Another important consideration is the broader context in which an intervention is being implemented. Different aspects of the context can support or inhibit successful implementation. One aspect of context is the “unit of change.” The primary implementer can be an individual (e.g., a case manager in a foster care agency), an organization (all staff in a community-based organization), or a whole community (city or state). It is useful to monitor progress in implementing interventions when considering whole-organization and systemic change. The same three constructs (fidelity, competence, and concerns) can be applied to the whole system as well as the various subgroups. The same considerations regarding TTA, coaching, and assessing movement during implementation apply, but now it is to groups and whole communities.
Figure 2: Understanding Practitioners in Their Broader Context
Source: Goodman, 2011.
Implementation will be more successful when there is clear and consistent support for using an intervention across the system. The plan for monitoring implementation should include measuring how well the system is supporting its use. Figure 2 illustrates an education system in one state, but the concept behind the graphic can be applied to any state system because most large-scale change efforts should be supported at the organizational, local, and state levels, which can be considered units of change. Implementation progress needs to be monitored within each unit, and overall. When a change initiative is being led from the “top,” there is a “cascading” relationship in which each unit of change supports the next. In addition, needs and barriers are expressed to the next unit (e.g., the building team expresses its needs and barriers to the district team) so the right supports will be provided. Regular measures of fidelity, use, and concerns within each unit are important to maintain an informed, strategic view of progress and needs.