implementation principles and implementation...

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IMPLEMENTATION PRINCIPLES AND IMPLEMENTATION SUCCESS

A Research Report

Presented to

In partial fulfillment of the requirements for the

Masters of Business Administration Degree

by

Mark Mitchell and Laura Wier

November 2004

Supervisor: Professor Norman Faull

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Implementation Principles and Implementation Success

Prepared by: M. Mitchell & L. Wier Page i

Preface

This report is not confidential and may be used freely by the Graduate School of

Business.

We would like to express our thanks and appreciation to everyone who assisted with this

report. We would like to extend particular thanks to the following people:

• Professor Norman Faull who provided guidance and shared his passion for

operational strategy implementation with us.

• To Organisation-A who so openly and honestly shared their implementation story.

• To Organisation-B for the help in collating their story, as well as for agreeing to

meet with us late on a Friday afternoon!

• To the Vendor and the associated Supplier, a special thank you for your assistance

and support throughout this process. A special thank you for opening our eyes to

the issue of HIV/AIDS and for sharing your deep passion for this issue with us.

Finally, to both our partners, Jocelyn and Darryl – thank you for all your support and

understanding throughout the past two years of our MBA.

We certify that, except as noted above, this report is our own work and all references are

accurately recorded.

Signed:

Mark Mitchell Laura Wier

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Prepared by: M. Mitchell & L. Wier Page ii

Abstract

The purpose of this research report is to assess whether adherence to generic

implementation principles is associated with operational strategy implementation success.

This research has been performed because successful implementation remains difficult to

achieve. It has also been observed that people and organisations are generally not

conscious about the problems surrounding the concept of implementation or the inherent

learning and competitive benefits that are derived from continuous, successful

implementations.

The research has been achieved through the evaluation of two HIV/AIDS Intervention

Programme implementation’s against the Eight Principles of Effective Implementation

in order to assess whether adherence to the generic implementation principles will

contribute to implementation success. These implementations were chosen, as HIV/AIDS

remains an epidemic of absolute urgency.

Results of the research indicate that alignment to the Eight Principles of Effective

Implementation do improve the ability to implement operational strategy more

successfully. We hope that these findings will make a contribution to the understanding

of how to implement an HIV/AIDS Intervention Programme more effectively.

Key Words: Implementation, Implementation Framework, Operational Strategy,

HIV/AIDS Intervention Programme

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Prepared by: M. Mitchell & L. Wier Page iii

Table of Contents

1. INTRODUCTION.................................................................................................................1 1.1 Purpose of the research.........................................................................................................1 1.2 Constraints on the research...................................................................................................2 1.3 Report layout ........................................................................................................................3 1.4 Glossary of acronyms ...........................................................................................................4

2. STUDY OBJECTIVES .........................................................................................................5

3. LITERATURE REVIEW......................................................................................................7

4. RESEARCH METHODOLOGY ........................................................................................10 4.1 Research strategy................................................................................................................10 4.2 Research methodology........................................................................................................11 4.3 Data gathering.....................................................................................................................13 4.4 Data sample ........................................................................................................................14 4.5 Approach to the analysis.....................................................................................................16

5. FINDINGS ..........................................................................................................................20 5.1 Summary of principles identified per organisation.............................................................20 5.2 Detailed comparative findings per principle.......................................................................21

5.2.1 Principle 1: Never stop asking the question 22 5.2.2 Principle 2: Have ‘dual organisation’ capability 23 5.2.3 Principle 3: Create a fault-tolerant environment 25 5.2.4 Principle 4: Prepare a plan of action or project plan 26 5.2.5 Principle 5: Surface the ‘force for effective implementation’ 27 5.2.6 Principle 6: Use the ‘force for effective implementation’ to elicit appropriate behaviour 29 5.2.7 Principle 7: Take the ‘first small steps’ 31 5.2.8 Principle 8: Lead like a relentless but reflective bulldozer driver 32

6. ANALYSIS OF FINDINGS................................................................................................33 6.1 Principle 1: Never stop asking the question........................................................................33 6.2 Principle 2: Have ‘dual organisation’ capability.................................................................34 6.3 Principle 3: Create a fault tolerant environment .................................................................35 6.4 Principle 4: Prepare a project plan......................................................................................36 6.5 Principle 5: Surface the ‘force for effective implementation’ ............................................37 6.6 Principle 6: Use the ‘force for effective implementation’ to elicit appropriate behaviour..38 6.7 Principle 7: Take the ‘first small steps’ ..............................................................................40

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6.8 Principle 8: Lead like a relentless but reflective bulldozer .................................................41

7. LEARNING AND REFLECTIONS ...................................................................................43 7.1 Learning elicited from this research ...................................................................................43 7.2 Additional factors not catered for by the principles............................................................44 7.3 Considerations for future research......................................................................................45

7.3.1 Proposed new relative strength rating scale 45 7.3.2 Complexity of individual choice 46 7.3.3 Issues that specifically relate to HIV/AIDS 46

8. CONCLUSION ...................................................................................................................48

9. APPENDICES.....................................................................................................................50 9.1 Appendix A: Coding methodology used to perform the analysis .......................................50 9.2 Appendix B: The Organisation-A story..............................................................................51

9.2.1 Background 51 9.2.2 Assigned areas of responsibility 53 9.2.3 Preparation for the rollout 55 9.2.4 The launch 58 9.2.5 The rollout 59 9.2.6 Information sharing 61 9.2.7 Evaluation and self assessment 63

9.3 Appendix C: The Organisation-B story ..............................................................................68 9.3.1 Background 68 9.3.2 Assigned areas of responsibility 68 9.3.3 Preparation for the rollout 69 9.3.4 The launch 70 9.3.5 The rollout 70 9.3.6 Information sharing 71 9.3.7 Evaluation and self assessment 71

9.4 Appendix D: Working papers per principle........................................................................73 9.4.1 Principle 1: Never stop asking the question 73 9.4.2 Principle 2: Have ‘dual organisation’ capability 74 9.4.3 Principle 3: Create a fault-tolerant environment 76 9.4.4 Principle 4: Prepare a plan of action or project plan 77 9.4.5 Principle 5: Surface the ‘force for effective implementation’ 79 9.4.6 Principle 6: Use the ‘force for effective implementation’ to elicit appropriate behaviour 81 9.4.7 Principle 7: Take the ‘first small steps’ 83 9.4.8 Principle 8: Lead like a relentless but reflective bulldozer driver 83

