Implementing or scaling-up an option

Problem Options Implementing M & E

Spanish version

This stage aims to address issues related to the implementation of a given option. It is structured in two different goals that may need to be achieved (A and B). In total, six different types of questions that may need to be answered to achieve the goal are included in this stage.

Open the goal that is mostly related to your specific query, and a list of types of questions will be displayed. More details about each type of questions will be provided, including examples and the methodological approaches to address each question.

A. Planning and describing the implementation of an option

Can it be done and what needs to happen to implement?

Implementing

This goal aims to plan and describe the implementation of a given option by identifying who has to do what to implement an option, what role the context has in the implementation process and what is the implementation level of a given option.

This goal looks at variables and conditions required for a given option to be implemented. These can be structured in behavioral (e.g., what individuals need to do for the option to be implemented) and contextual variables (that are often split in inner and outer settings). This can also be interpreted as what conditions are needed for an option to be feasible to be implemented.

Open the question that is mostly related to your specific query, and more details about the question, examples and methodological approaches will be displayed.

Question A1. Identifying who has to do what to implement an option

This type of question aims to find stakeholders’ behavioural variables that are required for an option to be implemented (i.e., what people need to do to implement an option).

Some examples of this type of question are:

  • What is the role that healthcare workers should play in implementing DRGs in a hospital?
  • What should social workers do to adapt existing poverty guidelines measurements?
  • What key actions should nurses conduct to implement mobile breast cancer screening?

Methodological approaches to address question A1

  • Delphi studies (to get consensus from experts)
  • Cross-sectional study (survey, point-in-time or snapshot study or analysis) of people's experiences
  • Qualitative inductive (from particular to general i.e., creating theory) methods to describe a phenomenon (e.g., grounded theory)
  • Qualitative deductive (from general to particular i.e., testing theory) methods to describe a phenomenon (e.g., qualitative description, narrative approaches)

Question A2. Identifying the context in which the option could be implemented

Scale and spread

This type of question aims to find variables related to the inner or outer setting (or context) in which an option is feasible to be implemented (including the political climate).

Some examples of this type of question are:

  • What contextual variables should be present to successfully implement DRGs in a given healthcare facility?
  • What is the role of context in implementing new guideline measurements for poverty?
  • In what contexts the implementation of a mobile breast cancer screening unit is feasible?

Methodological approaches to address question A2

  • Jurisdictional scan (comparative analysis) to understand what other jurisdictions have identified as contextual variables
  • Qualitative deductive (from general to particular i.e., testing theory) methods to describe a phenomenon (e.g., qualitative description, narrative approaches)
  • Cross-sectional study (survey, point-in-time or snapshot study or analysis) of people's experiences
  • Delphi studies (to get consensus from experts)

Question A3. Describing whether implementation of an option is underway and at what stage level

Scale and spread

This type of question aims to assess the level of implementation of an option (or group of options) in a given moment of time (or over time) in a concrete setting.

Some examples of this type of question are:

  • What is the implementation level of universal health coverage in a given region?
  • Have integrated care been implemented in regional hospitals in a given country?
  • How much of the educational reform to improve teacher quality has been implemented in a given country?

Methodological approaches to address question A3

  • Cross-sectional study (survey, point-in-time or snapshot study or analysis) of people's experiences
  • Descriptive (not predicting) time-series analysis (including trend analysis)
  • Qualitative deductive (from general to particular i.e., testing theory) methods to describe/critically analyze a phenomenon (e.g., qualitative case studies)
  • Qualitative deductive (from general to particular i.e., testing theory) methods to describe a phenomenon (e.g., qualitative description, narrative approaches, documentary review of public speeches, etc.)

B. Setting up a sustainable implementation process by identifying barriers, facilitators and implementation strategies

How can implementation be improved?

Implementing

This goal aims to find barriers and facilitators, and implementation strategies that could address and take advantage of them, respectively. Barriers and facilitators can come from different domains (inner and outer settings, individuals (e.g., skills and capacities), etc.), from different levels (e.g., government, policy, system, etc.), and across different type of actors (e.g., service providers, users or patients, organizations, etc.).

Additionally, it is not always clear whether a given variable constitutes a barrier or facilitator, or to whether a given variable could be framed in a positive (facilitator) or negative (barrier) way. Then, we can also call barriers and facilitators as implementation considerations.

The implementation process entails identifying strategies to ensure a sustainable implementation of an option. Implementation strategies can take the form of interventions to address or take advantage of barriers and facilitators, or they could also be mitigation measures for the potential risks of implementing an option (e.g., risk-control or risk-management strategies).

Open the question that is mostly related to your specific query, and more details about the question, examples and methodological approaches will be displayed.

Question B1. Identifying and understanding barriers and facilitators to implement and option

This type of question aims to find barriers (variables that could block or delay the implementation of a given option), and facilitators (variables that could make the implementation of a given option easier) . This type of question includes the identification of barriers and facilitators, as well as understanding how they block, delay or enable the implementation process.

Some examples of this type of question are:

  • What barriers exist to implementing an audit and feedback system in hospitals?
  • Is the awareness of healthcare professionals a barrier to implementing a universal vaccine mandate?
  • What facilitators exist to implement an audit and feedback system in hospitals of a given jurisdiction?
  • Is having easy access to a police station a facilitator to implement a crime prevention program?

Methodological approaches to address question B1

Not available yet. We will upload a consensus methodological approach very soon. Learn more about our approach to reach consensus.

Question B2. Identifying and understanding implementation strategies to deal or take advantage of barriers and facilitators

This type of question aims to find implementation strategies that could address barriers and take advantage of facilitators. This type of question includes the identification of implementation strategies, as well as understanding how they address the barriers and take advantage of facilitators.

Some examples of this type of question are:

  • What implementation strategies can be applied in schools to maintain social distancing during COVID-19 requirements?

Methodological approaches to address question B2

No consensus has yet been reached on what methodological approaches are most suitable to address this question. Learn more about our approach to reach consensus.

Question B3. Prioritizing barriers, facilitators and implementation strategies

This type of question aims to assess the importance of barriers and/or facilitators, and implementation strategies in the implementation of a given option in a specific setting or context.

Some examples of this type of question are:

  • What are the most important barriers and facilitators to implementing an audit and feedback system in hospitals of a given jurisdiction?
  • What are the preferred implementation strategies to increase awareness of healthcare personnel in a massive vaccination campaign?
  • What are the most important barriers and facilitators of implementing a new curricular change for schools?

Methodological approaches to address question B3

No consensus has yet been reached on what methodological approaches are most suitable to address this question. Learn more about our approach to reach consensus.

Assuming that one potential decision of a new option might be to conduct a pilot or a implementing an option at small-scale, this goal also aims to draw on lessons learned from the early implementation of a given option to plan the scale-up of it.

Take a look at the demand-driven approach used to create the Matching Q-M tool, as well as a list and explanation of all methodological approaches included.