Chapter 12: Implementation

human resources management (HRM)

Four fundamental functions (PADS): personnel planning, acquisition, development, and sanction.

outcomes

Intended results and are broken into short-term (immediate: changes in awareness, attitudes, knowledge, skills), mid-term (medium: changes in behavior or the environment), long-term (risk reduction, changes in health status, or QOL).

Program Registration and Fee Collection

Program registration and feee collection may take place before the program (preregistration). Think about the type of payment.

inputs

Resources (infrastructure) that are used to plan, implement, and evaluate a program. Includes Human Resources, partnership, funding sources, equipment, supplies, materials, and community resources.

financial management

The process of developing and using systems to ensure that funds are spend for the purposes for which they have been appropriated. - Accounting: The process of recording and summarizing these transactions and interpreting their effects on the program budget. - Fiscal year: funding year, January 1st to December 31st OR July 1st to June 30th. - Fiscal accountability: Refers to the needs for sound accounting, careful documentation of expenses, and tracking or revenues. - Audit: Review and confirmation that financial reports are accurate and that standard accounting procedures were used to prepare the reports. - External audit: One that is conducted by a qualified independent account just once a year. - Internal audit: Frequent and ongoing audit conducted by an employee f the organization not responsible for the accounting practices.

Legal Concerns

deals with negligence and reducing the risk of liability

type III errors

failure to implement the health education intervention properly

PERT chart

Acronym for program evaluation and review technique. More complex than Gantt charts and not used much with health programs. Presents visual representation of the relationship between and among tasks to be completed. Indicates the order of completion by sequentially numbering the tasks. Includes three estimates of time for each tasks (optimistic, pessimistic, and probabilisitic time frame).

reducing the risk of liability

Disputes may arise between those offering the service (planner) and those (program participants) receiving it or other (third) parties Recommendations planners would follow (7) on 340.

activities

Interventions or strategies used in a program to bring about change.

Phase 1: Adoption of the Program

Planners must ensure that the marketing process produces a relevant product (health promotion program) so that the PP will want to participate in it.

total implementation

Planners should work towards total implementation through piloting and phasing in processes. Exceptions for one shot programs.

critical path method (CPM)

Similar to PERT but focuses on total time to complete the tasks and the critical dependent tasks. Provides a graphical view go the project and predicts the time required to complete the project. Consists of the set of dependent tasks that together take the longest time to complete.

informed consent

- (1) making the participants fully aware fo the relevant information about the program (2) making sure the participants comprehend the information provided (3) obtaining the participants voluntary agreement, free of coercion and undue influence, to participate. - 7 steps to obtaining informed consent on 336 and 337.

Dealing with Problems

- Anticipate for problems so they can be resolved more easily if they do happen in the implementation process. - Problems can be due to logistics, participant dissatisfaction, or personal or medical emergency.

Program Participants with Disabilities

- Disability: Defined on the basis of specific activities of daily living, work and other functions essential to full participation in community-based living. - Guidelines, criteria, and issues to consider when implementing programs for individuals with disabilities (343).

Monitoring Implementation

- Essential function in program implementation and it involves the ongoing collection and analysis of data and other information to determine if the program is operating as planned. Form of process evaluation. - Basic monitoring data and information for a program has these utilities: (1) provides operating and descriptive data and information (2) provides basic information for comparing outcomes to program objectives (3) provides education information (4) monitoring data serves as a preventive maintenance function by tracking indicators.

Ethical Issues

- Ethical issues: situations in which competing values are at play and program planners need to make a judgment about what is the most appropriate course of action. - Beneficence: doing good. Requires program planners to protect participants by maximizing anticipated benefits and minimizing harms. - Nonmaleficence: not causing harm

Implementation of Evidence-Based Interventions

- Focus on implementation science. - Four step fidelity assurance protocol: (1) Deconstructing the program into its components and planners prepare a step-by-step plan for program replication in the new setting; make sure to include the culture. (2) Planners identify the agencies that are ready to replicate the intervention (3) Planners monitor the fidelity of the program y using standardized checklists to ensure that the primary components are being delivered. Include rating of those implementing the program. (4) Using evaluation tools of the program in order to track program participants' progress and be able to compare the collected data to the expected outcomes.

phasing in

- Good when there is a very large PP. Allows planners to have more control over the program and helps to protect planners and facilitators from getting in over their heads. - Four ways to phase in: (1) different program offerings (2) limiting the number of participants (3) choice of location (4) participant ability

Procedures for Record Keeping

- HIPPA: Sets national standards that health plans, health care clearinghouses, and health care providers who conduct certain health care transactions electronically must implement to protect and guard against the misuse of individually identifiable health information. - Anonymity: Exists when no one can related a participant's identity to any information pertaining to the program. - Confidentiality: Exists when planners are aware of the participants/ identities and have promised not to reveal those identities to others.

