beginning with the end in mind: supporting the development of health improvement plans designed for...
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Beginning with the End in Mind: Supporting the Development of Health Improvement Plans Designed for Action
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Participants will…
• Know important elements of an actionable CHIP that also enables ongoing monitoring and evaluation.
• Be able to describe techniques for engaging partners in a participatory action planning process.
• Know the major phases of implementation and ways to set a group up for successfully moving from planning to action.
Learning Objectives
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Priorities have been selected based on having a picture of what is…
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Refer to the data related to Priority
Issue.
In some cases, more work on
understanding the problem may be
necessary.Illinois Public Heath Institute
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Action planning to address priorities begins with the end in mind…
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Current Status of the Priority Issue
Vision for the Future with Improvements Related to the Priority Issue
What changes need to occur to achieveVision?
Illinois Public Heath Institute
FACILITATING ACTION PLANNING
Beginning with the End in Mind
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What is your experience with community health improvement action planning and implementation?
Thinking about one such experience…• How would you describe the action planning process in
one word?• What went well? What were the challenges?
• How did you/they get ‘the ball rolling’ with implementation?
• Where did the implementation process get ‘stuck’?
• What should have been done differently?
Peer Sharing:Experiences with Action Planning & Implementation
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“Rather than trying to explain or teach what is needed, the facilitator attends to the process of
change. To facilitate is to elicit, sustain, and enhance change. To facilitate is to let go of
controlling others toward predefined results and to help them accomplish what they want.”
-Jim Rough Dynamic of Facilitation
Participatory Methods for Action Planning
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Facilitating Action Planning
Participatory Action Planning…
•Brings diverse experiences and ideas into the process
•Helps ensure buy-in for implementation
•Brings key stakeholders to the table; avoids the norm, ‘If you aren’t at the table, you are on the menu’
•Is more successful when guided by a skilled facilitator
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Organizing the Process
• Identify up front what is known about resources and budgets available for creating and implementing the CHIP
• Timeline• Schedule• Human resources
• Review and feedback loops
• Finalization and adoption decisions
• Documentation of the process
Organization & Infrastructure
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Organizing Human Resources
• Engage a Steering committee (advisory group or coordinating council) in laying the foundation for the action plans
• Connected to all parts of the community• Balance of thinkers, ‘do-ers’, and decision-makers
• Engage action planning teams/workgroups in building the action plans
• Ensure that those who are responsible for acting on the plan are involved in its creation
• Identify a ‘lead’ or chairperson and other important roles
• Every group needs a ‘mover and shaker’
Organization & Infrastructure
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A high quality CHIP includes…
• What, how, who, when are clearly delineated
• Actions target multiple levels of the Socio-ecological Model
• SMART objectives for each strategic priority
• Alignment with Healthy People 2020
• Evidence-based health improvement strategies
• Monitoring and evaluation activities, measures, timeline
Consulting on Key Elements of the CHIP
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PHAB requires:•Objectives•Time-framed targets for strategies•Evidence-based strategies•Policy changes needed to accomplish objectives•Accountable parties for each objective
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Levels of Objectives & Measurable Outcomes
Illinois Public Health Institute
Organization & Infrastructure
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Organizing the CHIP Structure: A Basic Model
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What can be done to create the necessary changes?
Important questions to answer before writing the action plan
•What are the existing resources, assets and strengths for this work?
•Who is already engaged in this work? What are they doing to address this issue? Can we partner?
•Who else needs to be engaged in this work?
•What are the barriers? How can the barriers be overcome?
•What has worked elsewhere (other communities, states etc.)?
•What are the evidence-based approaches to create the change we seek?
14Illinois Public Health Institute
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Example: Action Planning Worksheet
Sample from IPHI
Facilitating Participatory Analysis of Issues
• Root cause analysis: Why do these issues really exist? What is at the root of this issue? What should we really focus on?
• Underlying contradictions (barriers and blocks): What may block us from addressing our strategic issues and moving toward our vision?
• Stakeholder analysis: Who will be affected by our strategies and how can they be engaged?
• Environmental scan: What currently exists in our community that may influence the success of our strategies?
Participatory Methods for Analysis
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Root Cause Analysis
• Social Determinants Tree• The Five Whys• Health Problem Analysis worksheet
Role of the facilitator• Help the group gain a deeper
understanding of the issues• Walk the group step-by-step through a
process that links the identified issue to the root problem by asking ‘why’ and ‘how ’
• Infuse social determinants of health and health equity into the conversation
Participatory Methods for Analysis
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Sample from IPHI
Underlying Contradictions
• Unquestioned assumptions, mindsets, beliefs, and practices that oppose the vision.
