Do You Know Your Role in the Implementation System?
By Dr. Julia E. Moore, Executive Director
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The importance of role clarity
A substantial source of conflict when working on implementation projects is role clarity. Role clarity issues occur at the frontline implementation level, but often there are also bigger role clarity questions at a system level. For example, you might have multiple organizations that are implementing a new evidence-based program or practice, a program developer or researcher as part of the team, and another organization that is helping them through that process. You may also have a funder that is involved by supporting the implementation project financially and possibly in other ways.
The absence of good role clarity can snowball into different challenges. Redundancy can occur when multiple system stakeholders are trying to work on the same tasks. Inefficiencies may be apparent when there is a lack of ownership and responsibility, and key activities slip through the cracks. A lack of role clarity can also incite emotional reactions such as anger, confusion or frustration towards stakeholder partners. If any of these resonate with you, it’s a great idea to think about how you could use a framework to understand the different key stakeholders and their roles in the implementation system.
The Interactive Systems Framework for dissemination and implementation
The Interactive Systems Framework for Dissemination and Implementation (ISF; Wandersman et al., 2008) was designed specifically for this purpose. Although the framework was originally developed for prevention, it is been adopted and used in a range of settings, including public health, healthcare, community, education, and juvenile justice.
The Interactive Systems Framework for Dissemination and Implementation (ISF; Wandersman et al., 2008)
The ISF includes three key stakeholder groups: 1) the synthesis and translation system (bottom); 2) delivery system (top), and 3) support system (middle).
The synthesis and translation system are those who are responsible for synthesizing and translating evidence. For example, if you are building an intervention using an evidence-based guideline and selecting implementation strategies (ideally using theory and evidence), those activities would fit in this bottom box.
The delivery system includes those who are responsible for delivering an intervention. This is the implementation team. These people often work within the setting where the intervention is being delivered, and are supporting people in that setting to change their behavior. For example, if the intervention is happening in a long-term care home, the implementation team might be made up of a nurse manager, a personal support worker, a nurse, and an occupational therapist. Their role is to deliver the intervention within their organization.
Many implementation efforts also include a support system, which resides between the synthesis and translation, and delivery systems. People in the support system serve as a liaison, brokering relationships between the front line implementers and those people who are developing and synthesizing the interventions. The support system is comprised of people who have expertise in implementation science and the intervention itself, to support those on the frontline with intervention-specific questions and implementation challenges.
The ISF depicts the basic structure of an implementation system. At times, the system may be more complex, particularly as the intervention grows larger in size and scope. For example, I have recently worked with several organizations that have two “layers” of a support system. They may have a large number of people providing implementation support (with roles or job titles like implementation coach, implementation facilitator, or technical assistance provider). Since there are no university or graduate school programs specifically designed to teach people how to become an implementation coach, organizations have increasingly been working with a master implementation coach, to help train and support people to become implementation coaches and effectively support frontline implementation. This results in having two types of support systems embedded in one another.
Encompassing the implementation system is the larger context, which provides inputs to, or impacts the operation of, the implementation system. This includes macro-level policies, politics, funding, availability of research, political and societal priorities, etc. The model is not always this clear-cut; I’ve seen several situations where the funder plays a more integrated role, not only funding projects, but serving as a support system for the frontline implementers. This means that stakeholders in the system may not have just one role, but can occupy multiple roles in the system.
Once you and your stakeholder partners are able to identify your positions and roles in the implementation system, it may become clearer who occupies what role and where the various responsibilities for implementation fall. If it isn’t clear to you, bringing the ISF to a team meeting is a great way to start the conversation in providing better role clarity.
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