.17 5.75 5.35

Community 18 8 6.17 6.75 4.5 4.75 4.5 5.17 6.5 5.33

Community 15 6 5.33 5.71 3.94 4.5 5.04 5.83 5.92 5.20

Community 16 2 5.33 6.25 2.8 5 4.38 4.17 6 5.19

Community 14* 5 5 5.5 2 5 3.25 4.33 7 5.15

Community 13 5 4.73 5.7 4.07 4.7 5.35 5.47 5.6 5.07

Community 17 1 4.93 5.42 4.17 4.3 4.55 5.27 5.2 4.79

Community 19 2 4 5.13 4.67 5 4.38 4.33 6 4.60

Community 21 1 3 5 5 4 4.25 5 5 4.18

Challenges prioritizing SCALE activities

• “If the coalition as a whole knew about SCALE I think that they would be incredibly excited about it. However, because they know so little about it, SCALE is not a priority in our community. Those of us that understand SCALE fully understand its importance and feel a sense of urgency to get others on board”

• “I often feel like the lone voice trying to promote use of the methods, which I'm sometimes afraid makes me sound like a broken record. In many ways it relates back to my comments in the previous section, especially the increased pressures on people's time. “

Differences between SCALE and P2P Component Subcomponent SCALE

Pathway to Pacesetter

P-value

Effect Size (Hedges’s g)

Full Readiness Index2 5.60 4.91 <0.001 1.49 General Capacity1

Culture 6.08 5.48 0.01 0.76 Climate 6.06 5.72 0.02 0.65 Structure 5.62 5.32 0.07 0.45 Innovativeness 6.01 5.61 0.04 0.55 Resource Utilization 5.00 3.98 0.004 0.87 Leadership 6.16 5.89 0.09 0.41 Staff Capacity 5.27 4.90 0.06 0.49 Process Capacities 5.81 5.43 0.02 0.63

General Capacity Index 5.75 5.29 0.006 0.81


Innovation Specific KSA2 5.88 5.03 <0.001 1.28

Program Champion3 5.95 5.10 <0.001 1.06

Implementation climate (supports)3 5.45 4.36 <0.001 1.56

Inter-organizational Relationships3 5.34 4.74 0.01 0.73

Innovation-Specific Capacity Index 5.65 4.82 <0.001 1.46

Motivation2 Relative Advantage 5.40 4.56 0.002 0.99

Compatibility / Alignment 6.06 5.16 <0.001 1.32

Complexity 3.31 3.76 0.07 0.45 Ability to pilot 4.78 4.63 0.25 0.21

Observability 5.11 4.09 <0.001 1.51

Priority 5.54 4.44 <0.001 1.17

Joy 6.26 5.18 <0.001 1.46

Motivation Index2 5.41 4.61 <0.001 1.48 *Sample Sizes for these analyses: 1) SCALE = 22, P2P = 20; 2) SCALE = 21, P2P = 19; 3) SCALE = 21, P2P = 18

Qualitative Measure

• Structured interview

1. Strengthens construct validity of factors and subcomponents

2. Explores what change would have been necessary to facilitate improvements in readiness

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Readiness Interview Highlights for Survey Ratings and Supports to Increase Ratings

Readiness Subcomponent

Question Response

Inter-Organizational Relationships

On average, you rated Inter-organizational Relationships as a 4.82 out of 7. What would it take for you to rate it higher?

“If we could have access to coaches with different sets of skills where we needed specific expertise, that would help. It would be cool to have to more access to some of the other coaches.”

Structure On average, you rated Structure as a 5.52 out of 7. Why didn’t you rate it lower?

“We do have it well defined and documented in terms of structure and what people’s roles are.”

Structure On average, you rated Structure as a 5.52 out of 7. What would it take for you to rate it higher?

“Since taking the survey, we have developed a steering committee. We hope that as the steering committee gets more established the score can improve a little bit.“

Compatibility/ Alignment

On average, you rated Compatibility/Alignment as a 5.71 out of 7. Why did you rate it this way?