• Not a ‘lack of’, but rather a log jam or kink in the hose
• Images and attitudes, structures and patterns out of which people operate
Role of the facilitator• Create space for dialogue about clusters of
barriers and underlying themes• Help the group recognize productive
avenues for action that respond to, impact, or go around
Participatory Methods for Analysis
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Focus Question: What is blocking us from moving toward our vision?
1. NO DISCUSSION OF ‘LACK OF’2. Focus on one element of the vision: individual brainstorm obstacles
(external policies, patterns or structures, internal images, perceptions or attitudes)
3. Share brainstorm with small groups, develop one list for small group4. Bring ideas back to the large group, develop large group list5. Form clusters of ideas, name the clusters6. Review results and discuss:
1. What stands out about our obstacles?2. What is the importance of each cluster?3. What is the underlying contradiction (the block)?4. Discuss actions that could deal with each cluster of contradictions5. Prioritize the actions to address the contradictions
Participatory Methods for AnalysisUnderlying Contradictions
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Stakeholder Analysis
• Identify and develop key relationships for successful implementation
• Circles of Engagement
Role of the facilitator• Help the group understand each
circle and identify stakeholders within each
• Create a picture of the current situation, the ideal situation, and identify gaps
Participatory Methods for Analysis
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Environmental Scan
• Gain insight into community contextual factors related to the priority area, and that may drive or influence the implementation of the action plan.
• ToP Wall of Wonder
Role of the facilitator• Create space for dialogue that clearly describes present
and future assets, challenges, benefits, and dangers• Discuss plans for present and future trends, factors and
events• Help identify synergistic linkages to and gaps in existing
efforts
Participatory Methods for Analysis
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Participatory Methods for AnalysisToP Wall of Wonder
Level of influence
Past Present Future(foreseeable)
Trends
Federal
EconomicPolitical/Policy
SocialCultural
EnvironmentalTechnology
FactorsEvents
FactorsEvents
Themes that play out over
time
StateFactorsEvents
FactorsEvents
FactorsEvents
Themes that play out over
time
LocalFactorsEvents
FactorsEvents
FactorsEvents
Themes that play out over
time
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Sample from IPHI
Example: Action Planning Worksheet
Example: Action Plan Template
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Sample from Wisconsin Association of Local Health Departments and Boards
Strategies/Action Steps Partners/Persons Responsible
Timeline Outcome Indicators
Objective:
Goal/Outcome:
Monitoring/Evaluation Approach:
Example: Action Plan Template
Strategies/Action Steps Partner/Person Responsible
Timeline Outcome Indicators
Monitoring/EvaluationApproach
Desired Outcome (product):
Desired Outcome (product):
Example: Sustainability Planning Template
Sample from MPHI
Example: Action Plan Template
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FACILITATING IMPLEMENTATION
Beginning with the End in Mind
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Participatory Methods for Implementation
“Creativity is thinking up new things. Innovation is doing new things… A powerful new idea can kick
around unused for years, not because its merits are not recognized, but because nobody has assumed
responsibility for converting it from words into action. Ideas are useless unless used. The proof of
their value is only in their implementation.”
-Theodore Levitt
How do you think of your action plan? If you think of your plan…
• As a stack of paper: you will use it to fill up a file.
• As a burden: you will use it to remind yourself and others of overwork.
• As a carrot and stick: you will use it only on others less committed than yourself.
• As a covert operation: you will use it yourself and keep it from others.
• As a critical opportunity: you will pour all your energy into it, and burn out and get grumpy before long.
Transitioning from Action Planning to Implementation
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If you think of your action plan as a roadmap for a momentous journey for your community, you will:
• Move eagerly forward to each new step
• Participate in and appreciate both the ups and downs of the road
• Capture images of beautiful sights along the way
• Notice and welcome changes in yourself and others as you move toward your destination.
Transitioning from Action Planning to Implementation
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Implementation is…
• A shift in the whole system.
• Realizing the goals and milestones of the plan.
• Engaging people as change forces.
• Actively facilitating the whole journey to ensure intended results.
• Actively monitoring the whole journey to ensure learning and growth.
Moving from Action Planning to Implementation
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PHAB requires communities to
implement elements and strategies of the health improvement plan, in partnership
with others.
The role of the facilitator during implementation is to…
• Attend to the task, people, and process.
• Set-up processes that are participatory and responsive.
• Assess the situation on an ongoing basis, and facilitate processes to help the group retain or determine new focus.