9.5 Appendix E: Summary of statistic measures per organisation............................................84

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9.6 Appendix F: Summary of findings per organisation...........................................................85 9.7 Appendix G: Contact log ....................................................................................................86

10. REFERENCES ....................................................................................................................88

Table of Figures

Table 1: Glossary of acronyms........................................................................................................ 4 Table 2: Summary of data gathering methods performed ............................................................. 16 Table 3: Relative strength rating scale .......................................................................................... 17 Table 4: Summary of principles identified in Organisation-A ...................................................... 20 Table 5: Summary of principles identified in Organisation-B ...................................................... 21 Table 6: Proposed new relative strength rating scale .................................................................... 46 Table 7: Measurement statistics per organisation.......................................................................... 84

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Prepared by: M. Mitchell & L. Wier Page 1

1. INTRODUCTION

1.1 Purpose of the research

Successful implementation has always been a challenge in any environment. The ability

to succeed in implementation results in a business being able to ‘do’ what they plan to

‘do’. As stated by Bossidy (2002, p.6), ’Execution is not only the biggest issue facing

business today: it is something no one has explained satisfactorily’

This research report attempts to assess whether adherence to generic implementation

principles is associated with operational strategy implementation success. This will be

achieved through a process of exploratory research of two implementations of an

HIV/AIDS Intervention Programme.

The reason for choosing to review an HIV/AIDS Intervention Programme

implementation is because one of the greatest challenges facing the South African

business environment today is the potential future economic consequence of the

HIV/AIDS pandemic. New international research estimates that, between 1992 and 2002,

HIV/AIDS cost the South African economy about R422,5 billion. This cost is mainly

attributed to deaths and labour absenteeism. The report by the International Labour

Organisation also pointed out that if this situation was not dealt with, this cost would

worsen to a predicted twenty percent loss of the labour force by the year 2010. Stopping

the spread of HIV/AIDS is a societal and business imperative. To ensure a successful

implementation of an HIV/AIDS Intervention Programme is therefore of strategic

business importance. (Taho, 2004, p.1)

These implementations have been selected because of the variation in their perceived

success rates. This approach has allowed us to compare each organisation’s

implementation to the generic principles in order to assess if alignment to each of those

principles correlates to the perceived success rate of that implementation. This approach

has also enabled us to identify if any other factors, that are not included within the

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generic implementation principles, have contributed to implementation success. It has

also provided us with the opportunity to review if any key principles have been omitted

in one implementation or strongly focused on in another, thus enhancing the possibility of

confirming which key implementation principles are most critical.

Given that HIV/AIDS remains an epidemic of absolute urgency, we hope that the

findings will be able to make a contribution to the understanding of how to implement an

HIV/AIDS Intervention Programme even more effectively.

1.2 Constraints on the research

We would like it to be noted that, given the confidential nature of the testing process, we

have been unable to interview any employees who were tested, as this would be a breach

of confidentiality. This research therefore does not include the perceptions of these

participants regarding the implementation process of the programme.

Time and financial constraints meant that we were only able to pursue a single trip to

Johannesburg, which is where Organisation-B and the Vendor are situated. This resulted

in these two companies unstructured interviews only being performed face-to-face. The

Vendor does have a branch office in Stellenbosch where a structured interview occurred.

All further data gathering occurred via telephone or email.

A further constraint was the fact that data gathering was limited to that of the Human

Resource Departments within each organisation who were responsible for the

implementation of the HIV/AIDS Intervention Programme. In the case of Organisation-

B, it was further limited to two sources within the Human Resource Department, who

spoke on behalf of all role players within the organisation. Due to their various roles

within the implementation process, a certain amount of bias given their stake in the

implementation has to be allowed for on the part of the people interviewed.

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Finally, the ability to extract information regarding the implementation of the programme

in Organisation-A and Organisation-B was clearly influenced by the personalities of the

individuals and the culture of the companies. Organisation-A employees were extremely

open in information sharing while those of Organisation-B were more controlled in the

manner in which they divulged and communicated the information.

1.3 Report layout

This report contains the following sections:

1. Introduction

2. Study objectives: Describes what is to be achieved through this research.

3. Literature review: Reviews supporting literature on both the topic of

implementation and each of concepts addressed by the Eight Principles of

Effective Implementation.

4. Research methodology: Details our research strategy, provides the reasons

we chose to pursue case base research, as well as the methodology that we

pursued. It also discusses the data gathering techniques and data sampling

process pursued. Finally it describes the analysis approach that was taken for

this research.

5. Findings: Divided into two parts. Firstly a summary per organisation of the

number of occurrences found per principle, and secondly, a commentary per

principle per organisation, allowing comparisons to be drawn.

6. Analysis of findings: Reviews each of the Eight Principles of Effective

Implementation in terms of both Organisation-A and Organisation-B in

order to elicit the learning in relation to each principle.

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7. Learning and reflections: Discusses the learning elicited from this research,

some additional factors that influenced the implementations and some

considerations for future research of this nature.

8. Conclusions: Reviews the purpose of the research, the method followed and

the results at a strategic, operational and organisational level.

1.4 Glossary of acronyms

The following table details those acronyms that are used within this research report.

Table 1: Glossary of acronyms

Acronym Description

VCT Voluntary Counseling and Testing

ARV Anti Retroviral

AMAG Aids Management Advisory Group

HIV Human Immunodeficiency Virus

AIDS Acquired Immune Deficiency Syndrome

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2. STUDY OBJECTIVES

This research is attempting to understand if adherence to implementation principles will

imply implementation success. Implementation can be defined as the move from an

existing state with current outcomes, to a desired future state as defined by a set of new-

targeted outcomes. The Eight Principles of Effective Implementation, as devised by

Norman Faull, have been developed in an attempt to answer the following question, as is

likely to be posed by a chief executive officer striving for greater implementation success

within his organisation: ‘How can we improve our track record for the effective

implementation of operations strategy?’

