Using Quality Improvement Strategiesto Implement an Intervention

Module Created ByPopulation Health Improvement Partners

www.improvepartners.org

Assessing your

Community

Implementing & Evaluating

Establishing Goals &

Objectives;Planning for Evaluation

Finding Evidence

Selecting Best Fitting EBAs

Adapting

Where do We Stand?

Learning Objectives

• Describe key tasks in planning for and implementing an intervention

• Provide QI tools to help your team plan for and implement selected interventions

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=Positive Outcomes

4Source: State Implementation and Scaling-up of Evidence –based Practices

Effective Strategies & Interventions +

Effective Implementation

•CDC Community Guide•National Cancer Inst•CTRT website•iMAPP•Others?

Tips for Successful Implementation

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• Establish an Implementation Team• Cleary define and communicate how the

intervention will operate • Select “early adopters” to do a small

pilot test to understand and learn how to adapt/adjust implementation efforts

• Use improvement cycles to learn what works, what creates barriers, and what can be improved

Role of an Implementation Team

• Makes the intervention happen• Engages stakeholders• Creates readiness for implementation• Ensures fidelity to the intervention• Provides TA and support to overcome barriers• Monitors outcomes and feedback to improve implementation

of the intervention

Sources: National Implementation Research Network and SAMSHA

Characteristics of Implementation Team

• Content Expertise: implement with fidelity• Program Management: implement on time & under

budget• Quality Improvement: monitor data and

continuously adapt implementation process• “Customer Perspective”: view point of someone

who will be using the intervention in their daily life• Partner Representation-provide resources,

expertise, and staff to help implement

What percent of interventions are effective without an Implementation Team?

Trivia Question

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Tips for Successful Implementation

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• Establish an Implementation Team• Cleary define and communicate how the

intervention will operate • Select “early adopters” to do a small

pilot test to understand and learn how to adapt/adjust implementation efforts

• Use improvement cycles to learn what works, what creates barriers, and what can be improved

Planning Tools for Implementation

• Program Charter• High-level Timeline• Work Plan

Program Charter

Program Overview and Timeline

Content Created by the Center for Public Health Quality

Work Plan

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Think about your intervention:1. How can you use these tools to plan how you

will implement your intervention?2. Share your thoughts with the group

Tips for Successful Implementation

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• Establish an Implementation Team• Cleary define and communicate how the

intervention will operate • Select “early adopters” to do a small

pilot test to understand and learn how to adapt/adjust implementation efforts

• Use improvement cycles to learn what works, what creates barriers, and what can be improved

Identify Early Adopters(Everett Rogers’ work)

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Late Majorit

y

35%

Early Majority

35%

Early Adopters

13%Traditionalists

15%2%

InnovatorsContent Created by the Center for Public Health Quality

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Think about your intervention:1. Who might be the “early adopters”?2. What ways might you recruit the “early

adopters”?3. Share your thoughts with the group

Tips for Successful Implementation

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• Establish an Implementation Team• Cleary define and communicate how the

intervention will operate • Select “early adopters” to do a small pilot

test to understand and learn how to adapt/adjust implementation efforts

• Use improvement cycles to learn what works, what creates barriers, and what can be improved

Why Use Improvement Cycles?

Ideal

Reality

Ideal

Reality Reality

Ideal

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Why Use Improvement Cycles?

• Helps adapt good ideas to your specific situation:–Forces us to think small–Forces us to be methodical, make

predictions and learn –Allows rapid adaptation &

implementation of changes

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PDSA Cycle

Act Plan

Study Do

• Objective of cycle• Questions/predictions• Plan to carry out the cycle(who, what, where, when)

• Carry out the plan• Document problems/unexpected observations

• Begin analysis of data

• Complete the analysis of data

• Compare data to predictions

• Summarize what was learned

• What changes are to be made?

• Adapt? Or Abandon?

• Next cycle?

Use the PDSA cycle to test changes and organize feedback

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Rapid Cycles of Change

Hunches Theories

Ideas

Changes That Result in

Improvement

A PS D

APS

D

A PS D

D SP ALearning

Very Small Scale Test

Follow-up Tests

Wide-Scale Tests of Change

Implementation of Change

PDSA Cycle Forms

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PDSA Tip: Scale Down

• Years• Quarters• Months• Weeks• Days• Hours• Minutes• Number of

clients/staff

“Drop 2”

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Meeting Structure

Communication Intervention Component 1

Learning & Improvement in Parallel

A PS D

A PS D

A PS D

D SP A

A PS D

A PS D

A PS D

D SP A

A PS D

A PS D

A PS D

D SP A

A PS D

A PS D

A PS D

D SP A

A PS D

A PS D

A PS D

D SP A

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Coaching & TA

Intervention Component 2

Feedback and Improvement

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• Adapting Intervention Core Elements• Caution: although it is

important to be responsive to feedback you CAN NOT change the core elements of an intervention and expect the intended outcomes

  

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Activity: Using Improvement Cycles

Intervention Components: Targeting Store Owners– Monetary incentives– Nutrition education session/booklets– Cultural guidelines– Corner store guidelines (e.g. buy, stock,

and purchase)

Intervention Components: Targeting Consumers– In-store intervention materials– In-store promotions (incentive cards, nutrition

sessions)

Your turn!

APPLY IT!

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Think about your intervention: 1. How can your team build in improvement

cycles ?2. Share at least one idea for how you plan

to use improvement cycles.

Sources Referenced for this Module

• National Implementation Research Network• SAMHSA (2012). A Road Map to Implementing

Evidence-based Programs. Retrieved from: http://www.nrepp.samhsa.gov/Courses/Implementations/resources/imp_course.pdf.

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