Dagens hatte Centre for Evidence & Implementation: http://www.cei.org.au/ Specialist Certificate Implementation Science, University of Melbourne: https://online.unimelb.edu.au/medicine-and-public-health/community-servicescourses/implementation-science/specialist-certificate-in-implementation-science European Implementation Collaborative: http://www.implementation.eu/ Nordic Implementation Conference (2018) Albers, Høgh & Månsson (2015). Implementering Fra Viden til Praksis på Børneog Ungeområdet
Implementering
Talepunkter 1. Lokalisering dagens lens 2. At tackle implementering på et organisatorisk plan Ledelse Parathed Implementeringskapacitet 3. Diskussion
Grundlæggende antagelser
Grundlæggende antagelse I: Evidenshierarkiet Systematiske reviews & metaanalyser RCT er Kohorte-studier 'Case series' Case studier Ideer, meninger, anekdoter, ekspert-input
Grundlæggende antagelse II: Implementeringsligningen Effektive Interventioner Effektiv Befordrende = Implementering Kontekst Positivt Outcome
Implementering en definition Implementering er den bevidste anvendelse af specifikke og distinkte strategier til at facilitere brugen af evidensbaserede interventioner i klinisk og organisatorisk praksis. Implementering er en målbevidst proces, der bør beskrives i tilstrækkeligt omfang så udenforstående kan observere aktiviteter der sigter mod at muliggøre og forbedre en implementering. Mitchell, 2011 / Fixsen et al., 2005
Grundlæggende antagelse III & IV Den organisatoriske kontekst af en implementering. bidrager til kvaliteten af en implementering. kan forandres så den understøtter og er til fordel for en implementering Charles Glisson, University Distinguished Professor, Children s Mental Health Services Research Center College of Social Work University of Tennessee
Instrumenter til at tackle den organisatoriske kontekst Ledelse Organisatorisk Parathed Implementeringsteams
Implementeringens domæner Damschroder et al. (2009)
Implementeringens interne kontekst (Damschroder, 2009) Struktur Sociale netværk / kommunikation Kultur Klima Parathed Interne grupper Koordinering Hierarkisk kultur? Forandringstrang Ledelsens engagement Intern arbejdsdeling / specialisering Deltagere i beslutningstagning Antal ledere pr medarbejdere Klarhed i rolle og positions beskrivelser Iværksætter kultur? Interventionens kompatibilitet Kommunikation Team kultur? Interventionens prioritering Integration vertikal / horisontal Tilpasningsdygtig? Incitamenter / klima for læring Hierarkiske niveauer Innovationsvenlig? Mål for og feedback på fremskridt Tilgængelige ressourcer Adgang til informationer og viden
Organisatorisk parathed (Scaccia et al., 2015) Organisatorisk Parathed (R) = MC 2 Komponent M = Motivation Generel Kapacitet Innovations-specifik kapacitet Definition perceived incentives and disincentives that contribute to the desirability to use an innovation attributes of a functioning organization... the human, technical, and fiscal conditions that are important for successfully implementing a particular innovation with quality Påvirket af Innovationens relative fordele (er den kompatibel; kompleks; testbar; observerbar?) Organisationens kultur, klima, innovationsvenlighed, ressource udnyttelse, ledelse, struktur, kapacitet Innovations-specifik viden og ekspertise, innovations fortalere, implementeringsklima, intra- og interorganisatoriske netværk
Teknisk vs. adaptiv ledelse (Heifetz & Laurie, 1997, p.124-134) Udfordring Teknisk Adaptiv Heifetz definition problems that are already within our know how; problems for which we have the solutions, the right designs in place I call those technical problems. One could also call them routine problems. Situationens klarhed Stor Lille Tilgang SOPs & autoritet Kollektiv læring the adaptive challenge forces a response that s outside our common repertoire, where our current know how just isn t quite sufficient; where there isn t an expert on the subject, who could fix the problem; where our current organizational design and structure, stories, narratives and metaphors don t do the job.
Transformativ vs. delt ledelse Transformativ Ledelse Karisma + Inspiration + ind. hensyn Fokus på den enkelte, formelle leder Bygger på følgere The paradigm relies upon the simplistic concept of the leader as the giver of direction and as a manipulator of will, who frames and solves specific management or social problems. (Hughes, 2016, Loc 2517) Delt ledelse the actions of any individual leader are less important than the collective leadership provided by many members of the organisation, including both formal and informal leaders. (Yukl, 2010, p. 503) Kapacitet for samarbejdende forandringsledelse Mindre fokuseret på formel ledelse Mere afhængig af teaming Bygger på kollaboratører
Implementeringsteams Ansvarlig enhed der guider det evidensbasered programmer igennem implementeringens mange faser Fokus på: Kvalitet, integration, holdbarhed af implementeringens infrastruktur i organisationen Identificere & løse problemer Data-dreven beslutningstagning Koordinering af finansiering, policy strukturer etc. Holdbarhed / bæredygtighed
At sætte et implementeringsteam (Metz & Bartley, 2012) Kernegruppe af minimum 3-5 medarbejdere Teamet har Ressourcer frem for alt tid til at dedikere til implementeringsarbejde (planlægge, støtte, evaluere, kommunikere) Blandede kompetencer (innovation; implementering; PDSA cirkler; CQI; forandringsprocesser; brug af instrumenter og data) Teamet har ansvar / er ansvarlig Adgang til beslutningsmagt
Hm...... Spørgsmål? Kommentarer...?
Tak For yderligere information kontakt venligst: Bianca Albers Senior Advisor, Evidence in Policy and Practice +61 429 330 966 I Twitter: @bianca_albers I Skype: bialbers bianca.albers@cei.org.au www.cei.org.au
Referencer Damschroder, L.J., Aron, D.C., Keith, R.E., Kirsh, S.R., Alexander, J.A., Lowery, J.C. (2009). Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science, Implementation Science, 4:50 Fixsen, D., Naoom, S., Blase, K.B., Friedman, R.B., Wallace, F. (2005). Implementation Research: A Synthesis of the Literature, University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network Heifetz, R.A. & Laurie, D.L. (1997). The Work of Leadership. Harvard Business Review, January-February 1997, 124-134. Hughes, M. (2016). The Leadership of Organizational Change. New York, United States: Routledge. Metz, A. & Bartley, L. (2012). Active Implementation Frameworks for Program Success, Zero to Three, 32(4), 11-18. Mitchell, P. (2011). Evidence-based practice in real-world services for young people with complex needs: New opportunities suggested by recent implementation science, Children and Youth Services Review, 33, 207-216 Scaccia, J.P., Cook, B.S., Lamont, A., Wandersman, A., Castellow, J., Katz, J., Beidas, R.S. (2015). A Practical Implementation Heuristic for Organizational Readiness: R = MC2, Journal of Community Psychology, 43(4), p.484-501 Yukl, Gary (2010). Leadership in organizations. New Jersey, United States: Pearson.