Guide to Fostering Change to Scale Up Effective Health Services

The Leadership, Management, and Sustainability (LMS) Project of Management Sciences originally produced this guide in 2007 for the Implementing Best Practices (IBP) Consortium for Health (including Management Sciences for Health - MSH). It was and is intended to assist in bringing change in performance and quality of services to heath services/programmes with an emphasis on reproductive health (RH) programmes. The IBP Initiative is a global partnership involving 38 international agencies dedicated to demonstrating a dynamic model of international and local cooperation on RH.

The updated guide is the result of the year 2012 surveys with users and non-users of the 2007 guide and a review of other recent guidelines and tools for effective change. The new, electronic guide is meant for policy makers, programme managers, operations researchers, or other health professionals who want to bring about change in a health practice or set of practices.

The updated guide "provides a pathway that links proven change practices to 'how to' steps for successful change. It links effective change practices with proven clinical and programmatic practices to achieve results" by:

•    Describing principles fundamental to effective change.
•    Increasing awareness of proven approaches to effective change.
•    Providing "how-to" steps for successful change including scale-up.
•    Describing key challenges of scaling up and recommending strategies, tools, or approaches for meeting those challenges.
•    Offering cases that show how the steps have been implemented in real-life situations.

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.

A summary of the change phases detailed in the guide follows:

*" Preliminary Phase: Forming the Change Coordination Team

* Phase I: Defining the Need for Change   
a.    Identify the problem - a practice or set of practices that is impeding the provision of high-quality services. Analyse the root causes, and reformulate the problem as a challenge.
b.    Identify and agree on the desired change, its purpose, the anticipated results, and the potential obstacles.

*Phase II: Planning for Demonstration and Scale-Up
a.    Identify a dedicated change agent and an implementing team.
b.    With the change agent, identify and analyse relevant effective practices from other settings.
c.    Select and plan to adapt a proven practice.
d.    Plan to implement and monitor the pilot of the practice at test sites.
e.    Take actions and make choices in implementation that will enhance sustainability and future scaling up.

*Phase III: Supporting the Demonstration
a.    Help create and maintain and environment that will support the change agent and implementing team throughout the change process.
b.    Implement the change effort at test sites.

*Phase IV: Going to Scale with Successful Change Efforts
a.    Evaluate, consolidate and disseminate lessons learned from the pilot, and decide whether the practice warrants scale up.
b.    If the pilot succeeded, use a systematic approach and participatory process involving key stakeholders to develop scaling-up strategy and secure resources to support implementation of the strategy.
c.    Monitor the process of scaling up to ensure sustainability and provide evidence-based decision-making.
d.    Implement the scaling-up strategy.
e.    Measure and communicate the results of the scaled-up practice."

The toolkit is available online (see below) or offline in CR-ROM format here: Offline Toolkit Order Form.