strategic implementation case study

Bringing Strategy To Life

After developing a strategy with OTM, leaders at CSL Behring Global Finance needed a way to implement their strategy to enhance awareness and effect real change amongst everyone within the organization. Leadership realized that they needed a strategy implementation process that was both integrative and comprehensive in order to achieve their goals.

What we did:

Leaders sought to increase awareness at all levels within the function. With this goal in mind, a major portion of the implementation process was to conduct small-group conversations. Together with OTM, they developed a plan that would incorporate a set of distinct protocols to use during these conversations.

The Result:

The results following this active process were clear. 100% awareness was present throughout every level of the organization, to the point where strategy was built into everyday business conversation. A strategy that is recognized by all throughout the business is much more likely to remain sustainable for years to come. What resulted from this redesign was an organization actively immersed in its own strategic intent, and fit for purpose. Success!

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Organization design is not about organization charts and personalities. It is about ensuring your operating model is ‘fit for purpose’, aligns to your organizational goals, and helps with strategy implementation.

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5 Real-Life Examples of Effective Strategy Implementation

Shannon Ledwith

Shannon works with the Sales Team to generate high quality leads and provide insights on market trends.

Gain insights from 5 real-life examples where strategic implementation transformed businesses significantly. Contact us for more information!

Table of Contents

Every organization must make a big strategy shift at some point or another to stay at the forefront of its industry. In some cases, a big strategic change may also be necessary to simply survive. Successfully shaping and executing a new strategy is challenging, but there are a few standout examples we can all learn from.

ClearPoint Strategy provides tools that can make this process more efficient and measurable, ensuring that strategies are not only planned but also successfully implemented.

See ClearPoint Strategy in action! Click here to watch a quick DEMO on the software

Here are 5 companies with good strategy execution , coming from different markets and industry positions.

1. The City of Germantown, Tennessee

• Their approach transformation: They transitioned to a corporate model and treated citizens as customers and municipal services as market offerings.
• Their vision crafting: They developed "Germantown Forward 2030" through a collaborative process that involved input from over 200 citizens.
• How they achieved success: By consistently monitoring and transparently communicating progress, Germantown enhanced its operational efficiency and received prestigious national recognition.

The City of Germantown took a unique approach to planning and strategy execution because it chose to follow a corporate framework versus a more traditional local government model. The city views its citizens as customers, staff as teams, and operations as goods and services.

This shift in thinking came about in 2015 after city administrators read the book, “We Don’t Make Widgets: Overcoming the Myths that Keep Government from Radically Improving.” The general idea is to build and successfully execute a strategy around what citizens want, focusing on outcomes. For example, citizens don’t want a bigger police force; they want whatever ensures a safe community and low crime rate.

The city’s first step in taking a “for-profit” approach to organizational strategy was to create the “Germantown Forward 2030” vision. The 2030 vision was built over a methodical, one-year process by a 30-person steering committee and incorporated input from more than 200 citizens. Once the vision was finalized, a citizen task force created a measurable, actionable strategic plan with objectives, projects, and performance measures .

Every quarter, Germantown’s city administrator meets with department directors to review progress and results, which are then shared publicly with citizens via a community dashboard built by ClearPoint Strategy . Strategic planning isn't always easy, but the City found great ways to overcome the biggest pain points in the process to achieve success.

Over the past four years, Germantown has seen success with this approach to planning and strategy execution. The city operates more efficiently and cost-effectively, and there is greater transparency both internally and externally on goal progress. The results have been so positive that Germantown won a 2019 Malcolm Baldrige National Quality Award from the U.S. Department of Commerce. The city is one of only four municipalities nationwide to have ever earned this presidential-level honor, which is the highest level of recognition for performance excellence that a U.S. organization can receive.

ClearPoint Strategy supports such public sector initiatives by providing robust tools for strategic planning and community engagement, tracking progress transparently.

2. Best Buy

• How they revitalized retail: They reinvented their business model, focusing on enhancing the customer experience and competing effectively in the digital age.
• Their strategic initiatives: Best Buy launched the Renew Blue strategy, emphasizing customer service, employee engagement, and partnerships with tech giants.
• Their success Metrics: The strategy led to sustained sales growth, improved profitability, and increased customer and employee satisfaction, marking a significant turnaround for the company.

Best Buy is an ideal example of a company that completely reinvented itself and found the secrets to successful strategy execution. In 2012, Best Buy had plummeting profits, sales, and stock prices. It had lost relevance and was failing to compete with Amazon.

In a last-ditch effort to survive, the company hired Hubert Joly as its CEO. Joly proved to be a visionary leader, most notably for launching Best Buy’s Renew Blue transformation strategy. Here are the five key goals of the strategy, including some of the most successfully executed initiatives for each:

• Reinvigorate the customer experience. Best Buy implemented a price-match policy, improved the online and in-store shopping experiences, offered free in-home technology consultations, and provided 24/7 customer tech support.
• Attract “ transformational business leaders ” and energize employees. The company enhanced employee training, expanded employee benefits, provided paid time off for part-time workers, and offered backup child care.
• Work with vendors to innovate and drive value. The company invited leading technology brands to create their own in-store kiosks and established a groundbreaking partnership with Amazon to sell Amazon Fire TVs.
• Increase the company’s return on invested capital by growing revenue and efficiency. Best Buy shut down stores, exited geographic regions, and cut administrative and non-product costs.
• Make the world a better place through recycling efforts and giving people access to technology. Best Buy significantly reduced its carbon footprint and introduced the largest consumer electronics recycling program in the U.S.

The Renew Blue strategy planning and execution has been an unheralded success. When Joly transitioned from CEO to executive chairman in June 2019 , Best Buy had five consecutive years of comparable sales growth, increased its non-GAAP operating income rate, achieved $1.9 billion in cost savings and efficiencies, improved profitability and shareholder return, increased its Net Promoter Score, and hit record-low employee turnover rates.

By using strategic tools like ClearPoint Strategy , companies can monitor such comprehensive transformations in real-time, ensuring that every strategic initiative is aligned with corporate goals.

Claim your FREE 41-page Strategy Execution Toolkit for enhanced strategic performance

3. origin bank.

• Their strategic overhaul: They discarded their old strategic plan in favor of a new, data-driven approach that emphasized innovation and market responsiveness.
• Their strategy execution process: Origin Bank adopted a detailed "waterfall" strategy, breaking down broad goals into specific, actionable steps.
• Banking on results: Their new strategy enhanced profitability and customer service, showcasing the bank's adaptability and forward-thinking approach.

In 2017, Origin Bank realized it was losing traction in the market and wasn’t keeping up with the banking industry’s pace of innovation. The bank decided to completely scrap its strategic plan and start fresh with a new strategy that focused on:

• Consolidating strategic priorities
• Aligning the vision and strategy
• Analyzing results with data—primarily, metrics tied to strategic outcomes
• Reviewing past performance and predicting future performance
• Gaining leadership buy-in

Using these guidelines, Origin Bank began its strategy execution process by whiteboarding its high-level goals. From there, it became a “waterfall” approach where goals were broken down into objectives, objectives divided into projects, and projects into action items. Origin Bank also developed measures to track progress for each of those waterfall elements.

Companies with good strategy execution always take this next step, too: developing a reporting process to consistently monitor and evaluate performance. Origin Bank established three meetings, each with a distinct purpose, to be held each quarter. The focus of the meetings ranges from a general performance overview of the strategy to detailed “red alerts” indicating where strategic elements are off track. Every quarter after the meetings, proposed changes to the strategy are presented to Origin Bank’s board of directors for approval.

Changing its strategy has helped Origin Bank increase its profits and customer service levels. Overall, the bank has been able to take an innovative approach to its operations with a strategic plan that reflects its vision, includes more accountability and collaboration, centralizes strategy execution management, and requires all changes to be vetted through a “decision tree.”

With ClearPoint Strategy , financial institutions can manage and track their strategic execution, ensuring alignment across all levels of the organization.

See ClearPoint Strategy in action! Click here to watch our quick 6-minute demo

• Pivoting to services: IBM shifted from a hardware-centric model to a service-oriented approach, focusing on holistic solutions for clients.
• Their strategic transformation: Under Louis Gerstner's leadership, IBM revamped its corporate strategy, aligning employee incentives with company performance and streamlining operations.
• The turnaround triumph: This strategic pivot is celebrated as one of the greatest corporate turnarounds, with IBM achieving substantial growth in income, revenue, and market value.

In the 1980s, IBM was the dominant technology brand, with sky-high revenue and market share. But the company failed to evolve along with customers’ computing needs, and it became siloed and dependent on hardware sales. IBM’s power position eroded over the next decade, culminating with the announcement of an $8 billion second-quarter loss in 1993 (the largest in corporate America’s history at the time).

Louis Gerstner, brought on as IBM’s CEO in 1993, led the company’s transformational shift from products to services. In essence, IBM changed its strategy from being a multinational technology provider to a holistic, shared-services partner. Core elements of the strategy were to:

• Offer the best technology stack to clients (even if it included competitor products) versus pushing standalone hardware sales.
• Tie employees’ pay to company performance (versus department performance).
• Consolidate marketing and branding efforts under one agency, instead of 40+ agencies.
• Standardize processes and reporting procedures for all internal functions and consolidate those activities in key centers.
• Divest low-growth, low-margin product lines and technologies (e.g. memory chips, printers, personal computers, etc.).

IBM’s new strategy worked and is hailed as one of the greatest corporate turnarounds of all time. IBM quickly proved that the services business was more viable than hardware product sales, successfully diversifying its offerings and investing in strategic growth areas. During Gerstner’s tenure from 1993-2001, the company increased its income from $3 billion to $7.7 billion, revenue from $64 billion to $86 billion, and stock market value to $180 billion.

Tools offered by ClearPoint Strategy can aid such significant transformations by aligning company-wide efforts and resources effectively.

5. Cobb EMC

• Their strategic realignment: Cobb EMC redefined its strategy to better align with organizational goals and values, focusing on operational efficiency and community engagement.
• Their implementation and innovation: They introduced project-based operations and the "Idea Machine" for employee feedback, fostering a culture of continuous improvement.
• Empowering success: The new strategy led to significant cost savings, reduced rates for customers, and increased charitable contributions, alongside boosting employee morale.

Cobb EMC , a not-for-profit electric cooperative, made a distinct strategy shift in 2014 after consistently underperforming and failing to achieve key goals. There was a lack of alignment across the organization, with no clarity on whether they were making progress on the strategy and aligning departments to corporate results.

Cobb EMC deliberately and thoughtfully formed a new strategy that would play out over the next few years:

• 2014: The board of directors and senior leadership completed a SWOT analysis , using it to develop new strategic goals and update the company’s core values.
• 2015: Leadership reviewed the strategic goals and aligned them with company objectives. Cobb EMC also brought in a consulting group to complete another, more extensive SWOT analysis.
• 2017: Cobb EMC consolidated all strategy-related data, creating scorecards for goals at the department, division, and corporate levels.
• 2018: Newly appointed CEO Peter Heintzelman increased the company’s focus on project-based operations, dedicating resources to align department-level projects to organization-level strategies. The “Idea Machine” is introduced, allowing Cobb EMC staff to anonymously submit feedback and suggestions to leadership.

Taking these steps to create a new strategy was hugely beneficial to Cobb EMC. The company had centralized, real-time data for the first time and created its first three-year strategic plan that closely aligned departmental projects and corporate goals. Within two years of executing its plan, Cobb EMC was able to uncover new operational efficiencies and cost savings : The company saved $8 million through restructuring, lowered utility rates by $5 million for its customers, and gave $1.3 million to charity. Additionally, Cobb EMC was able to increase staff morale levels throughout these significant changes.

ClearPoint Strategy provides platforms that facilitate such strategic alignment and execution, enhancing both internal and external transparency.

From Planning to Performance: The Power of Strategy Execution

Whether the goal is to stay at the front of the pack or avoid extinction, strategy shifts are critical for organizations in every industry. As you’ve read, this process can take many forms—what’s most important is that you execute the new strategy you carefully created.

Get your FREE eBook on 8 effective strategic planning templates here

The secrets to successful strategy execution.

Successful strategy execution is not just about what you do, but how you do it. The key lies in aligning your organization's culture, resources, and processes with your strategic goals. Regularly monitoring progress, adapting to feedback, and maintaining clear communication channels are also crucial to turning strategic plans into tangible outcomes.

By integrating these key principles, your company can achieve its strategic goals and foster a culture of continuous improvement and innovation. Discover how to elevate your strategy execution by exploring the 5 secrets of strategy execution . This guide could be the catalyst your organization needs to refine its execution approach and secure a competitive edge in your industry.

