Phase II: Planning for Demonstration and Scale-Up

In Phase II of the Process for Fostering Change, the coordination team works with the change agent to identify practices that have effectively addressed a similar challenge in a comparable setting. They choose a practice that best meets their needs, make any necessary adaptations, plan the details of a pilot test at one or more test sites and identify the indicators of success that will be monitored throughout the pilot and evaluated at the end. The coordination team and change agent should think ahead to scaling up the change. They should, for example:

  • Anticipate where the change will be implemented and involve members of that organization from the outset.
  • Test the change in settings that are comparable to those where large-scale implementation is expected to take place.
  • Try to work with the level of resources that are likely to be available in the routine program during scale-up.

In this manner, they will have anticipated some of the requirements for expansion and institutionalization and already be somewhat prepared for scale-up.

Step 1. Identify a dedicated change agent (if one has not already been appointed) and an implementing team.

Identify a change agent who is familiar to and trusted by his or her colleagues, and assemble a team to provide support and assistance. The change agent is dedicated to and accountable for the process. Involving the team creates buy-in among those who will implement and be affected by change, providing energy to initiate the changes and ongoing motivation to sustain them.

Challenges

  • Finding a change agent who:
    • Meets the criteria and is eager to accept the assignment.
    • Has the support of program leadership and the trust of his or her colleagues.
    • Does not have a conflicting personal agenda or priorities.
    • Has been allocated the time and resources to take this role.
    • Has the courage to take risks.
  • Forming an implementation team whose members:
    • Have the skills needed to bring about the change.
    • Recognize the benefits of the change.
    • Are enthusiastic about working with the change agent.
    • Have been allocated the time and resources to take this role.

Underlying causes of the challenges

  • Some excellent potential change agents might not meet all the criteria.
  • Potential change agents or team members of­ten have other conflicting responsibilities.
  • In leading a controversial change effort, the change agent might encounter risks to job se­curity or to his or her reputation among colleagues and within the broader community.

Key activities to address the challenges

  • Agree on the criteria for a successful change agent.
  • Scan for individuals who meet the criteria.
  • Clearly communicate the details of the change to candidates, and clarify the expectations of the job.
  • Choose a change agent who is willing and able to meet these expectations.
  • Offer adequate training, counseling and mentoring to enable the change agent to fulfill her or his role.
  • With the change agent, form a change coordination team whose members will share responsibility for implementing the change. Be sure some members of the team have complementary skills so they can effectively support the change agent.
  • Gain the support of leadership to free the change agent and team members from some other duties.
  • Provide vigorous ongoing support for the change agent from senior management, col­leagues and community members.

Step 2. With the change agent, identify and analyze relevant effective prac­tices from this or other settings.

This step helps the team confirm that the proposed change is possible and avoid expending energy, good will and resources on measures that are unlikely to work.

Challenges

  • Creating awareness of and access to practices with the potential to succeed in this situation.
  • Objectively determining which practices have proven effective in comparable settings.

Underlying causes of the challenges

  • The organization or program has limited opportunities to read about or communicate with other programs with relevant experience.
  • Claims of effectiveness of practices might surpass reality.
  • Practices implemented elsewhere might not have been done so with comparable human, technical or financial resources.

Key activities to address the challenges

  • Establish criteria for a practice that has proven effective.
  • Look for effective practices that have already been implemented in your region or country to address the identified problem and its causes.
  • If effective practices are not available locally, consult resources for evidence-based practices internationally.
  • Document what practices are available and your rationale for choices.

Step 3. Select and plan to adapt a proven practice.

The coordination team, change agent and implementing team now focus energy and re­sources on one promising practice or set of practices.

Challenges

  • Selecting the most appropriate practice from those that have been considered.
  • Making the case for the choice with decision makers in the country or region.

Underlying cause of the challenges

Key decision makers might be skeptical about adopting and supporting a new practice with which they are unfamiliar.

