Excellence Foresight with Nancy Nouaimeh

Implementation Science in Action: Making Change Practical for Leaders

• Nancy Nouaimeh • Season 3 • Episode 13

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Change rarely fails because of bad strategy; it fails because execution collides with human reality. We sit down with Julia Moore from the Center for Implementation to unpack how leaders can swap “train and pray” for practical, evidence-informed strategies that people will actually use. From hospitals to schools to public health, Julia shows how to design for behavior, not just broadcast information.

We start by reframing the work: define the thing you’re implementing, identify everyone involved, and get precise about what must change in daily behavior. Then we diagnose barriers and facilitators at the individual, organizational, and system levels, mapping them to behavior science so strategy selection isn’t a guess. Julia opens her toolkit—the free Strategies Tool that links barriers to actions, and Map to Adapt, a process that helps teams decide when to tailor, when to pause, and when to pivot while protecting what matters most.

The conversation moves into leadership as five core functions: understand, connect, inspire, enable, and transform. We talk about why authority no longer carries change, how to build trust and navigate power dynamics, and why storytelling outperforms slide decks when you need hearts to move before metrics improve. Julia also bridges quality improvement and implementation science, showing how combining cycles and measures with barrier-driven strategy and adaptation planning accelerates real-world results.

If you’re a leader craving clarity and traction, you’ll leave with a practical path: start with self-awareness, equip your team with the right skills and resources, and remove the friction that blocks progress. Grab the free mini course Inspiring Change 2.0, share this episode with a colleague who leads change, and leave a review with one barrier you’re committed to tackling next.

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Nancy Nouaimeh:

Welcome to the Excellence Foresight Podcast. I'm Nancy Nouaimeh, your host, and an organizational excellence and culture transformation professional, passionate about helping leaders turn change into a competitive advantage. Each episode, we dive into what it takes to build high-performing, sustainable organizations. And today we're tackling a big topic: implementation science in action, making change practical for leaders. Did you know that 70% of change initiatives fail? Not because of poor strategy, but because execution breaks down and resistance takes over. Organizations with strong change management practices are six times more likely to succeed. In this episode, we'll uncover how mastering execution transforms change from a risk into a growth engine and how leaders can make change practical and sustainable. That's why I'm thrilled to have Julia Moore from the Center for Implementation with us. She focuses on making the science of change practical and accessible. Julia Moore brings experienced supporting professionals in hospitals, schools, and public health organizations, shaping how programs are implemented. She has spent years turning research into practices that stick, including her involvement with Healthcare Excellence Canada's extra program, which develops future leaders in health systems. Julia, welcome to the Excellence Foresight.

Julia Moore:

Welcome. Thank you so much, Nancy, for having me. I'm super excited to be here.

Nancy Nouaimeh:

Great. So let's start. Your work focuses on making implementation science practical. Why do you think so many organizations struggle to translate theory into action?

Julia Moore:

I mean, I think the reality is so often what happens is people in organizations get tasked with implementing new programs or new practices or new policies. But unfortunately, as you know, we're not actually trained in the science of how to effectively implement things. And so I think we're tasking people with doing these things that sometimes we think are small, right? Sometimes they say, oh, implement this new policy, get that people using this new program. When in fact, that's actually a harder thing to do than we expect. And those people don't necessarily have all of the skills and the competencies to effectively do that. And in my experience, they want so desperately to find ways to implement change more effectively. And people are struggling and looking for answers out there.

Nancy Nouaimeh:

Yeah, like you're focusing on the struggle that people go through and the lack of understanding, what it takes really to make change successful. So I think from your experience and real work in hospitals and public health organizations, what are the unique challenges that you've seen when trying to make science practical in these settings? And what do you do usually with working with hospitals and public sector organizations in the sphere?

