Because the quality of implementation is so important to program outcomes, it is essential to learn what is necessary to achieve this level of implementation. There is now convergent evidence from implementation science about how this can be accomplished. Several authors have independently developed conceptual models or frameworks regarding how implementation can be carried out effectively based on systematic research and practice in diverse areas such as health care, education, mental health prevention, treatment for adults and children, and management ( e.g., Damshroder et al. 2009; Fixsen et al., 2005; Hall & Hord, 2006; Klein and Sorra 1996; Spoth, R., Greenberg, M., Bierman, K., & Redmond, C. (2004).
Meyers, Durlak and Wandersman (in press) synthesized this literature and found there was consensus regarding 14 steps that were related to quality implementation, and they created the Quality Implementation Framework (QIF) to describe these steps. The QIF, which is divided into a four-phase temporal sequence, and also contains information on the major goals that should be accomplished at each step is presented in Table 2.
It is important to consider and effectively address each step in the implementation process. For example, before implementation begins, it is important to assess such issues as how well the program fits the setting, if staff holds realistic expectations about what can be achieved, whether there is genuine buy-in or acceptance for the new program, and how to train staff effectively for their new roles. Once implementation begins, on-going technical assistance is needed to help staff implement with quality. It is also essential to develop and maintain a good monitoring and feedback system during implementation (Steps 12 and 13 in Table 2). This is because implementation often varies over time: sometimes quality drops and other times it increases. Both types of changes have implications. If implementation drops to too low a level after a good start, there is a need to intervene quickly through professional development activities to improve implementation. Such a drop may also signal a need to re-examine whether commitment, support and enthusiasm still exist for the new program, and what steps might be taken to rekindle the initial interest and support of the organization and its staff.
Increases in implementation have been noted in longer and complex programs in which it may take more than a year to achieve quality implementation. Therefore, patience is required in estimating the true value of some programs. Depending on how complicated and comprehensive a program is, it may take up to 3 years before quality implementation can be achieved (Goldstein, 2011). Therefore, one cannot assume that the level of implementation displayed during the early stage of a program will be the same as that achieved at the end of the program. A good monitoring and feedback system is important so that practitioners receive positive feedback about the good job they are doing, and that efforts to improve implementation can be made quickly if needed.
As reflected by the Quality Implementation Framework, systematic research and practice in implementation science have indicated that quality implementation:
- Is a systematic process of coordinated steps; quality implementation can be achieved with careful planning;
- Has a temporal sequence; some things should be done before others; in fact, 10 of the 14 steps should be addressed before the program begins; and
- Requires many different types of activities and skills that include assessment, negotiation, collaboration, planning, and critical self-reflection.
In sum, the time and effort required of implementation should not be rushed. Attempts to short-change the process or omit important steps can undermine quality implementation.