Programs and practices are sustained when the core elements are maintained or delivered with integrity after initial implementation support has been withdrawn, and adequate capacity exists to continue maintaining these core elements.

Implementation support practitioners support the sustainability of programs and practices by helping communities to develop a shared vision and mutual accountability, and by facilitating existing relationships, problem solving and resource sharing. They also help to identify, understand and address the dynamic changes that occur over time in the use of interventions/approaches, the characteristics of the practice settings, and in the broader system that establishes how services are delivered.

Core competencies that support sustaining change include:

  • Growing and sustaining relationships
  • Developing teams
  • Building capacity
  • Cultivating leaders and champions

Growing and Sustaining Relationships

Implementation support practitioners recognise relationships as foundational to implementation work and spend time building affiliations, making personal connections, and recognising themselves as outsiders to the implementation setting.

Implementation support practitioners should have the competency to:

  • Grow and sustain diverse, authentic, respectful and trusting relationships with stakeholders to guide and support implementation and systems change efforts.
  • Support two types of relationships:
    • the relationship between the implementation support practitioner and key stakeholders involved in implementation; and
    • the relationships among the systems and community stakeholders, including consumers, who have a stake in the implementation effort.
  • Build two types of trust:
    • Intrapersonal trust - the belief that the implementation practitioner is reliable, competent, and committed to the change effort on behalf of the organization they are supporting.
    • Interpersonal trust - the perception of the implementation practitioner and their stakeholders that they are in a collaborative and reciprocal relationship pursuing the same aims.

Key Activities - Growing and Sustaining Relationships

The key activities which implementation support practitioners conduct, relating to this competency, include:

  • Build trust with others by modeling transparent action and accountability.
  • Seek out relationships with implementation stakeholders from all aspects of the system.
  • Engage in ongoing self-assessment and diagnostic assessment of relationship strengths and weaknesses.
  • Encourage and make use of feedback to strengthen relationships.
  • Regulate distress in relationships by creating space for stakeholders to discuss challenges and dispute assumptions when conflict emerges.
  • Seek to demonstrate value to the stakeholders involved in implementing.
  • Enter the implementation space with humility as a learner, recognising that local actors have important expertise and experience to contribute to the implementation process.
  • Demonstrate commitment and persistence in the face of complex challenges.
  • Have difficult conversations with stakeholders and be open to feedback.
  • Show kindness and vulnerability.
  • Demonstrate empathy.

Helpful Hint - Growing and Sustaining Relationships

Implementation support practitioners know that implementation takes place through trusting relationships.

Implementation support practitioners build trust through honest listening, using feedback, demonstrating commitment, providing credible information, showing vulnerability, and staying in difficult situations.

When trusting relationships exist, information is more readily exchanged and multiple stakeholders, including the implementation support practitioner, can exert influence on the implementation process.

Developing Teams

Implementation support practitioners should have the competency to:

  • Develop and coach implementation teams that will be responsible for a change effort.
    • An implementation team is a group of stakeholders that oversees, attends to, and is accountable for facilitating key activities in the selection, implementation, and continuous improvement of a program or practice.
    • Ideally, teams should be established at every level of a program or system, or to target different aspects of an initiative.
  • Develop strategies for stakeholder leadership through developing teams and including multiple actors and perspectives, including the focus population, in activities such as implementation planning, communication, problem solving, and data-driven decision-making.

Key Activities - Developing Teams

The key activities which implementation support practitioners conduct, relating to this competency, include:

  • Help to identify relevant implementation team members among those involved in the implementation.
  • Facilitate the development of clear governance structures for implementation teams, e.g. through team charters or agreements.
  • Support teams to perform the following core functions:
    • select, operationalise, tailor and adapt interventions
    • develop operational processes and resources for building staff competency
    • identify, collect, analyse and monitor meaningful data
    • engage leadership, staff and stakeholders in using data for improvement
    • build capacity for sustainment, and
    • build cross-sector collaborations that are aligned with new ways of work.
  • Support the development of effective team meeting processes including the establishment of consistent meeting schedules and standing agendas.
  • Ensure teams have support from leadership for their roles and functions.
  • Help to develop communication protocols to support feedback loops among multiple, linked implementation teams for a single initiative.
  • Develop processes for the continuous assessment and improvement of team functioning, including gathering feedback from team members.
  • Ensure that implementation teams provide opportunities for members to learn and grow through participation on the team.
  • Work to enhance team cohesion and trust among team members.
  • Help to manage conflict among team members.

Helpful Hint - Developing Teams

Implementation support practitioners help to develop teams, ensure that team meeting processes are structured and effective, and build the competency of team members to support implementation.

They may do this by supporting the development of a team charter and agendas for team meetings.

Implementation support practitioners often facilitate team meetings in the early stages of implementation to explicitly support team development and ensure that team members have the opportunity to learn and contribute during team meetings. Over time, implementation support practitioners seek to transition facilitation of team meetings to local leaders and champions.

Building Capacity

Implementation support practitioners should have the competency to:

  • Increase the knowledge, skills, motivation, and attitudes of leaders, staff, and key stakeholders to achieve their implementation goals.
  • Pay attention to all types of capacity (psychological, behavioral and structural) at all levels of the system (individual, organization, network, and system), including:
    • Intervention/approach-specific capacity: The knowledge, skills, motivation and attitudes about a specific intervention or chal¬lenge, such as understanding a particular researchsupported program.
    • General capacity: The knowledge, skills, motivation and attitudes required for a fully functioning organization or system, e.g., filled leadership positions or a human resource department or unit.
    • Analytic capacity: The knowledge, skills, motivation and attitudes to gather information about a problem, analyse patterns and dynamics, and reflect critically on root causes and potential solutions.
    • Adaptive capacity: The knowledge, skills, motivation and attitudes to adjust actions and strategy in response to analysis.