Julia Moore:

So I mean, I think the first thing is that there are lots of people right out there who have these jobs to implement things, right? And they have lots of different job titles, right? Like quality improvement people, they may be program managers, you know, change agents. Like they have lots of different job titles, but they have the same role, the same function, right? Like they're trying to implement things. And oftentimes they draw on their experience and things that they read. And a bunch of those things are actually amazing, great things that are really, really helpful. And then as humans, we start relying on some things that we become super comfortable with. So the one I see most often is we love to train people and educate people as a way of making them change. We're like, if we just give people the information, if we just do a training, it's gonna work. And we sort of jokingly call this at the Center for Implementation, the train and pray approach to implementation, because it's kind of like let's train people and pray that they change. But the research is really clear training is often necessary, but not sufficient because people have a lot of barriers that aren't about knowledge and skills. And so we need to understand what are the barriers, what are the barriers for individual people? And what are the barriers at the organization or even the system level that make it challenging to go and implement things. And so I think that we really try to support people to understand ways to capture and understand those barriers so that ultimately they can pick strategies that directly address barriers to change.

Nancy Nouaimeh:

I think this is very, very important. I think what you're talking about here, Julia. And I think understanding those barriers and having strategies to really tackle that is important. And I like the fact that you've mentioned the overlap a little bit between different roles and what we're trying to implement and do. So certain clarity, I think, definitely is is required. And I think the work you're doing helps people get that. So let's dig into that. And if you can a little bit give us more insights into how do you help people really identify the required strategies.

Julia Moore:

So, yeah, so I think that the way that we like to think about identifying strategies, and so we think of strategies as um, okay, wait, let me step back. When people are going to implement a thing, we like to talk about the thing they're implementing as the thing. Like, so maybe it's a program, maybe it's a policy, maybe it's a practice, right? Like there's a thing that they are trying to implement, a new technology. We like to break down that thing into understanding who are all the people who are being asked to change. We call those the who's. And for each who, what are they being asked to do differently? And so we try to break down who are all the who's and what are they being asked to do differently. And sometimes there's a lot of things and sometimes there's not a lot of things, but we often forget some of the who's and don't clearly define what we want them to do differently. Once we do that, and that ideally should be done in a co-created approach so that the people who are being asked to change are helping co-create and define what that looks like. Then we want to understand, okay, what are people's barriers and the facilitators to actually addressing those who's and what's. And so we like to map those out to theories of change and we like to use frameworks to say, hey, let's understand and break down why people may or may not be willing or able or motivated to change. And then we use behavior change theory to go and pick strategies that directly address those barriers. So, like simple examples, if memory is a problem, reminders are a great strategy to address that. But often memory is not the main barrier, right? We often have more emotional barriers or barriers because we're not confident this is going to work, we're not confident we can do it, we don't believe that there's gonna be a benefit. It doesn't necessarily align with how we see the world. Or maybe there's like organizational level challenges, like it's not a priority, leadership isn't really supporting it, we don't have enough resources. And so then we go through a process of picking strategies that directly address those barriers. Um, and so we actually have a tool called the strategies tool that helps people go through that using behavior change theory developed by researchers in the UK, like we didn't develop the theory, but it links together all those different pieces so that people can say, hey, what strategies might work for us in our context?

Nancy Nouaimeh:

Wow, this is amazing. So you're really giving people tips on how to really do that. This is really great. And in your work, Julia, have you seen any differences and impact of culture and systemic differences on the way the what you're doing is is really um being implemented, the way science is implemented in these projects.

Julia Moore:

I mean, absolutely. So we work very internationally. Um, and maybe let me clarify. So we work with people in two ways. So we have people we collaborate with and partner with on actual initiatives that they're scaling. And then we also engage with a lot of people through our online courses and our certificate program. So we have five soon-to-be-six online courses and we have a level one implementation support certificate. And so we have people from literally around the world who are learning to become implementation support specialists. And so we have to think about what is relevant. Um, you know, I live in Canada, but what is relevant in Canada? But we have people across North America, we have a lot of people coming from Africa, from South America, increasingly from Europe and Asia, lots of people down in Australia and New Zealand. So we need to find ways to think about this that are applicable across countries and across topic areas, because we work across human services, so like health, education, social services, justice. And so culture plays a huge role. And we believe everyone needs to be thinking about the context in which they're working. The context in terms of maybe the team or the unit or the department, the organization, and even the system. So maybe the province or the state or the district and the country, because all of those things impact implementation. And we see that over and over again. And again, I think there's systematic ways people can learn how to do that that set them up for success.