“We’re not going to get it all right, there are probably other initiatives that SCALE isn’t working as closely with within our consortium. We can’t look at everything. We realized we needed to focus efforts on one community first. Other communities in the county may want some attention too.”


On average, you rated Compatibility/Alignment as a 5.71 out of 7. What would it take for you to rate it higher?

“Once we can apply what we learn to other communities and towns, I think the score would improve.”

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Phase-specific Assessments

• Look at activities specific to certain action phases of SCALE (more time limited) • e.g. complete a driver diagram, develop aims, etc.

• Do not assess general capacity at this time

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Phase-Specific Category Related Activities Description

Developing and implementing the community health plan

Developing the community health plan

Using tools and knowledge to put together community health plan. This plan was due 2.1.16

Implementing community health plan

Using tools and knowledge to enact the activities in the community health plan

Incorporating health equity in implementation

Ensuring that health equity is addressed when implementing the community health plan

Incorporating people with lived experience in implementation

Ensure that people with lived experience are involved in implementing the community health plan

Reporting metrics

Being able to document output of implementing the community health plan.

Phase-Specific Subcomponent of Innovation-Specific Capacity

Community N KSA Champion Supportive Climate Relationships Innovation Index Community 6 2 6.42 7 6.5 6.5 6.61 Community 4 3 6.52 6.67 6.42 6.67 6.57 Community 2 2 6.21 6.5 7 6.25 6.49 Community 1 2 6 7 6.25 6 6.31 Community 9 5 6.2 6.4 6.25 6.2 6.26 Community 23 1 5.86 6 7 6 6.22 Community 10 2 4.86 7 6 6.25 6.03 Community 7 3 5.48 6 6 6.33 5.95 Community 16 2 4.86 6.5 5.88 6.5 5.94 Community 11 1 5.86 6 6.25 5.5 5.90 Community 5 3 5.86 6.33 5.92 5.5 5.90 Community 15 6 5.45 6.17 5.83 6.08 5.88 Community 18 4 5.57 6 6 5.75 5.83 Community 3 1 5.71 6 5 6.5 5.80 Community 17 4 5.57 6 5.5 6 5.77 Community 19 2 5.43 5.5 5.5 6 5.61 Community 13 1 5.42 7 6 4 5.61 Community 14 2 5.14 6 5.25 6 5.60 Community 12 2 4.85 7 5.13 4.5 5.37 Community 8 3 5.57 5.67 4.33 4.5 5.02 Community 20 4 4.79 5.5 4.5 5.25 5.01 Community 21 4 4.48 5.67 4.08 4.67 4.72 Community 221 1 3.43 6 2 3.5 3.73

Readiness for Integrated Behavioral Health and Primary

Care

The Satcher Health Leadership Institute

• The mission of the Satcher Health Leadership Institute at the Morehouse School of Medicine (SHLI/MSM) is to develop a diverse group of exceptional health leaders, advance and support comprehensive health system strategies, and actively promote policies and practices that will reduce and ultimately eliminate disparities in health.

Why integrated care?

• Practices that effectively integrate behavioral health services and primary care have been shown to improve:

• Clinical outcomes

• Mental health, wellbeing, and quality of life

• Team performance

• Satisfaction

• Health system cost savings

The Integrated care leadership program (ICLP)

• Provides clinical and administrative health care professionals with the knowledge and training needed to successfully develop integrated care practices.

• Promotes health equity among vulnerable populations.

• Develops health leaders equipped to further integrate behavioral health in primary care.

• Strengthens capacity among health care providers and practices to implement and sustain integrated care practice.


• Addresses mental health disparities and advances health equity to achieve the IHI Triple Aim:

1) Improve the patient experience of care, including quality and satisfaction

2) Improve the health of populations

3) Reduce the per capita cost of health care

I n s t i t u t e f o r H e a l t h c a r e I m p r o v e m e n t , 2 0 1 2


• 11 sites in the 2016 inaugural cohort

• Online training curriculum

• Technical assistance and coaching

• Monthly webinars

• Site visits (Georgia-based sites)

• Eligibility for innovation awards (Georgia-based sites)

• Quarterly analysis of site-specific readiness data

R=MC2: DEFINING FEATURES

o Readiness is viewed on a continuum, rather than dichotomously as “ready or not”.

o Readiness is dynamic. The readiness of an organization for implementation fluctuates over time.

o R=MC2 is part of a comprehensive planning, implementation, and evaluation approach. Readiness is not just a precursor to implementation, but also a construct that encompasses the conditions necessary for quality implementation throughout the lifespan of the EBI.

