1. Using Quality Improvement Strategies to Implement an Intervention Module Created By Population Health Improvement Partners www.improvepartners.org

2. Assessing your Community Implementing & Evaluating Establishing Goals & Objectives; Planning for Evaluation Finding Evidence Selecting Best Fitting EBAs Adapting Where do We Stand?

3. Learning Objectives Describe key tasks in planning for and implementing an intervention Provide QI tools to help your team plan for and implement selected interventions 3

4. = Positive Outcomes 4 Source: State Implementation and Scaling-up of Evidence –based Practices Effective Strategies & Interventions + Effective Implementation CDC Community Guide National Cancer Inst CTRT website iMAPP Others?

5. Tips for Successful Implementation 5 Establish an Implementation Team Cleary define and communicate how the intervention will operate Select “early adopters” to do a small pilot test to understand and learn how to adapt/adjust implementation efforts Use improvement cycles to learn what works, what creates barriers, and what can be improved

6. Role of an Implementation Team Makes the intervention happen Engages stakeholders Creates readiness for implementation Ensures fidelity to the intervention Provides TA and support to overcome barriers Monitors outcomes and feedback to improve implementation of the intervention Sources: National Implementation Research Network and SAMSHA

7. Characteristics of Implementation Team Content Expertise: implement with fidelity Program Management: implement on time & under budget Quality Improvement: monitor data and continuously adapt implementation process “Customer Perspective”: view point of someone who will be using the intervention in their daily life Partner Representation-provide resources, expertise, and staff to help implement

8. What percent of interventions are effective without an Implementation Team? Trivia Question 8

9. Tips for Successful Implementation 9 Establish an Implementation Team Cleary define and communicate how the intervention will operate Select “early adopters” to do a small pilot test to understand and learn how to adapt/adjust implementation efforts Use improvement cycles to learn what works, what creates barriers, and what can be improved

10. Planning Tools for Implementation Program Charter High-level Timeline Work Plan

11. Program Charter

12. Program Overview and Timeline Content Created by the Center for Public Health Quality

13. Work Plan 13

14. APPLY IT! 14 Think about your intervention: 1.How can you use these tools to plan how you will implement your intervention? 2.Share your thoughts with the group

15. Tips for Successful Implementation 15 Establish an Implementation Team Cleary define and communicate how the intervention will operate Select “early adopters” to do a small pilot test to understand and learn how to adapt/adjust implementation efforts Use improvement cycles to learn what works, what creates barriers, and what can be improved

16. Identify Early Adopters (Everett Rogers’ work) 16 Late Majorit y 35% Early Majority 35% Early Adopters 13% Traditionalists 15% 2% Innovators Content Created by the Center for Public Health Quality

17. APPLY IT! 17 Think about your intervention: 1.Who might be the “early adopters”? 2.What ways might you recruit the “early adopters”? 3.Share your thoughts with the group

18. Tips for Successful Implementation 18 Establish an Implementation Team Cleary define and communicate how the intervention will operate Select “early adopters” to do a small pilot test to understand and learn how to adapt/adjust implementation efforts Use improvement cycles to learn what works, what creates barriers, and what can be improved

19. Why Use Improvement Cycles? Ideal Reality Ideal Reality Reality Ideal

20. 20 Why Use Improvement Cycles? Helps adapt good ideas to your specific situation: –Forces us to think small –Forces us to be methodical, make predictions and learn –Allows rapid adaptation & implementation of changes

21. 21 PDSA Cycle A ct P lan S tudy DoDo Objective of cycle Questions/predictions Plan to carry out the cycle (who, what, where, when) Carry out the plan Document problems/unexpecte d observations Begin analysis of data Complete the analysis of data Compare data to predictions Summarize what was learned What changes are to be made? Adapt? Or Abandon? Next cycle? Use the PDSA cycle to test changes and organize feedback

22. 22 Rapid Cycles of Change Hunches Theories Ideas Changes That Result in Improvement AP SD A P S D AP SD D S P A Learning Very Small Scale Test Follow-up Tests Wide-Scale Tests of Change Implementation of Change

23. PDSA Cycle Forms 23

24. 24 PDSA Tip: Scale Down Years Quarters Months Weeks Days Hours Minutes Number of clients/staff “Drop 2” 24

25. Meeting Structure Communication Intervention Component 1 Learning & Improvement in Parallel A P S D A P S D A P S D D S P A A P S D A P S D A P S D D S P A A P S D A P S D A P S D D S P A A P S D A P S D A P S D D S P A A P S D A P S D A P S D D S P A 25 Coaching & TA Intervention Component 2

26. Feedback and Improvement 26 Adapting Intervention Core Elements Caution: although it is important to be responsive to feedback you CAN NOT change the core elements of an intervention and expect the intended outcomes

27. 27 Activity: Using Improvement Cycles Intervention Components: Targeting Store Owners –Monetary incentives –Nutrition education session/booklets –Cultural guidelines –Corner store guidelines (e.g. buy, stock, and purchase) Intervention Components: Targeting Consumers –In-store intervention materials –In-store promotions (incentive cards, nutrition sessions)

28. APPLY IT! 28 Think about your intervention: 1.How can your team build in improvement cycles ? 2.Share at least one idea for how you plan to use improvement cycles.

29. Sources Referenced for this Module National Implementation Research Network SAMHSA (2012). A Road Map to Implementing Evidence-based Programs. Retrieved from: http://www.nrepp.samhsa.gov/Courses/Implementati ons/resources/imp_course.pdf. http://www.nrepp.samhsa.gov/Courses/Implementati ons/resources/imp_course.pdf 29