Nancy Nouaimeh:

Um, absolutely. And I think the focus on really understanding the systems is very important. And we've seen this in more and more in the frameworks we we're working with for excellence, and also we we teach this in different uh leadership programs because it's very important, I think, to understand the context and look at things from a systematic point of view. So I think that's important. And what you've explained is really moving from train and prey, right? To really starting to understand how execution works and what makes it successful. Now, and we know that execution is really goes through uh effective change leadership, Julia. So you often talk about competencies for effective change leadership. If you had to pick the top three competencies leaders need today, what would they be and why?

Julia Moore:

That is a hard question, Nancy. Um so okay, when we talk about competencies, we talk about we have competencies that we think about for implementation support. And there's 10 super concrete competencies, right? Like things I've talked about, things like being able to assess barriers and facilitators, being able to plan for adaptations, plan for sustainability. So these super concrete topic areas. And then we have what we call functions. So we have these five functions. They are to understand, like to be able to deeply understand, for example, the context and the complexities of the context in which you're working, the people you're working with. We want people to be able to connect with others because all implementation work is people work. It is relational work. We believe that people need to be able to inspire. And this is not about telling people what to do. We know that change today is not a top-down process. It is a process of engaging people and inspiring and motivating them. We believe in enabling and so removing barriers and making it easier for people to do things. And an internal one, well, not always internal, but the idea of transform. How can we transform the way that we think about ourselves to understand how we are showing up in the work and to transform the way our teams are showing up in the work? And so interestingly, people love focusing on those very technical competencies, and those are undeniably important. But if you ask me what leaders need today, I would say it's these five kinds of functions that we talk about. Um, because I think that's leaders who are showing up with those things are the leaders who are making change happen. They are supporting change, they are supporting teams, and they are supporting sustainability in incredible ways. So that's where I would start for the most important ones.

Nancy Nouaimeh:

Yeah, and I totally agree with you. It's it it's really about a mindset shift. Uh, and what you're talking about is really changing the technical skills that will always be important, but definitely having that mind that mindset shift, which is really critical, I think, for leaders. And I think the success we see is more from leaders who have those uh five functions, and you've talked about connection. It's really critical these days, I think, to have that connection and it's all about people finally, right? Um, so yeah, I totally agree with you. I I've seen a lot of failure that comes from organizations and teams and leaders not focusing on people as vectors for implementation. So thank you for that, Julia.

Julia Moore:

Wait, can I say something about that, Nancy?

Nancy Nouaimeh:

Yes, absolutely.

Julia Moore:

So so it's super interesting. When I started, so I've been training people for 10 years in implementation science. And um, I was very focused on those technical things for a very long time. And about five years ago, people started coming and saying, Hey, that's great. You can teach me about theories and frameworks, and I can do all these different things. But at the end of the day, the problems that we are having are about building trust and navigating the power dynamics that are playing out in the middle of implementation. And for us, it was this huge light bulb moment of we can build courses and we can support people in building these technical competencies and we will continue to do that forever. But also we shifted and started saying, hey, what is the science behind how to build trust? What is the science behind how to navigate power dynamics? We ended up digging deep into this, building courses around it. We do workshops around it. And one of the takeaways I have is I cannot believe that this is not something we teach every single person in undergraduate, because no human is working alone. Like we have to interact with other people. And I dream, I have two kids, I dream that by the time they're in university that that we will be teaching them how to build trust and navigate power dynamics because that's the central to all work that we do. And it's kind of baffling to me that that that's not kind of core to what we're teaching people to do as they get into the workforce.

