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Once a plan of what type of awareness raising initiative is made, it is time to take action and implement the plan.

At this stage in the process, it is important to have both good management of the resources and clear communication about what is happening with the involved stakeholders.

Pilot interventions

No matter how much you follow the guidance given in this Toolbox, it is difficult to know how well an implementation will go in real life. Unforeseen problems can arise and the needs or resources can rapidly change. By piloting a strategy with the Plan-Do-Study-Act (PDSA) cycle, the committee can test the impact of theory put into practice, make adaptations and then later scale up successful interventions.

Plan-Do-Study-Act cycle
Figure 1. Plan-Do-Study-Act cycle adapted from Institute for Healthcare Improvement .

Plan-Do-Study-Act (PDSA): 

P: Plan – prepare an action plan for implementation

D: Do – trial the actions in a specific unit or area, or with a certain group of patients

S: Study – compare the baseline and progress measures

A: Act – take action depending on the results. Continue with the trial in one unit or spread your implementation plan to other areas

Scale up interventions

Pilot projects can be scaled up in time, size or breadth of their reach. The length of time can be extended, a project can be implemented in additional units or departments, or they can reach out to additional personnel that were not targeted in the first approach. Challenges can arise when scaling up interventions that maybe did not exist in the original iteration. As with any implementation, the context and setting should always be considered and adjustments made appropriately.

Selected Resources

Resource Description
Science of Improvement: How to Improve Tool for accelerating improvement in health care, without replacing existing change models that organizations may already use (Institute for Healthcare Improvement).
Nine steps for developing a scaling-up strategy Manual to facilitate systematic planning for scaling up of interventions (WHO).

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Australian Commission on Safety and Quality in Healthcare. The OSSIE toolkit for the implementation of the Australian guidelines for the prevention of Infection in Health Care 2010 [Internet]. Commonwealth of Australia; 2010 [cited 2014 Aug 21]. Available from:
Wang S, Moss JR, Hiller JE. Applicability and transferability of interventions in evidence-based public health. Health Promot Int [Internet]. 2006 Mar;21(1):76–83. Available from:
World Health Organization - WHO. Nine steps for developing a scaling-up strategy [Internet]. WHO. [cited 2014 Aug 19]. Available from:
Institute for Healthcare improvement - IHI. Science of Improvement: How to Improve [Internet]. How to improve. 2014 [cited 2014 Aug 21]. Available from: