Agile Implementation and Management: Navigating the Fog of Implementation
You have a beautiful logic model. Your intervention has been prototyped and tested. Now you face the hardest part: implementation in the real world.
Implementation is where plans meet reality. And reality is messy.
Agile project management provides tools for navigating this messiness—maintaining direction while responding to unexpected challenges.
The Agile Manifesto for Public Health
Traditional vs. Agile Management
Traditional "Command and Control":
- Detailed upfront planning
- Sequential phase execution
- Rigid adherence to plan
- Change as deviation/failure
- Documentation over communication
Agile Adaptive Management:
- Iterative planning cycles
- Incremental delivery
- Continuous adaptation
- Change as learning
- Collaboration over documentation
Adapting Agile Values
The software industry's Agile Manifesto adapts for public health:
Original → Public Health Adaptation:
"Individuals and interactions over processes and tools" → Community relationships over administrative procedures
"Working software over comprehensive documentation" → Functioning programs over perfect grant reports
"Customer collaboration over contract negotiation" → Community co-creation over grant compliance
"Responding to change over following a plan" → Adaptive iteration over rigid fidelity
Agile Roles
Product Owner (Visionary):
- Maintains vision of program goals
- Prioritizes what to work on
- Represents stakeholder interests
- Makes scope decisions
Scrum Master (Facilitator):
- Removes obstacles for the team
- Facilitates meetings and processes
- Protects team from distractions
- Coaches Agile practices
Development Team (Doers):
- Self-organizing cross-functional group
- Determines how to accomplish work
- Commits to sprint goals
- Delivers working program components
Backlog Creation and User Stories
The Product Backlog
The backlog is the master list of everything the program needs to accomplish—not a to-do list, but a prioritized inventory of work.
Backlog Characteristics:
- Prioritized by value/urgency
- Refined continuously
- Never complete (always evolving)
- Visible to all stakeholders
User Story Format
Work items are expressed as User Stories:
"As a [user], I want [feature], so that [benefit]."
Examples:
"As a participant, I want evening class options, so that I can attend after work."
"As a facilitator, I want a training manual, so that I can deliver consistent sessions."
"As a program manager, I want attendance tracking, so that I can identify dropouts early."
Story Components
Each story includes:
Title: Brief description Description: The user story statement Acceptance Criteria: How we know it's done Estimate: Relative effort (story points) Priority: Order in backlog
Prioritization Criteria
Prioritize stories based on:
Value: How much does this contribute to outcomes? Risk: What happens if we don't do this? Dependencies: What else does this enable? Effort: How hard is this to accomplish?
High value + high risk + low effort = do first
Sprint Planning and Kanban Boards
The Sprint Cycle
Sprints are time-boxed periods (typically 2-4 weeks) to complete a set of stories.
Sprint Events:
Sprint Planning: Select stories, commit to sprint goal Daily Standup: 15-minute sync on progress and blockers Sprint Review: Demo completed work to stakeholders Sprint Retrospective: Reflect on process improvements
Sprint Planning Process
- Review backlog priorities
- Discuss upcoming stories
- Team selects stories for sprint
- Define sprint goal
- Break stories into tasks
- Commit to completion
Sprint Goal Example:
"By end of sprint, we will have completed facilitator training and pilot tested two curriculum modules."
Kanban Boards
Visualize work flow on a board:
| To Do | In Progress | Review | Done | |-------|-------------|--------|------| | Story 3 | Story 1 | Story 2 | | | Story 4 | | | | | Story 5 | | | |
Work in Progress (WIP) Limits
Limit concurrent work to prevent bottlenecks:
- In Progress: Maximum 3 stories
- Review: Maximum 2 stories
When limits are reached, team focuses on completing work before starting new items.
Benefits of Visual Management
Transparency: Everyone sees status Bottleneck identification: Work piling up reveals problems Accountability: Ownership is visible Progress tracking: Movement across board shows momentum
Implementation Mapping and Fidelity
Balancing Flexibility and Fidelity
Agile enables adaptation—but evidence-based interventions require fidelity. How do you balance these?
Fidelity Domains:
- Content: Delivering core curriculum
- Dosage: Sufficient sessions/time
- Delivery: Appropriate facilitation methods
- Quality: Competent implementation
Flexibility Domains:
- Scheduling adaptations
- Cultural customization
- Local resource substitution
- Supplementary activities
Implementation Actors
Implementation Mapping identifies key actors:
Adopters: Decision-makers who approve and support
- What do they need to say yes?
- How do we maintain their support?
Implementers: Staff who deliver the program
- What training do they need?
- What resources and support?
Maintainers: Those who sustain the program
- What capacity is needed?
- What incentives for continuation?
Supporting Each Actor
For each actor, specify:
- Performance objectives (what they need to do)
- Determinants (what affects their behavior)
- Support strategies (how we enable them)
Example:
| Actor | Performance Objective | Determinant | Support Strategy | |-------|----------------------|-------------|------------------| | Facilitator | Deliver curriculum with fidelity | Knowledge, skills | Comprehensive training | | Facilitator | Adapt materials culturally | Confidence, permission | Adaptation guidelines | | Supervisor | Monitor quality | Time, tools | Fidelity checklist | | Partner org | Provide space | Incentive | Co-branding opportunity |
Crisis Response and Adaptive Planning
Expecting Disruption
Plans fail. Budget cuts happen. Partners withdraw. Pandemics occur. Key staff leave.
Agile planning anticipates disruption rather than assuming smooth implementation.
Common Disruptions
Resource Disruptions:
- Funding delays or cuts
- Staff turnover
- Space/facility issues
- Supply chain problems
External Disruptions:
- Policy changes
- Partner organization changes
- Community events
- Public health emergencies
Program Disruptions:
- Lower-than-expected enrollment
- Higher-than-expected attrition
- Implementation quality issues
- Unexpected side effects
Building Resilience
Risk Identification: For each critical dependency, ask: "What if this fails?"
Contingency Planning: For high-impact risks, develop Plan B
Adaptive Capacity: Build slack into timelines and budgets
Communication Protocols: Define how disruptions are communicated and escalated
Pivoting While Preserving Mission
When disruption occurs:
- Assess impact: What's affected? How severely?
- Preserve core: What must we maintain to achieve mission?
- Identify alternatives: What other approaches could work?
- Decide and communicate: Make clear decisions, communicate widely
- Implement and monitor: Execute pivot, watch for new issues
Example Pivot:
"COVID-19 prevented in-person classes. We preserved core curriculum content by rapidly developing virtual delivery. We adapted discussion activities for Zoom. We maintained dosage by increasing session frequency. We lost some social support elements but preserved educational content."
The Retrospective Discipline
After each sprint (and after disruptions), conduct retrospectives:
What went well? (Continue doing) What didn't go well? (Stop or change) What will we try differently? (Experiment)
This continuous learning builds organizational capacity to handle future challenges.
Continue Your Learning
This article is part of an 8-week course on Adaptive Program Planning in the Digital Age. Learn systems thinking, AI-augmented assessment, Human-Centered Design, and Agile implementation for modern public health practice.