The Components of Effective Strategy Execution

Effective strategy execution is built on a foundation of clear objectives, precise planning, and robust communication. It involves:

1. Strategic clarity and commitment : Ensure that every member of the organization understands the strategic goals and their role in achieving them. Secure commitment from all decision-makers and stakeholders to align efforts and foster a unified approach to execution.

2. Alignment of resources and roles : Align jobs, resources, and processes with the strategic objectives to ensure cohesive movement towards the goals. Design roles and responsibilities to optimize performance in line with the strategy.

3. Effective communication and engagement: Maintain clear and continuous communication to empower employees with the knowledge of how their work contributes to the broader strategy. Foster a culture of engagement and motivation, celebrating milestones and encouraging team involvement in the strategic journey.

4. Execution framework and adaptability: Implement a structured approach to execution, like the "waterfall" method, to break down strategic goals into actionable steps. Regularly monitor progress using key performance indicators ( KPIs ) and be prepared to adapt the strategy based on performance data and evolving circumstances. Use a tool like ClearPoint Strategy to enhance strategy execution. ClearPoint Strategy is a comprehensive platform for aligning goals, tracking progress, and adapting plans based on real-time data and insights.

5. Balancing innovation with control: Encourage innovation and experimentation within the framework of the strategic plan, allowing for creativity while maintaining focus on the strategic objectives. Develop processes to evaluate and integrate new ideas and opportunities, ensuring they contribute positively to the strategic goals.

Elevate Your Strategy Execution with ClearPoint Strategy

Ready to transform your strategic vision into impactful results? Discover how ClearPoint Strategy can revolutionize your approach to strategy execution. With ClearPoint, you can seamlessly align your goals, monitor progress with real-time insights, and adapt your strategy to meet the ever-changing demands of your industry.

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How do you measure strategy implementation.

To measure strategy implementation:

- Define KPIs: Establish Key Performance Indicators (KPIs) that align with strategic goals. - Set Milestones: Break down the strategy into specific, measurable milestones. - Use Dashboards: Implement performance dashboards to track progress in real-time. - Regular Reviews: Conduct regular progress reviews and status meetings. - Feedback Mechanisms: Gather feedback from stakeholders to assess effectiveness. - Benchmarking: Compare performance against industry standards or past performance.

Why is strategy implementation important?

Strategy implementation is important because:

- Achieves Goals: Translates strategic plans into actionable steps, ensuring goals are met. - Aligns Resources: Ensures resources are utilized efficiently to support strategic objectives. - Enhances Accountability: Holds individuals and teams accountable for delivering results. - Improves Performance: Drives continuous improvement through regular monitoring and adjustments. - Maintains Focus: Keeps the organization focused on long-term objectives despite short-term challenges. - Facilitates Change: Helps the organization adapt to changes in the market or environment.

What is the strategy implementation process?

The strategy implementation process includes:

- Define Objectives: Clearly articulate the goals and objectives of the strategy. - Develop Action Plans: Create detailed plans outlining the steps needed to achieve the objectives. - Allocate Resources: Ensure necessary resources (financial, human, technological) are available. - Communicate: Share the strategy and action plans with all stakeholders to ensure understanding and buy-in. - Execute: Implement the action plans, following the defined steps and timelines. - Monitor and Review: Regularly track progress, measure performance against KPIs, and adjust plans as needed.

Why does strategy implementation fail?

Strategy implementation fails due to:

- Lack of Clear Objectives: Undefined or vague goals lead to confusion and misalignment. - Poor Communication: Failure to communicate the strategy effectively to stakeholders. - Inadequate Resources: Insufficient allocation of financial, human, or technological resources. - Resistance to Change: Organizational culture and employee resistance hinder implementation. - Lack of Accountability: No clear ownership or accountability for executing the strategy. - Insufficient Monitoring: Failure to regularly track progress and adjust plans accordingly.

Who is responsible for strategy implementation?

Responsibility for strategy implementation typically involves:

- Executive Leadership: Sets the strategic direction and ensures alignment across the organization. - Middle Management: Translates strategic goals into operational plans and oversees execution. - Project Managers: Manage specific initiatives and projects that support the strategy. - Employees: Execute the tasks and activities outlined in the action plans. - Strategy Office: In larger organizations, a dedicated strategy office may coordinate and monitor implementation efforts. - Stakeholders: Provide input, support, and feedback to ensure successful implementation.

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A case study for strategic planning implementation

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Rocky Craley, Vice President ( Email )

“Making a strategic plan is the easy part… implementing it, well, that’s a whole different ball game.”

At a glance.

SWBNO partnered with Raftelis to develop a comprehensive strategic plan addressing operational, financial, and customer service challenges.

The plan's implementation focuses on leveraging internal expertise, setting clear metrics, and using data to drive decision-making and measure progress.

Ongoing evaluation, adaptation, and leadership commitment are essential for successful strategic plan execution.

The Sewerage and Water Board of New Orleans (SWBNO) is an organization employing more than 1,300 high-performing individuals who work together to produce drinking water, clean wastewater, and move stormwater for nearly 400,000 residents and millions of visitors each year. Raftelis worked with SWBNO to start a transformational journey just a few years ago by undertaking a comprehensive strategic planning effort where stakeholders met, discussed, and identified key focus areas, goals, and tactics to elevate their utility services.

However, wisely, SWBNO realized that identifying, defining, and creating a strategic roadmap was only the beginning. To affect change within their organization and community, SWBNO needed to be committed to the implementation and execution of the plan. They understood that the integration of the plan into the culture of the organization was the only way to show progress and, ultimately, success.

Strategic Plan Development

SWBNO, like many utilities, has long faced challenges: operational, financial, geographic, and workforce-based, to name a few. In 2021, the utility, with the assistance of Raftelis, initiated a strategic planning process to serve as a catalyst for organizational change and to guide the next phase of rebuilding the organization for the future. The plan directs the organizational goals, budget priorities, and progress monitoring in the organization’s long-term focus areas. While SWBNO did not have a formal strategic plan before this effort, considerable activities were underway across the organization to improve operations, resiliency, and customer satisfaction.

SWBNO’s planning process involved input from a broad group of internal and external stakeholders, including SWBNO’s Board of Directors and the Board’s strategy committee, the Executive Director and leadership team, employees (through focus groups and an employee survey), and other local community and business leaders. The goal of the strategic planning process was to build trust among internal and external stakeholders, develop actionable strategies and measurable objectives, and increase communication and collaboration across the organization.

SWBNO Strategic Plan Focus Areas

After considering all feedback, Raftelis worked with SWBNO to develop and ultimately adopt the 2022-2027 Strategic Plan . The plan highlights six focus areas. Each focus area is further defined by a list of key issues, goals, and intended results.

• Ensuring Financial Stability
• Advancing Technology Modernization
• Addressing Workforce Development and Enrichment
• Elevating Customer Service and Stakeholder Engagement
• Improving Infrastructure Resiliency and Reliability
• Driving Organizational and Operational Improvement

Implementation  

After the plan was developed, implementation became the priority. SWBNO staff began the implementation effort by creating the first of what will be annual work plans against the five-year strategic plan’s six focus areas.

The focus areas contain a series of initiatives and projects that, when implemented, will move SWBNO toward the achievement of its desired outcomes. Elements of the implementation process for SWBNO include leveraging internal subject matter expertise and continuing to use key staff members and small teams that are knowledgeable, energized, and committed to the achievement of the strategic plan. These subject matter experts and teams developed detailed implementation plans that advance the organization toward goal achievement.

SWBNO is holistically evaluating performance by defining success for each focus area, tracking relevant metrics, identifying targets or goals for the desired outcomes, and measuring progress on a grading scale. The utility is currently using a cloud-based performance management software platform called Ellio to measure both the progress of tactical level implementation as well as their performance around several key performance indicators (KPIs) and inform executive staff and the Board on the overall effectiveness of implementing the plan. The example below shows two years of historical data for performance associated with the average speed of answering customer service calls and even layers in benchmarking data from the American Water Works Association’s Benchmarking Survey for comparison.

The Path Forward

SWBNO is committed to the success of the strategic plan. Since the plan is relatively new, implementation efforts have been ongoing, including changes and enhancements to metrics identification, tracking, and reporting. Overall, with each passing month, quarter, and year, the commitment to performance tracking improves and momentum is building. SWBNO staff are empowered to make a change, and with interdepartmental coordination, process transparency, and accountability, the path forward is clear and bright.

The approach in 2024 will include work sessions with executive leadership and biannual meetings of the full strategic plan leadership. Clear and actionable tactics that directly relate back to the challenges identified in the initial plan are imperative this year, as focus area leads are given more autonomy in reporting and reviewing metrics. SWBNO is looking forward to the new and exciting ways the ongoing implementation of the strategic plan impacts the utility and ultimately elevates SWBNO’s service to its customers.

Implementation Highlights and Key Takeaways  

• Be open to the adaptation of the implementation plan during the process.
• Hold regular work sessions with executive leadership to ensure accountability and an understanding of the progress and alignment to the goals of the organization.
• Hold biannual meetings with the full strategic plan leadership to help everyone see how all the pieces fit together and are important to the overall progress.
• Define clear and actionable tactics that relate directly back to the challenges identified in the initial plan. This helps staff focus and prioritize the goals and clarifies why they are working on the initiatives.
• Give the focus area leads the autonomy to report and review metrics. The focus area leads are closer to the teams and can help motivate progress more strongly than someone from outside the group. Begin using the data for decision-making and clearly communicate results to staff so they can see how the data is useful to the organization.
• Celebrate the successes and achievements along the way. Leaders should communicate to staff that their work is important and leads to improvement and change within the organization.

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Infrastructure is essentially a series of complex, valuable parts, or assets, and systems that relate in such a way as to provide the services necessary to sustain life, economy, and community. Once those assets are defined, an organization must next understand the condition of those assets and the level of service they are expected to perform. This can then inform investment, maintenance, and operational decisions.

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Succession Planning: A Nantucket Story

Succession planning is more important than ever to maintain effective services due to an aging workforce and strong private sector competition for local government agencies. A succession plan should identify critical positions within the organization where turnover poses the biggest risk of disrupting operations. Then the plan should develop pathways to fill these positions when they become vacant.

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• What is strategy implementation? 6 key ...

What is strategy implementation? 6 key steps to success

Strategy implementation is the process of turning your strategic plan into action. Whether you’re executing a new marketing plan to increase sales or introducing a new work management software to increase efficiency—your plan is only as valuable as the implementation. In this article, we cover the pitfalls of strategy implementation and how you can avoid them. Plus check out different frameworks associated with this process to set you up for success.

Having a strategic plan is great, but unless you have the bandwidth, resources, and support to implement your plan it’s not going to drive actual change in your organization.

We’re going to cover the key steps of strategy implementation, including potential pitfalls and how you can avoid them, and introduce you to a few frameworks to help you successfully implement any strategy you’re currently working on.

The 6 key strategy implementation steps

Before you can implement your strategy you need to create a strategic plan .

Your strategic or implementation plan outlines the steps your team or organization needs to take in order to achieve a goal or objective. Your implementation plan is the roadmap to a successful strategy execution and should include the following steps:

Define your goals

Conduct proper research

Map out any risks

Schedule all milestones

Assign tasks

Allocate helpful resources

Once your strategic plan is set, it’s time to get it on the road! There are six steps to follow on your way to a successful implementation.

Step 1: Set and communicate clear, strategic goals

The first step is where your strategic plan and your strategy implementation overlap.  

To implement a new strategy, you first must identify clear and attainable goals. As with all things, communication is key. Your goals should include your vision and mission statements , long-term goals , and KPIs . 

The clearer the picture, the easier the rest of your strategy implementation will be for your team and organization—simply because everyone will be working towards the same goals. 

Step 2: Engage your team

To implement your strategy both effectively and efficiently , you need to create focus and drive accountability. There are a few ways in which you can keep your team engaged throughout the implementation process:

Determine roles and responsibilities early on. Use a RACI matrix to clarify your teammate’s roles and ensure that there are no responsibility gaps.

Delegate work effectively . While it can be tempting to have your eyes on everything, micromanagement will only hold you back. Once you’ve defined everyone’s roles and responsibilities, trust that your team will execute their tasks according to the implementation plan.

Communicate with your team and ensure that everyone knows how their individual work contributes to the project. This will keep everyone motivated and on track.

Step 3: Execute the strategic plan

Allocate necessary resources —like funding for strategic or operational budgets—so your team can put the strategic plan into action. If you don’t have the right resources you won’t be able to achieve your strategic plan, so this should be a top priority. Here’s how you can ensure that your team has the resources they need:

Start with the end in mind to effectively align your project’s objectives, key deliverables, milestones, and timeline.

