A "How To" Process for Fostering Change to Scale Up

The process detailed in this guide is directed at individuals and teams who wish to initiate and support a needed change in a health practice or set of practices. A change coordination team can form in two ways:

  1. The team might be established in direct re­sponse to a practice or practices that could be improved, before a change agent has been select­ed.
  2. The team might form to support a change agent who has already been identified to carry out an agreed-upon change in a practice or practices.

This guide is written with the first situation in mind—that the team is formed before a change agent has been chosen. In a situation where a change agent is already in place, that person will be an active participant throughout the process.

The phases, and the steps within each phase, outlined below and detailed throughout this Guide, are applicable to anyone working systematically to institute change. For each step, the reader will find:

  • The action and its purpose
  • Challenges that might be encountered in taking the step
  • Underlying causes of the challenges
  • Strategies for addressing the challenges
  • Tools to help teams meet the challenges, based on the documented experience of teams that have carried out similar change processes.

The steps represent a suggested sequence of events, but the sequence can vary in different situations.

The guide also includes three case studies which provide illustrative examples of how coordination teams have applied the phases and steps in this Guide to the process of making important changes in health practices.

The Change Process: An Overview

Preliminary Phase: Forming the Change Coordination Team

Phase I: Defining the Need For Change

  1. Identify the problem—a practice or set of practices that is impeding the provision of high-quality services. Analyze the root causes, and reformulate the problem as a challenge.
  2. Identify and agree on the desired change, its purpose, the anticipated results, and the potential obstacles.

Phase II: Planning for Demonstration and Scale-Up

  1. Identify a dedicated change agent and an implementing team.
  2. With the change agent, identify and analyze relevant effective practices from other settings.
  3. Select and plan to adapt a proven practice.
  4. Plan to implement and monitor the pilot of the practice at test sites.
  5. Take actions and make choices in implementation that will enhance sustainability and future scaling up.

Phase III: Supporting the Demonstration

  1. Help create and maintain an environment that will support the change agent and implementing team throughout the change process.
  2. Implement the change effort at test sites.

Phase IV: Going to Scale with Successful Change Efforts

  1. Evaluate, consolidate and disseminate lessons learned from the pilot, and decide whether the practice warrants scale up.
  2. If the pilot succeeded, use a systematic approach and participatory process involving key stakeholders to develop a scaling-up strategy and secure resources to support implementation of the strategy.
  3. Monitor the process of scaling up to ensure sustainability and provide evidence-based decision-making.
  4. Implement the scaling-up strategy.
  5. Measure and communicate the results of the scaled-up practices.