A range of tools can be used to support the implementation of a policy, practice, programme or service.
What tools can I use?
Here we outline a number of tools and approaches which can support the implementation of a policy, practice, programme or service. These tools and approaches have been tested and used by CES, implementation practitioners and researchers around the world. Some tools draw from related disciplines such as project management and quality improvement.
Four considerations are useful when deciding which tools are most relevant to you:
- the intervention, policy, programme or practice being implemented
- the stage of implementation
- the specific context in which implementation is happening
- the implementation issues you want to address.
Implementation Tools include:
1. Needs assessment
A needs assessment clarifies the extent to which needs, as well as enablers and barriers to meeting those needs, are accurately known and prioritised. It helps leaders and decision-makers to identify the gap between what is currently in place and what is desirable to have in place.
The basic questions to be answered by a needs assessment are:
- What are the gaps?
- What is causing them?
- What can we do to fix it?
A needs assessment should come very early in the implementation process. It is sometimes considered a ‘pre-implementation activity’ or a ‘necessary first step’. Information on needs should be gathered from a variety of stakeholders, including from the perspective of individuals and organisations who will be directly involved in implementation.
It should also be noted if there is consensus on needs. If there is disagreement among stakeholders, follow-up engagement can be used to determine the reasons for this disagreement.
Needs assessment — Useful Links:
Community Tool Box: Assessing community needs and resources (Center for Community Health and Development at the University of Kansas, 2018)
Conducting a community assessment (Strengthening Nonprofits, 2010)
2. Theory of change and logic modelling
A Theory of Change is an explicit, step-by-step statement of the expected relationship between the intervention and the outcome. It outlines how what we put in (input X) allows to do something (output Y), leading to a change in circumstance (outcome Z). The inputs, outputs and outcomes should be conceptually and practically linked, including what evidence we have that it will work.
The key to developing a theory of change is to think of it simply in terms of a series of ‘if-then’ relationships. For example, if we get food, then we can eat food; if we eat food, then we are nourished; if we are nourished, then we are healthier. Each step, or relationship, should be informed by evidence about how needs arise and how change is achieved in previous steps or relationships.
The series of ‘if - then’ relationships and outcomes that express the programme’s theory of change can form the underlying basis of a Logic Model. A logic model is an adaptable tool that describes the theory of change underpinning an intervention, a programme or a policy, usually in graphical format on a single page.
The process of designing a logic model encourages a focus on outcomes from the start of implementation. It connects the essential components of an intervention or process. Making connections explicit and ensuring there is evidence to support them helps ensure the intervention is more likely to achieve the desired change.
There are a number of benefits to developing and using a logic model:
- It provides coherence across complex tasks
- It helps differentiate between ‘what we do’ (outputs) and ‘results/changes’ (outcomes)
- It keeps focus on shared goals
- It helps to improve monitoring and evaluation
A logic model will not capture all of the complexity of implementing in the real world, nor is it intended to. Other approaches, such as a needs assessment or sustainability planning, can be used in conjunction with a logic model to provide greater depth and understanding of context.
The various components of a logic model are:
- Situation Analysis: The context, opportunities, problems and needs in relation to the intervention
- Outcomes: Intended or unintended changes that occur as a result of an intervention
- Outputs/Activities: Key tasks and areas of work that will help to achieve the desired outcomes
- Inputs: Resources needed to carry out the activities/outputs identified
- Monitoring and Evaluation: Process for assessing progress and the extent to which the intervention is working towards desired outcomes
- Evidence: research, experience, policy and consultation that underpins all aspects of the logic model.
3. The Hexagon tool
The Hexagon Discussion and Analysis Tool helps organisations evaluate new and existing interventions based on six contextual fit and feasibility indicators. Indicators are based on the programme or intervention, and on the site or context.
1. Evidence – is the evidence base strong in terms of number of studies, population similarities, outcomes, fidelity and cost-effectiveness?
2. Usability – is the intervention well defined; are there sites in which it has already been implemented; is it replicable; is it adaptable to local context?
3. Supports – can relevant implementation supports be put in place, including expert assistance, staffing, training, coaching, IT systems, administration?
Implementing Site Indicators
4. Need – has the target group been established; is there data from a variety of sources indicating population needs; is there perceived need among the community; does it address existing gaps?
5. Fit – does it fit with the current interventions and the context in terms of alignment, complementarities, values, culture and history, and organisational structure?
6. Capacity – is there capacity to implement the intervention; are there qualified staff; can the intervention be financially, structurally and culturally sustained; is there buy-in from stakeholders?
The tool can be used at any stage during implementation to determine an intervention’s fit with the local context. It is most commonly used during the Exploring & Preparing stage, to help identify an appropriate intervention. Implementation teams can use the tool to carry out this assessment and help to determine readiness for implementation in a given context.
The Hexagon tool — Useful Links:
The Hexagon Tool: Exploring context (Metz & Louison, 2018)
4. Implementation Plan
Implementation is more likely to be successful if planning is done before, rather than after an intervention is developed. Planning should begin during Stage 1 of implementation and be a main focus of Stage 2. In later stages, it can be reviewed and updated to reflect changing contexts and circumstances.
An implementation plan outlines important information required to achieve the desired outcomes from implementing an intervention. A comprehensive implementation plan should:
• Detail the objectives of the initiative
• Outline tasks and activities necessary for its dissemination and implementation
• Lay out who is responsible for the delivery of activities
• Set out time frames and milestones
• Provide an outline of governance and accountability structures
• Articulate the inputs, outputs and intended outcomes of the implementation process
• Consider risks and risk management strategies
• Identify monitoring and reporting processes.