Phase III: Supporting the Demonstration

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. The accomplishments and lessons learned during the pilot test will strongly influence future scale-up.

Step 1. Help create and maintain an environment that will support the change agent and the implementing team throughout the change process.

The change agent and implementing team need motivation and encouragement to persist when they en­counter roadblocks and frustration. Providing needed inputs at critical moments will help encourage a positive mindset across the organization and will lay the foundation for sustainability and scale-up.

Challenges

  • Fostering open communication across all relevant units and levels of the organization.
  • Maintaining commitment over time, despite setbacks and frustrations.
  • Dealing with resistance to change among a variety of people, for many different reasons.

Underlying causes of the challenges

  • This effort might engage parts of the organization that do not customarily work together.
  • Changes will be uncomfortable for some people in the organization.
  • The pace of change might be too slow for those who are eager to see results.
  • Staff members will go through phases of denial, resistance, exploration and acceptance of change at different paces.

Key activities to address the challenges

  • At the start of the process and periodically throughout, work with the change agent to:
    • Describe the change process in detail; highlight progress and explain what will happen next.
    • Clarify how the change will enhance the work of the organization.
    • Specify the roles of each organizational unit in contributing to successful change.
  • Help the change agent create cross-organizational working groups responsible for specific activities within the process.
  • Focus energy on credible people who recognize how the change will improve services but be patient with those who resist or are slower to accept the change.
  • Help the change agent accept the normality of differing reactions to change and ad­dress the needs of people at each phase: denial, resistance, exploration and acceptance.
  • Find ways to motivate, acknowledge and reward staff members for chang­ing their accustomed practices.

Step 2. Implement the change effort at test sites.

Use the implementation plan to test the demonstration. Use the monitoring data to identify what aspects of the demonstration are and are not working.

Challenges

  • The demonstration is not proceeding on time or on budget.
  • Lack of evidence that the change effort has a relative advantage over existing practices.
  • Health systems, staff and procedures are ill-equipped to embrace and manage the change.

Underlying causes of the challenges

  • The scope and extent of the resources needed for the demonstration (for example, time, financial, staff resources) were not fully anticipated.
  • The M&E plan lacks the right indicators to determine the success of the demonstration.
  • The demonstration was implemented in haste, without full preparation, knowledge and acceptance of the change.

Key activities to address the challenges

 

Resources