Nancy Nouaimeh:

Yeah, I think that we have some work to do in that sphere. I think my kids are in the university now, and yeah, it's not, I think it's not really thought enough. So I think we can do more around that. And in every workshop I've been delivering, also, I think I always put that element of focusing on people, change management, and talking about culture. And then I see the reaction of people technical is great, but these are the things that they are eager to learn, eager to to know more about and be able to practice somehow. So, Julia, if one competency leader is often underestimate, but is critical for success from all what you spoke about. Can you just list one? Or which you want the one you believe it's really the most critical.

Julia Moore:

I mean, this is my bias. So I think I think that inspiring people is one of the most critical. I think that the number of times that people come to me and say, I can't make change happen because we don't have authority, right? Everyone wants to make change, not everyone. A lot of people want to make change through authority. And I think that in the world today, there was maybe a time where that was possible. And in the world today, I don't think that that's possible almost anywhere. And so instead of seeing change as being, oh, I need authority over others to make change happen, I think that when we have a mindset shift to thinking about how can I influence and inspire people to want to show up differently, to want to do these things in different ways, I think it truly transforms the way that people show up to the work and the way that teams and those around us work together. Um, and whenever people tell me that I don't have authority, like I can't make change happen, I tell them, I never have authority. I have no authority in any implementation. Like I've worked on over a hundred initiatives. I've never had authority. But it doesn't mean that we can't make change happen. We can't support people through that process. Um, and so to me, I think that's where I would, that's the one that I would go to first. But I will confess that that might vary by day based on who I've been talking to that week or that month, um, and what challenges they're facing.

Nancy Nouaimeh:

Yeah, I think it's one of the, I mean, it's the most critical. Uh, I think competency also is the harder one to the hardest one really to to to develop, I think, because not everybody is an influencer or have that capacity. So I think there's a lot of work that um could be could be done also in that one. Do you have any tips, maybe Julia, to share with our audience about how to become more influencer in in what they're doing or influencing others into walking the walk with them?

Julia Moore:

So I think that the so a few different tips and ideas that come to mind. So one of them is oddly being able to influence and inspire. I like to think about it as inspire more than influence, but being able to inspire others often comes first in working on the self. I think that we are able to, we're better able to inspire others when we understand how we are showing up, when we understand what biases we're bringing to the table, when we understand what is triggering us in different moments, change is emotional. The experience or the possibility of loss is so big for people when we talk about change that people are getting triggered. And then if you're trying to inspire others, it's easy to get triggered when they're getting triggered. So I think that there's a lot of self-work that has to happen first. And then I think terms of like concrete, like action-packed strategies, um, I think one of my favorite things to focus on for people. So is the power of storytelling. So we do, we know a lot of people. I work with a lot of people who believe so deeply in the programs and policies that they want to implement that they want to focus on data and evidence to tell the story of why that we need to do this new thing. And the reality is, humans are often not influenced by data that much. They are much more influenced by the power of storytelling. And um, so we spend a lot of time working with people to help them understand like, what is the story? What is the underlying why? What is the vision of what you want to achieve? And how can you get people to be emotionally connected to the vision rather than focusing on the data? It can be backed by data, you can use that in your stories, but that should not kind of be the starting place for a lot of this work.

Nancy Nouaimeh:

Yeah, and you're talking about the Julian, it's making me think like uh coming from a quality background, we always focus on facts and data, and we share that as the first thing to share. And I know that it doesn't really work, and we see there's a lot of um, I think, gaps between um the teams when we talk about this and being able to implement, I think, quality programs, just talking about data and talking about the why, but not in an inspirational way, it doesn't really help. So, thank you for for highlighting this. And I think you have that great storytelling, which I could see from from your answers. So I think there's a lot that our uh audience also can learn from you um from in that respect. So um just can I say something?

