Implementation Stages

Here we look at implementation stage by stage, and the outcomes or changes related specifically to the implementation process.

The stages of Implementation

Implementation in the real world rarely follows a linear path from one step to the next, but research indicates that there are generally four stages in implementing any intervention. The first two stages involve exploratory and planning activities. In stage three the intervention is implemented for the first time, reviewed and improved, before being fully implemented in the fourth stage.

Each stage needs time and attention. It is important to be patient and not to skip any of the stages. Rushing through stages will not adequately compensate for this need.

   

This is the exploratory stage where fundamental questions are answered, such as what will actually be implemented. This means selecting, designing and developing the intervention to be implemented.

This is a key decision-making phase in implementation. Spend time assessing the needs of those affected by the intervention. Consult with stakeholders to secure buy-in. Build a supportive climate and identify champions who will drive the change. Assess readiness and capacity for implementation.

Activities during this stage include:

  • Assessing needs and the evidence base for the intervention
  • Assessing fit, feasibility and appropriateness
  • Assessing implementation readiness
  • Developing leadership for implementation
  • Stakeholder engagement planning
  • Selecting or designing the intervention
  • Identifying outcomes
  • Developing a theory of change and logic model
   
   

During this stage, the foundation is laid for effective implementation. At the end of the stage, there should be a plan for implementation outlining the tasks required, people responsible and timelines for delivery. An implementation team should be identified to guide the process.

Preparatory activities begin at this stage to ensure the setting can absorb the intervention. This may involve securing funding, hiring and training staff, and arranging any other necessary resources.

Activities during this stage include:

  • Assessing enablers and barriers for implementation
  • Developing an implementation plan
  • Establishing implementation team(s) and other structures to support implementation
  • Securing resources
  • Identifying champions to support implementation
  • Designing monitoring, evaluation and feedback systems
  • Determining and delivering staff training, capacity building and support requirements
  • Planning for sustainability.
   
   

During this stage, the intervention is implemented for the first time. This may initially be on a pilot basis before later being fully rolled out. Expectations may be high, but implementation can often proceed more slowly than expected. Managing the expectations of stakeholders and preventing them from becoming disheartened is an important part of this stage.

The implementation plan developed in stage 2 should guide activities. It should be shared widely, particularly with those who are responsible for delivery, monitoring and evaluation. It should also be reviewed and updated to reflect changing contexts and circumstances.

Activities during this stage include:

  • Maintaining ongoing communication with key stakeholders, explaining why the intervention is necessary and securing continued buy in
  • Providing ongoing professional development opportunities, coaching and mentoring for stakeholders implementing and delivering the intervention
  • Monitoring implementation, service and client outcomes
  • Using data and feedback to inform ongoing improvements
  • Adapting for local context where appropriate.
   
   

During this stage, the intervention is fully operational and integrated into the setting. It is used consistently and supported by structures and resources.

At this stage, the outcomes of the intervention are ready to be evaluated. This provides an opportunity to show impact and progress the intervention through continuous improvement cycles. Those involved in implementing should also reflect on the implementation process and learn from the experience. This learning can help inform future decisions about implementing other interventions.

Activities during this stage include:

  • Maintaining skilful practice
  • Developing more efficient and effective structures
  • Evaluating implementation, service and client outcomes
  • Engaging in continuous improvement cycles.
   

Tools & Resources

The Implementation Stages – Key Activities tool gives more information about the four stages and includes a checklist of activities at each stage.

Putting Evidence to Work – a School’s guide to Implementation provides guidance for schools about how stages in implementation can be used to inform school improvement.

The A—Z of Implementation

There are a range of terms used when writing or talking about implementation and in implementation science. This glossary provides a short definition for each of these terms.

Adaptable components

Elements of an intervention which may be tailored to local settings during implementation without undermining the integrity of the intervention itself.

Barriers

Factors which hinder the implementation process and reduce the probability of successful implementation.

Capacity

The ability or power to do, understand or absorb something. This can apply to an individual, a team, an organisation or a whole system.

Coaching

A formal, typically short-term, arrangement between a coach and an individual focused on developing work-related skills or behaviours.

Community

A group of people living in an area or having characteristics in common (e.g. city, neighbourhood, organisation, service, business, professional association); the larger socio-political-cultural context in which an intervention is intended to operate.

Consultation

The action or process of formally discussing something with stakeholders, generally asking stakeholders a relevant question and receiving answers to that question. While the views of stakeholders may then be used to influence decisions, there is no commitment or requirement to do so.

Context

The set of circumstances or unique factors in which implementation takes place. This can refer to both the wider, systemic context, as well as the specific setting in which a specific intervention will be implemented.

Continuous Improvement Cycles

Ongoing use of emerging data and evidence on outcomes and implementation, and using that information to learn from experience, inform future implementation and improve outcomes. Progress is, therefore, achieved in an incremental manner over time.

