PHHE 469 Principles of Health Planning Week 13 – The Bottom Line Important Final Material ▪ IN PHHE 469: Introduction to the Idea of Planning as a necessary element in providing for the health care needs of the community ▪ Composed of Four elements > Theory > Needs Assessment > Intervention > Evaluation Impact Program Evaluation Outcome 1 Theory success> Cause > Intervention > Effect (successful program) (program hypoth) (program design) (desired results) ▪ Program is successful: all part of process working well together, logical development, effect follows Impact Program Evaluation Outcome 2 Theory failure > Cause > Intervention > Effect (Unsuccessful Program) (faulty hypothesis) (Bad Program Design) (Bad or no Results) ▪ Program Unsuccessful due to theory failure ▪ Alignment between program hypothesis (theory) and program design (intervention) bad (not compatible) ▪ Program does not produce the desired outcome or effects Impact Program Evaluation Outcome 2, continued… ▪ Called Theory Failure because if the hypothesis had been valid, then the program design should have produced the desired outcome or results. ▪ Because the desired outcome was not produced, the hypothesis is not supported and a different hypothesis has to be considered. (Is this necessarily bad? Think of the null hypothesis…) Impact Program Evaluation Outcome 3 Program Failure > Cause > Intervention > Effect (Unsuccessful Program) (Faulty hypothesis) (Bad program design) (Failed outcome) ▪ Program failure occurs when there is a misalignment between the program hypothesis (cause) and the program design (intervention) ▪ Program fails to produce desired outcome or effect. (Not driven by a valid program hypothesis). Impact Program Evaluation Outcomes: Significance When program fails to achieve its desired outcomes or result due to theory failure, the result is still a valid test of the program. ▪ We can still make inferences about the program because the test itself is valid ▪ If we know what made the program fail, we can do a better job when we redesign a replacement program (or better yet, if this is an ongoing evaluation we have time to reposition the existing program so we don’t waste precious resources) Impact Program Evaluation Outcomes: Significance, page 2 ▪ When a program fails to achieve the desired results due to program failure, it tells us that the program wasn’t properly tested. ▪ When this happens, we can’t tell anything about the success or failure of the program because it wasn’t properly implemented as planned. E-Lecture 13.1 Strategic Planning Why Strategic Planning? Strategic Planning a.k.a. the Strategic Management process is based on the belief that organizations should continuously monitor internal and external events and trends so that timely changes can be made as needed. The rate and magnitude of changes that affect organizations are increasing dramatically. The need to adapt to change leads to questions such as, “What kind of business should we become?” “Are we in the right area?” “Should we reshape our business?” “What new competitors are entering our industry?” What are the different components of Strategic Management? The Strategic Management process has three different components: (1) Formulation, (2) Implementation, and (3) Evaluation. Strategy formulation includes developing a vision and a mission, identifying an organization’s external opportunities and threats, determining internal strengths and weaknesses, establishing longterm objectives, generating alternative strategies, and choosing particular strategies to pursue. Strategy implementation requires a firm to establish annual objectives, devise policies, motivate employees, and allocate resources so that formulated strategies can be executed; strategy implementation includes developing a strategy-support culture, creating an effective organizational structure, redirecting marketing efforts, preparing budgets, developing and utilizing information systems, and linking employee compensation to organizational performance. Strategy evaluation is the final stage in strategic management. Managers in health and human services always need to know when particular strategies are not working well; strategy evaluation is the primary means for obtaining this information. Given that Strategic Management is a “good thing,” what specific benefits can be derived from the practice? There are certain financial and non-financial benefits that can come about as a result of regular, systematic application of strategic management principles. Financial benefits: Research indicates that organizations using strategic management concepts are more profitable and successful than those that do not. High-performing firms tend to do systematic planning to prepare for future fluctuations in the internal and external environments. Firms with planning systems more closely resembling strategic-management theory generally exhibit superior long-term financial performance relative to their industry. e-Lecture 13.1 Strategic Planning Revisited continued… Non-financial benefits: Besides helping firms avoid financial demise (death), strategic management offers other tangible benefits, such as enhanced awareness of external threats, an improved understanding of competitors’ strengths, increased employee productivity, reduced resistance to change, and a clearer understanding of performance-reward relationships. In addition to empowering managers and employees, strategic management often brings order and discipline to an otherwise floundering firm. Consider these other benefits of strategic management: 1. 2. 3 4. 5. 6. 