Identify available resources like your team’s capacity, your available budget, required tools or skills, and any other unconventional resources

Define a clear project scope so you know exactly what your project needs when.

Share your project plan with everyone involved in the implementation process using a work management tool.

The better built out your strategic plan is, the easier it will be to implement it.

Step 4: Stay agile

You’ll inevitably run into issues as you begin implementing your strategy. When this happens, shift your goals or your approach to work around them. 

Create a schedule so you can frequently update the status of your goals or implementation strategy changes. Depending on the strategy you’re implementing, you can create weekly, monthly, or quarterly project status reports . Share these updates with your external stakeholders, as well as your internal team, to keep everyone in the loop.

Having a central source of truth where you can update your team in real time will help you streamline this process. Asana’s work management software allows your team to coordinate projects, tasks, and processes in real time but also gives you the freedom to get work done asynchronously —providing everyone with the visibility they need to understand who’s doing what.

Step 5: Get closure

Once you implement the strategy, connect with everyone involved to confirm that their work feels complete. Implementing a strategy isn’t like a puzzle that’s finished when the last piece is set. It’s like planting a garden that continues to grow and change even when you think you’re done with your work.

Getting closure from your team will be the second to last milestone of your strategy implementation and is a crucial step toward completion.

Step 6: Reflect

Conduct a post-mortem or retrospective to reflect on the implemented strategy, as well as evaluate the success of the implementation process and the strategy itself. This step is a chance to uncover lessons learned for upcoming projects and strategies which will allow you to avoid potential pitfalls and embrace new opportunities in the future.

What you need to implement a strategy

No matter how well thought out your strategy is, you’ll need these five key components to successfully implement any strategy.

You’ll need a team that not only understands the strategy you want to implement but also has the skills and bandwidth to support you. Appoint, hire, and train the right people for the job and ensure that the competencies needed to succeed are present in your project team.

Asana’s Customer Success team was invaluable to our implementation process. They took the time to understand our business and showed us how to create practical workflows and processes to get the most out of Asana. We couldn’t have done it without them.”

Effective resource allocation is one of the most important parts in strategy implementation. Resources can be both financial (e.g., cost of labor) and non-financial (e.g., time to implement strategy).

Organization

Everyone in your organization needs to know what their responsibilities are so they can be accountable for their part in implementing the strategy. This also means that the chain of command has to be defined and communicated so everyone knows who to communicate with during the implementation process.

The tools, capabilities, and systems you’ve put in place are another key component. You have to know what the functions of each of these systems are and how they will support your strategic management process during and after the implementation. 

The final key component is the organizational culture within your company. Rolling out new strategies can be confusing and stressful for teams. Ensuring that everyone knows what they need to know and feels valued and included is crucial for a successful and effective implementation.

McKinsey’s 7S framework

McKinsey & Company is a world-renowned management consulting firm that, among other things, created a framework of seven factors needed to implement a strategy successfully.

The factors can be split into hard elements (strategy, structure, and systems) and soft elements (shared values, skills, style, and staff). While the hard elements are easy to identify and influence directly, the soft elements are less tangible and typically influenced by the company culture versus a manager or other direct contact.

Let’s take a quick look at the McKinsey 7S Model, beginning with the hard elements:

Strategy: Your organization’s plan to establish or maintain a competitive advantage over others in the field

Structure: Your company’s organizational structure

Systems: The day-to-day procedures and activities performed by your teams

These are the soft elements of the framework:

Style: The leadership style in your organization

Staff: Your team and their general capabilities

Skills: Your team’s competencies and skills

Shared values: Your organization's core values

You can apply this framework to your strategy implementation process by looking at your organization’s shared values first and ensuring that they align with your hard elements. Next, identify how well your hard elements support one another and where changes could improve their interaction. After you’ve established that, do the same for your soft elements.

This analysis helps you identify elements that are working well and elements that need improvement. Applying this framework to your strategic plan and strategy implementation process helps you get a better feel for how well your organization can implement change.

The three Cs of implementing strategy

Business consultant and author Scott Edinger coined the three Cs of implementing strategy —clarity, communication, and cascade. They’re the three steps you should keep in mind if you want to implement your strategy successfully.

Let’s take a closer look at what they represent.

Clarify your strategy. Ideally, strategy was well received in the boardroom and your stakeholders and executives are on board. However, if it’s not clearly defined, you may lose your mid-level and frontline team members along the way. Your team can only implement a strategy they understand, so be clear with what your goals and strategic objectives are.

Communicate your strategy. A poster, announcement, or newsletter won’t be enough to communicate a new strategy to your organization. Diversify your communication strategy to ensure that teams know what’s going on and create opportunities to ask questions so everyone feels like they’re part of the process.

Cascade your strategy. A well implemented strategy cascades through your entire organization. Involve your organization’s managers and ensure that they understand the strategy so they can forward relevant information, tactics, and processes to their teams. While you may have informed your organization during the communication stage, this step is crucial in aligning every last teammate with your new strategy.

Next, let’s have a look at some of the challenges you’ll encounter during strategy implementation.

Strategy implementation pitfalls and solutions

A big undertaking like the implementation of a new strategy comes with its fair share of obstacles. Below are four of the most common pitfalls you’ll encounter when implementing a strategy plus a few tips on how you can create solutions for your team. 

1.  Overwhelming or meaningless strategic plan

Problem: If the strategic implementation lacks meaning and potential or if there is an overwhelming number of puzzle pieces to consider, it can really put a wrench in your implementation. 

Solution: Use SMART goals to ensure that your strategic plan is specific, measurable, achievable, realistic, and time-bound. This framework will ensure that your strategic plan is both meaningful and possible to implement.

2. No implementation in sight

Problem: It’s great to have a strategic plan but without the resources and support from upper management, the implementation may never happen.

Solution: Your strategic plan should include clear goals, consequences, and requirements to inspire the actual implementation of your strategy. The clearer the document, the easier it will be to get the resources needed to turn it into action.

3. Lack of communication and ownership

Problem: A team that’s not 100% sure what the strategy actually is and doesn’t feel confident about their respective tasks can make your implementation process come to a halt before it’s even begun.

Solution: Clearly define each team member's responsibilities and delegate any relevant work. This gives team members a sense of ownership over the outcome of the strategy implementation. Ensure that your teammates have the authority and resources to execute their tasks.

4. Lack of accountability and empowerment

Problem: Low visibility and a lack of accountability can make your team feel helpless. 

Solution: Schedule regular strategy review and team meetings to discuss each team member’s progress, issues that are arising, and strategy shifts that can contribute to the success of your implementation. Track the progress to give your team a sense of accomplishment whenever they check off another goal they’ve met.

As long as you’re aware of the challenges, you can tackle them head on and avoid unnecessary setbacks.

Plan, implement, celebrate

Change isn’t easy but in order for your team to grow, it’s crucial that your organization does too.

Whether you’re in the midst of developing your strategic plan with a small project team or you’re already communicating your strategy to the entire organization, reliable project management software is critical in ensuring that everyone has access to the resources they need.

And once the strategy is successfully implemented, don’t forget to give yourself and your team a pat on the back. After all, celebrating milestones like these is important too!

Sources: Harvard Business School | MindTools | OnStrategy

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Gagnon Associates

Management & Organizational Consulting

Case Study:  Strategic Plan  Development & Implementation

This Case Study describes how Gagnon Associates helped in the development and implementation of this client’s first, comprehensive strategic plan.

The Company

America’s oldest direct-mail catalogue marketing company.

The Situation

After years of enviable growth, the company encounters a business down turn and withstands the first layoffs in its history.  Impact on company morale is significant, and though the imperative to resolve on a future course is clear, consensus on future direction remains to be achieved.  This will also be the first time the company has developed a comprehensive plan for the entire enterprise vs. managing its separate business channels independently.

The Approach

Orvis engages Gagnon Associates to lead the executive team and a select group of additional senior managers through a comprehensive team-based Strategic Planning Process . Extensive, confidential interviews of the Executive Team provide, in the words of the CEO, a “needed and welcomed opportunity to ‘go to confession,’” while a consolidated reporting of key interview themes provides them with “new and valuable insights” critical to moving forward.

Guided by Gagnon Associates, executives conduct a comprehensive Scan of the Orvis operating environment and an assessment of the company’s strengths, weaknesses, opportunities and threats to serve as a context for planning.  Next, over a two-to-three month period Gagnon Associates leads Orvis senior executives through the rigorous planning process itself.  Executives achieve consensus on company direction and, for the first time, develop concrete, corporate-wide goals, strategies, initiatives, timetables and accountability structures to achieve their common vision.

The Results

Within little more than a year, the COO reports that, due to the “heightened focus” on growth and profitability resulting from the plan, a key distribution channel experiences an 80% increase in sales.  A second channel is forecast to grow by 20%.  A comprehensive brand-building initiative is completed along with the complete revitalization of the human resource function and associated programs.

A reengineering initiative in the company’s merchandise operations/sourcing function transforms the new product development process and achieves 70% of the resulting cost-savings targeted for the next year by year end of the current year.

The CEO credits the Strategic Planning Process with providing “valuable insights that encouraged me to change my style and approach to leading the Company.”   He asserts, “The Planning Conferences themselves provided the leadership group some valuable benefits, especially in the area of clarifying and improving the effectiveness of how we make high-level decisions . . . . We do a better job of ensuring clear disposition of issues and avoiding ‘drift’ than we did before.”

The plan results in a strategic refocusing of company direction, a revitalized organization, and improved business results described by the client as nothing less than “a turnaround.”

Strategic Implementation of Enterprise Architecture: Navigating Challenges and Embracing Opportunities

• November 16, 2023

• Sourabh Hajela
• Executive Editor - CIO Strategies

This document provides a strategic lens for Enterprise Architecture implementation, highlighting essential methods to overcome challenges and leverage opportunities.

This document offers a strategic perspective on implementing Enterprise Architecture, focusing on navigating its challenges and capitalizing on opportunities. It presents a nuanced understanding of aligning business and technology, underpinned by a case study and thorough research.

The document addresses the urgent need for companies to stay agile and competitive in an ever-changing business environment. Enterprise Architecture (EA), with its promise of aligning business processes with technology, holds immense potential. Yet, realizing this potential is not without its challenges.

Many organizations, despite their keen interest and substantial investments in EA, find themselves struggling with its complex implementation. Misconceptions about the role and purpose of EA often lead to missteps, with the repercussions being more than just theoretical. These implementation misfires can result in increased costs and extended timelines, significantly impacting business operations.

This document offers a pragmatic approach to these challenges. Anchored in a case study from a leading global manufacturing company, it provides a realistic perspective on the common pitfalls and overlooked aspects of EA implementation. By blending insights from industry stakeholders with an extensive review of existing literature, the guide formulates a comprehensive model. This model pinpoints the crucial factors for successful EA implementation, offering practical strategies to capitalize on opportunities and avoid common traps.

For professionals in the field of business-IT alignment, this document serves as an invaluable asset. It equips them with the knowledge and tools to navigate the complexities of EA implementation, turning potential challenges into opportunities for growth and innovation.

Main Contents:

• Overview of Enterprise Architecture Implementation Challenges : An in-depth look at the complexities and common obstacles faced by organizations in implementing EA.
• Case Study Analysis : A detailed examination of a global manufacturing company's experience with EA implementation, providing real-world insights and lessons.
• Critical Success Factors for EA Implementation : Identification and exploration of key factors that significantly influence the success of EA initiatives.
• Strategies for Navigating EA Implementation : Practical strategies and approaches for effectively managing the implementation process of Enterprise Architecture.
• Alignment of Business and IT through EA : Discussion on how to align business processes and objectives with IT infrastructure using EA.

Key Takeaways:

• Proactive Problem Identification : Understanding the common challenges in EA implementation allows organizations to preemptively address potential issues.
• Learning from Real-World Experiences : The case study provides valuable insights into practical challenges and successful strategies, offering a template for other organizations.
• Importance of Critical Success Factors : Recognizing and focusing on critical success factors is essential for the successful implementation of EA.
• Effective Communication and Stakeholder Engagement : Emphasizing the need for clear communication and involvement of all stakeholders in the EA process.
• Strategic Planning and Adaptability : The guide underscores the importance of strategic long-term planning and the ability to adapt to changing business and technological landscapes.

CIOs and IT Leaders can utilize this document to navigate the complex landscape of aligning business strategies with IT infrastructure. It offers a detailed examination of the intricacies involved in EA implementation, which can be instrumental for CIOs in identifying and addressing the unique challenges their organizations face. It provides a strategic framework for understanding and tackling the common hurdles in EA, such as misalignment of business and IT goals, communication gaps, and implementation barriers.

