Examples from manufacturing and human services
For example, Toyota Production Systems (TPS) is a just-in-time manufacturing system (i.e., no unnecessary inventory at each input and output stage) requiring massive reorganization of production units, visual control and communication by workers with other workers, and specific arrangements of plant operating and management structures to support production teams and a consistent flow of materials (Kasul & Motwani, 1997).
SOURCE: Toyota created, developed, and evaluated TPS methods at their auto manufacturing plants in Japan and began replicating their system in affiliated parts manufacturing and auto assembly plants around the world.
DESTINATION: The Toyota Supplier and Support Center (TSSC)works with those organizations found worthy of the total commitment required to make the necessary changes.
COMMUNICATION LINK: TSSC provides consulting and implementation support free of charge (e.g., analyzes the client’s manufacturing capability; prescribes the best implementation strategy with adaptations of some features of the TPS based on local circumstances and values; directly observes and analyzes workers on the line, supply chains, etc.; identifies the key aspects at an operations level; helps the plant redesign the workspace to emphasize and conserve human motion, improve safety, eliminate waste, and improve efficiency).
FEEDBACK mechanisms: Task assignments are detailed and focused and the TSSC staff spend about 1 week per month for about 3 years observing performance, reviewing progress, answering questions, and assigning new tasks until full implementation is achieved.
INFLUENCE: Car makers operate in an environment where consumers want a wide variety of individually tailored products. To remain competitive, manufacturers have to develop low-volume, high variety production strategies that call for flexibility in manufacturing done via more automation and integration of processes on the floor.
The result is Toyota can deliver a high quality car equipped to the customer’s specifications within 21 days of the order being placed at a local dealership, 2 to 3 times faster than the industry standard.
Another example is Multisystemic Therapy (MST; Henggeler & Borduin, 1990; Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998), a treatment for serious antisocial behavior in youth that is delivered via a homebased model of service delivery.
SOURCE: MST methods were developed and evaluated with serious and chronic juvenile offenders by Henggeler, Borduin, and colleagues in Missouri and South Carolina and is a well-known evidence-based program.
DESTINATION: MST works with service systems to identify those organizations that have met certain criteria on a site-assessment instrument (e.g., leadership willing to adopt the MST framework, “fit” of MST with the intended target population, adequate referral and funding mechanisms, consonance of leadership and clinician perception of the nature of MST, team structure with specific MST supervision weekly, accountability for outcomes at the therapist, supervisor, and organizational levels; organizational structures that support the team, willingness to examine outcomes systematically).
COMMUNICATION LINK: MST Services, Inc. is the official purveyor of the MST program nationally (e.g., information sharing, site assessment, staff training, staff consultation and coaching, staff evaluation).
FEEDBACK mechanisms: The MST Institute has a web-based system for collecting adherence data monthly at the practitioner and supervisory levels and using those data to inform decision making and consultation at the therapist and organizational levels. Adherence data are collected monthly for the life of each implementation of the MST program.
INFLUENCE: There is increasing demand for evidence-based services to children and youth that can operate within typical organizational constraints, funding sources, and referral streams while maintaining high fidelity and good outcomes.
As a result, MST Services, Inc. has established many high-fidelity implementation sites that benefit youths and families across the country and internationally.
This conception of the implementation processes helps to focus attention on the “moving parts,” that is, those aspects that help to bring national programs and practices into contact with practitioners who can provide direct benefit to consumers locally. The generality of the concepts presented in Figure 1 is highlighted by the examples from manufacturing and human 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.