Our intention is to evaluate each HIV/AIDS Intervention Programme implementation

against the Eight Principles of Effective Implementation in order to assess whether

adherence to the generic implementation principles will contribute to implementation

success.

The Eight Principles of Effective Implementation focuses on two areas: (a) key factors

that pertain to the organisation in general (the first three principles) and (b) key factors

that pertain to a specific initiative (the last five principles). Adherence to all Eight

Principles of Effective Implementation is expected to produce a more successful

implementation.

The Eight Principles of Effective Implementation are listed below:

Key factors that pertain to the organisation in general

1. Never stop asking the question

2. Have ‘dual organisation’ capability

3. Create a fault-tolerant environment in which to learn to improve the track record

of effectively implementing an operations strategy

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Key factors that pertain to a specific initiative

4. Prepare a plan of action or project plan

5. Surface the ‘force for effective implementation’ as a function of:

a. The clarity regarding what one wants to achieve in outcome terms

b. The confidence in knowing how to achieve this new outcome or at least

having a ‘working hypothesis about how to achieve it’

c. The conviction as to why it is necessary to achieve this new outcome

Furthermore, use this ‘force’ to judge the ‘point of no return’ or ‘point of

commitment’ for the particular initiative.

6. Use the ‘force for effective implementation’ to elicit the appropriate behaviour

from stakeholders who:

a. Have the power to sabotage the intervention (negative power can be

individual), or

b. Whose supportive behaviour is highly likely to determine the degree to

which the outcome is achieved and sustained (positive power is collective)

7. Take the ‘first small steps’

8. Lead like a relentless but reflective bulldozer driver

Our intention in performing this research is to understand which principles have been

weakly adhered to, and if focused on in future, should provide opportunity for

implementation improvement. We concur with the view of the Director General of the

International Labour Organisation, Juan Somavia, that “HIV/AIDS is not only a human

crisis, it is a threat to sustainable global, social and economic development”

(www.redribbon.co.za). It is in this context that we believe the research has the potential

to add value if insights are gained on how to improve the effectiveness of an HIV/AIDS

Intervention Programme implementation.

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3. LITERATURE REVIEW

This research recognises the requirement that in order for an organisation to achieve

competitiveness, it is imperative to be able to implement successfully. Further to this,

Chew, Leonard-Barton and Bohn (1991), state that a reason why implementation success

should be in the interests of every business, is that, “the firm that is better than its

competitors at implementation receives new technology at what amounts to a discount

price”. This automatically provides the business with a competitive advantage. Bossidy

(2002, p.21) takes this a step further by claiming that not only is execution fundamental

to strategy, but also that no strategy can be planned without taking into account the

company’s ability to execute it.

Principle 1 and Principle 3 of The Eight Principles of Effective Implementation as

explained in the study objectives of this document, discusses the need to create a climate

of continuous improvement, allowing learning to take place in order to improve future

implementation initiatives. We found this to be supported by Klein and Sorra (1996,

p.1060) who make a similar observation about how implementation effectiveness affects

future implementation. They state that when implementation is successful, people learn

how to implement better, and acceptance of change is incorporated in the culture, which

in turn, oils the wheels of future implementation efforts. Bossidy (2002, p.86) also states

that an environment in which people are allowed to learn from their mistakes seems to be

more effective in implementation. Pfeffer and Sutton (2000, p.6) also claim that

‘effective implementation is always a process, and learning to improve it is, even more

so, a process. And that which is learnt from doing is more likely to be applied than what

is learnt “from reading, listening, or even thinking” ’.

A combination of clarity of the end goal and a strong desire to achieve that end goal is

considered by Principle 5 to be the driving ‘force’ required to achieve a successful

implementation. Kotter (1996, p.162) also acknowledges that a high urgency rate helps

enormously in completing the required steps in an implementation process. Not only does

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one require a ‘force for implementation’, one also requires key resources to buy-in to the

implementation, as described by Principle 6. Nutt (1996, p.255) supports the concept of

people buy-in where he refers to the “implementation tactics as studied by Coch and

French (1948) who found that people reacted more favorably and became more

committed when they participated in change-making processes than when they did not”.

The need to know what is to be achieved, as well as how it is to be achieved for a specific

strategic initiative is explained by Principle 4. In preparing the detailed activities that

need to be performed, Bossidy (2002, p.23) highlighted the relevance of robust dialogue

in order to surface the realities of the business, such that the plans are relevant and that

the people responsible for preparing the plans take accountability for them.

Another consideration in creating the action plan is that of Principle 7, which encourages

the concept of interim deliveries. The benefits of interim deliveries are that they provide

short-term wins that motivate the team to continue and create an opportunity to test if

what they are delivering is aligned with the long-term goal. Kotter (1996, p.118) also

stated “the process of producing short-term wins can help a guiding coalition test its

vision against concrete conditions”. Bossidy also considers the concept of short-term

wins a requirement in order to achieve successful implementation. Bossidy (2002, p.122)

further states that, “The leaders whose visions come true build and sustain their people’s

momentum. They bring it down to earth, focusing on short-term accomplishments - the

adrenalin-pumping goals that get scored on the way to winning the game”.

Finally, there has to be rigorous pursuit of the end delivery until you meet that end goal

which is acknowledged by Principle 8. Bossidy (2002. p.127) stated, “Following through

ensures that people are doing the things they committed to do, according to the agreed

timetable. If people can’t execute the plan because of changed circumstances, follow-

through ensures they deal swiftly and creatively with the new conditions”.

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The literature review shows support for the Eight Principles of Effective

Implementation as defined by Norman Faull, which we have adopted as the hypothesis

for this research.

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4. RESEARCH METHODOLOGY

4.1 Research strategy

The fundamental reason for undertaking this research is to improve our knowledge on the

phenomenon of implementation, specifically, whether adherence to generic

implementation principles is associated with operational strategy implementation success.

We intended to achieve this through the analysis of two independent implementations of

an HIV/AIDS Intervention Programme that had a perceived difference in implementation

success. This relative success was based on the fact that Organisation-B had achieved a

higher percentage of employees to be tested to Organisation-A over a similar time period.

In order to achieve this we needed to be able to understand how each implementation was

performed which would allow us to compare each organisation’s story to the Eight

Principles of Effective Implementation and to assess where there had been alignment

and where not.