7. It allows for identification, prioritization, and exploitation of opportunities. It provides an objective view of management problems. It represents a framework for improved coordination and control of activities. It minimizes the effects of adverse conditions and changes. It allows major decisions to better support established objectives. It allows more effective allocation of time and resources to identified opportunities. It allows fewer resources and less time to be devoted to correcting erroneous or ad hoc decisions. 8. It creates a framework for internal communications among personnel. 9. It helps integrate the behavior of individuals into a total effort. 10. It provides a basis for clarifying individual responsibilities. 11. It encourages forward thinking. 12. It provides a cooperative, integrated, and enthusiastic approach to tackling problems and opportunities. 13. It encourages a favorable attitude toward change. 14. It gives a degree of discipline and formality (and professionalism!) to the management of an organization. What are some Key Terms in Strategic Management? 1. Vision and Mission Statements: Vision statements answer the question, “What do we want to become”? Mission statements are “enduring statements of purpose that distinguish one business from other similar firms. A mission statement identifies the scope of a firm’s operations in product and market terms.” It addresses the basic question that faces all strategists: “What is our business?” It should include the values and priorities of the organization. 2. External Opportunities and Threats: External opportunities and threats refer to economic, social, cultural, demographic, environmental, political, legal, governmental, technological, and competitive trends and events that could significantly benefit or harm an organization in the future. Opportunities and threats are largely beyond the control of a single organization, thus the term “external.” 3. Internal Strengths and Weaknesses: Internal strengths and internal weaknesses are an organization’s controllable activities that are performed especially well or poorly. Identifying and evaluating organizational strengths and weaknesses in the functional areas of a business is an essential strategic-management function. e-Lecture 13.1 Strategic Planning Revisited continued… 4. Short-Term Objectives and Long-Term Objectives: Objectives can be defined as measurable, specific kinds of results that an organization seeks to achieve in pursuing its basic mission. Short-Term usually refers to one year; Long-Term more than one year. Short-term objectives are sometimes referred to as “annual objectives”. Like LongTerm objectives, they must be measurable, quantitative, challenging, realistic, consistent and prioritized. 5. Strategies: Strategies are the means by which objectives (ultimately, goals) will be achieved. Business strategies may include geographic expansion, diversification, acquisition, product development, market penetration, retrenchment, divestiture, liquidation and joint venture. 6. Policies: Policies are the means by which annual objectives will be achieved. Policies include guidelines, rules and procedures established to support efforts to achieve stated objectives. Policies are most often stated in terms of management, marketing, finance/ accounting, production/operations, research and development, and computer information systems activities. If Strategic Management is so important to the success or failure of health or human services organizations, why is it that some firms don’t conduct strategic planning, or management? Some reasons for poor or no strategic planning include the fact that there may be poor internal reward structures or incentives in an organization for this kind of planning. The staff also may be stuck in crisis mode; too busy conducting “management by crisis.” The Board of Directors or top management might also regard Strategic Management as a “waste of time” or “too expensive” to implement. Some firms become content with prior years’ successes, not wanting to “rock the boat” or spoil what they feel they’ve found is their formula for success. There are other reasons, too, why organizations and the management of those organizations refuse to act. Fear of failure, sometimes coupled with fear of the unknown, is a big motivator. Many of these corporate fears, you will find, are directly linked to personal management insufficiencies or inadequacies that individuals they are projecting onto the organizational canvas. e-Lecture 13.1 Strategic Planning Revisited, continued… Then, too, you have a situation where management may feel overconfident, as if there is nothing more than they could possibly learn about running an organization. A situation could also occur where an organization has a prior experience with strategic planning which was performed poorly, with correspondingly poor results. The problem may have caused by poor implementation or lack of adequate evaluation processes. Or there could have been too much cash outlay for the return in bottom-dollars. Some upper level management staff could become suspicious and fearful that a fellow planner or strategist was trying to be an “empire-builder.” These persons could feel their job security was threatened. Or perhaps there is just an “honest difference of opinion” among staff as to be best way to conduct long-range planning. Whatever the reason, however, the organization that chooses NOT to be proactive, NOT to embrace Strategic Management Principles, is placing itself at risk for organizational failure in this changing world of health care and human services. -30- • Mostly from Kettner, Chapters 6-10. Some items from class. • Use your Index to Kettner to look