Introduction

- Impact of program will be judged on the effectiveness of interventions and the quality of implementation.

pilot testing

- Known as piloting or field testing. Allows planners to work out any bugs before the program is offered to a larger segment of the PP and to validate the wrk that has been completed up to this point. Program should be piloted in a similar setting and with people similar to the PP. - Check on four areas: (1) interventions strategies were implemented as planned, known as fidelity (2) interventions strategies work as planned (3) adequate resources were available to carry out the plan (4) participants in the pilot group had an opportunity to provide feedback about the program. - Important to have the program participants critique.

Training for Facilitators

- Make sure that the program intervention is implemented as planned (fidelity). Need this because great effort goes into adoption, adapting, or creating an intervention for the specific PP; appropriate intervention is needed because it will be able to evaluate and document the effectiveness of an intervention. - To ensure that the program is implemented as planned, facilitators need to be familiar with the intervention. Need standardization.

Phase 3: Establishing a System of Management

- Management is the progress of working with and through others to achieve organizational or program objectives in an efficient an ethical manner. Sets of resources include human, financial, and technical resources. Good management is needed to ensure that programs are effective and efficient (effective: ones that meet stated goals and objectives and efficient: when resources are made of best possible use). - Three skills needed by managers: technical, interpersonal, and conceptual. - Depending on the type of program being planned, management process ranges from a small portion of a single planner's time and resources. - Three major resources: human resource management (HRM), financial management, technical resources management.

Documenting and Reporting

- Planners need to decide what types of data and information need to be collected to serve and protect their program. - Documentation includes: keeping track of program registration, attendance, use of program resources, and collection of data for evaluation. - Good documentation can: (1) assist planners in monitoring program implementation (2) provide feedback (3) help identify where changes must be made (4) provide feedback on participant satisfaction with a program (5) provide evidence if there is a legal challenge to any aspect of implementation. - Planners should keep stakeholders informed: (1) accountability (2) public relations for the program and organization (3) participant motivation, satisfaction, and recruitment. - Organizations then need to identify a secure location for their storage.

Phase 2: Identifying and Prioritizing the Tasks to be Completed

- Planners need to identify and prioritize a number of smaller tasks. Recommended that planners use some for of planning timetable or time line that represent the dates, time span, and sequence of events involved in a program. They aid in monitoring program progress. Commonly includes basic time lines, task development time lines, Gantt charts, PERT charts, and critical path method (CPM). Could include an estimate of dates when activities or tasks will take place and time allocated to complete them. - Example of basic time line for a needs assessment: appoint committee, determine the purpose and scope, gather data, analyze data, identify RF, identify problem focus, validate needs. - Planning time tables: Task development time lines, Gantt charts, PERT, critical path method (CPM)

Safety and Medical Concerns

- Planners need to inform participants about the program they are considering joining (informed consent) - Informed consent forms (wavier of liability or release of liability) do not protect planners from being sued. Informed consents fo make participants aware of special concerns. No such thing as waiver of liability. - Need to obtain medical clearance if the act of participating the program puts anyone at medical risk. Steps must be taken to ensure the safety and health of all associated with the program. - Safe program includes: findings a safe program location, providing appropriate security at the location, ensuring that all building codes are met at the location, and ensuring that other facilities used are free of hazards.

First Day of Implementation

- Referred to as the program launch, program rollout, or program kickoff. Extension of promotion (p in marketing). Focus of promotion is on creating and sustaining demand for a product, which can lead to the initiation of the program. - Some special planning needs to take place for the first day of implementation: (1) decided on a day when the program is to be rolled out (2) kick off the program in style (3) obtaining news coverage [news hook: helps to interest the media in the program being launched, means something that will make the media want to cover the launch].

