Planning

The fundamental objective of planning is to design a course of action to promote effective implementation by building local capacity for using the intervention, collectively and individually [1]. The specific steps in plans will be based on the underlying theories or models used to promote change at organization and individual levels [2]. For example, the Institute for Healthcare Improvement [3][4], Grol et al. [5], and Glisson and Schoenwald [6] all describe comprehensive approaches to implementation on which implementation plans can be developed. However, these theories prescribe different sets of activities because they were developed in different contexts – though commonalities exist as well. Grol et al. list 14 different bodies of theories for changing behaviors in social or organizational contexts [2], and Estabrooks et al. list 18 different models of organizational innovation [7]. Thus, the particular content of plans will vary depending on the theory or model being used to guide implementation. Implementation plans can be evaluated by the degree to which five considerations guide planning: stakeholders’ needs and perspectives are considered; strategies are tailored for appropriate subgroups (e.g., delineated by professional, demographic, cultural, organizational attributes); appropriate style, imagery, and metaphors are identified and used for delivering information and education; appropriate communication channels are identified and used; progress toward goals and milestones is tracked using rigorous monitoring and evaluation methods [8][9]; and strategies are used to simplify execution. The latter step may include plans for dry runs (simulations or practice sessions) to allow team members to learn how to use the intervention before going live [10], running trials to allow users to test procedures, gain confidence, and build an environment of psychological safety [10], or taking an incremental approach that breaks the intervention down into manageable parts that can be implemented incrementally [11]. The plan can be formal or informal but should consider all salient contextual factors – both modifiable and non-modifiable. Workarounds can be developed for non-modifiable factors, and strategies can be designed to change factors that can be modified (e.g., increase stakeholders’ knowledge of the intervention).

Planning is one of four fundamental activities in the PSDA (Plan-Do-Study-Act) cycle for implementing change in quality improvement efforts [12]. An assumption underlying implementation models is that they guide planning. This is not always explicitly stated, however. Greenhalgh et al. describe a continuum of conceptual and theoretical bases for spread of innovations in organizations from “let happen,” unpredictable, emergent adoption to “make it happen,” scientific, planned implementation [8]. More research is needed into the role of planning and the nature of quality of planning and its influence on implementation.