We decided that the best way to obtain each organisation’s implementation story would

be to interview as many employees as was possible who had been closely involved with

the implementation process. This would allow us to gather multiple stories, which we

were hoping, would provide us with a richer account of the implementation process. We

also hoped that hearing the story from different employees would allow us to hopefully

recognise where a story was strongly biased.

Once we had spoken to all the employees, we intended to collate all the information that

we had gathered into a single story, which we would then analyse. Our proposed

methodology was to highlight each occurrence of a principle and also attempt to

objectively give each occurrence a relative strength rating. We realised that this would

possibly involve an element of bias from each of our perspectives, but we hoped that if

we performed this rating independently, and then together debated each one, we would be

able to limit the degree of individual bias.

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We then intended to compare Organisation-A to Organisation-B to be able to try to see if

alignment to each of these principles did provide a greater chance of implementation

success.

We were also interested to see if there were any behaviours or activities that occurred in

either organisation during the implementation that were not addressed by any of these

principles.

4.2 Research methodology

Given that our research is of an explorative nature in that its intention is to test the theory

of whether alignment to the Eight Principles of Effective Implementation will achieve

improved operational strategy implementation, and that this analysis is dependant on the

review of a real operational implementation, we decided that the most appropriate

research methodology to adopt would be that of case based research.

When we were deciding on which operations management research methodology to

pursue, we did consider each of the following methodologies in order to assess whether,

given the nature of our problem, we were using the most effective research technique.

The alternative investigative approaches that we considered included the following

methods:

• Survey research involves the use of questionnaires to gather data from a large

population samples. This was inappropriate as we did not want to limit the

information that we would receive from those employees involved in the

implementation process and the sample size we are working with is too small.

• Case research is ‘a history of a past or current phenomenon, drawn from multiple

sources of evidence’ as described by Leonard-Barton (1990) (Saunders, Lewis &

Thornhill, 2003, p197). Because of its source, a case study can be used not only for

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exploration but also for theory building, theory testing and / or theory extension or

refinement (Voss, Tsikriktsis & Frohlich, 2002, p.196)

• Action research is when one becomes more involved with the real-life action of

an organisation specifically with the aim of creating knowledge. This is an

‘approach to research that aims both at taking action and creating knowledge or

theory about the action.’ (Saunders et al, 2003, p.220).

• Models and Simulations are used to obtain a more holistic view of how different

factors interact in big systems and are specifically quantitative using a number of

variables.

The three advantages to case research that Meredith (1998, p.197) highlights are the

following (as developed by Bebensat et al.):

• Firstly, phenomena can be studied in their natural setting and that meaningful as

well as relevant theory is gained through actual observation.

• Secondly, through case study one develops an intimate understanding of not only

the nature but the complexity behind phenomena, and in this way one is able to

answer the questions of why, what and how more accurately.

• Finally, case study is an appropriate method of exploratory research where

variables are still unknown and the phenomena not understood. (Voss et al, 2002,

p.197)

A further benefit of case based research that supported our choice of methodology is that

it provides one with ‘an intimate understanding, of not only the nature but the complexity

behind the phenomenon, one can more accurately answer the questions of why, what and

how’ (Saunders et al, 2003, p.248). This is at the core of our research, our need to

intimately understand exactly how each organisation’s implementation occurred. In order

to compare each story against the Eight Principles of Effective Implementation, we

need to understand what each organisation did, how they did it and why it was done in a

specific way in order for us to develop the implementation story such that we would be

able to analyse it against the principles. We were completely dependent on those

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employees who were involved in the implementation to share their experience with us in

order that we could attempt to understand what actually occurred.

It was very apparent to us that our decision to perform case based research was the right

one. Further to this, the research would be qualitative in nature, as we wanted to provide

the employees with an open canvas to ‘paint their story’ as they perceived it to be. We

also wanted to be given sufficient detail such that we could ‘attempt to understand the

meanings that people give to their deeds or to the social phenomena affecting their

actions’ (Oka, 1996, p.2).

4.3 Data gathering

Having identified the issue we intended to research and the research approach we

intended to follow, we began a detailed literature review in order to obtain a broader

understanding of the issues that surround successful implementation. We found there to

be very little written about successful operations strategy implementation. We also

performed numerous Internet searches to provide background on the issues of HIV/AIDS

within South Africa, as well as an understanding of the HIV/AIDS Intervention

Programme whose implementation at two organisations we would be reviewing.

We then conducted a series of unstructured interviews, as they do not have any

predetermined set of questions. They instead provide both the researchers and

interviewees an opportunity to talk freely about the relevant topic and it is up to the

researchers to generate and develop questions according to the responses and comments

of the interviewees. The reason for this initial approach was that we did not want to in

any way be seen to be influencing or priming the interviewees.

Having gained a very broad and what was considered to be skeleton, story from the

employees that we interviewed, we realised that in order to obtain a better understanding

of the implementations, we would have to perform some semi-structured interviews. This

type of interview requires the researchers to prepare interview guides that consist of a

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general set of questions. These guides allow the researchers to generate their own general

questions to develop relevant areas of inquiry during the interviews. We are very aware

of the fact that once we began interacting with these employees, the environment was

likely to change. The very nature of question asking could result in interviewees thinking

about issues that they otherwise would not have.

As the use of general questions did not elicit the results we expected, we then resorted to

more explicit questions and hence moved into structured interviews. The focus here is on

a set of specific questions that were used for every interviewee who had previously been

interviewed in a semi-structured interview. In this way we were able to compare different

interviewees’ responses to the same set of questions.

From both the semi-structured and structured interviews we attempted not only to

uncover and understand the ‘what’ and the ‘how;’ but also to place more emphasis on the

exploration of the ‘why’ (Saunders et al, 2003, p.248). During all these interviews

performed we continued to analyse what was being said while proceeding through the

interview with each interviewee. This methodology assisted us in deciding what

questions should be asked next in the discussion.

