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Fidelity and Infidelity

Posted on November 15, 2011

John A. Ovretveit (bio) discusses the importance of assessing not only the quality of an intervention, but how a particular intervention will work within a given context.

 

One thing I've been wrestling with which the [2011 Global Implementation] conference allowed me to sort of put my finger on or pin down and think about more was what I call the match between the intervention and the host context. This is also related to the issue about fidelity or adaption.

So the first point I'm making is, for some changes, fidelity is absolutely essential, and you don't even bother trying if you can't do it. What you need to do is assess the situation for the chances of them being able to implement it with fidelity. Now there are other changes, other approaches, where it's less necessary, and in fact fidelity is the last thing you want. You want infidelity. You want people locally to adapt it, change it, and keep working on trying to make that idea or that group of principles work in their setting. And their creativity and resourcefulness in thinking about that change is absolutely essential, and that's what you need to support is how to give them the license and the help to make that adaption and show them examples of how other people have adapted it.

Now I'm a bit concerned that I think there's work to be done in this field looking across a range of interventions and say which interventions, which bits are non-negotiable, and you have to follow this exactly. And which bits can be adapted, which aspects need to be tailored to the situation and setting, and to get more inside that rather than— there is a bit of tendency to say fidelity is essential, and the system has to change to make that happen.

We have to have ways of assessing what needs to change, so that people are able to assess, "Should we even think about it, should we even try?" Because I think sometimes we try to force fit certain things to happen, and some people may nod and say, "Yes, okay, give them the money," but everyone knows there's no way we can get that working in that kind of situation or place.

So really what I'm talking about is a way of assessing intervention context fit, or the matching, and to be able to judge whether or not a service or system is able to make that change, and what they need to do differently to make the change a success. So it's not just about the intervention. It's about the intervention and context fit or non-fit.

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Excerpted from interview with Dr. Øvretveit at the 2011 Global Implementation Conference in Washington, DC.

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