This is a seminal article that summarizes the research on the new and overdue discipline of implementation.  The latter research and thus this document are slightly biased towards human service (versus business) experience in implementation.  The authors undertake an expansive and thorough review that enables them to distill several helpful frameworks (i.e., generic implementation conceptual model, core -implementation - component framework, framework for how organizational and external factors might influence the functioning of core implementation components, and defined stages for implementation).  In addition there is a comprehensive section summarizing the research findings related to program start-up (e.g., recruitment, training/coaching, evaluation and fidelity).  Finally, consistent with the authors' primary thesis (that successful implementation requires a longer-term multilevel approach), the concluding chapter in this document includes specific recommendations tailored to four different audience levels or stakeholder groups: 1) policy makers; 2) researchers; 3) implementers; 4) purveyors or consultants.   This document should be required reading for each of the latter groups.

[Fixsen, D., Naoom, S.F., Blase, D.A., Friedman, R.M., Wallace, F. (2005)  Implementation Research: A Synthesis of the Literature.  University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231). http://nirn.fmhi.usf.edu/resources/publications/Monograph/index.cfm , 119 pages.]

Conceptual Model and Framework

The conceptual model for implementation that Fixsen, Naoom, Blase, Friedman and Wallace lay out is extremely elementary and pragmatic, containing five components: 1) Source; 2) Destination; 3) Communication; 4) Feedback; 5) Influence. The outcomes derived from this model are:

• Changes in adult professional behavior
• Changes in organizational structures and cultures
• Changes in relationships to consumers/stakeholders

Their five-element model performs as a lens for better specifying the activities designed to put into practice an activity or program of known dimensions.

The framework depicting the core components for implementation (also known as implementation drivers) consist of a six stage (component) cycle:

1. Selection,
   
2. Pre-service Training, 
   
3. Consultation and Coaching, 
   
4. Staff Evaluation, 
   
5. Program Evaluation,
6. Facilitative Administrative Supports.
   

 Within this cycle the authors see learning generally progressing "from orientation and new learning to mechanical use, routine use, refinement, integration, and innovation as new knowledge, skills, and abilities become developed."  The six components above are all deemed to be highly interdependent (or in the authors' terms, integrative and compensatory).

Fixsen et al. frame organizational contexts and external influences as critical; "systems trump programs".  They diagram a simple model of three concentric rings, with the inner core circle containing the above implementation drivers (e.g., training, coaching, performance measures), the next outward ring the organizational components (e.g., selection, program evaluation, administration) and the final outer ring portraying the Influence Factors (e.g., social, economic, political).  The three frameworks (conceptual model, core components and organizational and external influences) articulated in this document are depicted as having elegant linkages that form an overall ‘ecology' of implementation; these frameworks are also unique to the new field of implementation.The authors have deduced from their immense literature review (more than 1000 published articles were given a full text review) six stages of implementation which are reflected in the figure below. 

They consider the above stages to be sequential, each with unique performance requirements that to the degree met, will either increase or decrease the probability of subsequent implementation success. 

It is difficult for a 2-3 page synopsis to do justice to this comprehensive document summarizing implementation literature.  The authors have taken great care to craft a document that is as elegant in format as it is foundational in scope.  The reader, whether policy-maker, administrator, line practitioner or consultant, will find numerous take-aways, helpful sound bites and aphorisms in this document to guide their future implementation work.  Some quotable examples follow. 

• Before we begin to delve into the mysteries of implementation, we want to affirm the obvious.  Implementation occurs in the context of community.
• A persistent problem encountered throughout this review of the implementation evaluation literature is the lack of a common language and the lack of a common framework for thinking about implementation.
• A purveyor is an individual or group of individuals representing a program or practice who actively work to implement that practice or program with fidelity and good effect.
• An advantage of having a well organized and persistent approach to implementation of evidence-based practices and programs may be that the purveyor can accumulate knowledge over time.
• ...the real world of applied psychology as an environment full of personnel rules, social stressors, union stewards, anxious administrators, political pressures, interprofessional rivalry, staff turnover, and diamond-hard inertia.  

How would you rate this article?