The inclusion of a real-world case study in the guide gives CIOs a practical reference point. They can draw parallels to their situations, learning from the successes and mistakes of others in similar roles. This aspect is particularly beneficial for CIOs looking to apply proven strategies and avoid common pitfalls in their EA initiatives.

The document also serves as a tool for fostering collaboration and understanding within an organization. By presenting a clear picture of how effective EA implementation looks, CIOs can align various departments and stakeholders around a common goal, ensuring a more cohesive and integrated approach to business and technology alignment.

This document is a valuable asset for CIOs seeking to enhance their organization's agility, efficiency, and competitiveness through strategic EA implementation. It not only aids in problem-solving and strategic planning but also helps in building a resilient and forward-thinking IT infrastructure aligned with the broader business objectives.

Don’t Miss These Related References:

• Strategic Implementation of Enterprise Architecture in Multinational Corporations
• Enterprise Architecture Implementation Report
• Implementation Considerations of Enterprise Architecture
• Using Enterprise Architecture for Effective ERP Implementation
• Case Study: Enterprise Architecture Implementation Best Practices

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Strategic Implementation: Toyota Case Study

• To find inspiration for your paper and overcome writer’s block
• As a source of information (ensure proper referencing)
• As a template for you assignment

The effective implementation of the definite strategy is based on the effective strategic management where such factors as the organizational structure, control systems, and organizational culture are important. The management of any company realizes its new strategies with references to these factors, and the level and type of development of the corporate structure, culture, and control systems can influence the strategic implementation significantly.

In 2011, Toyota Motor Corporation presented some perspectives and strategies to overcome the difficulties associated with the recall issues of 2010 and the customers’ reaction to the recall. The presented strategies were oriented to winning back the customers’ loyalty.

The report’s task is to analyze the possible effectiveness of the developed strategies to overcome the issues with references to Toyota Motor Corporation’s organizational structure, control systems, and organizational culture.

The Effectiveness of Strategic Implementation within Toyota Motor Corporation Basing on Organizational Structure, Control Systems, and Organizational Culture

The type of the organizational structure depends on the environment within which the company operates. According to Burns and Stalker, there are two types of the organizational structure which are the mechanistic and organic organizational structures (Burns & Stalker, 2009).

Toyota Motor Corporation takes one of the leading positions within the car industry which is characterized by its stability. It is possible to note that Toyota Motor Corporation’s management is based on the centralized decision-making and standardization as important features to preserve the corporate stability.

In spite of the fact managers pay much attention to stimulating the individual’s initiative and effective team work, the decision-making process is standardized and based on the strong hierarchy (Hill & Jones, 2009). Thus, the type of the organizational structure can be discussed as mechanistic.

The control system of Toyota Motor Corporation can be discussed as financial management in which managers are more focused on profits than on quality, and the problem is in the fact the quality of the work as well as quality of production decreases in this situation (McNamara, n.d.). The extreme focus on profits was determined as on the problems facing the company’s management in 2010 (Shirouzu, 2010).

The organizational culture of any company is complex, and it is based on the values, attitudes, and beliefs shared by the leaders, managers, and employees of the company in relation to the organization’s mission, goals, and the ways to reach them. According to Tharp, the organizational culture can be ‘control’, ‘create’, ‘collaborate’, or ‘compete’ (Tharp, 2009).

The organizational culture of Toyota Motor Corporation can be analyzed as ‘control’ because it is based on the strong hierarchy, formal policies, strict following the company’s principles, and strict coordination. Although the accents are based on the development of self-managing teams and more flexible decision-making process, the company’s culture lacks the necessary flexibility.

The strategies mentioned in Toyota’s annual report of 2011 are oriented to restructuring the company’s management and changing the approaches to the decision-making process. To overcome the issues associated with the customers’ loyalty and brand image, it is necessary to focus on the safety problems with references to management aspects.

Thus, the orientation to making the decision-making process and control systems more flexible can be effective to renew the approach to management within the company, but the implementation of these strategies can face the problem of the employees’ inability to adapt to the new goals priorities.

The organizational structure and culture of Toyota Motor Corporation are based on the rather conservative approaches to implementation, and this fact can be discussed as the difficulty to overcome the mentioned problems.

Toyota Motor Corporation’s Strategies for Implementation

Toyota Motor Corporation determined several strategies to implement within the company in order to overcome the problems connected with safety issues, ineffective management, and winning back the customers’ loyalty in relation to the brand.

It was announced in the company’s annual report of 2011 that Toyota Motor Corporation is ready to implement definite strategic changes regarding the organizational structure, basing on the main aspects of the corporate culture. Thus, the definite changes in human resources were expected with references to the structural modifications in order to create the competitive management structure and renew the company’s image.

The main changes were connected with restructuring the company’s hierarchy in relation to providing more rights to the lower managers, reconstructing the Toyota Group to centralize the company, in transforming the decision-making process, and expressing more interests in the customers’ opinions and vision of the company’s products ( Toyota: Annual report 2011, 2012).

The corporate culture of Toyota Motor Corporation is based on valuing the role of the individual in the process and the individual’s creativity, much attention is paid to the company’s reputation based on the quality of the products. However, the decision-making process was too based on the company’s complex hierarchy to provide the quick response to the definite issues or customers’ expectations.

It was necessary to develop the approach according to which managers could make the necessary decisions according to the current data and information. The definite changes in the decision-making system proposed by the company’s strategic department can be discussed as successful to address the mentioned issues.

The main challenges for the implementation of this strategy are based on the peculiarities of the company’s organizational structure depending on the strict vertical hierarchy.

According to the new strategies, more rights should be given to the local management groups of the company with references to the general flexibility used in the decision-making process.

The next strategy is the focus on the position of the general manager to provide the direct communication with the team leaders and employees in order to reactive the access to the on-site information according to which it is possible to make the conclusions about further continuation of the work or overcoming the problematic issues.

The team leaders, engineers, and specialists should be also involved in the problem solving process in order support the company’s claims about the focus on the role of everyone in the company’s development ( Toyota. Vision and philosophy, 2012).

It is possible to state that the mentioned strategies are important for the implementation within Toyota Motor Corporation to make its corporate structure and culture more flexible in relation to the modern and globalization tendencies, but the effective implementation of the strategies which are associated with changing the approaches to corporate organization is based on the effective pre-implementation work.

The employees should be aware of the goals and principles of the new strategies correlated with the company’s traditional corporate culture. Toyota Motor Corporation’s strategies can be discussed as rather effective to contribute to developing more flexible management system with further winning back the customers’ loyalty. Nevertheless, the strategic implementation process can be associated with some difficulties and challenges typical for the changing corporate environment.

Burns, T., & Stalker, G. (2009). Mechanistic vs. organic organizational structure (contingency theory) . Web.

Hill, C., & Jones, G. (2009). Strategic management theory: An integrated approach . USA: Cengage Learning.

McNamara, C. Management function of coordinating/controlling: Overview of basic methods . Web.

Shirouzu, N. (2010). Inside Toyota, executives trade blame over debacle . Web.

Tharp, B. M. (2009). Four organizational culture types . Web.

Toyota: Annual report 2011 . (2012). Web.

Toyota. Vision and philosophy . (2012). Web.

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Information systems strategy and implementation: a case study of a building society

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• van Gend T Zuiderwijk A (2022) Open research data: A case study into institutional and infrastructural arrangements to stimulate open research data sharing and reuse Journal of Librarianship and Information Science 10.1177/09610006221101200 55 :3 (782-797) Online publication date: 22-Jun-2022 https://doi.org/10.1177/09610006221101200
• Travica B (2020) Infopolitics Informing View of Organization 10.4018/978-1-7998-2760-3.ch006 (228-268) Online publication date: 2020 https://doi.org/10.4018/978-1-7998-2760-3.ch006
• Ijab M (2019) A Process Model for Green Information System Innovation 2019 6th International Conference on Research and Innovation in Information Systems (ICRIIS) 10.1109/ICRIIS48246.2019.9073666 (1-6) Online publication date: Dec-2019 https://doi.org/10.1109/ICRIIS48246.2019.9073666
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12 Successful CRM Implementation Case Studies to Learn From

CRM implementation can seem like a monumental task to complete. From knowing which CRM to choose, to understanding how to fit it in with the rest of your sales stack , there’s a lot involved from pricing to convincing decision-makers to making sure it works well from the start.

If you’re looking for CRM implementation case studies to give you ideas and confidence to get started, then look no further.

12 CRM Case Studies

Want to get this done right (the first time)? Learn from the CRM case studies of companies that implemented a new CRM successfully to improve the customer experience, drive customer engagement , and increase revenue.

1. How Customer.io Uses Automated Handoffs to Enable Smarter Sales

Company: Customer.io

Customer.io is an established martech provider that needed a CRM to work better with both an inbound and outbound sales process. Plus, they needed it to fit well with their current tool stack and give them automated workflows.

This case study interview with Alex Patton, Director of Marketing and operations at Customer.io, digs deeper into the technical setup the company uses with its CRM platform and how that process maximizes the team’s time and productivity.

2. 6 Tips for Assessing Your CRM + Optimizing Workflow—from a Revenue Coach

Company/Organization: High Kick Sales

Kyle Stremme’s consulting firm, High Kick Sales, enables sales teams to create an optimized process and tech stack. This case study explores the insights Kyle gained from helping B2B and B2C companies develop their CRM systems and processes, plus details on how he helps managers analyze their current CRM and decide on a better system.

3. Implementing Customer Relationship Management (CRM) in Hotel Industry from an Organizational Culture Perspective

Company: Anonymous UK hotel chain

This study, done by the International Journal of Contemporary Hospitality Management, examined a hotel chain in the UK as it implemented a new CRM, noting what worked and what didn't about its implementation process.

They administered a questionnaire to 346 hotel chain managers and found that organizational culture readiness was one of the most determining factors in the success of a CRM implementation.

4. Choosing and Implementing a CRM for Small Business

Company: Bean Ninjas

Bean Ninjas is an accounting firm for eCommerce businesses. Their tech stack was dissonant and unconnected, and their ‘CRM’ (actually a project management tool) didn’t even have email built-in. The lack of functionality was impacting their business.

Their self-written case study goes through choosing the right CRM, implementing the system into a more optimized sales workflow , technical integrations, and the end results.

5. How AAXIS Digital is Saving an Estimated $250,000 by Switching from Salesforce to the HubSpot CRM Platform

Company: AAXIS

This CRM implementation case study focuses on how an enterprise company migrated from one extensive CRM to another, saving them lots of money on a system they weren’t using to the full.

The case study explores how they chose their new CRM and their accomplishments with it, including increasing marketing automation and better aligning sales and marketing. For specific Salesforce resources, check out our list of CRM implementation resources .

6. Replacing HubSpot with Close: Scaling Trufan in a CRM Reps Love

Company: Trufan

Trufan (now Surf for Brands) is a fast-growing SaaS startup with a tech-savvy target market. So, they needed a CRM that could move quickly alongside their team, helping them build well-constructed automation that could scale as they grew.

This CRM implementation case study shows how a wrong decision slowed their progress and how a new solution helped them scale faster.

7. A Successful CRM Implementation Project in a Service Company

Company: Anonymous service company from Slovenia

This academic case study by Piskar Franka and Armand Faganel examines the process a service company in Slovenia followed alongside CRM consultants to implement a new solution.

They concluded that a proper CRM implementation can improve customer relationships , achieve greater information sharing between employees, and lead to better strategic decisions. This is mostly interesting for historical purposes, as it gives some insight into the complexity involved in implementing a CRM into a larger company in 2007.

8. Hownd Cut CRM Costs by 80 percent in 2 Weeks—While Saving SMBs During COVID

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Please note you do not have access to teaching notes, a case study of issues of strategy implementation in internationalization of higher education.

International Journal of Educational Management

ISSN : 0951-354X

Article publication date: 11 January 2013

The purpose of this research is to identify and critically evaluate key issues faced by an institution in the quest to implement higher education internationalization.

Design/methodology/approach

A qualitative research is conducted in a post‐1992 UK university. A total of 20 interviewees from three key departments participated in this project. Content analysis, critical discourse analysis and categorisation of meaning were applied on analysing three sources of data collection.

This study identifies critical issues that impede international strategy implementation within an institutional context. These issues include resource allocation, communication, operational process, cooperation and coordination, organizational culture, resistance to change, student support and external environment. Researching findings indicate that most issues are rooted internally. Higher education (HE) internationalization is deemed to be integration and cohesion.

