Implementation Tools

Implementation Stages: The Right Tools at the Right Time

Implementing an effective program over time follows a Framework of Implementation Stages, from Exploration to Installation to Initial Implementation to Full Implementation.¹
Specific tools are available at each step of the process.² Learn more below and access tools to use at each stage along the way. Implementation Stages, described below

Exploration Stage

Exploration is the first stage in implementation and involves:

Assessing the needs of the children, staff, and community.
Examining potential practices’ fit and feasibility of implementation (and budget implication).
Developing ways of communicating with staff, parents, and the community.
Identifying necessary infrastructure elements.
Forming or repurposing an implementation team.

Tools to Use

To identify what the evidence says…Use Evidence Center Accelerators and Toolkits.
To find a process to brainstorm strategies that work… Use Results-Based Accountability’s Turn the Curve process and Measurement Tools.
To know whether your strategy will positively affect your population groups… Use Evidence Center Tips and Guides for Ensuring Effectiveness as part of the Accelerate with Evidence process. Learn how to Adopt or Adapt your strategy.

Installation Stage

During Installation, we are putting place the foundations for the practice change we want to see. Teams work to:

Assess and address gaps relevant to Context, structure and process.
Assure resources – funding, hardware, implementation team membership.
Develop learning infrastructure - Initiate feedback loops.
Develop infrastructure to support practice and organizational change –Training, coaching system design, align rewards with objectives.

Tools to Use

To decide which strategy to implement… Use the Hexagon Tool.
To find examples of strategies you can choose from… Use the MCHbest strategies database .
To know what other states and jurisdictions are doing on similar topics… Use Innovation Hub.
To measure the impact of your strategy… Use RBA’s 4-quadrant measurement structure.

Initial Implementation Stage

During the Initial Implementation Stage, the innovation is in place and in use. In this stage, staff are attempting to use newly learned skills (e.g., the evidence-based curricula) in the context of an organization that is itself just learning how to change to accommodate and support the new ways of work. The key focus of this stage is on continuous improvement. This is the most fragile stage where the awkwardness associated with new behaviors and ways of work are strong motivations for giving up and going back to comfortable routines (business as usual). During this stage, teams:

Collect data to assess performance.
Use data to target improvement efforts.
Identify and reinforce implementation supports to ensure practice as intended.
Attend to emergent needs and manage adaptive and technical challenges that emerge.
Share progress with community stakeholders and leaders.

During this stage, teams need:

Support to systematically collect and use data.
Sufficient resources to use stage-based best practices.
Additional, tailored support from specialists that use existing progress monitoring and data to prioritize and target support.

Tools to Use

To help ensure your practice is designed to advance health outcomes in the context of SDOH… Choose from these Evidence-Based Tools.
To learn about factors to consider as you begin a program... Think of these Implementation Considerations (Rural Health Information Hub).
To access peer-reviewed training and planning tools... Read this article: Jacobs JA, Jones E, Gabella BA, Spring B, Brownson RC. Tools for Implementing an Evidence-Based Approach in Public Health Practice. Prev Chronic Dis 2012;9:110324.
To engage ongoing technical assistance… Contact the National MCH Workforce Development Center to join a learning cohort or apply for one-on-one, customized technical assistance.

Full Implementation Stage

Full Implementation is reached when 50% or more of the intended practitioners, staff, or team members are using an effective innovation with fidelity and good outcomes. Full implementation of an innovation occurs once the new learning becomes integrated into practitioner, organizational, and community practices, policies, and procedures. Over time, the innovation becomes “standard practice” and a new operationalization of “business as usual” takes its place in the setting. During this stage, the focus shifts to:

Sustaining the practice with high fidelity.
Managing turnover and drift.
Continuous improvement cycles.
Scaling up of the practice.
Documenting and sharing your progress and methods.

Tools to Use

To measure increases in knowledge… Use the Kirkpatrick Evaluation Model
To Learn more about evaluation… Find trainings from the MCH Navigator’s Evaluation Learning Spotlight
To access resources on how to conduct various evaluation methods and examples of each… Use the MCH Library’s Evaluation Toolkit

References

¹An Integrated Stage-Based Framework for Implementation of Early Childhood Programs and Systems Allison Metz, National Implementation Research Network, UNC-Chapel Hill Sandra F. Naoom, National Implementation Research Network, UNC-Chapel Hill Tamara Halle, Child Trends. Leah Bartley, University of Maryland School of Social Work. May 2015.
² Fleming O, Krisowaty L, Richards J. What Works, Is Promising, and How to Make it Happen: Tools and Strategies for the Title V MCH Block Grant Review. MCHB/DSCH Call. 09/07/21.