• Engage stakeholders in consensus building.
Moving from Action Planning to Implementation
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Moving from Action Planning to Implementation
“We are all much more likely to act our way into a new way of thinking
than to think our way into a new way of acting.”
-R. Pascale, M. Millemann & L. GiojaChanging the Way We Change
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Moving from Action Planning to Implementation
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• Getting started
• Building & sustaining momentum
• Making adjustments
• Bringing closure Institute of Cultural Affairs, Technology of Participation (ToP) ‘Four Dimensional Model of the
Implementation Journey’
Four Phases of Implementation
Elements of this Phase
• Need to integrate into operations and existing demands
• People work in unfamiliar ways; turf issues and changing roles
• People feel excited, discouraged, challenged, anxious
• ‘Implementation Dip’• Need for coordination of structures,
roles, and patterns of interacting• Need for high energy, rapid, visible
‘quick wins’
Moving from Action Planning to Implementation:Getting Started
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Keys to Success in this Phase
• Ensure the plan has potential for quick, highly visible results
• High energy, Kick-Off event• ‘Catalytic actions’ to smooth out
challenges of working together• Communicate the plan to all
stakeholders• Decide on a guidance group and
process• Set up a monitoring and
communication system (process & products)
Moving from Action Planning to Implementation:Getting Started
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Elements of this Phase
• Energy will ebb and flow, long term initiatives will tire people out
• Leadership and staff may be in flux• The guidance group may struggle with
how to hold themselves and others accountable
• Organizational development and refinement of systems and technologies is likely needed
• Support of individuals and building of capacities becomes critical
• Steady and reliable monitoring and communication is the lifeblood
Moving from Action Planning to Implementation:Building & Sustaining Momentum
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Keys to Success in this Phase
• Celebrate small accomplishments• Make public displays of progress• Maintain regular, informal reports,
feedback, and interchange• Keep stakeholders in the
communication loop• Trainings for individual and team
capacity building• Develop new leadership, rotate roles• Utilize unexpected leverage points
Moving from Action Planning to Implementation:Building & Sustaining Momentum
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Example: Quarterly Action Plan Team Report
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Title of Action PlanTeam chairperson
Quarter: Project year:
Accomplishments Date of Accomplishment
Blocks/difficulties Going well
Team recommendations for next quarter
Planned actions next quarter
Example: Solutions Workshop
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1. Define the topic you are working on
2. Clarify the ‘what’ and ‘why’ of the topic
3. Brainstorm ‘Issues Facing Us’Go around, each person lists an issue, and keep going until all issues are listed.
5. Brainstorm ‘Possible Actions’Go around, each person brainstorms a different action to consider to address the issues until all are listed.
4. Star 1-3 Key Issues to Focus OnFrom the list, choose 1-3 key issues that you believe are the most relevant challenges
6. Choose 3-4 Actions You Will DoAs a group, review the list of suggested actions, circle 3-4 actions that you will actually do.
7. Create and Image or Slogan to Solidify your DecisionDraw a graphic image or write a short statement that explains and clarifies the actions you will take.
Elements of this Phase
• Significant learning about ‘what works’ and what does not work
• Deep struggle and new resolve• Group capacity and camaraderie pays
off• Moving toward self-sustaining
initiatives• Deciding between a bump in the road
and hitting a wall• ‘Failures’ become revised strategies• People will need help in being honest
about reporting what did not get done
Moving from Action Planning to Implementation:Making Adjustments
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Keys to Success in this Phase
• Prepare for low points and high points• Develop short range action plans when
you get stuck• Be prepared to change directions when
your plans are no longer appropriate• Strengthen facilitation skills of the
group• Reframe failures• Use a visual monitoring form (both on
display and on paper)• Hold milestone meetings to mark
turning points and plan to move ahead
Moving from Action Planning to Implementation:Making Adjustments
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Re-Maneuvering Planning Session
• Bring back together the action planning team/workgroup• Review the vision, results of data gathering, and strategic
priorities that lead to this strategy and action plan• Discuss what still seems on target and what is off• Brainstorm:
• What has been accomplished?• What accomplishments have really moved us forward?• What blocks are we hitting?• What is needed right now to get on track?
• Develop a 90-day action plan that coordinates with existing plans
Example: Re-Maneuvering Planning Session
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Example: 90 Day Action Plan
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Strategic direction Strategy: Title (what)
Intent (why) Start date End date
Action Steps Who When Where
1.2.3.4.
1.2.3.4.
1.2.3.4.
1.2.3.4.
