Innovators are frequently in such a hurry to get their product to market that important implementation planning steps receive only cursory attention. Believe it or not, there’s a science for that.
The NIH defines implementation science as “the study of methods to promote the integration of research findings and evidence into healthcare policy and practice.” Implementation science looks at major bottlenecks that might impede implementation, whether it’s health literacy, behaviors, governments, the economy, or management.
In a recent study, published in Health Research & Policy Systems, researchers compared implementation frameworks for health innovations. From this comparison, the research team outlined a generic framework for implementing health innovations that innovators can use as a starting point.
What Is a Framework Anyway?
If you’ve ever built a house from playing cards to pass the time, you know that a house with no foundation or supportive beams is incredibly weak. From a builder’s perspective, frames are absolutely essential.
For those seeking to improve health systems with innovations, skipping the deep-thinking planning stages may be a big mistake.
Frameworks give you a very broad picture. You can look at [them] to see the implementation process, and each stage within the process. Frameworks show you what you need to look at during each stage, and give strategies for addressing barriers and evaluating success.
Whether in graphics or narratives, frameworks identify the key variables of implementation. Frameworks guide the questions innovators ask about the external system and local environment, according to Moullin, and can help ensure the success of their innovations.
5 Questions Every Innovator Should Ask
Without further ado, here are five questions (based loosely on the generic framework) that every innovator should ask when considering a framework for implementation:
1. Who Has Skin in the Game?
Who are your end users? How will they use your innovation? Moullin cautions:
If you don’t look at the external environment, you’re missing an important part…
When Interactive Research and Development (IRD) sought to implement Zindagi Mehfooz (Safe Life), a technology-driven system for collecting vaccine data in Pakistan, IRD recognized that they’d have to persuade parents to vaccinate their children in order to have data to record. Implementing this data and mHealth-driven innovation meant considering its context. It meant promoting behavior change. In order to encourage rural Pakistani parents to enroll in the vaccine program, IRD linked the RFID tag it gave to each child for tracking to lottery cash prizes.
2. What Are My Peers Doing?
nuviun spoke with Christina Synowiec, senior program officer at the Center for Health Market Innovation (CHMI) in Washington, D.C., about the importance of forging working relationships with peers – even competitors. She told nuviun:
It’s really useful to bring together organizations who face similar challenges or are at similar stages of development. We find a lot of times that the most meaningful and valuable conversations have to do with identifying the common challenges and drawing out tacit knowledge about operations on the ground.
CHMI recently released a Primary Care Innovators Handbook, which is an incredibly valuable resource for those looking to implement innovations in healthcare.
…There are not always clear solutions to tough challenges, but [we] have found that there is value in sharing ideas and experiences, testing new approaches, and sharing the results to enable successful innovations to spread more rapidly between organizations and across geographies. – CHMI handbook
3. What Processes Are Required for Implementation?
Every implementation process has stages and steps, but Moullin’s study found that one size doesn’t fit all when it comes to health innovations. A closer look at the implementation process and what has worked for others should help innovators better understand how to get from ideation to implementation to sustainability.
4. How Will Success Be Measured?
Moullin indicated that the evaluation stage is often left out of implementation planning. Is success to be measured in the number of downloads, revenue, or behavior change? Proving that an innovation impacts health outcomes can take time, but is usually necessary before governing bodies – and physicians – will adopt them.
5. Will This Implementation Have Unwanted Side Effects?
When an implementation goes well, there can be some growing pains, but, for the most part, needs are met and the players are happy. However, when an implementation goes badly, there can be unforeseen consequences, such as staff turnover and the challenges of sustaining change.
A Generic Framework
Moullin and team studied 49 different implementation frameworks in order to generate a generic framework. Their generic framework looks a bit like a series of related Venn diagrams. They say it’s not a new framework, but a composite and recommend using it as a guide for the planning process.
nuviun asked Moullin what advice she’d give to innovators. She said:
Spend more time in the planning phase – don’t go straight into providing something, don’t rush out large-scale roll-outs. People seem to skip the planning process, which is important to get buy-in. You can’t go straight into implementation.
The nuviun blog is intended to contribute to discussion and stimulate debate on important issues in global digital health. The views are solely those of the author.