Implementation Tools

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
  2. Theory of change and logic modelling
  3. The Hexagon tool
  4. Implementation Plan

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:

  1. Situation Analysis: The context, opportunities, problems and needs in relation to the intervention
  2. Outcomes: Intended or unintended changes that occur as a result of an intervention
  3. Outputs/Activities: Key tasks and areas of work that will help to achieve the desired outcomes
  4. Inputs: Resources needed to carry out the activities/outputs identified
  5. Monitoring and Evaluation: Process for assessing progress and the extent to which the intervention is working towards desired outcomes
  6. Evidence: research, experience, policy and consultation that underpins all aspects of the logic model.

Theory of change and logic modelling — Useful Links:

Template for a Logic Model (Centre for Effective Services)

Theory of change basics: A primer on theory of change (Taplin & Clark, 2012)

ESS support guide: Developing a logic model (Evaluation Support Scotland, 2018)

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.

Programme/Intervention Indicators

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.

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.