Executing

Quality of execution may consist of the degree of fidelity of implementation to planned courses of action [1], intensity (quality and depth) of implementation [2], timeliness of task completion, and degree of engagement of key involved individuals (e.g., implementation leaders) in the implementation process. There is not a consensus in the literature about how to assess fidelity – especially how to do so in a standardized way across studies and settings; it may not be appropriate to do so. Pearson et al. defined fidelity in terms of the extent to which hard core components of the intervention were implemented and also, quality and depth of implementation (together comprising intensity of implementation) [2]. The latter dimension (intensity) was subjectively determined based on organizational documents, meetings, communications, and other study materials. Execution of an implementation plan can be organic with no obvious or formal planning which makes this construct challenging to assess. However, in addition to a well developed plan, three general approaches increase the likelihood of success. Dry runs are simulations or practice sessions that allow team members to learn how to use the intervention before going live and help train and prepare users [3]. Pilots or trials of a new intervention also allow users to test procedures, gain confidence, and build an environment of psychological safety as members are encouraged to take on new behaviors, and make adjustments [3]. More complex interventions may lead to incremental interventions [4][5][6]. Breaking down the intervention into manageable parts that can be adopted incrementally has a positive relationship with adoption [4] because incremental implementation allows people to feel that they have enough time to do their work and to learn new skills associated with the shift to the new intervention [7]. Successes in early increments of the implementation help increase confidence, give an opportunity to make adjustments, and gain new “believers.”