Research limitations/implications

This research contributes to rich understanding of challenges of the present case study; therefore, further research in this area is encouraged to test these highlighted issues through quantitative population studies in other institutions.

Practical implications

Research findings show different understanding of critical issues of HE internationalization, and highlight the areas that need to be improved. This study encourages different key departments to conduct and evaluate internationalization internally.

Originality/value

This research suggests that HE internationalization is primarily an internal matter of integration rather than a process driven only by external environment. This study addresses particular forms of critical issues within an institutional context through a qualitative analysis.

• Internationalization
• Higher education
• Strategy implementation
• United Kingdom

Jiang, N. and Carpenter, V. (2013), "A case study of issues of strategy implementation in internationalization of higher education", International Journal of Educational Management , Vol. 27 No. 1, pp. 4-18. https://doi.org/10.1108/09513541311289792

Emerald Group Publishing Limited

Copyright © 2013, Emerald Group Publishing Limited

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Implementation of MLOps for Deep Learning in Industry: Case Studies

In the rapidly evolving world of artificial intelligence (AI) and machine learning (ML), the integration of Machine Learning Operations (MLOps) into deep learning workflows has become a crucial factor for success. MLOps brings together ML development and operations, ensuring that deep learning models are not only accurate but also deployable, scalable, and maintainable in production environments.

This article explores several case studies of successful MLOps implementations for deep learning across various industries, illustrating how these organizations have leveraged MLOps to achieve their goals.

Table of Content

1. Case Study: Spotify’s Recommendation System

2. case study: netflix’s content personalization, 3. case study: tesla’s autopilot system, 4. case study: amazon’s product recommendations.

Spotify, a global leader in music streaming, relies heavily on recommendation algorithms to deliver personalized content to its users. Deep learning models are central to Spotify’s recommendation system, which predicts user preferences based on listening history and behaviour.

• Scalability : Handling millions of users and their interactions with the system.
• Model Updates : Ensuring that model updates are deployed seamlessly without impacting user experience.
• Performance Monitoring : Continuously monitoring model performance to handle shifts in user preferences.

MLOps Implementation

• Automated Pipelines : Spotify developed automated data pipelines using Apache Kafka and Apache Airflow for real-time data ingestion and processing. This enables continuous data flow from user interactions to model training.
• Model Management : Spotify uses MLflow for model versioning and experiment tracking. This allows data scientists to manage different versions of models and track their performance over time.
• Deployment : The company adopted Kubernetes for container orchestration, which simplifies the deployment and scaling of deep learning models. Spotify’s models are deployed as microservices in a Kubernetes cluster, allowing for flexible scaling based on demand.
• Monitoring and Retraining : Spotify implemented a monitoring system to track model performance metrics in real-time. They use custom tools for anomaly detection and model drift, enabling proactive retraining and model updates.
• Improved Scalability : The use of Kubernetes and automated pipelines significantly improved the scalability of Spotify’s recommendation system.
• Enhanced Model Performance : Continuous monitoring and retraining mechanisms led to better model accuracy and user satisfaction.
• Efficient Updates : Automated deployment processes ensured that new models were rolled out smoothly, reducing downtime and maintaining a consistent user experience.

Netflix’s success hinges on its ability to deliver personalized content recommendations to its vast user base. The company employs deep learning models for content recommendation, personalized marketing, and user engagement.

• Real-Time Processing : The need for real-time recommendations based on user interactions and content updates.
• Model Complexity : Managing and deploying complex deep learning models efficiently.
• Data Privacy : Ensuring compliance with data privacy regulations while handling large volumes of user data.
• End-to-End Pipelines : Netflix uses its internal data infrastructure, including Apache Spark and AWS, to manage end-to-end ML pipelines. This involves data collection, preprocessing, model training, and deployment.
• Model Governance : They implemented model governance using tools like Seldon Core, which supports model versioning and rollback capabilities. This ensures that the models in production are consistently managed and updated.
• Continuous Integration and Deployment (CI/CD) : Netflix employs a CI/CD pipeline tailored for ML models, allowing for automated testing and deployment of new models. This minimizes the risk of introducing errors during updates.
• Privacy Compliance : Netflix adheres to strict data privacy protocols and implements encryption and anonymization techniques to safeguard user data during model training and deployment.
• Real-Time Recommendations : The robust data infrastructure and end-to-end pipelines enabled Netflix to deliver real-time recommendations with high accuracy.
• Efficient Model Management : Model governance tools facilitated seamless management of model versions and ensured compliance with data privacy regulations.
• Improved User Engagement : Personalized content recommendations led to higher user engagement and retention rates.

Tesla’s Autopilot system is a sophisticated driver-assistance technology that relies on deep learning models to interpret data from sensors and cameras, enabling semi-autonomous driving.

• Safety and Reliability : Ensuring that deep learning models operate reliably in real-world driving conditions.
• Data Volume : Managing and processing vast amounts of data collected from Tesla vehicles.
• Regulatory Compliance : Meeting safety and regulatory standards for autonomous driving systems.
• Data Management : Tesla developed a scalable data pipeline using Apache Kafka and TensorFlow Extended (TFX) to handle the massive volume of driving data. This pipeline supports real-time data ingestion, preprocessing, and feature extraction.
• Model Training and Evaluation : Tesla employs large-scale distributed training using TensorFlow and GPUs to train deep learning models. They use Kubernetes for managing the training infrastructure and TensorBoard for model evaluation and visualization.
• Deployment and Updates : Tesla’s deployment strategy includes Over-The-Air (OTA) updates, allowing them to deploy model improvements directly to vehicles. This approach ensures that all vehicles receive the latest model updates without requiring physical service visits.
• Safety and Testing : Tesla conducts extensive simulation and real-world testing of its models to ensure safety and reliability. They use tools for automated testing and continuous integration to identify and address potential issues.
• Enhanced Driving Assistance : The deep learning models contribute to the advanced capabilities of Tesla’s Autopilot system, including lane-keeping and adaptive cruise control.
• Scalable Data Processing : The data pipeline supports the efficient handling of large volumes of driving data, enabling continuous model improvements.
• Regulatory Compliance : OTA updates and rigorous testing ensure that the system adheres to safety and regulatory standards.

Amazon’s e-commerce platform relies on deep learning models to provide personalized product recommendations, optimize search results, and enhance user experience.

• Personalization : Delivering highly personalized recommendations based on user behavior and preferences.
• Real-Time Processing : Processing user interactions and generating recommendations in real-time.
• Scalability : Handling the scale of data and requests generated by millions of users.
• Data Pipeline : Amazon utilizes a robust data pipeline built on Apache Kafka and AWS Lambda for real-time data processing and feature extraction.
• Model Training and Serving : They use SageMaker for model training and deployment, allowing data scientists to build, train, and deploy models at scale. SageMaker provides built-in support for distributed training and hyperparameter optimization.
• Model Monitoring : Amazon implements monitoring tools to track model performance and user feedback. This includes tracking metrics like click-through rates and conversion rates to evaluate the effectiveness of recommendations.
• Continuous Improvement : Amazon employs A/B testing and experimentation frameworks to continuously evaluate and improve recommendation models. This helps in identifying the most effective models and features.
• Improved Recommendations : The deep learning models provide highly personalized product recommendations, enhancing the user shopping experience.
• Scalable Infrastructure : The data pipeline and AWS tools support scalable model training and deployment.
• Increased Sales : Personalized recommendations lead to higher conversion rates and increased sales for Amazon.

These case studies illustrate the successful integration of MLOps practices in deep learning projects across different industries. From managing real-time data and scaling infrastructure to ensuring model reliability and compliance, MLOps plays a critical role in optimizing the performance and deployment of deep learning models. As organizations continue to embrace MLOps, they can achieve greater efficiency, scalability, and success in their AI initiatives

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• Open access
• Published: 14 September 2024

Implementation strategies for decentralized management of multidrug-resistant tuberculosis: insights from community health systems in Zambia

• Joseph Mumba Zulu 1 , 2 ,
• Patricia Maritim 1 , 2 ,
• Hikabasa Halwiindi 3 ,
• Malizgani Paul Chavula 3 , 4 ,
• Margarate Munakampe 2 , 5 ,
• Tulani Francis L. Matenga 1 ,
• Chris Mweemba 2 ,
• Ntazana N. Sinyangwe 6 ,
• Batuli Habib 1 ,
• Mwiche Musukuma 7 ,
• Adam Silumbwe 2 , 4 ,
• Bo Wang 8 ,
• Patrick Kaonga 7 ,
• Mwimba Chewe 2 ,
• Ronald Fisa 7 ,
• Jeremiah Banda 5 ,
• Angel Mubanga 9 &
• Henry Phiri 9  

Archives of Public Health volume  82 , Article number:  157 ( 2024 ) Cite this article

Metrics details

Decentralized management approaches for multi-drug-resistant tuberculosis (MDR TB) have shown improved treatment outcomes in patients. However, challenges remain in the delivery of decentralized MDR TB services. Further, implementation strategies for effectively delivering the services in community health systems (CHSs) in low-resource settings have not been fully described, as most strategies are known and effective in high-income settings. Our research aimed to delineate the specific implementation strategies employed in managing MDR TB in Zambia.

Our qualitative case study involved 112 in-depth interviews with a diverse group of participants, including healthcare workers, community health workers, patients, caregivers, and health managers in nine districts. We categorized implementation strategies using the Expert Recommendations for Implementing Change (ERIC) compilation and later grouped them into three CHS lenses: programmatic, relational, and collective action.

The programmatic lens comprised four implementation strategies: (1) changing infrastructure through refurbishing and expanding health facilities to accommodate management of MDR TB, (2) adapting and tailoring clinical and diagnostic services to the context through implementing tailored strategies, (3) training and educating health providers through ongoing training, and (4) using evaluative and iterative strategies to review program performance, which involved development and organization of quality monitoring systems, as well as audits. Relational lens strategies were (1) providing interactive assistance through offering local technical assistance in clinical expert committees and (2) providing support to clinicians through developing health worker and community health worker outreach teams. Finally, the main collective action lens strategy was engaging consumers; the discrete strategies were increasing demand using community networks and events and involving patients and family members.

This study builds on the ERIC implementation strategies by stressing the need to fully consider interrelations or embeddedness of CHS strategies during implementation processes. For example, to work effectively, the programmatic lens strategies need to be supported by strategies that promote meaningful community engagement (the relational lens) and should be attuned to strategies that promote community mobilization (collective action lens).

Peer Review reports

Introduction

Tuberculosis (TB) remains one of the leading infectious causes of death globally despite concerted efforts to prevent transmission and provide treatment [ 1 ]. According to the 2023 Global Tuberculosis Report, 7.5 million new TB diagnoses, 10.6 million people who developed TB, and 1.30 million TB-associated deaths were reported in 2022 [ 1 ]. About 85% of people who develop TB can be successfully treated with a 6-month drug regimen of rifampicin and isoniazid or through regimens of 1–6 months if they develop multidrug-resistant or rifampicin-resistant TB (MDR/RR TB) [ 3 ]. Resistance to treatment is a growing public health concern: 410,000 people developed MDR TB in 2022 [ 1 ], comprising 3.3% of new cases and 17% of patients who had received treatment previously [ 2 ].

Zambia ranks 21st among the 30 priority countries [ 2 ], with a high burden of TB, HIV-associated TB, and MDR TB [ 5 ]. As of 2019, its estimated burden of TB was 59,000 cases [ 3 , 4 ].

In WHO End TB strategy for providing integrated patient-centered care and prevention, a key pillar entails treating all people with TB, including those with drug-resistant TB. However, of people diagnosed with MDR TB in 2022, only 42.8% started treatment [ 1 ]. One approach for extending the reach of MDR TB services to underserved populations, to enhance diagnosis and treatment, involves decentralized service delivery [ 1 ]. This approach delivers a comprehensive package of services at primary-care-level rather than at national- and provincial-level treatment centres [ 1 ]. It involves caring for patients closer to their homes, in district hospitals as opposed to distant specialist regional TB centers [ 5 ]. Engagement of communities, civil society organizations, and public and private care providers is another key pillar of the decentralized approach and End TB strategy [ 6 ].

In several studies, decentralization has resulted in higher treatment success [ 6 , 7 , 8 , 9 , 10 ]. Specifically, it has increased patient enrollment, reduced delays in initiating treatment, and improved follow-up in communities, as well as reducing treatment failure and mortality [ 6 , 7 , 8 , 9 , 10 ]. For example, in a recent national assessment of the impact of decentralized programmatic management of multidrug-resistant tuberculosis in Zambia, half (50%) of the facilities recorded better patient outcomes, including more patients (547) who received services after the decentralization, compared with 148 before decentralization [ 7 ]. In some countries, decentralization significantly reduced treatment costs [ 8 ].

