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Date of publication: First draft posted for discussion in May, 2010
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Implementation is defined as a specified set of activities designed to put into practice an intervention (program, service, policy or practice) of known dimensions or a selected and described comprehensive approach, coordinated set of agency & school interventions or whole school strategies interventions into a defined context such as a school, school board/agency, ministries or systems. Implementation processes are purposeful and are described in sufficient detail such that independent observers can detect the presence and strength of the “specific set of activities” related to implementation. In addition, the activity or program being implemented is described in sufficient detail so that independent observers can detect its presence and strength.

Implementation is the execution of a decision to adopt a program or approach, that is, the innovation or reform of a system suggested by research or experience is put into practice. The scope of the implementation will vary, according to the size, scope and complexity of the change. Innovations (ie specific interventions such as policies, programs, services, professional or organizational practices) are usually implemented without intending or causing a change or shift in emphasis among the basic functions of the organization. Reforms of the system, such as comprehensive or coordinated school health programs, do require a shift in the basic functions of school systems, public health systems and other systems.
When thinking about implementation the observer must be aware of two sets of activities (intervention-level activity and implementation-level activity) and two sets of outcomes (intervention outcomes and implementation outcomes). It is common to read about “implementation” of a program or practice as if it were an accomplished fact when often that process is not clearly described nor evaluated. Implementation outcomes should not be assumed any more than intervention outcomes are assumed.

Since the quality of the implementation process will affect intervention outcomes, program developers, practitioners, officials and policy-makers should measure and monitor implementation carefully. Several researchers have developed models that describe different stages of implementation such as adoption, implementation, evaluation, evolution and institutionalization. There is increasing attention being paid to factors that affect implementation. These include key mechanisms such as recruiting and supporting champions, involving staff, parents, community and students as well as anticipating the impact of local drivers such as high profile incidents, existing relationships among the participants, media attention and others. Implementation will also be affected by the dominant features and norms of the local context/neighbourhood/community, the readiness of the organization to innovate and the characteristics of the innovation or reform such as its complexity, cost, risk/reversibility and fit with the organization.

Researchers are currently developing a body of knowledge that is coming to be known as "implementation science". Several evidence-based implementation models have been developed including the PRECEDE-PROCEED model in health promotion, the Concerns-based Adoption Model from education and the Mariner Model, all of which have been applied to school health, safety and social development through schools.

Other evidence-based planning tools have been developed to help to select programs that are suitable to specific populations, contexts or issues. These include the Intervention Mapping approach. Online versions of these implementation planning guides are available, including the Intervention Mapping Protocol and another based on a Program Planning/Population Health Approach.

The focus of most implementation efforts are usually associated with the planning, knowledge and skills required to implement a specific program, rather than to implement a multi-intervention approach guided by the needs of the local context or community and based on selected values or principles. Capacity and capacity-building, as well as systems change strategies come into play when seeking long-term sustainability (institutionalization) of programs or approaches. Therefore, fidelity to the previously evaluated and effective program is a major concern in subsequent efforts to take that program to a larger scale. Fidelity to an approach is also important, not in the details of program implementation, but more in the ongoing respect for the values, principles and processes espoused in the approach.

Adapted from Implementation Research: A Synthesis of the Literature Dean L. Fixsen Sandra F. Naoom Karen A. Blase Robert M. Friedman, University of South Florida and the statement on implementation strategies of the International School Health Network.

Peer Reviewed Publications

Fixen et al. (2005) “Implementation Research: A Synthesis of the Literature”, Florida: University of South Florida.

Eccles et al. (2009) "An Implementation Research Agenda", Implementation Science 4, (1).

Emand, G. and W.M. Roth (2009) "Policy as Boundary Object: A New Way to Look at Educational Policy Design and Implementation", 2 (1): 19-35.

Proctor et al. (2009) "Implementation Research in Mental Health Services: An Emerging Science with Conceptual, Methodological, and Training Challenges", Administration and Policy in Mental Health and Mental Health Services Research, 36 (1): 24-34.

Wallin, L. (2009) "Knowledge Translation and Implementation Research in Nursing," International Journal of Nursing Studies, volume 46 (4): 576-587.

Reports, Resources





Discussion Questions (Posted as part of a Canadian Knowledge Exchange Project in May 2010)

1. Does this definition adequately define the nature, essential aspects and other features of the implementation process?
   
   
2. Can implementation of a better practice or policy proceed without having a specific program that includes published materials such as lesson plans, service delivery guidelines or implementation guide?