Core Components

Indispensable elements of an intervention or implementation plan, which cannot be changed without undermining it. All core components should be delivered with fidelity.

Data-Based Decision Making

Using processes for collecting and analysing different types of data to guide decisions with the aim of improving outcomes on an ongoing basis.

Diffusion

A process by which an intervention is communicated through certain channels over time. The spread of ideas through diffusion is generally a passive process, following an unpredictable, unprogrammed, emergent and self-organising path, e.g. word of mouth.

Dissemination

An active, negotiated and influenced means of spreading an intervention or information about an intervention to relevant target groups.

Enablers

Factors which increase the probability of successful implementation.

Evaluation

A planned investigation of a project, programme, or policy used to answer specific questions. It can be related to design, implementation, results, and outcomes (cause and effect) of an intervention.

Evidence-Based Interventions

Practices, programmes, policies, strategies or other activities that have been empirically shown through scientific research and evaluation processes to improve outcomes to some degree.

Fidelity

Delivering an evidence-based intervention exactly as intended by those who developed it.

Framework

A structure, overview, outline, or system consisting of various descriptive categories and the presumed relationships between them.

Implementation

The carrying out of planned, intentional activities that aim to turn evidence and ideas into policies and practices that work for people in the real world. It is about putting a plan into action; the ‘how’ as well as the ‘what’.

Implementation Plan

A plan outlining the key activities, responsibilities, timelines and other important information required to achieve the desired outcomes from implementing an intervention.

Implementation Readiness

The extent to which organisations and individuals are both ‘willing’ to, and ‘capable’ of, implementing any specific intervention.

Implementation Science

The scientific study of how interventions are incorporated into service settings. It seeks to identify activities, contexts and other factors that increase the likelihood of successful implementation and lead to improved outcomes for people.

Implementation Strategy

Any specific method or action aimed at overcoming barriers, increasing the pace and effectiveness of implementation, and sustaining interventions over time.

Implementation Team

A group or structure that oversees, supports and attends to, moving an intervention through the stages of implementation. They actively use strategies to facilitate implementation.

Inputs

Resources needed to carry out activities and outputs.

Intervention

Any policy, practice, service or programme that is being implemented. It can be a change to something already in existence, or an entirely new intervention.

Leadership

The action of leading a group of people, or the ability to do this. This does not just apply to leading a whole organisation or system – leadership can take multiple forms and can occur at any level of an organisation or system.

Logic Model

An adaptable tool that describes the theory of change underpinning an intervention, a programme or a policy. It allows the user to systematically work through the connections between the components of an intervention or process, usually in graphical format on a single page.

Mentoring

A formal or informal arrangement which typically involves an ongoing relationship of support for significant transitions in knowledge, thinking and skills.

Model

A deliberate simplification of a phenomenon. Models are intended to be descriptive and need not be a completely accurate representation of reality to have value.

Monitoring

The routine and systematic collection of information against a plan. It makes use of existing data and information about inputs, outputs, outcomes, or about outside factors affecting an organisation or project, with a view to ongoing cycles of improvement.

Needs Assessment

A process which clarifies the extent to which needs, as well as enablers and barriers to meeting those needs, are accurately known and prioritised by an organisation or group of people.

Outcomes

Intended or unintended changes that occur as a result of implementing interventions. These changes can occur at the level of individuals, groups, organisations or population, and can occur in the short-, medium- or long-term.

Outputs

Key activities and areas of work that will help to achieve the desired outcomes.

Organisational Culture

The norms, values and beliefs that exist and govern behaviour within an organisation.

Resources

A stock or supply of money, materials, staff, and other assets that can be drawn on by a person or organisation in order to effectively implement an intervention.

Stakeholders

Anyone who is affected by or is involved in the intervention being implemented. This includes staff, public, clients, managers, professional bodies, unions, educators, policy-makers and funders.

Strategies

Methods or actions that aim to overcome barriers, increase the pace and effectiveness of implementation, and sustain interventions over time.

Sustainability

An intervention can be considered to be sustainable when not only have the process and outcomes changed, but the thinking and attitudes behind them are fundamentally altered and the systems surrounding them are transformed as well. In other words, the intervention has become an integrated or mainstream way of working rather than something ‘added on’.

Synthesis

A structured process where relevant information and evidence on a topic is gathered, reviewed, assessed and brought together to support decision making.

Theory

A set of analytical principles or statements designed to structure our observation, understanding and explanation of the world.

Theory of Change

An explicit, step-by-step statement of the expected relationship between the intervention and the outcome, i.e. why providing input X should lead to a change in outcome Z, by way of output Y.

Vested Interests

A special interest in maintaining or controlling an intervention, arrangement or institution, usually for personal gain.