Zambia began treating drug-resistant TB patients following certification from the green light committee (GLC) in 2009 [ 2 ]. This was primarily done by setting up two drug-resistant TB treatment centers, the University Teaching Hospital (UTH) in Lusaka District and Ndola Teaching Hospital in Ndola District. Until 2018, these two centres admitted all drug-resistant TB patients for the entire 8 months of the intensive phase, posing challenges to patients who had limited access to the facilities. The substantial number of referrals delayed initiation of treatment and heightened demand on the ambulance services required for referral processes [ 9 ].

Like other complex health interventions, decentralized management synergizes resources from community-based and formal health systems. It frequently operates in a grey zone, “intersecting and navigating the domains of public, non-governmental, and private health sectors ” [ 10 ]. Community health systems (CHS) can play a crucial role in delivery and acceptability, as decentralizations aim to achieve universal health coverage (UHC) goals of bringing TB treatment and care closer to patients’ communities [ 6 ]. CHS is defined as “ the set of local actors , relationships , and processes engaged in producing , advocating for , and supporting health in communities and households outside of , but existing in relationship to , formal health structures ” [ 11 ].

Literature suggests that many low- and middle-income countries (LMIC) that have invested in CHS experience gains in health status [ 12 ]. These gains are partly due to the ability of CHS to extend preventive and curative health services for infectious diseases such as TB into communities through integrated community-based delivery approaches [ 10 , 13 , 14 ]. CHS can be conceptualized through four main lenses; programmatic, relational, collective action, and critical perspectives [ 13 , 15 ]. The ‘programmatic’ lens is concerned with CHS building blocks such as human resources, financing, technologies, and infrastructure [ 13 , 15 ]. The ‘relational’ lens focuses on forms of co-production or co-creation in implementation processes [ 15 , 26 ]. The ‘collective action’ lens is concerned with mechanisms and processes that enable actors in the CHS to mobilize and act collectively in implementation processes [ 13 , 15 ]. The ‘critical perspectives’ lens examines what lies behind programmes, including uncovering the deeper social, political, historical, economic, and health systems forces that hinder change or programme performance [ 13 , 15 , 16 ].

Successful delivery of TB services through CHS can be maximized by using implementation strategies aimed at improving implementation effectiveness [ 17 ]. Implementation strategies comprise methods and techniques that ease adoption, implementation, maintenance, and scale-up of evidence-informed interventions [ 17 ]. Powell et al. defined 73 discrete implementation strategies that can support implementation [ 18 ]. These strategies form 9 main groups: engaging consumers, using evaluative and iterative strategies, changing infrastructure, adapting and tailoring services to the context, developing stakeholder interrelationships, using financial strategies, supporting clinicians, providing interactive assistance, and training and educating stakeholders [ 19 ]. Literature on implementation strategies has largely relied on evidence from high-resource settings. Documenting these CHS implementation strategies can enhance the adoption, acceptability, and sustainability of programmes for addressing public health problems such as MDR TB [ 20 , 21 , 22 , 23 ]. Further, such evidence can strengthen sustainability of the decentralization process in MDR-TB service delivery [ 20 , 21 , 22 , 23 , 24 ]. This research aimed to delineate specific implementation strategies guiding the decentralization of MDR TB services in Zambia.

Study setting

In 2014, the Ministry of Health reported that Copperbelt and Lusaka provinces recorded a higher prevalence of TB: 1,211 and 932 per 100,000 population [ 25 ]. In contrast, the Central, North-Western, and Western provinces had a prevalence between 400 and 600 per 100,000 population; and Eastern and Muchinga provinces had the lowest prevalence, about 200 TB cases per 100,000 population [ 25 ]. The proportions of patients with MDR TB among new and previous cases appear higher in densely populated regions [ 26 ]. In 2015, Ministry of Health reported 99 cases against an expected target of 275. The drivers for this high TB prevalence have been increasing population, increasing urbanization from overcrowding, exposure to silica dust in mining, and poverty levels [ 25 ]. In 2018 the Ministry of Health, through the National TB and Leprosy Programme, with the support of international partners, introduced and scaled up decentralized management of TB and MDR-TB cases from the two national hospitals to other hospitals. They aimed to overcome the challenges associated with centralised care and treatment, including prolonged hospital stay, delayed initiation of treatment, poor patient monitoring, and higher default rates [ 27 ].

Study design

This study was part of the large comprehensive mixed-method project investigating the impact of decentralization of Multi-Drug-Resistant TB services in Zambia on uptake and adherence. It employed a qualitative case-study design to conduct an in-depth evaluation of implementation strategies applied in decentralized programmatic management, in the CHS context [ 28 ]. As shown below, the key aspects of the criteria for reporting qualitative research (COREQ) guidelines, such as description of the research team, study methods, findings, analysis, and interpretation, guided the study (See supplementary file).

Data collection methods

Data were collected by teams of male and female researchers from the University of Zambia and Ministry of Health with postgraduate training in qualitative research as well as extensive experience in implementation science and MDR-TB. None of the team members had worked with the respondents. The team comprehensively developed rapport with the respondents before commencing data collection. All participants who were approached agreed to participate in the study. A total of 112 qualitative face-to-face interviews were conducted in private/ confidential spaces in their homes, workplaces and health facilities. The in-depth interviews lasted between 30 and 60 minutes.

Data collection methods were in-depth interviews (IDI) with healthcare workers [ 18 ], community health workers [ 17 ], patients [ 32 ], and caregivers [ 21 ] at selected healthcare sites. We also conducted key-informant interviews (KII) [ 24 ] with managers from health facilities, district, provincial, and national levels. The interview guides were piloted prior to data collection (See supplementary file). Involvement of the various stakeholders in the interviews allowed us to triangulate views across distinct levels of the health system.

Study participants were purposively sampled based on their role in MDR – TB treatment and management. In order to collect comprehensive data, we sampled respondents at various levels of the health system, as shown in Table  1 .

Data analysis

All interviews were digitally recorded. Trained research assistants managed the recording and transcribed the data, with rigorous review by the co-authors to ensure consistency. We followed a thematic analysis approach: “a method for identifying, analysing and reporting patterns (themes) within data. It minimally organizes and describes a dataset in (rich) detail and goes further to interpret various aspects of the research topic” [ 29 ].

We used an inductive analysis approach to map data from the interview transcripts into the Expert Recommendations for Implementing Change (ERIC) compilation of strategies using the provided definitions and aligned the strategies to the categories proposed by Waltz et al. [ 18 ]. The field of implementation science has been growing rapidly over the past few years. In order to ensure consistency in reporting across studies, various taxonomies have been proposed to structure the description of key concepts. The ERIC framework provides 73 discrete strategies for operationalizing implementation strategies. It has been found applicable across a diverse range of settings, and we hope to contribute to expansion of its use [ 18 ].

The interview guides included a section on implementation process of MDR –TB. Because our primary interest was implementation of the decentralization processes, the interviews did not ask directly about the ERIC. A qualitative secondary analytical approach using a thematic coding framework allowed us to infer those strategies as shown in Table  2 .

Ten coders independently conducted data management and analysis using NVIVO version 12, (QSR Australia). Once mapped, the categories were refined in the first three community health systems lenses: programmatic , relational and collective action (Table  2 ). Data saturation, at which no additional new information can be attained, was discussed during the data collection and analysis stages. Results and discussion sections integrated the fourth lens (critical perspectives) in form of barriers to delivering decentralized MDR –TB services. The mapping and categorizing of data were done by a team of researchers from the University of Zambia and Ministry of Health with experience in implementation science and MDR-TB. As part of the process, writing workshops allowed comprehensive discussions.

Ethical clearance for this study was given by the University of Zambia Biomedical Research Ethics Committee (UNZABREC), Reference number 3003 − 2022. Further, permission to conduct the study was obtained from the Zambia National Health Research Authority and Ministry of Health. Prior to data collection, we obtained written informed consent from all participants. Participants were given an opportunity to seek clarification of the purpose of the research before choosing to participate. Also, participants were told that they had the right to withdraw or to stop the interview without any consequence.

This section describes implementation strategies employed in managing MDR TB in Zambia. It is organized around the programmatic, relational, and collective action CHS lenses. Under each lens, Table  2 lists the main ERIC clusters and their discrete implementation strategies.

Programmatic lens

Implementation strategies identified under the programmatic lens fell into four clusters: i) Changing infrastructure, (ii) Adapting and tailoring clinical and diagnostic services to the context, (iii) Training and educating health providers, and (iv) Using evaluative and iterative strategies to review program performance. Below, we explain the discrete strategies in each cluster. Quotations illustrate perspectives expressed in the interviews.

Changing infrastructure

Refurbishing and expanding health facilities to accommodate management of mdr tb.

Specific areas in refurbished health facilities were designated as MDR TB points of care. They ranged from entire refurbished buildings in Kabwe district to small wards in Mongu district and tents in Luanshya district. Both inpatient and outpatient services are provided (as bed space allows), and referrals are made only for complex cases. Implementing partner support was crucial to the refurbishing of such spaces.

“When we started, we were operating from a tent that was mounted somewhere in the hospital until we were given a shelter. So even when we started the decentralized system, we were still using a tent until maybe two years ago when we are given this structure. There were some renovations that were done in certain departments, and they were deemed fit to host TB services as those finally arrived here.” (001, KII, Coordinator).

In many parts of Zambia, where decentralization of MDR TB services had taken place, our study observed that patients had benefited a lot, by having services available at the nearest local health facility. This change was cost-effective: it reduced transportation expenses and distances covered, and fewer patients missed their appointment or review dates.

“…there is no need to spend a lot on transport as the hospitals are nearer, they treat you or you collect your drugs.” (003, IDI, patient).

Having MDR TB services closer to patients in the communities resulted in less congestion in health facilities. Because patients had many services nearby, they did not have to wait as long for results. This reduction in congestion allowed better interactions between patients and health workers.

“Also at least the patients go home early, at least they have a lot of rest, time for resting, also we are able to talk to patients one on one, because if they are a lot, you will be rushing so they can finish, but if they are few, at least a patient is able to open up to you if there is an inner problem that patient has?” (004, IDI, CHW).

The decentralized approach also enhanced interactions between patients and health workers because the health facilities were closer. The greater access also fostered stronger relationships between health workers and patients.

“Decentralized the system I think is, is the best. It’s the best because patients now have an interface with us, they know us because we are all locals in the province. So, you can even give them your number, they can call but I can imagine that time when it was in Lusaka.” (005, KII Coordinator).

However, absence of essential equipment, such as ECG machines, in certain facilities hindered health workers in effectively managing some patients. Additionally, drug shortages significantly impacted delivery of MDR TB services. These shortages were attributed to logistical and administrative challenges, including delays in drug procurement and challenges in transporting the drugs.

“(…) The DR TB drugs are more expensive, and we don’t want to just give facilities even if they don’t have patients. We only want to supply them with these a patient but that becomes a barrier what if I have a patient at short notice? So, it becomes a barrier on the part of the implementation.” (002, KII, Coordinator).

Adapting and tailoring clinical and diagnostic services to the context

Integrated outreach services.

Where microscopy had been the only diagnostic tool, GeneXpert machines and outreach trucks produced an increase in the number of TB cases identified. Where facilities lack GeneXpert, alternative equipment (such as fluorescent microscopes, digital X-ray machines, or LAM tests) is often not readily available. Many of these facilities only have light microscopes or face shortages of essential reagents. Deployment of outreach trucks equipped with diagnostic equipment and supplies, including X-rays, improved identification and treatment of active cases, enhanced patients’ access to care, reduced costs, and led to improved health outcomes. The trucks also significantly reduced the distances that patients had to travel, particularly when the sites had full diagnostic and treatment capacity.

“We target those areas with active case finding where we go and do public announcement with PA system, public sensitization then the patients will also go with the mobile TB truck because we have two aah mobile TB trucks as a province one which we were given by eradicating TB so the mobile TB truck has got the GeneXpert machine on it, one has got 16 modules then the other one has a four modules so what we do we have a team, we form teams of clinician to be doing the screening we have lab techs on that.” (006, KII Coordinator).

Enhanced sample referral system

Where samples still required transportation to Lusaka, most districts used a courier system such as FedEx and Zampost . This system enhanced diagnostic capacity in the newly established sites by linking smaller clinics to larger health facilities. In remote districts, where facilities lacked proper diagnostic tools and could not use a courier system, transportation of specimens was integrated into other health programmes, such as HIV Viral load testing.