Coordinator Collaborators Evaluation Budget Progress Update
Team members
Next Meeting
Example: Quarterly Meetings
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Quarterly Planning and Evaluation Meeting Schedule
ParticipantsThose involved in planning and implementation
Rational ObjectiveAssess accomplishments, recognize successes, and plan for next period
Experiential ObjectiveAffirm and re-energize individuals and the team
Product/Outcome•Clear tasks and roles for the next period•Report on progress to the steering committee
Qtr 1 Qtr 2 Qtr 3 Qtr 4
Qtrly Planning and Monitoring
Qtrly Planning and Monitoring
Qtrly Planning and Monitoring
Annual Planning and Evaluation
• Review of vision, objectives, and strategies
• Evaluation of 90 day action plan (accomplishments, activities completed, blocks, learnings
• Plan for next 90 days (measurable outcomes on qtrly timeline, review action plan
• Review of vision, objectives, and strategies
• Evaluation of 90 day action plan (accomplishments, activities completed, blocks, learnings
• Plan for next 90 days (measurable outcomes on qtrly timeline, review action plan
• Review of vision, objectives, and strategies
• Evaluation of 90 day action plan (accomplishments, activities completed, blocks, learnings
• Plan for next 90 days (measurable outcomes on qtrly timeline, review action plan
• Review vision, objectives, and strategies
• Evaluation of annual action plan (accomplishments, milestones, outstanding activities, blocks, learnings)
• Develop measurable outcomes for next 12 months on qtrly timeline
• Create detailed 90 day action plan
Elements of this phase
• Peer recognition of accomplishment begins to emerge
• Reaching out to other similar efforts
• Unanticipated outcomes, challenges, and consequences
• The ‘new’ reality emerges• Victory needs to be celebrated
and contributions affirmed and appreciated
• The change effort needs to be recognized for its larger significance
Moving from Action Planning to Implementation:Bringing Closure
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Keys to Success in this Phase
• Write a powerful story of what happened
• Build in unmistakable closure on tasks with an end date
• Hold a highly visible celebration• Recognize and appreciate
commitment and contributions• Articulate the learnings that
occurred• Assess and propose
improvements to the overall process used
Moving from Action Planning to Implementation:Bringing Closure
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Oklahoma Health Improvement Planninghttp://www.ok.gov/health/Organization/Board_of_Health/Oklahoma_Health_Improvement_Planning_Team_(OHIP)_/OHIP_Work_Group_Quarterly_Reports/index.html
Example: Implementation
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Within your small group:
1) Answer these questions:• What is one experience you have with action planning
and/or implementation?• What was one challenge you faced?• What would you do differently next time to resolve the
challenge?
2) Everyone shares and records:• 1 Give-Away: Something (resource, tool, tip) I know or use
that could be helpful to others• 1 Take-Away: Something I learned that I will take back
with me and explore further
Peer Sharing: Challenges & Resolutions
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The reporter for each group will…
• Summarize your group’s experiences
• Highlight 2-3 gems of the discussion• Lesson learned to resolve a key challenge• Challenge to explore further• 1 Giveaway & 1 Takeaway that could benefit the
large group
Peer Sharing: Large Group
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Key Points
• Action planning is both process and product.
• There are key issues to attend to in each of the phases of the implementation cycle.
• Facilitation is a key role in successful action planning and implementation.
Wrap-up
“The bottom line of systems thinking is leverage–- seeing where actions and changes
in structures can lead to significant, enduring
improvements. Often, leverage follows the
principles of economy of means; the best results
come not from large-scale efforts but from small, well-
focused actions.”-Peter Senge
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• When to Apply QI Tools to Support Measurement Activities, Public Health Foundation and National Network of Public Health Institutes, 2013. http://www.phf.org/resourcestools/Documents/QI%20Tools%20and%20Measurement%20Activities.pdf
• New CHIPP Resources (Website). Wisconsin Association of Local Health Departments and Boards. http://www.walhdab.org/NewCHIPPResources.htm
• The Community Guide. http://www.thecommunityguide.org/index.html
• NACCHO Model Practices Database.
• Choosing Effective Policies and Programs. County Health Rankings & Roadmaps.
• Healthy People 2020. http://www.healthypeople.gov/2020
• Guide to Clinical Preventive Services: http://www.ahrq.gov/clinic/pocketgd.htm
• National Resource for Evidence Based Programs and Practices: www.nrepp.samhsa.gov
• Technology of Participation. Institute of Cultural Affairs:
Resources
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Shannon Laing, MSW
Center for Healthy CommunitiesMichigan Public Heath [email protected]
Contact Information
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