A Conceptual View of Implementation
Based on the review of the literature and ideas from computer programming (Milojicic, Douglis, Paindaveine, Wheeler, & Zhou, 2000) and creativity fields (Altshuller, 1984), we arrived at a conceptual framework for implementation of well-defined programs and practices.
As shown in Figure 1, in its simplest form implementation has five essential components:
- a SOURCE a "best example," often a composite of the original practice or program that was developed and evaluated and the best features of attempted implementations of that practice or program,
- a DESTINATION the individual practitioner and the organization that adopts, houses, supports, and funds the installation and ongoing use of an innovation,
- a COMMUNICATION LINK an individual or group of individuals, named "purveyors," representing a program or practice who actively work to implement the defined practice or program with fidelity and good effect at an implementation site, and
- a FEEDBACK mechanism a regular flow of reliable information about performance of individuals, teams, and organizations acted upon by relevant practitioners, managers, and purveyors,
- that operate within a sphere of INFLUENCE social, economic, political, historical, and psychosocial factors that impinge directly or indirectly on people, organizations, or systems.
The essential implementation outcomes are:
- changes in adult professional behavior (knowledge and skills of practitioners and other key staff members within an organization or system),
- changes in organizational structures and cultures, both formal and informal (values, philosophies, ethics, policies, procedures, decision making), to routinely bring about and support the changes in adult professional behavior, and
- changes in relationships to consumers, stakeholders (location and nature of engagement, inclusion, satisfaction), and systems partners.
These are implementation components and outcomes that exist quite independently of the quality of the program or practice being implemented. Ineffective programs can be implemented well (e.g., the DARE program, Elliott, 1997; Ennett, Tobler, Ringwalt, & Flewelling, 1994). Effective programs can be implemented poorly (Fixsen & Blase, 1993; Fixsen, Blase, Timbers, & Wolf, 2001). Neither one is desirable. Desirable outcomes are achieved only when effective programs are implemented well (Fixsen et al., 2001; Leschied & Cunningham, 2002; Washington State Institute for Public Policy, 2002).
The generality of the concepts presented in Figure 1 is highlighted by examples from manufacturing and human (see example from Manufacturing and Human Services) services and applies with equal ease to a wide variety of programs and practices in agriculture, business, child welfare, engineering, health, juvenile justice, manufacturing, medicine, mental health, nursing, and social services.