Throughout the interviewing process, we were very aware of the fact that both the

interviewee and the interviewer were engaging in a simultaneous analysis. Due to the

very nature of conversation, the person being interviewed also actively engages in this

same process. Holstein and Gubruim have described this as ‘indigenous coding’ (Holstein

& Gubrium, 1995, p.56; Shaw, 1999, pp.175-176), that is, interviewees may also analyse

what they say while being interviewed. The researchers have attempted to take this into

consideration when analysing the interview data.

4.4 Data sample

The interview process included key role players who were involved in the

implementation of the HIV/AIDS Intervention Programme from both Organisation-A and

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Organisation-B. Organisation-A is based in Cape Town and Organisation-B has its Head

Office in Johannesburg. The key role players interviewed from both Organisation-A and

Organisation-B are from within the Human Resources Department.

Our interviews also included personal interviews with four of the key role players from

the Vendor. Three of these role players are based in the Vendor’s Johannesburg Head

Office and one of the role players is based at the Stellenbosch Branch Office. These

interviews provided us with valuable context with regard to the area of HIV/AIDS as well

as background to the HIV/AIDS Intervention Programme. We were also given the

opportunity to meet with the Executive Director, as well as the Managing Director and

Chairman of one of the Vendor’s Suppliers who is responsible for the Disease

Management of the programme. This provided us with invaluable insight into the issues

surrounding HIV/AIDS Intervention Programme implementation.

The table below provides a summary of the data gathering methods used to gather data

from the key role players within Organisation-A, Organisation-B, the Vendor and one of

its Suppliers. All the interviews performed with Organisation-A were on a one-on-one

basis, whereas those performed with Organisation-B were done in a group context

allowing for consultation among interviewees. There is a detailed list of all contact with

these organisations for review in Appendix G.

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Table 2: Summary of data gathering methods performed

Data Gathering Method Organisation-A Organisation-B Vendor Supplier

Unstructured interviews Face-to-face Face-to-face Face-to-face Face-to-face

Semi-structured interviews Face-to-face None Face-to-face None

Structured interviews Face-to-face Via email Via email None

Emails seeking clarification Yes Yes Yes None

4.5 Approach to the analysis

Having gleaned the information behind the implementation, as reported by key members

of each implementation team for both Organisation-A and Organisation-B, we then

populated an implementation story for each of the organisations, based on the content of

the interviews. The story for Organisation-A can be reviewed in Appendix B and the

story for Organisation-B can be reviewed in Appendix C.

We decided to use a colour coding method to be able to reflect each occurrence of a

principle within the story. The colour coding system can be reviewed in Appendix A. We

then applied the Eight Principles of Effective Implementation to the story, colour

coding each statement that related to one of the implementation principles.

At the same time as coding these statements, we also rated each principle with a relative

strength of Weak, Neutral or Strong. These ratings were a personal interpretation of the

degree to which we felt that the statement supported that specific principle. This rating is

included in brackets directly after the principle occurrence within the story. In order to

attempt to reduce subjectivity, we each rated the story independently and then

crosschecked each other’s rating, debating vigorously when we did not agree, until we

could reach consensus. We are very aware that this rating is subjective, left to each

individual’s personal interpretation. Our intention was that the rating scale should be

applied as follows:

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Table 3: Relative strength rating scale

Relative strength Description

Weak An action that does not assist in improving the chance for a successful implementation

Neutral An action that neither supported nor negatively influenced the implementation in anyway

Strong An action that shows alignment with a specific principle in order to ensure implementation improvement

The next step was to populate a summary table per organisation, detailing the number of

occurrences per principle, per relative, strength. Organisation-A’s summary table can be

reviewed in Table 4: Summary of principles identified in Organisation-A and

Organisation-B’s summary table can be reviewed in Table 5: Summary of principles

identified in Organisation-B. Given the richness of the Organisation-A story

(97 identified occurrences of a principle), it resulted in a skewed number of total

occurrences relative to the Organisation-B story (which had 26 identified occurrences of

a principle). After we had collated the two stories we recognised that this was acceptable

given that the Organisation-A story is sixteen and a half pages, whereas the

Organisation-B story is only five pages long.

We have attempted to create a weighting system to allow for better comparisons to be

made between the two stories. This weighting system calculates each total relative

strength number of occurrences of a principle as a percentage of the total number of

occurrences of all the principles. A summary of these calculations can be reviewed in

Appendix F: Summary of findings per organisation. Having reviewed the story of each

organisation and identified the occurrences per principle with an associated relative

strength, we then created a table per principle, detailing, for each organisation, the

specific occurrences for that principle, as well as the associated strength. This provided

us with an easier reference and summary for the analysis to be performed. These working

papers per principle can be reviewed in Appendix D: Working papers per principle.

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We then reviewed each principle in the context of both organisations and tried to assess

whether perceived alignment or non-alignment had an influence on the implementation of

HIV/AIDS Intervention Programme. We also tried to assess whether there were any

relationships between principles, which were also contributing to the perceived

implementation success or lack thereof. This commentary is provided per principle and

can be found in Section Six. Having performed the analysis and findings, we have

notated the learning elicited from this research and have attempted to draw conclusions

with regard to our findings and the Eight Principles of Effective Implementation.

Further to this we discuss those additional factors that we perceived not to be catered for

by the generic principles.

Throughout the process we have attempted to critique our methodology in order to learn

from the process and document our findings so that future research can review and

benefit from the research process we have had. These considerations are also recorded in

Section Seven of this document.

During the telling of each story, the interviewees made reference to certain activities that

would only occur after the time period in which we were performing our research. We

have left these commentaries in the story and also referenced them according to principle

and its relative strength. In order to separate these items from the current research, we

prefaced the relative strength with a ‘future’ and followed the associated strength with a

question mark. None of the story items referenced in this way have been included in the

principle calculations, the findings or the discussions. These observations will only be

that relevant action dependant on ‘how each organisation intends to implement’.

We are aware of the potential bias that could infiltrate our research and the danger of

thought versus opinion, so throughout the document we have attempted to provide

objective evidence as well as avoid any possible value judgments. We have at all times

attempted to reflect the data as key members of the implementation team reported it to us.

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In this regard, the only accurate ratification of our reporting would be if someone

repeated the study, replicated the result and drew the exact same conclusions.

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5. FINDINGS

The Findings section is divided into two parts. The first section presents a summary per

organisation of the number of occurrences found per principle within each Organisation’s

story. The second section provides a commentary per principle, per organisation,

presented in tabular format in order for the reader to be able to easily perform

comparisons.