Key activities to address the challenges

  • Analyze the selected practice to ensure it has the CORRECT attributes.
  • Adapt the practice(s) to the local environment being careful to maintain the key attributes the make the practice effective.
  • Communicate to decision-makers the results of the search and the justification for choos­ing a new practice to adopt.

Step 4. Plan to implement and monitor the pilot of the practice at test sites.

This step involves developing guidelines to lead the change process and determine and demonstrate success, establishing a clear path for the change agent, the implementing team and the change coordination team. Every player should know his or her role and should be held accountable throughout the process. The plan should encompass strategies for sustaining the changed practices.

Challenges

  • Ensuring that members of the coordination team prioritize the change effort.
  • Providing convincing evidence of what practices will work best in the local context, especially if the change is entirely new in the country or setting.
  • Identifying what the objectives of the change process are and agreeing to what successful change will look like.
  • Integrating the implementation plan into the existing work plan, monitoring and evaluation (M&E) plan and deliverables.
  • Testing implementation in the type, level and variety of settings where it is to be expanded.
  • Providing the financial and human resources needed to implement, monitor and sustain the de­sired change.

Underlying causes of the challenges

  • The coordination team members do not completely understand or accept their roles in the change process.
  • Relevant local practices have not been adequately explored and analyzed.
  • Poor understanding of what the proposed change is or the rationale for its importance or benefit.
  • Leadership has not fully endorsed the change and provided the necessary re­sources for sustainable implementation.
  • There is temptation to implement the demonstration in stronger or otherwise easier settings or facilities.

Key activities to address the challenges

  • Clarify roles and responsibilities for the coordination team, change agent and the implementing team.
  • Involve stakeholders, especially beneficiaries, in decision-making from the start.
  • Discuss and clearly document what the objectives (and, if appropriate, the sub-objectives or milestones) are for the change process.
  • Limit the use of external inputs and keep the pilot as simple as possible.
  • Test the change in settings representative of future sites for scale-up.
  • Identify tools that have proven useful in carrying out comparable changes.
  • Identify and plan for linkages to other sectors, systems and programs.
  • Specify all the activities needed to implement, monitor and sustain the change as well as who will take responsibility for them and over what period of time.

Step 5. Take actions and make choices in implementation that will enhance sustainability and future scaling up.

The coordination team should anticipate and lay the groundwork for the complexities of scaling up (see Phase IV), begin determining the needed resources for future scale up and develop a plan to acquire them.

Challenges

  • Engaging stakeholders in thinking ahead to scale-up early in the change process.
  • Cultivating ownership of the change more widely in the organization that will need to adopt it.
  • Believing that scale up simply entails "doing more of what we're already doing" and will automatically be successful if the demonstration worked on a small scale.
  • Securing the resources (for example, human, financial, and systems) needed for scale-up.

Underlying causes of the challenges

  • Evidence of successful change might not appear until later in the process.
  • The change is viewed as simply a pilot; requirements of bringing the change to scale are not considered.
  • There is a lack of understanding regarding what is involved with scaling up and what should be considered and monitored from the onset and throughout to ensure sustainability.
  • There are limited resources and/or constraints with accessing existing resource options.

Key activities to address the challenges

  • Determine whether the change, if successful, will be appropriate for expan­sion to new settings. If so, consider:
    • Whether it should be implemented within or beyond the organization.
    • The need for advocacy, policy change or alternative funding possibilities.
    • Socio-cultural, political or institutional barriers that must be overcome.
    • Stakeholders who need to be on board.
    • Dissemination strategies.
  • Develop and carry out a monitoring plan with interim indicators and milestones to con­firm that the change is progressing as planned.
  • Document the process, emphasizing:
    • Achievement of milestones.
    • Adherence to the schedule and budget.
    • Unanticipated roadblocks and how the change agent and change team have addressed them.
  • Evaluate the benefits of the change.

Resources