Black – implementation science

Many of us have been trained either as health care providers or teachers or professionals to work with individual children or classrooms of children, and we study children’s development. We learn what methods may work best or compare different methods of helping children learn. And from what we’ve learned, if we’re doing research then we may write papers about how those things work. But what we’re really interested in is knowing how to scale up what we have learned, how to move from science to practice. Many of us really don’t know how to do that, and what we’ve learned is that there is a specialty which is called implementation science that enables us to move from science to practice. So a typical way that a researcher might think that they’re moving to practice is by writing an article or publishing a paper. But really the number of papers that are read or articles that are read is not high. 

A second way they may do it is by putting it on a website. Oh, good news more people can look at it, but it’s still not making it happen. What implementation science does is it makes it happen. There are new ways of doing that that health care providers or teachers do not necessarily know. So some of those ways include involving a community, working with stakeholders, keeping track of what one has – is doing, keeping metrics. The system that we’ve used is called MERLA. That stands for monitoring, evaluation, research, learning and adapting. 

This is how it works: monitoring means that as you are moving a program forward you have to make sure that it’s continuing to work. So you’re looking not only at the outcome, but you’re looking at how far it’s reaching. Are you reaching those children who are most vulnerable, the hardest to reach because if you think about equity, they’re the ones who need it the most. The only way you’ll know if things are really working is if you – if you keep track of it. If you have the metrics to be able to know how far you have reached. 

So the evaluation then is evaluating those metrics. And they also include the workforce. Have you trained enough teachers or enough health care workers to be able to implement the program that you’ve shown works. So you evaluate what the metrics have shown you. Just collecting the data would not be enough, you have to be doing the evaluation. 

That leads into the research where you’re studying is what you have done actually having the impact on children that you thought it did. If you set up a very nice program but the children don’t attend, or you set up a very nice program, but the teachers don’t teach it, then it’s not really working. So you have to do the research to see if it works. 

What the L stands for is learning. Whose learning is that? That’s our learning. And what we learn is are we making a difference, are we reaching where we want to reach, are the teachers or the health care workers implementing the program the way that we think it should be implemented? If the answer is that there are gaps, then we move to the next which is we adapt. 

So by adapting, we go back to the monitoring and we have a continuous quality improvement.  In implementation science it’s all about the continuous quality improvement because that’s how you get sustainability, that’s how you are able to scale something. Because a community is not going to go for scaling something that doesn’t reach, that doesn’t work.