Implementation is where your planning turns to action. A strong work plan with a timeline and specific activities (and by whom) is enormously helpful. You’ll need to make adjustments periodically, sometimes due to outside factors and sometimes based on new information that surfaces as the work moves forward.
To help partners and staff feel supported during the implementation phase, have a structured process for sharing successes and challenges. Monitor for continuous improvement, track progress toward goals and keep your champions informed.
Align resources with strategies for greater impact. One approach is to identify a strategy in each of the Three Buckets of Prevention (Centers for Disease Control and Prevention). Once those are aligned, take a look at each strategy and identify policies and resources that will support it.
Policies may be legislative, but not always. Clinic, school and workplace policies count too. Likewise, “resources” can mean funding, but also infrastructure, staffing, and political will.
- It helps to have a structured process, and to engage partners early in that process.
- It also helps to address resource needs right from the start.
Below are a few of the challenges you may find, and some potential actions to consider.
Challenge: The intervention is evidence-based, but isn't working well in the population you're serving.
Try: Identify why the intervention isn’t working. Get feedback from community members. See if you can make small adjustments based on that feedback. Example: some families didn’t participate in well child visits because they equated them with immunizations. When community health workers helped educate families about the difference, and the value of well-child care, participation rates began to increase.
Challenge: People implementing interventions get discouraged when they meet resistance to change.
Try: Lead with empathy; change is hard work! Engage with partners to identify specific challenges, and co-develop strategies to address them. Example: for providers, the shift to population health management rather than focusing solely on individual patients is a major change. Invite their input, and try to facilitate training and technical assistance in a way that works best for their system.
Challenge: Interventions are going well, but the community doesn't seem aware of your success.
Try: Identify exactly what’s working and why, and share that information with partners and stakeholders. Ask one of your population health champions to serve in an ambassador role. Be prepared with evidence that it’s working and with one or two personal stories to help make the information come alive. For additional ideas, see the Communications section.
Challenge: There are many ways to align and partner, and these efforts may seem overwhelming.
Try: Use the Three Buckets of Prevention Framework. Identifying just one strategy in each of the three buckets is a great beginning to an aligned approach. Once you have strategies in each bucket, you can begin to align policies and resources that will help you achieve them..
Challenge: Your local or regional health priorities may not be the same as identified state or national priorities, making it harder to align efforts.
Try: Develop strategies that impact more than one health issue. A policy to reduce consumption of sugary beverages can impact obesity, diabetes and oral health. A trauma-informed approach in healthcare systems can impact both adult mental health and preventive care of children.
Challenge: Supporting and enforcing policy can be as important as establishing policy.
Try: Identify policies that are currently in place and may need greater support and enforcement.
Challenge: Look beyond funding when aligning resources behind a goal.
Try: Aligning resources such as infrastructure, partnerships, and pro bono services behind a shared goal can help move work forward. There are also intangible resources such as political will. When those are in place it is usually easier to obtain funding when funds become available.
- How Community Health Workers can help with interventions, Association of State and Territorial Health Officials (ASTHO)
- Implement Programs, Services and Other Interventions, Health and Human Services Administration Community Guide.
- "Towards Sustainable Improvements in Population Health," Centers for Disease Control and Prevention (CDC).
- "A Proposal for Financially Sustainable Population Health Organizations," U.S. National Library of Medicine National Institutes of Health.
- The Sustaining Improved Outcomes toolkit, from the New York State Health Foundation. On page 29 you’ll find a list of sustainability factors, including those that don’t require funding. On page 37 you’ll find printable worksheets to help partners select plan activities.