As leaders of a site, your role often includes providing support and resources so that frontline staff can implement the Gabby System successfully.
Your Role in Implementation
One of the more critical aspects of introducing a new program into a site is ongoing discussion among staff. We recommend that sites have at least one meeting each month during pre-implementation and implementation to discuss progress, facilitators, and barriers with the site champion and other staff members. Consistent communication will all involved staff members before and throughout implementation is necessary to ensure success of the Gabby System at your site as well as adequate resources and support for staff members.
Questions to Consider: Logistics
It might be helpful to ask the questions below during these meetings:
Will our site enroll women during preconception or interconception, or both?
How will women take the health survey? Will it be on a laptop during a home visit, on a computer on-site, or on their own device at home?
Who will address the health topics identified by the Gabby System with the clients? Will it be a case manager, nurse, doctor, or other staff member?
Will discussions about a client’s health topics happen during a home visit, on-site, phone call, a virtual meeting, or some other form of communication?
At what point and how often might site staff follow-up with clients who use the Gabby System?
Who will follow up with clients about their system use and any progress they have made?
Will site staff make referrals to resources and outside agencies based on information clients share with the Gabby System?
Who will review clients’ responses on the Administrative Page? Will it be the site champion or any staff member involved in enrolling clients?
Source: https://brooksgroup.com/sales-training-blog/sales-coaching-best-practices-series-team-meetings. Accessed March 12, 2020
Questions to Consider: Staff Responsibilities
Before implementing the Gabby System, you should determine what implementation will look like at your site with the site champion. Discussion about staff responsibilities and expectations/ goals should include the following questions:
Will the implementation of the Gabby System be a site-wide or targeted effort?
Will the site champion be the sole individual responsible for implementation or will implementation include several staff members?
Who do you see involved in this effort? Who are the stakeholders from within the site and who would partner with the site that would be involved?
Do you foresee challenges engaging community-based organizations or other partners in this process?
What do you hope to accomplish throughout this process?
Briefly discuss and review the process for achieving these goals.
Questions to Consider: Staffing
Another discussion will include considerations for staffing the program:
What level of site staff is required for the program and what are their roles? [Administrative, leadership, frontline, etc].
What is the staffing structure? [FTEs, on-call, 24-hour coverage, evening coverage, weekend coverage, etc.]
Are the staff already in place, or will they need to be hired?
If transitioning existing staff, need to determine how this can be done- will it be necessary to reclassify staff into new positions, or do existing job descriptions work?
If transitioning existing staff, how different is the new program from their current work? May need to do additional work to ensure the transition goes smoothly and workers are on board with, as well as part of the changes.
If staff is to be hired, job descriptions will need to be created.
Your Role in Monitoring and Evaluation
As a site leader, you may be interested in monitoring and evaluating the impact of the Gabby System at your site. The use of logic models can aid these processes (for more information on logic models, refer to Module 5).
Source: https://www.retentionscience.com/blog/automating-machine-learning-monitoring-rs-labs/. Accessed March 12, 2020.
Evidence-Based Frameworks
The content of the Gabby System is based on clinical guidelines and best practices. The implementation process at your site is informed by theoretical frameworks, models, and strategies used at pilot sites. Prior to the start of implementation, the research team conducted interviews with key site stakeholders based on the Consolidated Framework for Implementation Research (CFIR). The RE-AIM Framework was used to improve the impact of the Gabby System in implementation sites.
Reach of our target population by providing sites with techniques and tips around successful approaches to enrollment and retention, identifying potential barriers, and supplying sites with Gabby-specific strategies to engage the community at various settings and locations.
Effectiveness of the Gabby System by gathering client level feedback at the end of the implementation period, and maintain tracking systems to document site processes that may impact the delivery of the program to clients.
Adoption and willingness to deliver the program to clients by demonstrating to site staff and leadership the value of the intervention, assisting sites with resources necessary for implementation and providing data about delivery and effectiveness.
Implementation process such as engagement in implementation and Gabby System technical assistance required during the rollout.
Maintenance by receiving buy-in from stakeholders regarding sustainability at the organizational level and sites developing capacity for sustainment.
(Click to enlarge). Source: https://u.osu.edu/pubhhbp6510breastfeeding/re-aim-elements/. Accessed April 16, 2020
Sites may consider using the RE-AIM Framework to plan and assess key elements of reach, effectiveness, adoption, implementation, and maintenance including outreach activities, mechanisms for tracking progress, and staff involvement. For example, to evaluate effectiveness, you collect data on the health behaviors of client users to assess the extent to which the Gabby System has assisted clients in engaging in healthy behaviors. Funders, stakeholders or the government may require you to report certain data. These data should be collected through your monitoring and evaluation activities.
CFIR
Along with the RE-AIM Framework, the research team also used the CFIR to guide implementation. The Consolidated Framework for Implementation Research. CFIR is a framework that consists of constructs for effective implementation and encourages systematic analysis. The overall purpose of using CFIR is to tailor implementation and evaluation specific to your site. CFIR organizes the constructs into 5 domains: intervention characteristics, outer setting, inner setting, characteristics of individuals, and process. Examples of the constructs include adaptability, structural characteristics, leadership engagement, and patient needs and resources. CFIR can be used to assess facilitators and barriers and develop site-specific logic models. Along with providing guidance for implementation, CFIR also assists in evaluation processes.
To facilitate interviews, CFIR has interview guides that you can use instead of creating your own. The research team used these interview guides in their pre-implementation key stakeholder interviews.
Other Frameworks
Organizational Readiness for Implementing Change (ORIC) is a widely-used tool to measure and assess the level of readiness for implementation at your site. It includes items designed to evaluate individuals’ perceptions of their organization’s openness to and degree of preparation for change. ORIC measures site staff’s commitment to change and ability to implement change.
The CDC Evaluation Framework is a good tool that outlines the steps involved in evaluation and the standards that assess evaluation activities.
The above-mentioned frameworks are of possible tools that can be used to guide implementation. The research team used CFIR and the RE-AIM Framework because they connected best to the pilot sites, the culture of the sites, and the data they wanted to collect. Although the research team used these two frameworks, you may use any framework that you feel best fits the context of your site.
Your Role in Sustainability and Regeneration Efforts
Sustainability can be defined as continuity of a program. Sustainability should be considered before and during implementation. Developing a sustainability plan helps to ensure successful implementation of the Gabby System at your site.
EPIS Framework
The Exploration, Preparation, Implementation, Sustainment (EPIS) Framework has guided the preparation and implementation of sustainability plans for several Gabby System implementation sites. The EPIS Exploration Worksheethelps sites identify funding sources, client characteristics, key organizational stakeholders, community resources and partnerships, and other important factors that may be considered when developing a sustainability plan.
(Click to enlarge) Source: https://episframework.com. Accessed March 12, 2020
The figure above outlines EPIS and provides several examples of factors that are helpful to consider during preparation and implementation.
Although your sustainability plan should be developed during implementation, you may realize that once you reach the end of implementation and are looking to follow the sustainability plan, the plan may not be completely relevant to the current situation at your site. Regeneration refers to the adaptation of the program to fit the current context of your site. There may be changes in your client population, staffing, or resources which may not allow you to follow the sustainability plan that you had originally developed.
