Implementation strategies are supports, methods, or techniques used to produce or sustain practice change. Sometimes these strategies are delivered by experts from outside an organization, and other times delivered “in house” by designated employees of the organization. The most common implementation strategy is training. Other frequently used strategies are expert consultation, modifying workflow, or providing incentives. Implementation strategies are most effective when they intentionally address factors that influence implementation and when they aim for meaningful and measurable outcomes.1, 2 Implementation strategies are also called implementation supports or technical assistance.
Key Components
WHY? The use of evidence-based implementation strategies increases your chances of successful implementation of a practice (or innovation). Implementation strategies are most effective when they are used in three planful ways. First, the strategies selected should align with the factors influencing implementation, including the practice being implemented, people served by the practice, individuals who deliver the practice, organizations, and systems/communities. Second, strategies should be selected in collaboration with the people doing the implementing. Third, the goal or outcomes of the strategies should be clear and measurable. What practice change do you want to see, and how would you know if the strategy achieved its goal? For example, if the goal is to offer people with serious mental illnesses tobacco cessation treatment, the proportion of providers who are in a position to offer it, and the proportion of patients who use tobacco and receive it, should increase as an outcome of the implementation strategy.
WHAT? Experts have listed as many as 73 implementation strategies.3 Sometimes, they are used by themselves (e.g., workshop), and other times in combination (e.g., workshop, a learning collaborative, an expert consultant).
Examples of Implementation Strategies Across Nine Thematic Categories4
WHO? There are at least two groups of people in the implementation strategy process: the strategy deliverers and the strategy recipients. The deliverers could be based outside the system or organization or they could be “implementers” or change agents within the system or organization. The recipients may be individual front line care providers, supervisors, organizational leaders, and/or systems leaders.
HOW? Implementation strategy considerations are also influenced by time and resources. These factors must be transparent and negotiated between the strategy deliverer and the recipients. What costs are involved in delivering a strategy and in having staff members participate? What resources in terms of materials, training and technical assistance resources, equipment, data gathering, and processing or space may be necessary? What is the duration, or over how much time (weeks, months, years) is it necessary to deliver and participate in the strategy? The initial plan for a strategy may need to be modified, for example, because it is not working as designed, the intended recipients are not participating, or there are changes in the recipient leadership who seek different options.
WHEN? Considering the stage of any practice change is important, and the readiness and motivation to implement or sustain a practice change can vary. The impetus may come from outside the organization, such as a policy or reimbursement shift. The motivation can also be based on evidence for the benefits of a new practice on patients’ symptoms and functioning. Certain strategies may be more useful at certain stages of an implementation process: knowledge and skill building in earlier stages, expert consultation or clinical supervision in the middle stages, quality monitoring and financial or policy incentives in later stages.
Why This Topic Matters for Implementation
Implementation strategies are important because they can decrease the gap between evidence-based practice and actual practice, increase the probability of success of implementing a new practice or program, and facilitate practice change. Implementation strategies should be documented, so that, in the future, successes can be replicated and failures avoided or improved upon.
Key Resources
QUERI Roadmap for Implementation and Quality Improvement Resource Guide
This is a comprehensive practical guide to implementing effective practices into health care settings. It provides guidance on all stages of the implementation journey, from…
A Refined Compilation of Implementation Strategies: Results from the Expert Recommendations for Implementing Change (ERIC) Project
Implementation strategies are supports, methods, or techniques used to produce or sustain practice change. Sometimes these strategies are delivered by experts from outside an organization,…
Strategies Timeline, Activities & Resources (STAR) Log
Individuals and organizations need support and assistance to implement a new program or practice. Implementation strategies are supports, methods, or techniques used to produce or…