“Laboratory but this time around the ministry of health has initiated a way that the samples are transported by Zampost (Postal Services Company) so when we prepare the samples in the cooler boxes everything, we just call the staff at the Zampost to say the samples are ready to go then they send a motorbike rider who comes and takes them. I think the movement of the samples has been very good compared to the gap which was there that we needed to be moving the samples physically to Lusaka.” (007, KII, Provider).

Designating days for outreach services

Further adaptations for improving treatment included some facilities’ designating days on which they could attend to MDR TB patients. This marked a significant shift from the pre-decentralization era, when patients who missed their appointment dates at the University Teaching Hospital had to wait a month before they could see a provider again. Patients had more flexibility in rescheduling their review dates. Their local facilities now managed relatively fewer MDR-TB cases, in contrast to the previously more congested central facility.

“If they miss their appointment they will come if they ask for a different date will arrange for them to be seen by the doctor or call the doctor to say this patient didn’t come on the actual date but he has come today he said he wasn’t around or she wasn’t around there and then they will be seen, like UTH they never used to do that, I don’t think so. Because when they miss an appointment maybe someone will say no come on this period in time.”(008, KII, CHW).

However, lack of functional ambulances in some districts also hindered transportation of patients to health facilities that had adequate services. This transportation challenge delayed access to care and, in some instances, contributed to the spread of the disease.

“On care and treatment, I think that is where we have a bit of a challenge, for example I would say if a patient has been diagnosed from a facility, there is no readily available vehicle to pick them and take them to Solwezi general hospital so there are challenges when it comes to transport, so there will be delayed initiation.” (009, KII, coordinator).

Despite having courier systems, healthcare providers acknowledged the resource-intensive nature of this process, especially in scenarios with a very limited number of patients. Providers faced a unique challenge in balancing the efficiency of courier services against the sporadic and often low volume of TB specimens requiring transportation. As one provider noted:

“So that poses us a challenge because we do this once every month and at the same date when we do, either the same day or the next day, we also have to go get the specimen that we collected from them and take to TDRC. So, if a patient comes as a loner, it becomes difficult to get that specimen back to DRC.” (010, KII, Coordinator).

Training and educating health providers

Providing ongoing training.

Community health workers and nurses were trained in Directly Observed Therapy (DOT) to support MDR TB treatment. The aim was to improve adherence to TB medication regimens by regularly monitoring patients as they take their TB drugs. Training was also provided on how to conduct community sensitization and contact tracing.

“They had also trained them to follow patients in their homes, then it was very easy because they were also on the DOT’s program because they would make sure that patient takes drugs …. if they have not taken, they would come to report.” (011, KII, Provider).

Community health workers explained how this training enhanced their ability to effectively monitor patients’ adherence to treatment. The monitoring process entailed visiting the patients at both homes and workplaces. This proactive approach played a crucial role in improving patients’ uptake of drugs.

“So, because of this decentralization it’s easy for us to monitor since these clients are closer to us. They are close to our facilities, and also close to our TB treatment supporters. So the monitoring of these patients is better. Many are able to adhere to treatment.” (012, KII, Coordinator).

However, the training often overlooked those working in hospital areas where encounters with MDR TB patients are more frequent, such as outpatient departments and among nutritionists. The training content, however, did not explicitly cover providing service for populations with unique needs, such as children. Some districts addressed this gap through supplementary training supported by external partners.

“I think in 2020 we had some children who needed treatment there, and were presumed to have MDR TB sometime in January. And the worst part was that that time, only few were trained in MDR TB management for little one. So what we have gone for training was basically for adults, so it came as a challenge. But I knew with time it was phased (training was planned), CIDRZ came into train people in childhood MDR TB management.” (014, KII, Coordinator).

Using evaluative and iterative strategies to review program performance

Developing and organising quality monitoring systems.

To ensure delivery of a high quality of care, a key function of the decentralization process was establishing a surveillance system for MDR TB. Appropriate registers such as the MDR TB surveillance registers, which fed into existing monitoring and evaluation systems, were introduced to ease collection of data. The registers were aligned to other registers such as the TB treatment register, lab registers, and contact tracing registers. Patients were also given treatment cards. Though clinic meetings and audits were conducted, they were felt to place little emphasis on MDR TB, compared with presumptive TB. Provincial coordinators pointed out that they were able to generate quarterly reports to gauge the performance of the programme. One recommendation suggested to improve the surveillance system is to transition the paper-based registers to an electronic system.

“I think we need to go electronic, we need to use something like smart care, maybe we have been reluctant but I think it is something that can help us deliver the service better, why I am saying so is that if you decentralize and there is someone at the facility who doesn’t know how to manage the patient, sometimes I would just log in and see what is going on and help, so in short I think electronic/telemedicine should be in incorporated and it will help in the decentralization, so we need think ahead that we are in an era of technology.” (018, KII, Coordinator).

Regular audit and feedback processes

Weekly TB situation rooms provided an opportunity to review the performance of the decentralized MDR TB services and identify strategies to improve them. Quarterly clinical expert committee meetings reviewed difficult cases and provided technical support on the best patient management strategies.

“We also hold the quarterly clinical expert committee meetings where we review like patients like difficult patients so like each district has been given a chance to present on a difficult case that they have had in that quarter both for MDR TB and drug susceptible so in that platform we build capacity and we have a team experts that now advice on how that patient can be managed and also aah we have really improved in term of treatment outcome for DR patients.” (019, KII, Coordinator).

Relational lens

Implementation strategies under the relational lens fell into two clusters: i) Providing interactive assistance and (ii) Supporting clinicians. Discrete strategies under each cluster strategy are explained below.

Providing interactive assistance

Providing local technical assistance through clinical expert committees.

Various systems created spaces where health workers could interact, discuss cases, and mutually support one another in delivering MDR TB services. Clinical expert committees, including physicians, nurses, and other healthcare workers, were established as a key component in managing MDR TB. Their primary function was to review complicated MDR TB cases. By using the collective ability of its members, the committee could provide more effective treatment strategies. Availability of committees significantly enhanced quality of treatment. The frequency of their meetings depended on the reported complications. This adaptive approach allowed prompt intervention in urgent or severe cases, while also ensuring efficient use of resources during periods with fewer complex cases.

“Besides that, I think as a district we also participated ahh we were part of what was being called the clinical expert committee, that clinical expert committee I think there are a number of people, there are physicians, there are nurses and other healthcare workers.” (020, KII, Coordinator).

During national meetings, well-performing provinces served as examples of best practices, to create an incentive for providers to continually review their activities with an overall goal of improvement.

“Remember we never used to have the structures we have now, whenever you have the national expert committee, a provincial expert committee, we never used to have those structures, but when we started decentralizing, we started the trainings and put in place the structure such that we have got a provincial CEC now where we are making consultations.” (010, KII, Provincial TB Coordinator ).

However, the ability of provincial expert committees to travel across districts, providing technical assistance and facilitating implementation of decentralized services, depended on availability of resources. This constraint resulted in less frequent visits in recent years.

“There was an activity where we were doing whether we had to do peer-to-peer data quality audits …and have also cut on the economic cost to the client as well.” (021, KII, Coordinator).

Supporting clinicians

Developing health worker and community health work outreach teams.

To reduce the spread of the disease, trained teams and community-based volunteers conducted contact tracing among family members, friends, and neighbors of identified cases in the study districts. Contacts at hospitals, particularly bedside attendants, were also tested. Further, active case detection strategies focused on TB hotspots by conducting outreach programmes using specially equipped TB Trucks. The outreach work was a collaborative effort between community health workers (CHWs) and health workers. Providers pointed out that this strategy was effective in finding cases, particularly among populations such as business people who would have otherwise been missed by passive facility-based case-finding strategies.

“We form teams of clinicians to be doing the screening, we have lab techs on that aah on that mobile aah mobile vehicles the lab tech that will doing the sputum using the gene expert then we also have the nurses as well as CBVs that help us in terms of aah sputum collection as well as mobilizing and going door to door doing sensitization so each time, we conduct active case finding in the community.” (022, KII, Coordinator).

Involvement of CHWs, such as TB promoters attached to local health facilities, helped in scaling up contact tracing because they were able to target immediate contacts or neighbors of TB patients. CHWs played many roles in MDR TB, including helping clients with transportation, translation services, and psychosocial support. Further, the CHWs supplied valuable information on TB prevention, such as promoting regular opening of windows to reduce the spread of the disease.

“Then those who are already patients, sometimes we go in the communities for contact tracing. For example, for a patient who is on TB drugs we talk to that patient. Can we come to your place because TB of the sputum is infectious, so we follow them in the community to do contact tracing, we also go in the wards to do contact tracing especially for the ‘bed-siders’.” (024, KII, CHW).

Zoning districts

To ensure that clinician outreach teams reached even the most remote communities, the district was divided into zones, and a schedule was created for clinicians to visit patients in these designated zones. This approach helped to reduce costs and other travel-related barriers, thus improving access to services for all people including the most vulnerable.

“We have come up with the schedule where we have zoned the district into four zones and we have picked the high volume facilities where we are reviewing our DR patients because we looked at it since we don’t have resources uhm to give to all the patients as in form of transport money so it is cheaper to move the clinicians like following the patients to those facilities which is nearest where they are staying so that at least the patients can be able to come and be reviewed.”(023, KII, Coordinator).

Contact tracing and follow-up have produced noticeable improvements in the ability to retain patients in the treatment and care program.

“Yes, if you have not finished taking your medication, they make follow ups. You don’t have to stop taking your medicine because once you complete it you will get better. They don’t tolerate stopping medication, they even follow you home.” (025, IDI, ALE-TB Patient).

Conversely, challenges posed by inadequate phone network coverage or connectivity also had a significant impact on dissemination of MDR TB information. In areas with weak or unreliable network signals, TB promoters met considerable obstacles in their efforts to maintain regular patient follow-up. The struggle to establish consistent and effective communication channels in these regions underscored the urgency of improving infrastructure and technological support to ensure the continuous flow of critical health-related information.

“I have patients in Lukulu in an area that is cut off. Healthcare workers can’t reach there, So I’m worried about those patients and there’s no network.” (026, KII, Coordinator).

Further, the COVID-19 pandemic had a negative effect on feasibility of conducting directly observed therapy. Because of safety precautions, patient visits were scaled down to alternate days instead of daily. Additionally, facility staff who contracted COVID-19 were unable to deliver essential services.

“Well, I think there was a huge drop in OPD attendances. … people were avoiding coming to the hospital for two reasons…., they did not like the procedure of the nasal swab. …Then secondly, the stigma… once you are COVID-positive. When you fell sick, you would be isolated. Your patient and their family could not see them at the height of the second wave. So, there was that fear.” (027, KII, Coordinator).

Collective action

The cluster implementation strategy, engaging consumers, was actualized through three discrete strategies.

Engaging consumers

Increasing demand by using community networks and events.

For engaging or raising awareness about MDR TB patients, communication of key MDR TB health messages used channels such as posters in health facilities and radio jingles. To maximize demand for services, CHWs integrated MDR TB services into other outreach activities, such as screening for malaria and community sensitization activities on other diseases. Further, CHWs used public spaces such as churches and schools to deliver information on MDR TB. That strategy allowed CHWs to reach out to as many people as possible within the brief period.

“Yes, we used to involve them for the reasons that; if we have an issue of contact tracing, we never used to segregate that it is only MDR TB patients to be followed, we were also following the surrounding houses those that are near and even them at the gathering place. Sometimes we used to involve churches so that everyone could have an idea that indeed TB is there.” (028, IDI, CHW).

CHWs also used communal events to deliver information on MDR TB. Major commemorations such as World TB Day provided opportunities to conduct TB sensitization and raise awareness.

“We have integrated the information education and communication like the IEC at facility level especially like a month like this month like a month of march you know that march is aah a world TB day march so we have intensified like heightened a lot on TB sensitization and awareness so we have also integrated like ah TB sensitization in programs like school health services like during GMPs we are also talking about TB also the debates now like we currently have the debates running like in Kitwe and Lufwanyama so that we also use that platform to sensitize on TB, yes.” (029, KII, Coordinator).

However, translation of the messages into the local languages affected communication of the information. For example, multi-drug-resistant tuberculosis was sometimes misinterpreted as TB that cannot be cured. This misunderstanding led to a reduction in the acceptability of the MDR TB services.

“Maybe one day the term drug resistant may need to be revised because if you literally translate these drug resistant it simply means this TB which cannot be cured but what it means to professionals simply means that drug resistant this is TB which is resistant to face blind drugs face blind but if you just go in the community and say drug resistant, for them they know that this is TB which cannot be cured …we may come up with the better term.” (031, KII, Coordinator).