Key Activities - Building Capacity

The key activities which implementation support practitioners conduct, relating to this competency, include:

  • Prepare stakeholders for necessary changes, model or simulate the change that will be implemented prior to implementation.
  • Work with stakeholders to assess capacity strengths and needs related to the implementation.
  • Provide or secure training needed for stakeholders and partners to gain capacity, and connect with others who can provide training, modeling and coaching.
  • Model the use of knowledge, skills, behaviors, attitudes, and practices for stakeholders to demonstrate application in a real-world setting.
  • Coach stakeholders’ use of knowledge, skills, behaviours, attitudes, and practices in their daily work so that partners can gain confidence and competency.
  • Identify and help to change and/or implement organizational processes and structures required to develop capacity for implementation (e.g., human resources, technology).
  • Support stakeholders in identifying potential future external and internal challenges to implementation (related to, for example, finances, policies or staffing) and to develop strategies for building sufficient capacity to meet these.
  • Promote collaboration and partnerships as a way to build and expand capacities (e.g. through the use of community-academic partnerships, learning collaboratives, etc.).

Helpful Hint - Building Capacity

In building capacity, implementation support practitioners enhance the implementation knowledge, skills and attitudes of others – be it individuals, teams, organizations or systems. They do not take on the implementation work themselves. Instead, they support others in doing implementation.

At the individual and group level, this means enabling stakeholders to see educational and skill building activities as safe, relevant and beneficial. Educational and skill building activities should mirror the conditions under which stakeholders normally conduct their work, and include elements of behavioural modelling, making it possible for stakeholders to try out changes they want to introduce in their work environment.

At the organizational and system level, implementation support practitoners help to develop mechanisms, for example, situational cues, that enable new knowledge to be applied and new behaviours to be practiced. They also pay attention to the resources needed (time, equipment, finances) to follow through with intended changes and to the support structures available to stakeholders in the systems in which they work – for example, supervisors, mentors or peer support.

Implementation support practitioners regularly follow-up on capacity building activities, assess whether additional capacities are needed, and how these might be met.

Cultivating Leaders and Champions

Implementation support practitioners should have the competency to:

  • Support formal leaders to be implementation leaders who work across organization and system boundaries and silos.
  • Foster leadership behavior among all relevant stakeholders involved in an implementation and help to create space for new and emerging implementation leaders.
  • Cultivate implementation champions at multiple levels within and outside the implementing system and organization.
    • Champions have the ability to influence the opinions and behaviors of others.
    • They feel a sense of ownership over the implementation effort, have deep knowledge of the people and workflow impacted by change, and demonstrate grit and tenacity in the face of setbacks. They are persuasive to a range of stakeholders and demonstrate an ability to understand different perspectives.

Key Activities - Cultivating Leaders and Champions

The key activities which implementation support practitioners conduct, relating to this competency, include:

  • Identify existing leadership roles of relevance to implementation efforts.
  • Work and communicate with relevant formal leaders involved in the implementation to define, understand and develop their role and capacity as implementation leaders (e.g. through the use of appreciative inquiry or reflection techniques).
  • Develop processes and structures for regularly debriefs with leaders central to implementation efforts.
  • Support leaders to access data and information required for them to stay abreast of implementation work and the decisions they should be involved in.
  • Identify emerging leaders in or around the implementing system and consider how they may be further involved in and developed through implementation efforts (e.g. through the use of power analysis or systems mapping tools).
  • Support emerging leaders to share responsibilities and develop their confidence and competency (e.g. by co-facilitating meetings, co-supervising staff etc.).
  • When leadership transitions occur, work with stakeholders to provide planning, continuity, analysis and support as needed to ease the transition.
  • In collaboration with implementation stakeholders, identify champions within and outside the implementing system with a potential to positively influence the implementation efforts.
  • Support stakeholders in developing strategies to contact and engage these champions in relevant ways throughout the course of the implementation.
  • Ensure stakeholders regularly review championship roles to assess whether these are being cultivated as intended, are operating as desired, or if any losses in championship have occurred. If challenges are identified, facilitate problem solving as needed.

Helpful Hint - Cultivating Leaders and Champions

Implementation support practitioners foster leadership among their stakeholders. They work with designated leaders, i.e. those in charge of implementation, to ensure that clear implementation leadership is present in an organization and system. They also develop distributed leadership across a multitude of stakeholders to ensure that intended changes can be supported and progressed where and whenever needed.

Implementation support practitioners help leaders understand how they can best support implementation efforts, e.g. by displaying knowledge, support and engagement in relation to implementation efforts, or by signaling what behaviors will be expected, supported and rewarded in their organization or system. They also help leaders and champions be informed about ongoing implementation work and outcomes and may provide concrete advice on how to progress work.

Implementation support practitioners contribute to developing champions by role modelling leadership behaviors, e.g. by being professional, accountable or committed. They also identify opportunities to lead, and invite stakeholders at all levels of an organization or system to deepen their engagement in different aspects of implementation.

*Excerpted from Metz, A., Burke, K., Albers, B., Louison, L., & Bartley, L. (2020). A Practice Guide to Supporting Implementation: What competencies do we need?