Glossary of Terms
Change Agent Change agents facilitate the development, application and advocacy for new practices. They transmit their commitment and enthusiasm to those who do the day-to-day work, resulting in the implementation and institutionalization of new practices. Successful change agents work with management to support other staff in the change effort. They have the skills and temperament to lead teams to achieve results. Change agents can be front-line staff or management.
Change Coordination Team The change coordination team oversees the change process and fosters or facilitates the change. The team should have clear leadership capacity, as it will be responsible for identifying evidence-based practices and obtaining political support and resources from relevant stakeholders. If a primary change agent has already been identified, he or she will be a key member of the team.
The members of the change coordination team will vary with the setting and the nature of the proposed change. Team members might be appointed by the Minister of Health or other senior government officials and can include representatives of nongovernmental, donor and international organizations.
Clusters of Influence In his book Diffusion of Innovations, Everett Rogers discusses a theory of effective change and describes how innovations are spread and how the process of change works. Rogers describes three main clusters of influence in the diffusion of innovations that correlate to the spread of the innovation: peoples' perceptions of the innovation (benefit versus risk), characteristics of the people who adopt the change and contextual factors (especially communication, incentives, leadership and management).
Demonstration period A demonstration period is a limited period of time in which the innovation is tested on a smaller scale than eventually desired in order to learn what other changes will need to be made in order to facilitate its implementation at a larger scale. This is commonly referred to as the pilot test.
Early Adopters Early adopters are the first people to try new ideas, processes, goods and services. They act as pioneers or leaders, testing out what is new. Potential adopters look to early adopters for advice and information on an innovation. Once the innovation has caught on and is seen as a positive change,others are confident following the early adopters' lead. Early adopters are typically the most effective internal change agents.
Expansion Expansion, or horizontal scaling up, refers to the implementation of the change practice in different geographic sites or service facilities, or to its replication with larger or different population groups.
Implementing Team During Phase III, the implementing team undertakes the demonstration. They are supported by the coordination team, which helps maintain the energy, focus and consistency of the change process at test sites and oversees the continuous assessment and modification of the process.
Improvement Collaborative This method of quality improvement is a short- to medium-term (12- to 24-month) initiative that organizes teams of providers or community members, usually in geographically diverse locations, to work together to achieve shared aims and to communicate with each other on a regular basis. IC incorporates traditional interventions for improving services, such as provider training and updates to service standards, with quality improvement techniques such as creating a quality improvement team composed of local health care providers. These providers identify obstacles to new practice implementation, seek solutions to address them and monitor the overall results. All providers receive clinical training to provide new methods of care and implement the new standards in their local settings. Common improvement objectives and indicators are shared by all the teams in the Collaborative.
Innovation The innovation refers to the interventions or practices to be scaled up. The innovation is typically a package of interventions consisting of several components. The innovation might have been widely implemented elsewhere or may be an established effective or best practice, but it is still considered an innovation if it is new in the context where it is to be scaled up.
Innovators The innovators are usually a small group: 2.5 percent of the population. They are risk takers or are risk tolerant and like to try new things. They can be seen as different or reckless, but also visionary and inspiring.
Institutionalization Institutionalization, or vertical scaling up, refers to the policy, political, legal, regulatory, budgetary or other changes needed to ensure the practice is fully integrated into the structure and function of the health system on a sustainable basis.
Opinion Leaders The opinion leaders are those whose beliefs or ideas are widely regarded by society or a certain group of people and who therefore have influence over whether or not a particular change is adopted.
Resource team These individuals and organizations were involved in the testing of the innovation and seek to promote and facilitate wider use of the innovation during the process of scaling up. They might be formally charged with promoting the process or may act informally in this role.
Scale up Although scale up (also known as scaling up or going to scale) has been used in the literature with a wide variety of different definitions, this document uses the ExpandNet definition of scale-up: “Deliberate efforts to increase the impact of successfully tested health innovations so as to benefit more people and to foster policy and program development on a lasting basis.”
Scaling-up strategy The means by which the innovation is implemented, monitored, evaluated and communicated. This includes the plans and actions necessary to fully establish the innovation in policies, programs and service delivery.
Sustainability The goal of any scale up is for the scaled-up practice or innovation to be maintained and successful in the long run. Mainstreaming the practice or innovation into policies, systems and programs is key to sustainable change.
Beneficiaries, who will benefit from a new service, product, or way of operating.
Health service providers, who will implement the new practice or set of practices.
Managers and leaders within and outside the organization, who will provide the necessary support for implementation.
Policy makers, whose support is highly valuable for scale-up efforts.