By Sobia Khan and Julia E. Moore
2. Julia E. Moore (biography)
How can implementation practitioners – those who are implementing in practice rather than for research – become more effective? How can the pragmatism required to apply implementation science principles to practice be taught and fostered? What are the core competencies of implementation practice?
We conducted a scan of the literature and grey literature and then consolidated six existing core competency documents, covering implementation practice, knowledge translation, and knowledge mobilization. The core competencies outlined across these six documents required some synthesis and re-framing in order to really make sense and resonate with practitioners, particularly to address differences across settings.
Our report, Core Competencies for Implementation Practice (Moore and Khan, 2020), highlights the many different roles and responsibilities implementation practitioners and intermediaries may take on, so it is translatable to different initiatives and settings. Our coverage is broader than existing competency documents, capturing both the competencies required to design interventions for implementation (eg., mapping barriers and facilitators to a behavior change theory and selecting implementation strategies), as well as competencies needed to support implementation (eg., assessing readiness and contextual fit). These are the foundational pieces that need to be comprehended and acted upon in order to do implementation practice well.
A summary of the relevant implementation activities and associated core competencies is presented in the table below.
Each activity and competency is fleshed out in more detail in the report. Let’s take “Assess the context” as an example.
Context significantly affects the decision to adopt evidence, its implementation and its outcomes. Core competencies therefore focus on assessing and understanding the context while considering the perspectives of multiple stakeholders. Understanding the context helps guide the selection of strategies to overcome potential barriers and leverage facilitators. The competencies (19-22 in the table above) are:
- Assess readiness. Using surveys and/or interviews, assess individual and organizational readiness for change.
- Understand the system, context, and culture. Conduct a formal or informal assessment of the context, including barriers and facilitators at multiple levels (eg., the system, the organization, the implementation unit).
- Assess contextual fit. Assess the fit between the evidence, the system (eg., political, funding), and the organization (eg., culture and climate).
- Understand power structures and complex challenges. Complex challenges are situations in which there are no solutions or too many solutions with no clear choices. To create adaptive solutions to complex problems, seek information on the individuals who have influence and power within and outside of the organization and implementation unit.
Values
We also synthesised five core values from the literature we reviewed:
- Empathy. Being aware of and sensitive to the perspectives, thoughts, feelings, ideas, and experiences of others; respectfully valuing these contributions.
- Lifelong learning. Having a positive attitude about learning and continuous improvement, being curious and asking questions.
- Patience and resilience. Being patient and persistent through the process of implementation and being resilient in the face of resistance and other challenges.
- Valuing evidence and processes. Understanding and valuing research and various types and sources of evidence, and believing that implementation should be based on evidence.
- Valuing transdisciplinary teamwork. Believing in an atmosphere of collective collaboration and teamwork. Recognizing the added value of integrating evidence and perspectives from multiple disciplines.
Applications
Three key applications of the core competencies are to:
- help identify which competencies can be embedded into implementation roles in order to guide hiring or role development within organizations
- guide training needs – in other words, who needs to be trained on what aspects of implementation based on which competencies they must fulfill in their role
- for organizations that are acting as implementation supports (or intermediaries), the core competencies can be used to guide how support strategies for implementation can be developed and operationalized.
Conclusion
Do you have examples to share of how you have applied these competencies in practice? Are there some competencies that you think are more important than others?
To find out more:
Moore, J. E. and Khan, S. (2020). Core Competencies for Implementation Practice. The Center for Implementation and Health Canada: Toronto, Canada. The report and other implementation support resources are freely available from The Center for Implementation. (Online): https://thecenterforimplementation.com/core-competencies.
These competencies also serve as the foundation for a free online course Inspiring change 2.0: Creating impact with evidence-based implementation. (Online): https://thecenterforimplementation.teachable.com/p/inspiring-change.
Biography: Sobia Khan is the Director of Implementation at The Center for Implementation in Toronto, Canada. She supports capacity building, strategic organizational change, and evaluation based on implementation science and systems thinking. She has worked in a variety of organization types include hospitals, provincial agencies and academic institutions, and has practiced, researched and supported implementation at the organizational, community, provincial, national and international levels.
Biography: Julia E. Moore PhD is the Executive Director of The Center for Implementation in Toronto, Canada. Her experience in the field includes working on over 100 implementation projects in 8 countries. She has led and designed tailored courses and workshops that provide accessible training on the real-world use of implementation science.
Less of a gap now! I agree with Raimo’s comments about overlap between implementation and leadership – not surprising, but relevant and useful to remember.
Totally agree Niki! So relevant and useful to consider the intersection between competencies across different fields!
It is interesting to see the convergence of ideas related to competences in different areas of life. The essential new elements are the need to understand the big picture i.e. the system at hand and the need to have good people skills. We have discussed these in our recent blog and article on leadership in participatory modelling https://i2insights.org/2021/02/02/leadership-in-participatory-modelling/. The related paper has more on the leadership competences which relate very closely to the implementation competences you describe. Leading and implementing are processes which also need emotional skills when working with people. The concept of Systems Intelligence combines the systems perspective with positive engagement with people http://systemsintelligence.aalto.fi/ . We have suggested Systems Intelligence to be a core competence for future engineers too (R. P. Hämäläinen, E. Saarinen and J. Törmänen, “Systems Intelligence: A Core Competence for Next-Generation Engineers?,” 2018 IEEE International Conference on Teaching, Assessment, and Learning for Engineering (TALE), 2018, pp. 641-644, doi: 10.1109/TALE.2018.8615247).
Raimo, that is so interesting how much intersection there is across fields. It’s not surprising that leadership and implementation practice competencies have a large degree of overlap, since these are really the competencies to support individuals and organizations to change.
Your reflections about systems intelligence are so timely, as we have been working on incorporating systems thinking, complexity theory, and implementation science. We are literally in the middle of building course content related to this combination (https://thecenterforimplementation.teachable.com/p/embracing-complexity). When implementation practitioners are supporting or leading change initiatives that they plan to scale across systems (particularly complex systems), understanding systems thinking seems to be central. Interestingly, I have never seen examples of systems thinking embedded into implementation science or practice competencies, so will definitely be checking out your competencies for engineers.
Thanks for this, the table in particular is excellent and seems to have much wider application!
Absolutely agree! These competencies have a much wider application, since they are really about people who lead and support change.
Sobia and Julia, Thank you, thank you, thank you for this. I am interested to see you have chosen to synthesise the evidence around competencies, as opposed to practice, and would love to know more about that decision. Pleased to see relationships with stakeholders top of the list. Most of my work is with government or NGOs and I have come to appreciate how powerful stakeholders can be in achieving evidence-based practice. Sometimes the organisation making/influencing policy and practice wants to adopt an evidence-informed approach but the change in practice is resisted by the practitioners or consumer groups, so working with them at every stage will pay dividends. But on other occasions it can be the opposite with stakeholders, that is stakeholders, can, once better informed, demand evidence-informed services of a reluctant authority.
Niki, so glad you found them so helpful. Yes, we have seen the same thing – these stakeholder relationships are really central to change efforts. We decided to focus on competencies, since we provide training to implementers and the best practice is to have training guided by and focused on building competencies. Although we were trained in implementation science, our work is really focused on helping those responsible for implementing, spreading, and scaling change. Most of the competencies in implementation science are focused on researchers who have different roles that those supporting implementation. We really saw a gap and need in that area, which is why we focused on competencies for implementation practice.