Julia Moore:

Sorry, yes, can I say something before you jump there, Nancy? The other thing I want to say is about quality improvement and implementation science, because I think that's a really big question I get a lot right now is um what's the difference between quality improvement, implementation science? How do they work together? Um and I always tell people quality improvement and implementation science came from different sources, right? Like they started from different places, but they have the exact same end goal. And we are finding increasingly that people are recognizing that they can be learning from the flip side. Side. So if someone is first trained in implementation science, they realize, oh, there's all of these tools and resources from quality improvement that are amazing that can help them do their jobs better. And I would say we have a huge number of people who are trained in quality improvement who are saying, these pieces are awesome and I'm really struggling in certain areas. And they're finding implementation science is finding helping them find answers to things like we talked about barriers and facilitators to strategies, planning for adaptations, planning for sustainability, and thinking about scale up, which are not deeply embedded in quality improvement. And they're saying you can keep using all of your QI approaches, all your QI methods, and then infuse the pieces from implementation science that help. And we are just seeing incredible, incredible examples of people doing that literally around the world. And I think that's super cool.

Nancy Nouaimeh:

Yeah, I think this is really very important, also, like looking at just not the tools and what are we taught to use, in fact, in doing our work is also looking at all of these other elements that could help us really do things differently. And I think inspire. And when we talk about continuous improvement, definitely, I mean, inspiring the team to follow and to be able to take part of that journey is very important. I work with the shingle model and also we focus a lot on behaviors, we focus a lot on bringing the teams together and putting a nice process in place to help them, I think, be part of it. But also it's it's really about them understanding um the why in a nice way. But storytelling definitely and implementation science will help here. So I'll try to explore it myself, also, Julia, in the future. So thank you for that. Uh now, just Julia, if we move a little bit to the tool that you have. So we know that many leaders feel overwhelmed by frameworks and jargon. And I personally believe sometimes we're bringing too many things together sometimes for people to use, and it's hard to choose from those ones. And and I think I want to go back to your comment earlier. You mentioned a little bit that uh, I mean, people can can use uh these tools, like the implementation science and continuous improvement tools and stuff, it also goes back to a certain self-awareness of the leaders. What do they need and what do they have and what are their competencies and how to develop further? So if if we look at these frameworks and jargon, how and we want to get away a little bit from using things which people maybe not able to connect to directly. So, how do you simplify the complex science so it's actionable for busy executives and teens? And how do you make it really accessible for them?

Julia Moore:

Yeah, so I would say, I mean, that's what I spend the majority of my time doing is thinking about how we can make these um pretty complicated and sometimes very complex concepts really, really practical. And so interestingly, um tool development is one of the ways to do that. I will admit that I never wanted to be a tool developer. Um, and now I am full-on a tool developer. We spend a lot of time developing tools in-house for the Center for Implementation and having those available. All of our tools are free so that anyone can use them. And then I spend a lot of time actually helping teams develop implementation tools for their work. Um so I think that tools can help us kind of narrow in some of the complexity and some of the language to make people feel like they have concrete steps and people feel like they have concrete actions that they can take. And so let me give two examples. So we have this one tool called the strategies tool. And it literally helps people go through the process of saying, okay, you have to have understood your barriers, mapped them to a framework, and then you can click on a button and say, these are the kinds of barriers I have. And a list of strategies pops up and it says, these are possible strategies that can address those kinds of barriers. Behind the scenes is like evidence and theory and all these things, but people don't need to know all of the details of that. And so we see teams all the time, community partners, people sitting down, pulling up this tool and collectively saying, that strategy sounds good. Oh, these ones don't seem relevant. Oh, that might work, but I don't know if it's great. And they can collectively do that using theory sometimes without even realizing they're using theory. Ideally, someone at the table understands how the whole thing is working. I think that's the best case scenario, but everyone doesn't under need to understand that. And I also want to flag we have other types of tools. Um, one of my new favorite tools that just came out this year is called Map to Adapt. And the Map to Adapt tool is a process model that helps people think through all of the steps and stages to plan for adaptations. So we know today that when you're implementing things, you will need to make adaptations and changes along the way, especially if you're implementing something that was pre-packaged, already exists, like a program or a policy. We need to make adaptations. This isn't an algorithm that tells you the answer, it's a process to ask questions with the team to say step by step, ooh, these are the questions we should be asking. What is that going to look like for us? How are we going to make decisions? We have these moments that ask people to pause and say, is it worth it to move forward with adapting this thing? Do you need a different thing? Um, and so it's decision points are embedded inside of it. And so we're finding teams are loving that kind of tool because they have autonomy to drive the work, but the process exists and is laid out for them. And so I think that's one of the ways that can make this complex science more accessible to people.

