How Do We Make Systems “Ready” to Implement?
By Dr. Sobia Khan, Director of Implementation
Note: We have updated our website since this article was published. As a result, you may have been redirected here from a previous URL. If you are looking for the article, "Fostering System Readiness for Implementation: The MamaToto Package” by Kimberly Manalili , Teddy Kyomuhangi, and Dr. Jenn Brenner, please click here.
Readiness has been on many people’s minds lately. In the context of the current global pandemic and the Black Lives Matter movement, we are in an era of large-scale system transformation. In some cases, we find that this changing context has enabled willingness and capability to adopt programs, policies, innovations and values. In other cases, systems may even be less ready than they previously were, but often we must still move forward with implementation. What can we do in the latter situation, where we find ourselves having to implement in a less-than-ready setting but change can’t wait?
What is system readiness?
Here we turn to a type of intervention that we will call a “system readiness” intervention. System readiness is not a widely used term, but taps into a key aspect of the system that we tend not to assess – whether or not the system is both psychologically and structurally prepared for change. By “psychologically” prepared, we mean that system actors at multiple levels have the motivation to change. By “structurally” prepared, we mean the capacities are in place to change. We opt to use system readiness as a term instead of other more widely used terms such as “system strengthening” because we believe that motivation factors are key to implementation. System strengthening focuses solely on capacity, which we have tried in the past and know doesn’t target change as effectively.
In a previous bulletin, Jonathan Scaccia from the Wandersman Center wrote about the R=MC2 heuristic, which summarizes the concept of readiness nicely. R=MC2 which says the readiness is the motivation, general capacity and intervention-specific capacity for change. Readiness is the product of these components rather than the sum of these components, because if any one of these are zero, readiness cannot be achieved.
When we talk about a “system” having motivation, what we mean it that there is willingness to adopt a specific intervention because the characteristics of that intervention are optimal. If you’re familiar with Rogers’ diffusion of innovations model or the Consolidated Framework for Implementation Research, these intervention characteristics might resonate with you (e.g., compatibility, observability, trialability, complexity, etc.). There is also the motivation of individuals working with the system to consider, and this can be their motivation to use a specific intervention or their motivation to innovate in general. Intervention-specific capacity relates to things like the knowledge and skills people have for that intervention, or what resources or champions are in place. General capacity refers to general characteristics of the setting- what kind of culture and climate are in place, what the type of leadership the setting has, etc.
What is a system readiness intervention?
A system readiness intervention is one that aims to assess and address readiness and aims to target both general and intervention-specific factors in order to build that readiness throughout implementation. We find that when a program aims to target the uptake of a specific intervention while simultaneously building general capacity and motivation for change, this starts to establish readiness in the implementation setting. If you have a program that is only being implemented once (for example, for a research study), you can determine which areas readiness might need to be built using a readiness assessment tool (like the R=MC2), prioritize the areas that you are capable of impacting or changing in your period of implementation, and implement what we call “readiness strategies” alongside your regular implementation strategies. For example, if leadership is an issue, you would implement strategies targeting leadership engagement and buy-in in addition to implementing the intervention you intend to implement.
If you are lucky enough to be able to repeat cycles of implementation within the same setting, using this approach means that the first implementation might be an uphill battle, but in future cycles implementation starts becoming easier. Another benefit of this approach is that because general capacity and motivation are being targeted, it also becomes easier to implement other interventions (not just the first one you selected). In essence, you are setting the system up to succeed in the future by targeting readiness at the present moment. We were recently asked whether it is worth it to build “system readiness” when the intervention was not yet ready – our response is a definitive yes. When you are able to build system readiness first, you are establishing a strong foundation on which interventions can be implemented.
This article was featured in our monthly Implementation in Action bulletin! Want to receive our next issue? Subscribe here.