Readiness Questionnaire Mean Scores at Time Point 11

Items Average SCORE

Sub-component (N=33)

MOTIVATION

Relative Advantage

1. Integrated care is better than other processes we are currently using in our practice to meet the needs of our patients.

5.85

2. Integrated care is better than other processes we have considered using in our practice.

5.81

3. Integrated care represents an advance over other methods that are already available for our practice.

6.13


4. Integrated care fits well with other initiatives in our practice.

6.27

5. Integrated care will help us meet the needs of our patients.

6.62

6. Integrated care is timely given the current needs of our patients.

6.24

7. Integrated care fits well with the culture and values of our patients.

6.09

Complexity

8. In our practice, integrated care is simple and easy to implement.

4.12

9. There are so many components to integrated care that it is hard to understand all of the pieces.2

4.18

10. The complexity of integrated care will make it difficult to put this project into place.2

4.97

Priority

11. Integrated care is a top priority in our practice. 5.65

12. Our practice emphasizes that integrated care is very important to improve primary care quality and access to behavioral health services in our community.

5.88

13. We are aware of how important integrated care is for our practice right now.

6.00

INNOVATION-SPECIFIC CAPACITY

Innovation-Specific Knowledge and Skills 14. We have the knowledge we need to integrate care.

4.79

15. We have the concrete skills to integrate care. 4.91

Program Champion

16. An influential person in our practice strongly promotes integrated care.

5.88

17. At least one person we work with clearly communicates the needs and benefits of integrated care.

5.91

18. We have designated a person to share our progress in integrating care with other practices.

4.65

Implementation Climate Supports

19. Our practice actively supports integrated care. 5.79

20. We have enough resources in our practice to accomplish integrated care.

4.38

21. Our practice dedicates specific resources to integrated care.

5.00

22. There is a system in place to monitor how well integrated care is implemented.

4.27

23. We have ways to promote ongoing participation in integrating care.

4.94

Inter-organizational Relationships

24. We have made changes for the good of the practice.

5.91

25. We communicate well with other practices that are implementing similar projects.

4.72

26. We seek consultation from other organizations/practices to help us implement integrated care.

5.13


Items Average SCORE

Sub-component (N=33)


GENERAL CAPACITY

Culture

27. Our practice’s mission statement is understood by all of us. 5.79

28. We all know our practice’s vision. 5.79 29. We have a strong sense of belonging and identification within the practice.

5.79

30. Our practice has a common purpose. 5.94

31. We have good working relationships within our practice. 6.06

32. We know the goals of our practice. 5.94

Climate

33. Most of the time, people in this practice want to perform to the best of their abilities.

6.36

34. People are enthusiastic about their work. 5.74

35. We put in extra effort to make sure our practice succeeds. 5.97

36. Our workload is reasonable. 4.79 37. Morale is positive in our practice. 5.26

38. We have a positive attitude toward the work of the practice. 5.74

39. Turnover is not a problem in our practice. 4.00

40. People who work within our practice feel valued. 5.3

Structure

41. Our practice can quickly change procedures to meet new conditions and solve problems as they arise.

4.82

42. Our leadership committees (e.g. board, advisory, or steering) actively contribute to the goals of our practice.

5.7

43. We are able to communicate openly within our practice. 5.76

44. We understand each other when communicating within our practice. 5.65

45. We have a well-defined method to resolve internal problems. 5.06

46. There is a clear method for sharing information within the practice. 5.19

Organizational Innovativeness

47. We regularly take time to consider ways to improve how we do things. 5.58

48. People in our practice actively try to improve how we do things. 5.72

49. Our practice encourages everyone to share their ideas. 5.82

50. Our practice listens to people who have new ideas. 5.82

51. Our practice learns from its mistakes. 5.39

52. When we experience a problem in the practice, we make a serious effort to figure out what’s really going on.

5.71

53. We are deliberate in how we approach change. 5.35

54. Overall, our practice adapts to change well. 4.91

Resource Utilization

55. We have the ability to access sources of revenue and resources (e.g., multiple grants, public funds, third party private payers, etc.)

