beginning with the end in mind: supporting the development of health improvement plans designed for...

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’


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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


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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


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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


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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


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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


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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


time

LocalFactorsEvents

FactorsEvents

FactorsEvents


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:


Strategies/Action Steps Partner/Person Responsible

Timeline Outcome Indicators

Monitoring/EvaluationApproach

Desired Outcome (product):

Desired Outcome (product):

Example: Sustainability Planning Template

Sample from MPHI


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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.


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“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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• 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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• 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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• 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.


• 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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• 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



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 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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• 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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http://www.ok.gov/health/Organization/Board_of_Health/Oklahoma_Health_Improvement_Planning_Team_(OHIP)_/OHIP_Work_Group_Quarterly_Reports/index.html



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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http://www.phf.org/resourcestools/Documents/QI%20Tools%20and%20Measurement%20Activities.pdf

http://www.phf.org/resourcestools/Documents/QI%20Tools%20and%20Measurement%20Activities.pdf

http://www.walhdab.org/NewCHIPPResources.htm

http://www.thecommunityguide.org/index.html

http://www.healthypeople.gov/2020

http://www.ahrq.gov/clinic/pocketgd.htm

http://www.nrepp.samhsa.gov/

Shannon Laing, MSW

Center for Healthy CommunitiesMichigan Public Heath [email protected]

Contact Information

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mailto:[email protected]