Preparing and adapting tools for implementation

The tools in this Toolkit vary widely in scope and focus and may not be immediately ready for practical application in all settings. Most tools will require some form of preparation or adaptation before they can be effectively applied in each context. The approach required for preparation and adaptation will vary according to the type of tool, users and respective contexts in which they are applied. Considerations around adaptation may be outlined within the tool itself, and there are several adaptation frameworks and guides for different types of material in the published literature. Below we summarize some key points and questions that may be useful for users to consider when planning to use any tool to improve quality of care. Tool application is an iterative process and will likely require more than one round of refinement and improvement in practice. This will require a level of monitoring and review to assess the tool’s effect and impact, which in turn informs any necessary adjustments in practice.

Adapting to context

The adaptation of tools to local contexts requires consideration of many factors, such as the acceptability of the methods and approach in the context of local customs and culture; the language in which the tool must be made available; alignment with structures, systems and terminology in use; accountability mechanisms; issues related to funding/cost; and the feasible scope and scale of its use in the face of competing local needs. Health systems face constant and new challenges, whether triggered by new diseases/infections, environmental disasters, sociopolitical strife, or other challenges that can strain the quality of health services. It is important to consider the utility of a specific tool in this new/challenging environment, which may require changes in the scope of the tool, engagement of stakeholders, and even processes for implementing the tool. Tools chosen for implementation may require some modification or adaptation for the specific improvement needs you may encounter, including modification of the scope or technical content to reflect proximal/local quality improvement processes, the disease burden or existing guidelines.







 

Preparing for implementation

Ahead of implementation, there will also be a need to consider both the practical requirements for successful use of the tool (e.g. human, financial or other resources; training of tool users) as well as extrinsic factors that may influence its implementation. These include stakeholder engagement, political will, social advocacy, which often helps set the environment which will either catalyse or impede improvement efforts when implementing a specific approach, method, or tool.