Implementing with Buy-in & Backup

A few weeks back, we were discussing implementation enablers. We introduced who and what enablers are, then discovered the people behind implementation. Today, we’re discussing the importance of a supportive organisational culture and conduct in championing successful implementation.

?? An organisation that embraces innovation, risk-taking, and learning may have greater readiness for change

The norms, values and beliefs that determine behaviour.

Organisational culture is the norms, values and beliefs that determine behaviour within an organisation. It can help to embed an intervention in a particular context. For example, an organisation that embraces innovation, risk-taking, and learning may have greater readiness for change (Weiner, 2009). Some potential strategies to promote a supportive organisational culture include:

• Leaders communicating a strong vision for change
• The development of positive role models in an organisation
• Providing ongoing training and coaching to staff.

Organisational climate?is a term often used together with organisational culture. The concepts are similar and related. Climate refers to staff’s responses to their work environment and their perceptions of how an intervention will impact them personally. This often varies between individuals, teams and divisions in an organisation (Aarons et al., 2011).

Organisational support?is important for the successful implementation of an intervention. Supports come in the form of structures, systems, policies and procedures that align with the intervention. Examples include procedures for internal decision-making and mechanisms for managing industrial relations. These can help to overcome resistance to change. More generally, supports can affect people’s views of demands, resource availability, and situational factors for implementation (Weiner, 2009).

Organisational change?is needed where culture is poor, the climate is not receptive, or supports for the intervention are inadequate. Many change efforts focus on formal structures and work tasks in an organisation. This may be a mistake, as organisational culture provides the context for change (Health Service Executive, 2018). Change efforts should also concentrate on less tangible aspects of organisations. These include the values, assumptions and behaviour of people in an organisation.

How to communicate an intervention

Communication can involve a wide variety of people, including the public, implementation teams, practitioners, champions, managers, policymakers and anyone relevant to the implementation process.

Challenges in communicating about interventions are normal. Achieving success requires significant effort. Investing in this effort is worthwhile because:

• Communicating a vision for change helps to motivate staff and overcome resistance to change
• Communication provides an important mechanism for obtaining feedback
• Open communication helps to build trust and teamwork between those impacted by implementation.

Both formal and informal communication are useful. For example, mass media broadcasts and other impersonal methods are often used to build awareness. Simpler communication methods, like networking and ‘water cooler’ conversations, are also key to changing behaviour. Communication activities should be developed to nurture good relationships. This is more effective than a commanding and authoritarian approach.

Dissemination?is a targeted and facilitated process of distributing information. It involves convincing stakeholders in target groups to adopt an intervention. Key activities include planning information delivery and tailoring the message for specific audiences (Greenhalgh et al., 2004).

Knowledge Translation?aims to bridge the gap between research/knowledge and practice. It involves activities such as synthesising and applying complex information to make it easier to understand and digest. (Straus et al., 2009). Plain language summaries are one example of knowledge translation approaches. The Knowledge Mobilisation Toolkit (Ontario Centre of Excellence for Child and Youth Mental Health, 2014) is a useful online toolkit designed to inform and equip users with the knowledge and tools needed to mobilise knowledge, to improve outcomes for children, young people and families.

Knowledge broker?organisations perform strategic functions which generate knowledge and support it to be applied in decision-making and practice (OECD). The OECD has mapped over 70 knowledge broker organisations across the OECD countries, which take different forms in different parts of the system.

Tips for effective communication and dissemination

The following points are useful in developing and practising good communication:

• The motivation of the target audience (e.g. staff) is important. The role and motivation of the organisation and system are more influential in generating buy-in.
• Emphasise the benefits. Clearly describe how the intervention is new and different and how it is compatible with organisational values and current ways of working.
• State clearly why the intervention is better than before and how it will improve the work and outcomes.
• Filter the information to what is most valid and essential; this is an art and a science.
• Use mass media (emails, internal advertising and videos) to build initial knowledge and awareness. Then move towards interpersonal channels to tackle any confusion, misinterpretation or resistance.
• Opinion leaders within the system can act as effective sources of information to communicate and disseminate information about a new idea or way of working.

Monitoring and evaluation can be used to improve both the intervention and the implementation process.

Monitoring?is the routine and systematic collection and use of information against a plan. It uses existing data and information with a view to ongoing improvement cycles.

Evaluation?is a planned investigation of a project, programme, or policy to answer specific questions. It can be related to the design, implementation, and results (cause and effect) of an intervention.

Monitoring and evaluation use data to determine if indicators are being met and outcomes achieved. This information is used to improve both the intervention and the implementation process. Doing this well helps to identify ‘quick wins’. It also builds credibility, support, and momentum for an intervention.

Involving relevant stakeholders and effective planning are crucial aspects of monitoring and evaluation. This helps clarify what outcomes are useful to measure. It also helps to agree on specific responsibilities for monitoring and evaluation.

Monitoring and evaluation need appropriate reporting and review mechanisms. It is important to assess existing data collection processes before introducing new ones.

Continuous improvement cycles

Use data to inform decision-making so that progress is achieved in an incremental manner over time. This is continuous improvement.

Using data to guide decision making

Emerging evidence on outcomes and implementation creates an opportunity to learn from experience. Different data types can be collected and analysed to help guide ongoing decision-making. Data can be used to support effective feedback loops across multiple levels of a system or organisation. This is referred to as Data-based decision-making. The main goal of data-based decision-making is continuous improvement, and progress is achieved in an incremental manner over time.

Collecting relevant data is essential to support appropriate decisions and actions. Continuous improvement relies on feedback gathered from various stakeholders involved in the implementation process. This helps to connect policy to practice. It also promotes reflection and meaningful engagement with stakeholders.

A commonly used method aimed at continuous improvement is the Plan-Do-Study-Act Cycle (PDSA), which has four phases:

1. Plan: Use data to identify barriers and challenges; specify the plan to address them, as well as measures of progress
2. Do: Carry out the plan to address challenges
3. Study: Use measures identified during the planning phase to assess and track progress
4. Act: Make changes to the next iteration of the plan to improve implementation.

Resources and further reading

• The Measuring Outcomes Guidebook?(Strengthening Nonprofits, 2010): a guide for organisations interested in learning more about implementing or improving their procedures for measuring and monitoring outcomes.
• The Magenta Book: Guidance on what to consider when designing an evaluation (HM Treasury, 2012) is the recommended central government guidance on evaluation in the UK. It presents standards of good practice in conducting evaluations.