Concerns Associated with Implementation

- Safety and Medical Concerns - Ethical Issues - Legal concerns - Program registration and fee collection - Procedures for Record Keeping - Procedural Manual and or Participants' Manual - Program participants with disabilities - Training for facilitators - Dealing with Problems - Documenting and reporting

Procedural Manual and/or Participants' Manual

- Should be created when the program is very involved and/or have a number of different people facilitating the program. - Referred to as a training manual. Purposes is to (1) ensure that all who are associated with the program understand the program and its parameters (2) standardize the intervention so it can be replicated and to avoid type III errors (3) provide ideas for facilitation (4) provide additional background information on the topic (5) provide citations for additional resources. - Need and useful because (1) Good way of getting all program information into participants/ hand at one time (2) help participants organize information they receive and keep it all in one place (3) serve as references or resource for participants (4) if participants frequently use their manual as part of the program and become familiar with it, they may be more inclined to refer it to outside of the program sessions. - Manuals are more likely to be developed in-house (developing either procedural or participant manuals).

Phase 4: Putting Plans into Action

- There are three major ways of putting plans into action: by phasing them in, in small segments; and by initiating the total program all at once. - Inverted triangle: (bottom to top) total program, phased in, and pilot. Triangle represents number of people from the PP that would be involved in the program based on the implementation strategy. Disadvantages and advantages on 331. Total program indicate offering the program to a larger number of people than pilot. Recommended that all programs go through all three of strategies starting with piloting, phasing, and total program.

Phase 5: Ending or Sustaining a Program

- To determine how long to run a program. Greater concern is how to sustain a needed program for a longer period of time when goals and objectives have not been met or goals and objectives are long-term in nature. Problem because resources can be withdrawn. Here, referring to the maintenance and institutionalization of a program or its outcomes. - Techniques to sustain programs include (1) working to institutionalize the program (2) seeking feedback from program participants and evaluating the program in order to generate evidence to show its worth (3) advocating for the program (4) partnering with other organizations/agencies (5) revisiting and revising the rationale used to create the program initially (6) establishing a resource development committee to create business and marketing plans aimed at sustainability.

Logic Models

- Used at various times during the planning, implementing, and evaluating processes. Useful at implementation because they can help identify the steps that must be taken to implement and manage successful programs. - Systematic and visual way for planners to share and present their understanding of the relationship among the resources they have to operate a program, the activities they plan to implement, and the outputs and outcomes they hope to achieve. Road map that shows the connections among the key components of a program. - Take different shapes (liner, circular, lists) and be presented in various levels (simple, complex) but all depict the relationship and linkages of components (inputs, activities, outputs, short-term, mid-term, and long-term outcomes). - Meta-summaries of complex processes. - Four components: inputs (resources), activities (interventions or strategies), outputs (evidence of activities), outcomes (results and effects). - Logic model can also include: (1) purpose or mission of the program (2) the context, conditions, or situations under which the program will be offered (3) assumptions associated with the planned program (4) external factors that could influence success of the program (5) description of the evaluation of the proposed program. - Created with if then statements. Helps to create link in the chain of reasoning that takes planners from program resources to expected program outcomes.

Phases of Program Implementation

1) adoption of the program 2) identifying and prioritizing the tasks to be completed 3) establishing a system of management 4) putting plans into action 5) ending or sustaining a program

task development time line

Contains rows and columns (rows represent the tasks or activities completed and columns represent periods of time). Identifies the tasks that need to be completed and the time frame in which the tasks will be completed.

Gantt chart

Developed by Gantt as a production tool. Contains rows and columns. Does the same but provides an indication of the progress made toward completing the task by using different size lines to distinguish between projected time frame for a task and the progress toward completing the task. uses a marker above the columns to indicate the current date.

outputs

Direct results of the activities and include products, services, and new components of infrastructure.

negligence

Failing to act in a prudent (reasonable) manner. Two types of acts: omission and commission. - Omission means not doing something when you should. Commission means doing something you should not doing.

impact

Fundamental intended or unintended change occurring in organizations, communities, or systems as a result of the program.

Defining Implementation

Means to carry out. The act of converting planning, goals, and objectives into action through administrative structure, management activities, policies, procedures, regulations, and organizational actions of new programs. Implementation is one of the three stages of program diffusion, with the others being adoption and sustainability.

technical resources management

Referred to as other resources. Includes other resources besides human or financial. Resources included are communication, equipment, expertise, information, materials, partnership, relationships, space, and supplies. Most difficult category of resources because it is hard to quantify the amount go technical resource.

implementation science

to study how interventions, which have been shown to be effective in one setting, can be applied to sustain improvements to population health