Nancy Nouaimeh:

Wow, this sounds really amazing. And I like the fact that they can be autonomous in doing the work and also have a tool that supports them. I think this is really a great way of providing really necessary the tools to people to work rather than just giving them some rigid things. And I like the fact that you mentioned the adaptation, which is, I mean, coming from again from a quality background, we we like the fact that we can check and we can adjust things as we move forward to make sure that they remain fit for purpose. So, Trilliya, your tool seems really amazing. And um, I encourage everyone later to connect with you for that. But if you would like now, as we come at to the end of the house, if you could give one piece of advice to leaders who want to lead change with confidence and impact, what would that be?

Julia Moore:

Okay, wait, I'm gonna struggle because I have two pieces. So one is I think that there's what is I think that um, as we talked about, I think that there's a moment of like, if people want to lead change, I think that there's a hold up the mirror, like, how am I showing up? What can I do differently? Um, internal piece that when I think of the amazing leaders I've been working with over the past year, they are spending a lot of time on this self. And I think that that great leaders today spend a lot of time improving themselves. And then I think this next piece they do is they are equipping the people on their teams with the skills, the competencies, and the resources to lead good work. Because today, anything that is owned by the people who are responsible for doing it, I think goes so much better, right? Top down is not happening in the same way. And so, how can we be equipping the people on those teams to actually have those skills, those competencies, the resources that they need to move the work forward and drive that work? And so essentially, in fact, going back to the functions, that's enabling them to do what they need to do differently. So I think that those are the two things that come to mind.

Nancy Nouaimeh:

Well, the great advice is, I think, for leaders first to focus on their own development and then focusing on the team. I think this really creates the right environment for everyone. So thank you very much, Julia, for your story. Thank you very much for sharing your valuable insights. Is there anything you would like to share before we wrap up this session? One last word.

Julia Moore:

Um I would just like to say thank you, Nancy, for having me. This is amazing. I love, love, love the work that you're doing and love that you're connecting with people who are trying to create change across the system. Um, I know for lots of people, implementation science is new. Um, and so maybe I'll just put a plug. We have a free mini course. It takes about an hour, hour and a half. It is called Inspiring Change 2.0. And it's a great way to introduce implementation science to people in like tiny little bite-sized snippets if implementation science is brand new to them. So um I just wanted to say those, thank you so much, Nancy, for all of the amazing work that you do.

Nancy Nouaimeh:

Thank you. It's it was really a pleasure to be talking to you today. And first, when uh I saw implementation science, I have to admit it was a little bit kind of scary, like talking about science. But I think you you're really making it very accessible, very easy to understand. And I think there's a lot of great stuff that people can learn from uh from you and from the uh the work you're doing. So thank you again, Julia. Um, to our audience, remember excellence isn't accidental, it's intentional. As we look ahead to 2026, here's to clarity and vision, excellence in execution, and leadership that drives meaningful change. Join us for our next episode as we kick off the new year with fresh perspectives. Happy new year, everyone.

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Nancy Nouaimeh

Host
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Julia Moore

Guest