up these key terms: Functions of program design Concept of “inputs” Concept of “throughputs” “Intermediate outcomes” Concept of “final outcomes” “Inputs stage” of program planning: how relevant are methods of intervention? “Outputs” stage of program planning Why data collection/data entry procedures have changed over time Assumptions of effective-based program planning Reasons evaluations fail to provide information for program improvement Formative evaluations Summative evaluations Demographic characteristics of a target population Uses of the budgeting process in social service (health) agencies Differences between accounting and budgeting Most important function for the budget in HHS organizations Process of finalizing the budget for any nonprofit HSO: where/when budget must be submitted Planning purposes of the “budget” FTE stands for…? Terms and Concepts to Study for Part 1 (Objective Questions): The concept and meaning of “program design” throughputs intermediate outcomes “ inputs” stage of program planning major assumptions of effective-based program planning major reasons why evaluations fail descriptive characteristics of a target population: use of client demographic data/social histories differences between “accounting” and “budgeting” requirements for finalization of any nonprofit human services organization’s budget to be considered “final” 10. planning purposes of the budgeting process 11. line-item budgeting systems—definition, focus, use and impact 12. functional budgeting systems—definition, focus, use and impact 13. the classical definition of efficiency or productivity is… 14. operating costs that are treated as indirect costs 15. employee-related expenses (EREs) 16. cost allocation definition 17. performance measurement definition 18. Use of the term “monitoring” for social service agencies 19. Purpose of cost-efficiency data use 20. Impact program evaluation purpose 21. “Equity data” definition and uses 22. Cost-effectiveness kinds of assessment data--relationship to performance measurement 23. Theory failure—when does it occur, and why? Items to study, #24-26 on next page…… 24. Consequences of program failure, according to Kettner, and how it occurs 25. Assumptions about the outcome(s) of programs we’re seeking to implement 26. There will be new questions based on class activities and basic terms from the Allison text. 1. 2. 3. 4. 5. 6. 7. 8. 9. Illinois Project for Local Assessment of Needs (IPLAN) Illinois Department of Public Health Division of Health Policy What is IPLAN? ◼ Primary goals ◆ ◆ ◼ To establish a process for community involvement and participation in community health assessment and planning To make local health departments accountable to their communities rather than to the state Essential elements ◆ Organizational capacity assessment ◆ Community health needs assessment ◆ Community health plan, focusing on a minimum of three priority health problems Requirements for Certification of Illinois Local Health Departments BEFORE JULY 1993 AFTER JULY 1993 To be recognized as a local health department in Illinois, LHDs MUST DO– To be certified as a local health department in Illinois, LHDs MUST– 1. Potable Water 1. 2. 3. 2. 3. 4. 5. 6. 7. 8. 9. 10. Food Sanitation Maternal Health/Family Planning Child Health Communicable Disease Control Private Sewage Solid Waste Nuisance Control Chronic Disease Administration Assess community health needs Investigate hazards within the community Analyze identified health needs for their determinants 4. Advocate and build constituencies for public health 5. Prioritize among identified community health needs 6. Develop policies and plans to respond to priority needs 7. Manage resources and organizational structures 8. Implement programs and services to respond to priority needs 9. Evaluate programs and services 10. Inform and educate the community Illinois Administrative Code Section 600.400: Certified Health Department Code Public Health Practice Standards The local health department shall, at least once every five years, perform an organizational capacity self-assessment that meets the requirements set forth in Section 600.410. Illinois Administrative Code Section 600.400: Certified Local Health Department Code Public Health Practice Standards A community health needs assessment that systematically describes the prevailing health status and health needs of the population within the local health department’s jurisdiction shall be conducted once every five years. Illinois Administrative Code Section 600.400: Certified Local Health Department Code Public Health Practice Standards Develop a community health plan that addresses at least three priority health needs, identified pursuant to Section 600.400, during each certification period. The IPLAN Process Community Health Needs Assessment Local System Community Health Plan Public Program Development Health LHD Organizational Capacity Assessment Implementation Evaluation A Community Health Needs Assessment should contain-A description of the health status and health problems most meaningful for the community in the data groupings contained in the IPLAN Data System: ◼ Demographic & Socioeconomic Characteristics ◼ General Health & Access to Care ◼ Maternal & Child Health ◼ Chronic Disease ◼ Infectious Disease ◼ Environmental, Occupational, & Injury Control ◼ Sentinel Events A Community Health Needs Assessment should contain-◼ ◼ ◼ A description of the process and outcomes of setting priorities; A statement of purpose of the community health needs assessment that includes a description of how the assessment will be used to improve health in the community; A description of the community