Implementation in action
3. Overview of implementation stages
Implementation is a process and it unfolds over a series of stages (Figure 3). Different implementation activities are relevant during each stage.
Depending on where you're at in your implementation process, it may not make sense for you to follow every step in every stage, as outlined here. Consider which activities you've already completed, what decisions have already been made and what makes sense in your context. You may skip some steps or start at a later stage. Use the Implementation Stages - Deciding Where to Start tool (Appendix A) to help you determine where you are up to, and which stage and step should come next. You can also use the Implementation Progress Checklist to monitor your progress through the stages (Appendix B).
Figure 3: Stages of implementation
Stage 1: Engage and explore
Define what needs to change and for whom: Is there a need or gap in your service? Who is affected by this need or gap? Identify what these gaps are, then decide what outcomes you'd like from a new program or practice.
Select and adopt a program or practice: Look for existing programs and practices that could fill your gap. Ensure they can meet your needs, can create the desired outcomes, are a good fit for your context and are supported by evidence.
Set up an implementation team: Consider establishing a team that's responsible for moving the program or practice through the stages of implementation.
Consider likely enablers and barriers, and assess readiness: Identify enablers and barriers to implementation that will occur early in the process, (noting enablers and barriers will need to be continuously monitored throughout the stages). Focus particularly on the ways in which your organisation is ready - and unready - to implement the program or practice.
Stage 2: Plan and prepare
Choose implementation strategies: Decide which implementation strategies are best to drive the implementation process at each stage.
Develop an implementation plan: Develop an implementation plan that identifies how to put your implementation strategies into action. Carefully plan what needs to be done; when and where it needs to happen; how it is to happen; and who is responsible.
Decide how to monitor implementation quality: Identify the best indicators of implementation quality. Plan how you will measure and monitor these during the implementation process.
Build readiness to use the program or practice: Ensure your organisation will be ready to start using the program or practice. Use implementation strategies such as training, acquiring resources and adapting existing practices.
Stage 3: Initiate and refine
Start using the program or practice: The first practitioners start using the program or practice.
Continuously monitor and refine: Use continuous quality improvement cycles to monitor the quality of the implementation. Use this information to guide improvements or adaptations to your implementation.
Stage 4: Sustain and scale
Sustain the program or practice: Improve and retain your staff's competency levels. Ensure your program or practice is embedded into 'business as usual'.
Scale-up the program or practice: If the first implementation attempts are stable, introduce the program or practice to new teams, sites or contexts. This begins a new implementation process.