5.1 Summary of principles identified per organisation

The following two tables present a summary of the number of occurrences of each

principle and its associated strength per occurrence, as identified through the analysis of

each Organisation’s story. Organisation-A’s detailed story can be reviewed in Appendix

B: The Organisation-A story and Organisation-B’s detailed story can be reviewed in

Appendix C: The Organisation-B story.

Table 4: Summary of principles identified in Organisation-A

Principle Weak Neutral Strong

1 Never stop asking the question 0 0 8

2 Have ‘dual organisation’ capability 24 0 0

3 Create a fault tolerant environment 0 0 1

4 Prepare a plan of action or project plan 4 1 8

5 Surface the ‘force for effective implementation’ 7 0 11

6 Use the ‘force for effective implementation’ to elicit appropriate behaviour

20 1 7

7 Take the ‘first small steps’ 1 0 2

8 Lead like a relentless but reflective bulldozer driver 2 0 0

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Table 5: Summary of principles identified in Organisation-B

Principle Weak Neutral Strong

1 Never stop asking the question 0 0 0

2 Have ‘dual organisation’ capability 1 0 1

3 Create a fault tolerant environment 0 0 2

4 Prepare a plan of action or project plan 0 1 5

5 Surface the ‘force for effective implementation’ 0 0 7


0 0 7

7 Take the ‘first small steps’ 0 0 2

8 Lead like a relentless but reflective bulldozer driver 0 0 0

5.2 Detailed comparative findings per principle

The following section contains a commentary on the analysis and findings per principle

per organisation. Each table is structured in the same format and contains the following

information:

• A high level description of what is expected to be in place in order to support the

relevant principle;

• A summary of the number of occurrences of that principle grouped by its relative

strength;

• The associated colour that has been used to highlight the principle in each

organisation’s story; and

• A commentary discussing the principles as used by each organisation.

The colour coding technique can be reviewed in Appendix A.

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5.2.1 Principle 1: Never stop asking the question

• The key purpose of Principle 1 is to seek continuous improvement in how to implement operational strategy. The focus is on ‘learning by doing’ requiring one to reflect on what has been done, then to ask the question ‘if, then’ and then actively pursing the new activities required to correct what has been deemed to require improvement.

Weak Neutral Strong

Organisation-A 0 0 8

Organisation-B 0 0 0

Organisation-A Organisation-B • Organisation-A asked the question many

times and got the correct answer to the problem, however they did not follow through to resolve the problem.

• Organisation-A has relied heavily on the written medium, which is not necessarily proving effective.

• Organisation-A is trying to highlight the issue surrounding HIV/AIDS to encourage participation in the programme. They are however still relying on the email as the predominant means of communication.

• Although acknowledging that AMAG is quick to provide feedback, there were no examples cited as to how this feedback has actually influenced implementation.

• Organisation-B cited no occurrence where the implementation strategy had been reviewed in order to change the initial implementation methodology.

• Organisation-B does however mention that they encourage regular feedback from their employees, but there was no reference to this necessarily resulting in implementation methodology changes.

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5.2.2 Principle 2: Have ‘dual organisation’ capability

• The purpose of Principle 2 is that of a ‘dual organisation’ with a permanent capacity alongside the existing organisation. The focus of the ‘dual organisation’ capacity is to facilitate and manage continuous improvement within the organisation.

Weak Neutral Strong



Organisation-A Organisation-B • There is high evidence in Organisation-A

that there is insufficient capacity to pursue the required activities to ensure a successful implementation. This issue was highlighted in a number of interviews, which means that Organisation-A either is not capable of changing this or are choosing to ignore the lack of capacity for some reason.

• The impression is that the resource constraint is known by all involved with the implementation and nothing to date has been done to change this. It has to be assumed that this constraint is deemed acceptable to senior management and that the impact on delivery is therefore acceptable to them.

• We do not know if any formal capacity assessment was performed in order to make the decision not to bring any new resource on board.

• It was not specifically stated as to whether there was anyone available to assist during Wellness Week preparation, or whether the resource was identified but also did not have capacity.

• Being dependant on administrative employees within each department is seen as necessary in order to relieve capacity constraints of the Organisational Health Manager. It is not clear whether these resources necessarily had been formally requested to perform any activities.

• It was not stated whether the Executive Personal Assistant had existing spare capacity or whether existing work deliveries became secondary to the implementation.

• Although the Executive Personal Assistant was also expected to perform the required activities over and above the normal workload, allowances were made in order to ensure a successful launch and rollout.

• Organisation-B’s implementation strategy was to go for a one-off high success rate in terms of testing which meant that the timeline for implementation was reasonably short. This does not mean that capacity was not an issue for Organisation-B, but just that it had less influence as the dual workload could be more easily absorbed/managed given the shorter period of time.

• In Organisation-B capacity was ‘extended’ by using the line managers effectively to encourage participation.

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Organisation-A (continued) Organisation-B • When Resource do not show an active

interest in the implementation, it is not clear whether this is due to a lack of interest or a capacity constraint.

• The lack of immediate response by the Vendor Administrator could also imply a capacity constraint.

• The HIV/AIDS Intervention Programme comes second in the Organisational Health Manager’s priorities, which relates to the importance the Organisational Health Manager associates to this issue within a work context.

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5.2.3 Principle 3: Create a fault-tolerant environment

• Implementation success cannot be guaranteed. Principle 3 addresses the extremely important issues of having an environment that provides the required tolerance level such that employees will feel that they have the space and support from their leadership to learn. Failure needs to be recognised as an opportunity to learn, resulting in improved implementation success.

Weak Neutral Strong



Organisation-A Organisaton-B • In Organisation-A there seems to be

dissonance in that there is a high strong occurrence of Principle 1, which reflects the desire for continuous improvement. There seems however to be little action to show improvement. It seems difficult to turn words into action.

• Organisation-A has a desire to achieve certain predefined goals. There is however little incentive to ensure success, as nobody is really held accountable for the achievement of these goals. Delivery is not tied into employee assessment – there are no consequences.

