Multi-level Influences on Implementation Outcomes

Without hospitable leadership and organizational structures, innovations likely will not succeed for very long. Like gravity, organizational and external influence variables seem to be omnipresent and influential at all levels of implementation.

Based on years of experience, Rosenheck (2001) sees “organizational process as a largely unaddressed barrier and as a potential bridge between research and practice” (p. 1608). “Large human service organizations … are characterized by multiple and often conflicting goals, unclear and uncertain technologies for realizing those goals, and fluid participation and inconsistent attentiveness of principal actors. It is in this field of competition, ambiguity, and fluid managerial attention that efforts to import research findings into practice take place” (p. 1608).

The challenges and complexities go beyond individuals and the organizations for which they work. Goldman et al. (2001) state that a “major challenge is to identify policy interventions that facilitate implementation of evidence-based practices but also minimize barriers to implementation” (p. 1592).

The importance of facilitative administration is often discussed and rarely evaluated with respect to implementation outcomes. The impacts of external influence factors on evidence-based practices and programs are even deeper in the shadows of empirical findings. Consequently, there is little to “conclude” from the implementation evaluation literature.

Based on the literature review, we have a few speculations about the findings in these areas:

  1. It seems that the work of implementation is done by the Implementation Drivers (e.g., training, coaching, and feeding back information on the performance of practitioners).
  2. It seems that assuring the availability and integrity of the Implementation Drivers is the functional work of an organization. An organization decides to proceed with implementation, selects and hires/reassigns personnel, provides facilitative administrative support, works with external systems to assure adequate financing and support, and so on to assure the continuing availability of the Implementation Drivers.
  3. It seems that organizations exist in a shifting ecology of community, state, and federal social, economic, cultural, political, and policy environments that variously and simultaneously enable and impede implementation and program operation efforts.

Relationship Between Implementation Drivers and Organizational Components

The potential relationships among Implementation Drivers, organizational features, and influence factors are shown in the figure above. Various authors (Bernfeld, Blase, & Fixsen, 1990; Bernfeld, Farrington, & Leschied, 2001; Edwards, Schoenwald, Henggeler, & Strother, 2001; Morton, 1991; Paine et al., 1984; Salasin & Davis, 1977; Schoenwald & Hoagwood, 2001) have described such a multilevel approach to understanding the transactional effects shared by these domains. As discussed previously, the Implementation Drivers appear to be essential to changing the behavior of practitioners and other personnel who are key providers of evidence-based practices within an organization. The Implementation Drivers do not exist in a vacuum. They are contained within and supported by an organization that establishes facilitative administrative structures and processes to select, train, coach, and evaluate the performance of practitioners and other key staff members; carries out data collection and analysis functions to provide guidance for decision making; and intervenes in external systems to assure ongoing resources and support for the evidence-based practices within the organization.

Thus, as shown in the figure above, the Implementation Drivers must be present for implementation to occur with fidelity and good outcomes. The organizational components must be present to enable and support those core components over the long term. And, all of this must be accomplished over the years in the context of capricious but influential changes in governments, leadership, funding priorities, economic boom-bust cycles, shifting social priorities, and so on.  A function of Implementation Teams is to help initiate, improve, and sustain at each level and all levels to help assure coherent, consistent, and effective changes to support evidence-based programs and other effective innovations.