participation process, a list of community groups involved in the process, and method for establishing priorities. Community Health Committee ◼ ◼ ◼ ◼ ◼ ◼ ◼ ◼ ◼ ◼ ◼ ethnic & racial groups medical & hospital community mental health & social service organizations cooperative extension service schools law enforcement organizations voluntary organizations faith community businesses and economic development unions youth, senior citizens, other target populations Prioritize Community Health Problems Hanlon Method ◼ Nominal Group ◼ Delphi Technique ◼ PEARL (Propriety, Economics, Acceptability, Resources, and Legality) ◼ Detailed Analysis of Community Health Problems Health Problem Analysis Worksheet Direct Contributing Factors Risk Factors Health Priority aka - NCAA Chart Indirect Contributing Factors Health Priority A situation or condition of people Indirect Contributing which is considered undesirable, is Direct Contributing Factors likely to exist in the future, and is Factors measured as death, disease, or disability. . .and more. Risk Factors Health Priority Risk Factor A scientifically established factor (determinant) that relates Direct Contributing Indirect Contributing Factors directly to the level of a health Factors problem. Risk Factors Health Priority Direct Contributing Factor A scientifically established factor that directly affects the level of a risk factor. Risk Factors Health Priority Direct Contributing Factors Indirect Contributing Factors Indirect Contributing Factors A community specific factor that directly affects the level of the direct contributing Indirect Contributing factor. Direct Contributing Factors Factors Risk Factors Health Priority Outcome Objective The level to which a health problem (priority) should be reduced. Risk Factors Health Priority Indirect Contributing Direct Contributing Factors Factors Direct Contributing Factors Risk Factors Health Priority Impact Objective The level to which a risk factor should be reduced. Indirect Contributing Factors Direct Contributing Factors Indirect Contributing Factors Risk Factors Health Priority Intervention Strategy Demonstrated to be effective or used as national model and should address a contributing factor. Community Health Plan: Worksheet Health Problem Outcome Objective Risk Factor Impact Objective Contributing Factors Proven Intervention Strategies Resources Available Barriers Community Health Plan: Worksheet Health Problem Cerebrovascular Disease (Stroke) Risk Factor Tobacco Use Contributing Factors Addiction Sedentary Lifestyle Hypertension Advertising (Indirect) Resources Available Coalition will provide support to LHD with in-kind donations, staff, and clinical counseling space. Outcome Objective By 2004, reduce stroke deaths to no more than 70 per 100,000 (Baseline: 1997 crude rate 76.5 per 100,000). Impact Objective By 2002, reduce cigarette smoking to a prevalence of no more than 24 percent among people aged 18 and older. (Baseline: 1996 BRFS percentage 27.3). Proven Intervention Strategies Coalition will implement CDC’s community-based tobacco control program, focusing on delaying initiation, cessation programs, and advertising control. Barriers Limited number smokers seeking counseling. Media messages promote smoking. Peer pressure. Community Health Plan Description of the Health Problem, Risk Factors and Contributing Factors Corrective Actions Proposed Community Organizations Evaluation Plan Community Health Plan Description of the Health Problem, Risk Factors and Contributing Factors The problem is the high death rate associated with cerebrovascular disease (county CR = 76.5, state CR =61.7 p/100,000 or 23% above state rate). The major risk factor is cigarette smoking and county has higher percentage of smokers (27.6%) , especially males (31%) than state (24%, 28%, respectively). Addiction appears to be the chief contributing factor. Corrective Actions In order to effectively address this health problem a multi-sited and multitargeted campaign is required to delay initiation of smoking behavior, assist persons attempting to quit, and provide counter advertising to tobacco promotions. Proposed Community Organizations A coalition of community groups, including the LHD, Cancer Society, Lung Association, General Hospital, Teens Against Butts will collaborate with inkind donations, staff, and clinical counseling space to assist in meeting objectives. Evaluation Plan Coalition will meet quarterly to assess progress in achieving goals. Coalition will use the evaluation tool developed by the CDC to determine effectiveness of programming efforts. Surveys will be conducted amongst coalition members to ascertain stakeholder satisfaction with program. Code Changes in 2004 ◼ Staggered Due Dates – 2004 – 2007 (Round 3) ◼ Organizational Capacity Assessment Options – Section 600.410 The process for developing an assessment of organizational capacity shall address: a) the internal capabilities of the local health department to conduct effective public health functions, including an assessment of operational authority, community relations, information systems, and program management; or b) an organizational strategic plan developed within the previous five years that assesses strengths, weaknesses, opportunities and threats in the local health jurisdiction. MAPP/NPHPS and IPLAN ◼ ◼ ◼ Essential Health Services vs. Practice Standards “System” vs. “Department” Assessment of Organizational Capacity Internal Factors and External Environment Administrative Code Allows Flexibility in Model, but Practice Standards must be met Questions? Call the Division of Health Policy at 217 - 782 - 6235.
Purchase answer to see full attachment