• The perception is that from a management perspective there is also no real need to tolerate error or encourage improvement, as they are also not being assessed on goal achievement. Non-delivery seems to be acceptable.

• Given Organisation-A’s capacity constraints, there would be little time for talking or sharing of ideas and problems. This will obviously hinder the opportunity for pre-empting of errors or the resolution of issues raised, that can directly influence the attainment of the end goal.

• The Executive Personal Assistant stated in the interview that there was great support and a continuous supply of feedback from the superiors who were immediately available if there was an issue to be resolved.

• Organisation-B also encourages regular feedback from employees regarding the HIV/AIDS Intervention Programme.

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5.2.4 Principle 4: Prepare a plan of action or project plan

• The key purpose of Principle 4 is to monitor that an action plan is created that details exactly what activities are required to be performed in order to meet the predefined targeted outcomes. The action plan also needs to specify exactly how one intends to achieve these activities, when they need to be performed and who needs to perform them.

Weak Neutral Strong



Organisation-A Organisation-B • Organisation-A structured their

implementation with ongoing education, awareness and testing for a prolonged period of time in order to give all the employees from every department an opportunity to participate in education and testing.

• The action plan appeared to have targets and associated delivery dates. There was little reference in the interviews as to whether the detailed activities and associated responsibilities were included in the plan. There was also no reference as to whether this plan was communicated in advance to the associated areas where targets were set.

• The Organisational Health Manager replaced the original targets set by the organisation with new targets taking her capacity constraints into consideration.

• If the implementation team want to use internal resources, planning needs to take place long in advance to ensure it gets into the annual schedule such that those resources are available.

• Organisation-B put a lot of structure into the rollout strategy upfront, including what detailed activities had to be performed and when.

• Organisation-B structured their implementation with initial education, awareness and testing followed by ongoing education and awareness communication.

• Organisation-B created a detailed plan in advance to the rollout, specifying exactly what activities needed to occur, by when and by whom.

• Organisation-B had no targets other than attempting to ‘test as many as possible’ during the three-day testing period per region.

• Employees knew there was just one opportunity where they could be tested if they wanted to ‘know their status’. This also provided Organisation-B with only one chance to ‘test as many as possible’.

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5.2.5 Principle 5: Surface the ‘force for effective implementation’

• The purpose of Principle 5 is to assess how strong the motivational force is within the decision-making group of the organisation. It requires there to be both clarity of intended outcomes and a strong desire to achieve those outcomes. The commentary below describes exactly how this metric is calculated. The stronger the motivational force, the greater the likelihood of the organisation pursing its targeted outcome.

Weak Neutral Strong



Organisation-A Organisation-B • Organisation-A seemed to be

predominantly driven by the need to show society that they were ‘doing what was right’

• Organisation-A however very clear on wanting to ensure that their HIV positive employees received the appropriate treatment.

• Those directly responsible for the implementation were not personally very confident with regard to the implementation even though they were passionate about the cause.

• Organisation-B was very internally focused and predominantly influenced by their care for their employees.

• Organisation-B had also experienced some deaths which had heightened both their awareness and their sense of urgency to rollout an HIV/AIDS Intervention Programme.

Commentary • Principle 5 can be calculated using 3 factors. They are:

• ‘W’ – Clarity on knowing what you want to achieve in measurable outcomes • ‘H’ – Confidence in knowing how to go about achieving the outcomes • ‘Y’ – The degree of conviction about why you want to achieve those specific outcomes

• In order to assess the ‘force for effective implementation’, namely ‘F’, a rating scale has been used. • ‘W’ as detailed below attempts to assess the degree of clarity the organisation has with

regard to achieving their end goal. This is rated on a scale of 0 to 1 • ‘H’ is rated on a scale of 0 to 1 • ‘Y’ is rated on a scale of –1 to 1

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Commentary (continued) • Once each individual factor has been rated, the 3 ratings are multiplied in order to calculate

the ‘F’. The ‘F’ can be in a range of –1 to 1, where –1 is the absolute negative motivation and 1 is the absolute positive motivation. This rating is a notional metric to surface a realistic sense of, and then commitment to, a ‘point of commitment’ to the initiative.

• A strong ‘F’ factor should compel effective implementation and counter the inertia of ‘knowing-yet-not-doing’ behaviour.

Organisation-A Organisation-B

• We have rated Organisation-A as having a 20% ‘force for effective implementation’.

• We also requested two of the key resources involved with the Organisation-A implementation to rate the implementation using this scale. The table below reflects their assessment.

• The reality of the limited capacity is strongly reflected in the second rating.

W H Y F Strong 9 1 0

Weak 1 2 4

1 0.4 0.5 20%

W H Y F Retirement Fund Manager

0.5 0.5 1 25%

Organisational Health Manager

1 0 1 0%

W H Y F Strong 1 3 3

Weak 0 0 0

1 0.8 0.8 64%

• We have rated Organisation-B as having a 64% ‘force for effective implementation’.

• We had a response from a member of the Group Aids Forum who was prepared to rate the implementation using this scale. The table below reflects this response.

W H Y F Aids Forum Member

1 0.5 1 50%

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5.2.6 Principle 6: Use the ‘force for effective implementation’ to elicit

appropriate behaviour

• Principle 6 is focused specifically on the role of leadership obtaining ‘buy-in’ from those resources that are most likely to sabotage a successful implementation.

• Principle 6 together with Principle 5, are possibly the two most important of the Eight Principles of Effective Implementation in determining implementation success.

• Principle 6 focuses on using the motivational force defined by Principle 5 to influence and elicit the appropriate behaviour from those resources that are integral in ensuring implementation success.

Weak Neutral Strong



Organisation-A Organisation-B • Organisation-A made no reference to any

interventions taken to change the negativity and passivity experienced from employees.

• The benefit of the influence of a figurehead was made evident with the increased testing response when the one manager made attendance at the information session compulsory.

• Email was the main communication mechanism used for distributing news and information about the HIV/AIDS Intervention Programme implementation to each employee. The technology freeze meant that no emails could be sent for eight months.

• The Organisational Health Manager seemed satisfied with the content and volume of written communication sent to employees using electronic mediums. There was however no reference made as to how the implementation team could confirm if this electronic communication ever reached its intended audience.

