Implementation in action
7. Stage 4: Sustain and scale
During this stage, you'll aim to achieve 'full implementation'. This means your practitioners routinely apply the program or practice, and it's integrated into 'business as usual'. There are no fixed rules defining exactly when scale-up should take place, although we've outlined several considerations below.
7.1 Sustain the program or practice
Your program or practice can be considered sustainable when it becomes an integrated or mainstream way of working. It's sustainable when it's embedded as 'business as usual' and is part of routine practice; when it's no longer a 'new' or 'extra' part of your service delivery. You know your program or practice is sustainable when practitioners no longer revert to old ways of working or previous levels of performance, and don't drop core elements of the implementation process over a sustained period of time (e.g. two years). However, this doesn't mean your implementation efforts stop. During this stage, you should:
- continue to apply your continuous quality improvement processes, ensuring your data remain relevant and useful
- use relevant implementation strategies to ensure consistent quality of implementation (e.g. ongoing coaching)
- acknowledge and reward good implementation efforts.
Sustainment requires adequate and ongoing funding. It requires a good program or practice-context fit, and sufficient capacity to train new and replacement staff. It also requires ongoing support and stable stakeholder commitment. Constant change is a normal part of the child and family service sector, so it's important to ensure you're always ready to adapt to change. This means you need to consider sustainment from the very beginning of your implementation process.
7.2 Scale-up the program or practice
When you successfully implement a new program or practice, it can create great enthusiasm in organisations and communities, and should be celebrated. As you will know by this stage, implementing a new program or practice isn't always easy! Success can spur decision makers into expanding the program or practice. They may choose to implement it at a greater scale in identical, or slightly different, contexts. Both situations require cautious decision-making, guided by questions like:
- Did we achieve the implementation and client outcomes we intended? Does our data support this?
- Have these outcomes been positive and stable over time?
- Do we expect major changes to the current implementation context within the foreseeable future (e.g. policy or funding reform)?
If the answers to these questions indicate the initial implementation is stable, it may be natural to scale up or out.
Scaling is the process of implementing the same program or practice to other teams, sites, service providers or agencies. You should try to use the lessons you learned from the initial implementation process to identify potential enablers and barriers during expansion, as well as predict which implementation strategies you require. It can help to revisit the implementation plan from your initial implementation to review the barriers you identified, encountered and overcame at each stage, including any unintended consequences of implementation that needed to be addressed along the way.
Scaling up or out can be like an entirely new implementation process. It will lead your organisation back to some of the steps in earlier implementation stages, starting a new implementation process. For example, organisational readiness should be assessed with each new team or site, as their context and resources may differ. You'll probably need a separate implementation plan for each new implementing team or site.
If you plan to scale up the program or practice across a service system, ensure it's not mandatory for all sites and isn't tied to compliance requirements. Implementation of the program or practice will be most successful if the potential implementation sites have agency over the decision, and if they believe the approach will be beneficial.
Implementation teams and other implementation champions will be important resources during this stage. They can inform and guide the scaling process. Similarly, coaches who supported local implementation efforts and helped practitioners to learn and acquire new skills can help to share their skills and knowledge on a broader scale.