Phase 4: Develop an Implementation Plan

Why Phase 4 matters

A well-constructed implementation plan demonstrates readiness for EBI implementation and a high likelihood of achieving the desired outcomes. It should summarize the findings of your readiness assessments and the rationale for the EBIs chosen for each clinic.

An implementation plan promotes program success by ensuring that:

• Clinics are selected based on need and readiness.
• CRCCP recipients and participating clinics are collaborative partners in the process.
• Clinic data and processes have been assessed thoroughly.
• EBIs and process improvements match identified issues.
• EBIs are implemented in a way that is feasible and sustainable.
• Progress in implementing the plan is routinely assessed.
• Excellent communication is established from the beginning.

This is Phase 4 of the Field Guide for Assessing Readiness to Implement Evidence-Based Cancer Screening Interventions.

Phase 4 activities

Use these activities to develop an implementation plan.

4.1 Share and collaboratively interpret assessment findings

For this activity, start by meeting with the assessment team you convened in Phase 1. Share the assessment findings with your partner clinics. Plan at least 4 hours (with breaks) to share, discuss, and work together to interpret the findings.

4.2 Agree on ways to improve screening rate reporting and validation

Work with the assessment team to identify ways to improve the reporting and validation of colorectal cancer screening rates. This can be done in the meeting described in Activity 4.1 or after the assessment team has had time to think about the assessment findings.

4.3 Identify and document gaps and resources available to implement or enhance EBIs

Similar to Activity 4.2, you should meet with the assessment team to discuss any capacity gaps identified in the readiness assessment. For example, you may have found problems with information technology (IT), clinical workflow, or staff time. These gaps can hinder a clinic's ability to implement or enhance EBIs for its patients.

You and your partner clinics may not be able to address every gap identified, so work together to prioritize the most important ones. For example, you may decide to focus on improving electronic health record documentation or reminders or on training staff to improve the clinical workflow.

• Processes and protocols established for implementation.
• Clinical, administrative, and IT leadership support for implementation.
• Alignment between IT (including electronic health records) and EBIs.
• Clinician and staff support for EBI implementation, including a screening champion.
• Training available for clinicians and staff in new workflows and EBI implementation.
• Staff, time, space, and funds.

4.4 Select at least two EBIs to implement or enhance

CDC requires clinics to implement at least two of CRCCP's four priority EBIs. You and your partner clinics should choose EBIs to implement based on each clinic's priorities and the resources identified in the previous activity. If EBIs have been implemented for some time, identify which ones are appropriate for improvement or enhancement. You and your partner clinics can modify your approach at any point to improve the effectiveness of an EBI or to stop implementing an EBI because it is not addressing an identified need.

EBIs identified for implementation or enhancement should:

• Address gaps identified and agreed on as clinic priorities.
• Be feasible for the clinic to implement.
• Meet guidelines described in CDC's EBI Planning Guides.
• Have potential for long-term sustainability.

You can use the Evidence-Based Intervention Planning Guides to ensure that you implement EBIs that are important to each partner clinic. Remember that each EBI has several options. For example, patient reminders can include letters, postcards, emails, telephone calls, or text messages. Provider reminders can include flags in clients' charts, visual aids posted publicly, or information shared in care team huddles.

4.5 Document processes for implementing or enhancing EBIs

Recipients and clinic partners work together to document the process for implementing or enhancing the EBIs. Include the name of the person responsible for each step, the resources that person will use, and how the work will be done. Draw from your assessment findings to document these processes.

4.6 Develop a plan to address IT challenges

IT systems affect screening rate reporting and validation, screening workflows, and EBI implementation. Recipients can work with clinics to:

• Improve workflows.
• Improve reporting.
• Support EBI implementation.
• Capture clinic data required for monitoring progress, improvements, and annual reporting.

4.7 Plan for long-term sustainability

Planning for sustainability is critical for long-term program success. To document your plan for long-term sustainability, consider how you will maintain:

• Staff, leadership, and partner engagement.
• Systems for monitoring and evaluation to identify and address inefficiencies and document program outcomes.
• Integration of screening processes in routine clinical workflows.
• Training to ensure adherence to screening best practices.
• IT support for workflows and reporting.

The Clinical Sustainability Assessment Tool may be a useful tool to gauge the sustainability capacity for EBI implementation.

Frequently asked question

How are the readiness assessment and implementation plan related?

Readiness assessment findings inform what each clinic needs and how it will implement EBIs. Additional guidance about the implementation plan can be found in the CRCCP Manual (Part 1), which is available only to CRCCP recipients.

Next steps

If you have completed all the activities in this Field Guide, you have convened your team, designed and administered the readiness assessment, evaluated assessment data, and developed an implementation plan. Now, you are prepared to carry out the implementation plan you and your team have designed. Your program consultant is available to answer additional questions as you and your team complete the activities outlined in your implementation plan.

Congratulations on everything you have accomplished!