Using Change Management to Support Implementation

Change management is especially relevant to implementation, because implementing an innovation, whether it’s a new program, policy, or practice by definition involves some degree of individual and organizational change. How we approach and support change, both as leaders and staff, can make a huge difference in how change unfolds and in reaching intended outcomes.

When considering new programs, policies, or practices, what are some key questions teams can ask to inform solid decision-making around how to address needs?

Who developed the ‘it’? Is the group that developed and/or visibly sponsored use of the innovation reputable, credible, and/or trustworthy?

• See this principle in this website: Triple P International and the University of Queensland.

Does the ‘it’ have solid evidence supporting its effectiveness? Is it part of a reputable repository of evidence-based or evidence-informed interventions? Does the evidence support its use in communities and similar to your own? Does the ‘it’ show positive outcomes relevant to your environment and context and identified needs? Or, in the absence of evidence, are there data or reports that point to it as ‘promising’? 

• Explore the Triple P Evidence Base and general evidence clearinghouses related to specific fields, for example, What Works for Education; two clearinghouses related to Child Welfare.

Was the ‘it’ co-created with substantial opportunities for engagement from individuals or communities who could benefit from the ‘it’? Does the ‘it’ promote or require engagement as a core component?

• A helpful resource to explore levels of engagement is the Spectrum of Community Engagement to Ownership tool.

Is the ‘it’ better than what currently exists? Does it serve a population with needs that are not currently met through other ‘its’? Is the innovation better than other available innovations or current practice? 

• Comparing program outcomes, gathering acceptability feedback from potential users are ways to explore this question.

Can we adapt the ‘it’ to meet our local needs and context? Does the program have flexibility? Is there a menu of ‘must-have core components’ that are distinct from other ‘nice but not critical’ ‘it’ elements? Can the innovation can be modified, tailored, or refined to fit local context or needs?

• The ‘it’ purveyor can typically answer these questions in collaboration with your team.

Can we pilot the ‘it’ AND reverse course with minimal cost or disruption to our staff and organization? Can we test the innovation on a small scale?

• This typically involves an assessment with your team and partners to gauge the feasibility of a go/no-go approach.

How difficult is the ‘it’ to actually implement? What’s actually involved? How complicated is the innovation in its scope and/or the nature and number of connections and steps?

• Hear a real-life story about how complexity affects readiness in our Readiness for Implementation podcast.

Does the ‘it’ have a high-quality feel in the design of its materials and its content? Do you see an up-to-date website and purveyor support? Is the ‘it’ well-designed and packaged?

• Comparison checklists can help teams understand their perceptions and preferences.

How much is this going to cost? Are the costs relatively stable? How do costs change as reach expands or scale-up progresses?  Is the purchase and operating costs of the ‘it’ affordable?

• Model different cost scenarios for ‘its’ under consideration to understand the full cost of implementation.

Does the ‘it’ fit with leaders, teams, and communities’ vision and practice, policy, and program portfolio?

• Does it represent the values and approach of the organization or system?

(Note: Some content is adapted from The Consolidated Framework for Implementation Research.) 

“One of the things that we try to be mindful of in all of our programs is how it fits within the larger vision of DHHS.” 
– Hope Newsome, NC Department of Health and Human Services

Change Management

Change management involves implementing approaches to prepare and support individuals, teams, and leaders in making intentional and systematic organizational change. Change management is useful when organizations are considering major changes such as adopting or promoting new ways of doing things, changing the structure, or redirecting or redefining resources.

Key Stages of Change Management
Change management is similar to program implementation and has familiar stages:

• Planning: Developing a clear vision, identifying impacted stakeholders, and assessing the scope of the change.
  
• Roll-Out: Implementing the planned changes, managing resistance, and providing training and support.
  
• Monitoring and Evaluation: Tracking progress, measuring results, and making necessary adjustments. PDSA cycles can support this work.
  

Roll-Out in Depth

Change management is a process of translating planned changes or initiatives into action. It involves writing an action plan and then implementing these plans. This involves:

• allocating necessary resources
• communicating effectively with individuals and teams, and
• monitoring progress

Change implementation (roll-out) is a key step in the change management process. This stage aims to promote desired changes in processes, structures, systems, and/or behaviors. Careful coordination, flexibility, and engagement helps ensure that individuals, teams, and organizations successfully adapt to new conditions, achieve their goals, and see benefits from the change.

(Some content adapted from Change Management on Wikipedia.)

“I remember when I started my role three years ago, I was tasked with leading the department when it came to COVID efforts and developing 13 mental health offerings for schools that required really building trusted relationships. I think leadership practices during transition is applicable to any program. It’s really important to build those trusted relationships, especially with those subject matter experts and looping them into decision making, including those who are impacted really trying to foster collaboration, promoting transparency and open and honest communication. It needs to be a two-way street instead of just being talked at, but having a productive conversation and focusing on that co-creation in terms of what does the change look like? Not doing it alone, but including system partners, funded agencies leadership saying we are committed to change. “Thanks for your patience as we’re trying to go through this transition. We will share with you what we can, even if it may be tentative even if you don’t know the answer saying you don’t know, but you’ll try and get the answer somehow.”

“Really trying to confirm the identification of challenges and barriers, because it does acknowledge that change needs to happen. And not only focusing on the deficits approach, because I feel when there are times of transition, it’s very easy to have this sense of urgency and focus on what you don’t have or what’s needed to make this happen. I think really celebrating strengths or giving kudos, really honoring those milestones and accomplishments is really important too.” 

– Anne Odusanya, NC Department of Health and Human Services