Navigating the Implementation Maze: Unpacking the Two Types of Implementation Process Models
By Dr. Sobia Khan, Director of Implementation
5-min read
We at TCI have been supporting changemakers long enough to get a sense of the different kinds of feelings people have about process models. (As a reminder, a process model is a model that can guide you through the steps and stages of something). Some people don’t see the benefits of using a process model and would rather take on implementation more organically. Others want to use a process model but get incredibly overwhelmed about when to use one and why.
At TCI, we are big process model fans and have found it incredibly useful for everyone to use process models. Even if you aren’t keen on one particular process model, the idea of using one can be beneficial to your initiative - they usually help everyone involved have a common sense of where you are at and where you are going. We sometimes call process models “pathways” or “roadmaps” for this reason, because people like to see things laid out before them and like to see things laid out behind them as well to reflect on their challenges and successes. The key to seeing and experiencing the benefits of process models is understanding the functions of different process models and aligning these functions with why you need a process model. For example, if you needed to understand the process of changing the oil in your car, you wouldn’t use a process model for how to change a tire. In other words, don’t grab a map of Mexico to help you navigate the streets of Kampala, Uganda. The same goes for implementation - different process models are only useful if you are applying them in ways that help you actually do the thing you intend to do.
We have found that many of the general process models in implementation are very similar (outlining very similar processes for how to implement) - but have some key differences. When we dug deep, we realized that variations were because some models were starting with the assumption that you have to select change strategies (also known as implementation strategies), and some were starting with the assumption that you already selected your strategies (or are starting with an evidence-based program that includes change strategies in the program) and need to implement them. This is when we created two different pathways for implementation: the StrategEase Pathway and the Implementation, Spread, and Scale Pathway.
The StrategEase Pathway
This process model is used specifically when you need to understand the process of selecting change strategies. If you have a “thing” you want to implement but are unsure about or haven’t gone through the process of thinking about change strategies (e.g., reminders, action plans, champions, etc), then it helps to start with a process model like StrategEase. Similar process models include Implementation Mapping and the Knowledge to Action model. Essentially, any process model in this category of process models encourages you to think about the nature of change, barriers and facilitators to change, and aligning change strategies with those barriers and facilitators - these are the common steps and stages to what we call a “designing for implementation” process model.
Even if you think you have a good sense of what strategies to use from the get-go, we recommend revisiting this type of process model. An incredibly common situation we have experienced is that people say, “But we already know we are educating people!” and then realize when they use the StrategEase pathway that they have missed some important barriers, facilitators, and additional strategies. Another common situation is that people are starting with a program that is an evidence-based program or that has been implemented elsewhere - in this case, we still recommend revisiting a process model like StrategEase, particularly if you are implementing in a different setting or for a different population than originally intended. Remember that people experience different kinds of barriers and facilitators, and the equitable thing to do is to not make an assumption that what works for some will work for all - putting in the work to make sure you are confident that the strategies you selected will address important barriers and facilitators will save you a headache further down the road.
Implementation, Spread, and Scale Pathway
This type of process model is used specifically when you have your preparatory planning work done - you selected a “thing”, you have developed your practice profiles (you’re WHOs and WHATs), and you have a good sense of what change strategies will be used. There are many process models like the Implementation, Spread, and Scale Pathway in implementation science - common steps are developing your teams and support structures, understanding and addressing readiness and context, building capacities to implement, adapt and evaluate, and doing the actual implementation and evaluation work. You may be familiar with NIRN’s Stages of Implementation, EPIS (Exploration, Preparation, Implementation, Sustainment), or Getting to Outcomes, which are similar in nature and serve the same function.
This type of process model is invaluable to everyone who is implementing, because it lays out what exactly teams and supports will be doing throughout the implementation process and the kinds of things that require attention (like adaptations). A really great application of this process model is to use it to develop your implementation plans, which is a step that people tend to get stuck on - the process model steps and stages can help inform what kinds of activities might go into a plan. It is also a great reflective tool - i.e., looking back, where did we succeed and what could have been improved for us to implement a lot better? Recently, someone asked me the question, “How are we supposed to know where we should get tighter with implementation?” I developed a set of questions based on process models like the Implementation, Spread, and Scale Pathway for people to synthesize data, thoughts and reflections across different components and steps of implementation to help guide them to think about what was good and what was not so great that they can keep working at as they go through different implementation cycles.
Using both types of implementation process models
We tend to separate these types of process models for people who are newer to implementation science because separating them can help you more deeply understand these different processes and be more thoughtful about each of the individual steps. It helps to use the different steps to guide the work you do as implementation support and team - for example, knowing that you have to select change strategies as part of your planning work, you can plan structured activities within your meetings to map barriers and facilitators and use tools like the StrategEase Tool to select change strategies. As you gain more confidence in implementation, you might see that you can use both of these process models at the same time in your initiative, and start developing some “merged” versions of these so that your strategy selection process is embedded into the implementation process steps.
Embracing process models such as Strategease and Implementation, Spread, and Scale pathways provides tools to help you navigate the complex landscape of implementation. By understanding the distinct functions of these process models serve, you can enhance your implementation efforts by creating a sense that everyone is following the same roadmap, one that is iterative and dynamic, yet grounding people in the key activities to support implementation.
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