Societal myths and misconceptions also led some patients to not seek MDR TB services. Some patients and community members, for example, believed that people who have TB are also infected with HIV. The association of TB with HIV made some patients shun TB clinics. Others believed that those who were on medication could still infect others with TB.

“It’s TB we are talking about here and we hear rumors that the disease is contagious but then I had no choice but to convince myself that he will be okay since he is already on medication and receiving treatment. Most people say those with TB are also HIV patients.” (032, IDI, Caregiver).

Involving patients and family members

Further, families were identified as being an essential support system for patients. When the services were centralized, long distances limited involvement of families. With services nearby, in districts such as Ndola, neighbors could be also involved in collecting sputum samples.

“What was happening then, and we lost quite a number of patients because everybody that was there it was being taken to Lusaka and there was no social network with family and friends in Lusaka.” (034, KII, Coordinator).

With MDRTB treatment now accessible at local healthcare facilities and critically ill patients being admitted there, it has become more convenient for them to receive emotional and moral support from their friends and relatives, all without any added costs. Accessing MDR TB services in local facilities also made it easy for caregivers to nurse the patient while simultaneously managing their other responsibilities.

“ Actually, we are happy that she is receiving the treatment from here because if it was the issue of going to Lusaka it means for one to visit her, they need to prepare transport money but the way we are it’s fine she just goes for review and sometimes we can collect medicine for her.” (035, IDI, Caregiver).

Community health workers reported that decentralization had enabled them to make frequent visits and thus strengthened social bonds with their patients. Further, providing medication also promoted social bonds.

“As they were seen that you are frequently going there, we kind of created a family and immediately they see you they will say my mother I have already taken the medication.” (036, CHW).

Although community networks and events were supportive, social stigmatization affected implementation. Cases of TB stigma were also reported among family and friends. Some family members distanced themselves from MDR TB patients, whom they viewed as outcasts.

“Am saying the community looked at someone with MDR TB like an outcast.” (039, KII, Coordnator).

Intervening with patients to enhance uptake and adherence

Initially, patients received transport refunds to come for clinical reviews, and also food supplements. The National TB policy states that each patient ought to receive a full basket with various foods, including 2 kg of beans, 5 L of cooking oil, 2 kg of sugar, and 1 kg of soya flour. Yet responses to food baskets varied. Provinces with active partner support were able to continue providing some food, even though it was a diminished food basket with a handful of items. In Lusaka, for instance, patients were receiving only soya flour, whereas some districts provided no food at all.

“We also offer supplementary nutrition food to people who are actually, to people who actually in care of TB, yah, things like soya, herbs, some eggs and when we have enough even transport for them to pick, to pick up the drugs, yah, so, basically its one area that we actually, one area that we want people to know and come because we have all these things at their dispose.” (015, KII, Coordinator).

This support, however, later came to a halt in many provinces after partner support ended. In Copperbelt province, for instance, patients used to receive a K250 (approximately $10) transport refund, but that stopped once partner support ended in 2021. Both providers and patients pointed out that patients tended to stop taking medication midway because of challenges related to provision of the food basket and transport from the health facility.

“So now people stopped coming because they are taking medication without any food assistance hence others stopped coming.” (016, IDI, Patient).

Health workers mentioned that poor nutrition, because of limited capacity to buy food, also affected adherence to treatment and hence healing. They noted that this situation was complicated by the end of the nutritional support programme in the health facilities.

“.. sometimes you find that you run out of food, then you take those drugs, some medicines it is required to say when you take you eat something. But when you don’t have food, it is very difficult.” (017, IDI, Patient).

The study aimed to document discrete implementation strategies needed to effectively deliver decentralized MDR TB services in community health systems in low-resource settings. It contributes to enhancing community-based implementation research by contextualizing the ERIC compilation of implementation strategies in decentralized CHS service delivery [ 18 , 19 ]. This contextualization using the CHS programmatic, collective action, and relational lenses adds value to community-based implementation strategies in many ways.

First, the programmatic lens outlines discrete implementation strategies for strengthening CHS hardware components in delivering decentralized MDR TB services. These strategies, which include changes to health facilities, training, and increased availability of equipment and data/information in communities, provide structures and information for community outreach activities and for relational and collective-action-related implementation strategies. For example, programmatic lens decentralization strategies, such as refurbishing and expanding many health facilities in rural areas, training health workers including community health workers, using mobile trucks fitted with equipment and other medical supplies, eased delivery of quality MDR-TB services. These strategies contributed to improved utilization by enabling people to have a variety of quality services in their communities, as other studies have reported [ 30 , 31 , 32 , 33 , 34 ]. Providing services in the communities is also often preferred, as it reduces distances to health facilities and other related costs [ 11 ]. We thus agree that, through leveraging various community resources, CHS can promote uptake of various health services and possibly advance population well-being in attaining universal health coverage [ 7 , 35 , 36 , 37 ].

Second, relational implementation strategies are vital in delivering decentralized MDR TB services, as they facilitate strengthening linkages between health facilities and communities. One of the main relational strategies is the development of health worker and community health worker outreach teams. Involvement of community health workers also helped in increasing coverage and use of MDR –TB services. Acceptability improved because CHWs are recognized, trusted, and respected members of the community [ 38 ]. Developing such teams could enhance implementation of MDR-TB services by providing opportunities to accommodate diverse actors, interests, and expressions of power that characterize the CHS [ 22 , 35 , 39 ]. Further, relational approaches can support delivery of services by promoting shared communication, understanding of implementation problems, and increased commitments [ 40 ]. This collaborative approach can trigger better adaptation and acceptability of services through promoting local ownership and legitimacy of implementation strategies [ 22 , 29 , 30 ]. Use of spaces for consensus building during the implementation process, such as clinical expert committees, in which clinicians discuss complex cases, can also facilitate adoption of services by facilitating or enabling co-production and co-learning during service delivery [ 15 , 23 , 29 ].

Third, collective action implementation strategies, such as use of community networks, structures, and events to deliver and disseminate information, also promoted acceptability, penetration, and sustainability of decentralized MDR TB services at the community level. Use of community-based resources supports implementation processes by enhancing relevance and legitimacy of the services [ 41 , 42 ]. In addition, these strategies are vital in community-based implementation, as there are “ mechanisms and processes which enable actors in the CHS to mobilize , collaborate and act collectively on health ” [ 13 ]. Importantly, the strategies promote sustainability and penetration of health programs through widening participation and accountability as well as promote trust in health services [ 21 , 39 ].

However, health systems and socioeconomic barriers affected implementation of decentralized programmatic management of multidrug-resistant tuberculosis. Health systems barriers included lack equipment such as functional ambulances. Socio-cultural barriers were termination of nutritional support, as well as local myths and stigma relating to TB. To address these barriers, it is important to integrate a critical perspective approach (critical lens) in the implementation process in order to regularly identify or uncover deeper social and health systems forces that affect implementation [ 11 ]. By uncovering structural barriers, a critical perspective might help to trigger collective action aimed at promoting positive change in programme implementation processes [ 11 ].

Limitations and strengths of the study

One limitation of this study is the absence of implementing partners that support the implementation of MDR-TB in the sample. This absence limited the scope of the insights shaping decentralisation to largely stakeholders from the Ministry of Health, caregivers and patients. Another limitation is that the interview guide did not directly integrate the ERIC strategies, but we only inferred to the strategies from the responses provided during the interviews on implementation of the decentralization process. This lack of inclusion could have deprived us of an opportunity to gain additional insights on contextual strategies that shaped the implementation. Despite these limitations, conducting inclusive interviews with stakeholders at different levels of the health system (community, district, provincial, and national levels) provided useful information to facilitate a comprehensive understanding and implementation MDR TB services in Zambia.

The study builds on the ERIC compilation of implementation strategies by documenting CHS contextual discrete strategies applied in implementing decentralized programmatic management of MDR TB. The programmatic CHS-lens-related implementation strategies included refurbishing and expanding health facilities to accommodate management of MDR TB, adapting and tailoring clinical and diagnostic services to the context, and training and educating health providers. Relational CHS lens strategies included providing interactive spaces through clinical expert committees and developing health worker and community health worker outreach teams. Collective action CHS strategies consisted of community-driven integrated approaches to engaging MDR-TB patients.

In addition to mapping the ERIC strategies, the study has several policy and program implications. For example, it further contributes to community-based policy and implementation research by documenting relevant discrete relational and collective action strategies, namely, developing health worker and community health worker outreach, as well as increasing demand using community networks and events, respectively. Mapping CHS implementation strategies could promote implementation processes by helping experts appreciate the complexity of CHS strategies -- as being embedded in both health facilities and communities -- and develop program and policies that adequately integrate both formal and community aspects of the health system. Thus, to work effectively, the programmatic lens strategies need to be supported or integrated within strategies that promote meaningful community engagement (relational lens) and should be attuned and responsive to strategies that promote forms of community mobilization (collective action lens), while being cognizant of wider social and systems forces or barriers that affect the implementation process (critical lens).

Data availability

The datasets developed and/or analysed are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to extend our sincere gratitude to the study participants for their time and valuable insight/input during the interviews.

We acknowledge financial support from the Global Fund. Thanks also to David C. Hoaglin for editorial assistance.

Open access funding provided by Umea University.

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JMZ, PM, and MPC designed the study including the data collection tools and collecting data. JMZ, PM, HH, MPC, MM, TM, NS and BH analysed and interpreted the findings of the study, JMZ, PM and MPC were the major contributors. All listed authors including JMZ, PM, HH, MPC, MM, TFLM, CM, NNS, BH, MM, AS, BW, PK, MC, RF, JB, AM, HP Henry read and contributed to the development, revision of the paper and approved the final manuscript.

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Ethical clearance for this study was sought from the University of Zambia Biomedical Research Ethics Committee (UNZABREC), Reference number 3003 − 2022. Permission to conduct the study was obtained from the Zambia National Health Research Authority and Ministry of Health. The study was carried out in line with the Helsinki Declaration. Informed consent to participate in the study was obtained from participants.

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Zulu, J.M., Maritim, P., Halwiindi, H. et al. Implementation strategies for decentralized management of multidrug-resistant tuberculosis: insights from community health systems in Zambia. Arch Public Health 82 , 157 (2024). https://doi.org/10.1186/s13690-024-01384-4

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Received : 27 May 2024

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Published : 14 September 2024

DOI : https://doi.org/10.1186/s13690-024-01384-4

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Equality and efficiency tradeoffs in revenue recycling of emission trading scheme: a case study on the recent chinese national ETS market

• Published: 13 September 2024

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• Shuyang Chen   ORCID: orcid.org/0000-0002-1033-5053 1  

Owing to real constraints, a first-best climate policy is rarely socioeconomically optimal; therefore, policymakers may prefer a second-best or mixed policy, where revenue recycling (RR) is usually implemented as a complementary policy to the first-best policy. Unfortunately, how different RR policies affect equality and efficiency during first-best policy implementation remains to be researched. This paper attempts to narrow the research gap by designing and evaluating the RR policies for the emission trading scheme (ETS) simulating the Chinese National Emission Trading Scheme (CNETS). To achieve this research target, we have employed a dynamic recursive computable general equilibrium (CGE) model to analyze how the designed RR policies complement the ETS effects on emission abatement and economic growth. The results of the CGE model have confirmed the existence of a tradeoff between equality and efficiency. RR for income tax reduction is beneficial to emission abatement, but it has the worst performances on equality, Gross Domestic Product (GDP), and household welfare. RR for subsidizing renewable energy causes the lowest GDP loss, but it adversely impacts emission abatement owing to the induced economic boom. Lump-sum income transfer to low-income households is the best RR option because it is the most equitable way to use ETS revenues and induces the highest household welfare with satisfactory performances on emission abatement and GDP. Hence, ETS revenues are recommended to be transferred to low-income households.

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Abbreviations

Average propensity to consume

Business as usual

Constant elasticity of substitution

Constant elasticity of transformation

Computable general equilibrium

Chinese Household Income Project

Chinese National Emission Trading Scheme

28th Conference of the Parties

Emission trading scheme

Equivalent Variation

Gross Domestic Product

Nationally Determined Contribution

• Revenue recycling

Rest of the world

Social accounting matrix

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Chen, S. Equality and efficiency tradeoffs in revenue recycling of emission trading scheme: a case study on the recent chinese national ETS market. Environ Dev Sustain (2024). https://doi.org/10.1007/s10668-024-05380-0

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Received : 28 July 2022

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Published : 13 September 2024

DOI : https://doi.org/10.1007/s10668-024-05380-0

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