4.91

56. There is a clear financial plan for us to create sustainability. 4.81

57. There is a clear process by which the practice prioritizes and distributes resources.

4.90

Leadership

58. We have clear leadership in our practice. 6.09 59. Our leadership supports ongoing projects. 5.94 60. Our leadership approaches collaboration by relying heavily on building trust among stakeholders.

5.66

61. Our leadership expresses confidence in the capabilities of others. 5.82

62. Our leadership praises/recognizes when someone has done something well. 6.03

63. Our leadership has a plan to implement our projects. 5.44

64. Our leadership removes obstacles that prevent our programs from being implemented.

5.26

65. Our leadership lays out the standards we need to aspire to when putting our programs into practice.

5.59

66. Our leadership knows what they are talking about when it comes to our projects.

5.68

67. Our leadership recognizes and appreciates team efforts to help us successfully implement.

5.82

68. Our leadership supports our efforts to learn more about our projects. 5.85

69. Our leadership carries on through the challenges of implementing our projects.

5.82

70. Our leadership reacts to critical issues regarding the implementation of our projects by openly and effectively addressing the problem(s).

5.68

Staff Capacities

71. People who work with our practice have experience working towards integrated care.

4.34

Process Capacities

72. We are able to use strategic planning frameworks to accomplish our goals. 5.18

73. We know how to conduct a comprehensive needs assessment. 5.03

74. We are able to develop appropriate goals for our practice. 5.64

75. We know how to select an evidence-based strategy that best fits with our practice and community’s needs.

5.15

76. We know how to identify the capacities needed to put our strategies into place.

5.24

77. We are able to develop strategic plans. 5.52

78. We know what it takes to put our innovations into place. 5.39

79. We know how to evaluate what we do. 5.47 80. We know how to evaluate if our innovations are reaching our desired outcomes and goals.

5.42

81. We are able to implement ongoing improvement activities (e.g., PDSA, Six Sigma, Model for Improvement, etc.).

5.06

82. Our practice knows how to plan for sustainability. 5.25

Early Observations

• Practitioners readily resonate to the notion that readiness is relevant throughout the lifespan of an innovation/intervention, and thus, should be measured continuously.

• Practitioners seem less threatened by the notion of measurement in relation to readiness when emphasis is placed on viewing the construct on a continuum, rather than the dichotomous “ready or not.”

• Practitioners quickly see the value of the tool when framed in the spirit of improvement. Pairing this framing with site-specific summaries is an effective way to help practitioners discover the practical utility of the tool.

GTO

Readiness Research Frames

Frame Tool

Development Research and

Evaluation

Practice Implications

Goals

A psychometric stable and robust set of evaluation

tools (quantitative, qualitative, and

criterion measures) that can be used to comprehensively

examine the current readiness of individual,

organizations, and communities.

Determining the relative importance

of readiness subcomponents, and their relation

to readiness, implementation, and innovation

outcomes

Developing a comprehensive

guide for administering the tools, interpreting

and presenting data, and guide, and for providing support to build

Readiness through EBSIS

•ONCE YOU ARE READY….

.HOW DO YOU IMPLEMENT WITH QUALITY

GTO

References

• Scaccia, J.P., Cook, B.S., Lamont, A., Wandersman, A., Castellow, J., Katz, J., & Beidas, R. (2015). A practical implementation science heuristic for organizational readiness: R=MC2. Journal of Community Psychology Vol. 43, No. 4, 484–501.

• Wandersman, A., Duffy, J., Flaspohler, P., Noonan, R., Lubell, K., Stillman, L., et al. (2008). Bridging the gap between prevention research and practice: The Interactive Systems Framework for Dissemination and Implementation. American Journal of Community Psychology, 41, 171-181.

GTO

implementation science and organizational...

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