Topic 5: Initial Implementation Stage

During the Initial Implementation Stage, the new practice is first put into place and made available to consumers. The key focus of this stage is on continuous improvement. In Initial Implementation, staff are attempting to use newly learned skills (e.g., the evidence-based program) in the context of an organization, that is itself just learning how to change to accommodate and support the new ways of work.  This is the most fragile Stage where the awkwardness associated with trying new things and the difficulties associated with changing old ways of work are strong motivations for giving up and going back to comfortable routines (business as usual).

Implementation Teams

Implementation teams work together within and across levels of the organization
 to support the implementation infrastructure and ensure high fidelity implementation of the innovation. Implementation teams place a heavy emphasis on the systematic review of data during this stage to ensure that any changes to the model or approach are purposeful and planned, rather than reactionary or opportunistic.

The Initial Implementation Stage is a real challenge.  Massive investments in encouraging local sites and communities to use evidence-based innovations lead to about 10% use of the innovations as intended (Vernez et al., 2006).  The failure is not in the innovations – they are supported by research indicating they are quite effective when used as intended.  The problems occur in the lack of support for implementation best practices to support the full and effective use of the evidence-based innovations.  Establishing and sustaining changes to the point of integration into daily work is not likely unless there is external support for change at the practice level (support from coaches; Joyce & Showers, 2002), organization level (support from Implementation Teams; Aladjem & Borman, 2006; Nord & Tucker, 1987), and system level (support from Implementation Teams; Schofield, 2004).

During the Initial Implementation Stage all the components of the program or innovation are in place: initial practitioners begin using the new program and practices, the implementation supports begin to function, and the site, local and state systems begin to change to facilitate the use of the innovation and realize intended benefits. The Implementation Team is alert to see if the efforts in the Exploration and Installation Stages have secured the resources necessary for a successful launch. 

Implementation Drivers

Practice Tip

Remember, Stages are not linear.  They interact to produce optimal results.  For example, during the Initial Implementation Stage, the Implementation Team may identify weaknesses or gaps in the system.  Perhaps further Exploration work needs to be done with some individuals or groups, or Installation work needs to be extended to secure additional resources.  Solving these issues helps Implementation Teams develop protocols to strengthen these elements for future cohorts who will also use the innovation. 

The Initial Implementation Stage is the time to see whether the practitioners involved in the new work are mentally prepared for change and have been provided with sufficient knowledge and skill to use the innovation well.  This is a fragile stage since people feel awkward when trying new things.  While struggling to make this new way of work their own, some will be tempted to seek comfort by reverting to their prior practices.  Implementation Team members ensure that the coaching and data systems are functioning to offer support and encouragement to staff as they help manage these new expectations.  Celebrations of progress motivate continuing use of the new program or practices. 

Site data, observations of staff, and practitioner reports further inform what, if any, changes are needed in future trainings and coaching routines.  This allows for adjustment before moving into the full implementation stage.

In earlier stages, the Implementation Team and leadership determined how sites and organizations (e.g. scheduling, staffing) might need to change to create a hospitable environment for staff using the innovation.  During the Initial Implementation Stage, the plan is put into action.  Since no plan is complete, unanticipated changes will add to the “awkward” moments as adjustments to the plan occur.  (Note:  the Leadership Driver and addressing adaptive challenges can help move through this awkward stage. See Module 2:  Implementation Drivers – Leadership)

The motto for Initial Implementation is “Get started, then get better!”  To play an instrument, learn to drive, or initiate anything requiring new skills, we know it will take time to become good at it.  However, until you actually begin, you will not know your strengths or what needs additional attention.  Get started, then get better! 

Improvement Cycles

PDSA (Plan-Do-Study-Act) Cycles

As the new work is launched, practitioners may experience similar, consistent barriers to using an innovation as intended. The key activities of the Initial Implementation Stage focus on strategies to promote continuous improvement. Improvement Cycles make the connection between what we have built and how well it serves (form and function).  PDSA cycles are one strategy Implementation Teams can use to make meaningful changes, alleviate barriers, embed solutions, and improve intended outcomes.  The activities of PDSA cycles include:  

  • Plan — Identify barriers or challenges, using data whenever possible, and specify the plan to move programs or interventions forward as well as the outcomes that will be monitored
  • Do — carry out the strategies or plan as specified to address the challenges
  • Study — use the measures identified during the planning phase and collected during the ‘do’ phase to assess and track progress, and
  • Act — Make changes to the next iteration of the plan to improve implementation

Make use of Practice-Policy Feedback cycles to resolve systems issues

Policies that govern our work must be facilitators to any new practices (policy enables innovations).  An examination of the use of the practices at their intended level can be used to influence the development and modification of those policies and procedures (practice experience informs policies).

For example:

  • After restructuring roles for some staff members, the evaluation process is still based on their former position descriptions. The position descriptions and evaluation tools and process need to be updated and aligned to support the use of the innovation
  • Peer coaching is a component of a district’s selected evidence based practice; however, a district policy exists that a teacher may be out of the classroom only one day per semester for professional development.  The policy needs to be rewritten to align with the need for multiple classroom visits and the necessary debriefing after each visit.

For these kinds of issues, solutions may require support from leadership, policy makers or other key partners of the larger system.  Implementation Teams engage leadership in bi-directional practice-policy communication cycles to identify and resolve potential roadblocks at multiple levels of the system.  Through this early “diagnosis” and resolution, negative impacts on effective use of innovations can be minimized and consumer benefits can be realized. 

Communication links and protocols

As this new process unfolds, all stakeholders need to stay in communication to maintain the flow of information.  During the Initial Implementation Stage, Teams are tapping resources, staff members are spending time and energy on the new way of business, and frustrations can run high.  To maintain “buy-in” it is crucial to have transparency at all levels of the organization.  Using agreed upon communication protocols keeps everyone “in the loop” by providing updates on progress, a venue for questions, and opportunities for clarifications and problem-solving.