• From the initial launch, there was visible endorsement of the programme at a senior management level through the video by the Deputy Chairman.

• The implementation team seems to have been successful at eliciting supportive behaviour, as they state that ‘total support has been shown for the programme by both management and employees throughout this time’.

• It is difficult to assess how effective this support was in achieving their end goal given that no measurable targets were set before starting the VCT process.

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Organisation-A (continued) Organisation-B • The ability to encourage and influence

participation was possibly not very effective as it relied upon the Human Resource Department to influence employees, opposed to an employees direct line management.

• The benefits of line management encouraging their own employees is that they already have a relationship with them and therefore would be more likely to succeed in influencing behaviour.

• Given that it is not formally any individual resource’s responsibility to assist the Organisational Health Manager in a rollout, it is very difficult to guarantee assistance in this regard. There is also no escalation process to ensure that her capacity could be extended through this form of assistance.

• Given the confidentiality associated with testing, overt support of the programme is dependant on an individual leader choosing to encourage support for the programme.

• There seems to have been little focus, possibly due to capacity constraints, on eliciting the appropriate behaviour from key stakeholders (e.g. Employee Union, Employee Body, Senior Line Management or Departmental Line Management).

• Even if the Human Resource Department did not have the authority to elicit the appropriate behaviour, the question exists as to whether the Deputy Chairman was approached to help elicit appropriate behaviour.

• There is a passiveness shown towards this implementation by the leadership, from rollout ownership, to end-user.

• The capacity constraints experienced by the Organisational Health Manager have led to high levels of frustration for her. This could negatively influence her desire to actively influence others to participate in the programme.

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5.2.7 Principle 7: Take the ‘first small steps’

• The purpose of Principle 7 regards starting the action required to meet the organisations end goal. Providing interim milestones (or a pilot) is imperative in order to allow the implementation team to test their implementation methodology. This provides one with a psychological advantage if one is successful or an opportunity to review ones methodology if not. Principle 7 is closely associated with Principle 1, which focuses on learning from what has already been done.

Weak Neutral Strong



Organisation-A Organisation-B • Although the Human Resource Advisors

were trained to assist in the rollout it is not evident from the story the degree to which these employees performed this task.

• The utilisation of these employees was possibly not optimised due to the fact that the Human Resource Advisors were not formally contracted to perform this education.

• Wellness Week was a good example of the use of an interim milestone.

• Although the Vendor makes VCT testing available on a monthly basis, this does not seem to be the most efficient means to have employees tested, as the participation at these sessions remains extremely low.

• The Human Resource Department needs to review if the current method used for notifying employees when testing is going to occur, is actually reaching all employees. It should not be assumed that because an email has been sent, that the intended recipient has necessarily received it.

• Organisation-B had very clear milestones to be achieved during the rollout process. They did however only have one opportunity for employee testing. The number of employees tested during that time period was reviewed and a further testing session has been scheduled for November.

• Roles and responsibilities were clearly defined and employees were efficiently used.

• The rollout was not only supported by management but also formalised by the development of an HIV/AIDS Policy.

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5.2.8 Principle 8: Lead like a relentless but reflective bulldozer driver

• It has been proved that effective managers are both more patient as well as more demanding in terms of achieving the end goal. Principle 8 has the ‘patient side’ look for progress towards the end goal while the ‘demanding side’ keeps the pressure aimed towards the targeted outcomes.

• The key focus of Principle 8 is that problem solving occurs in order to remove obstacles such that one can achieve ones end goal.

Weak Neutral Strong



Organisation-A Organisation-B • Employees involved in managing the

rollout have set their own personal goals and do feel a personal pressure to achieve them.

• It is our perception that top management see the HIV/AIDS Intervention Programme as ‘an infrastructure in place’. There is no real need for management to pursue any further goals. No formal assessment or valuation of adhering to roles and responsibilities or achieving targets is linked to any performance review.

• As the programme is one of the many activities the Organisational Health Manager oversees, the shortage of her time plays a substantial role in her inability to show constant interest and pressure towards her targeted outcomes, as well as limiting her time to be reflective on the implementation strategy to date.

• Organisation-B cited no occurrences of Principle 8 in their story.

• The very nature of the environment of Organisation-B is competitive which encourages the pursuit of excellence.

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6. ANALYSIS OF FINDINGS

In the following section we review each of the Eight Principles of Effective

Implementation in relation to both Organisation-A and Organisation-B in order to

elicit learning relative to each Principle. The intention of these findings is to align with a

climate of continuous improvement, allowing learning to take place in order to improve

future operational strategy implementation initiatives.

We have attempted to weight the findings provided by each Organisation in order to be

able to compare more objectively the findings per principle of each Organisation. This

was required as the details provided by each interviewee for Organisation-A was a lot

more detailed, resulting in a richer story for assessment. This also, however, has resulted

in a higher number of occurrences per principle than that of Organisation-B.

In Appendix F, we have presented the weighting process that has been used. Firstly by

calculating as a percentage, the number of occurrences per principle and its associated

strength as a percentage to the total number of occurrences for all the principles.

Secondly by calculating as a percentage, the number of occurrences per principle and its

associated strength as a percentage to the total number of occurrences for that specific

principle. These weighting scales are used in the comparative analysis detailed per

finding below.

6.1 Principle 1: Never stop asking the question

Organisation-A has proved that it is capable of reflecting on what activities have been

performed to date and identifying the problems that seem to be limiting their ability to

succeed at implementation. Organisation-A does however appear to be weak at taking

action to implement the required solution needed to improve their implementation ability.

If this was resolved, Organisation-A’s ability to succeed in implementation should

improve. On reviewing the Organisation-A story, there is sufficient evidence to

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recognise that the two key areas that require resolution are their alignment with Principle

2 and Principle 6. Organisation-A needs to address the issue of capacity to perform the

rollout, as well as, have a key leadership figure engage in motivating line management to

actively participate in motivating employees to participate in the programme.

Organisation-B made no reference to Principle 1 throughout their story, which makes it

difficult to assess the degree to which alignment does actually occur to this Principle.

Organisation-B appears to have an escalation mechanism to senior management as they

mentioned in their story that when an issue is raised, the appropriate intervention is

implemented to resolve the problem. Organisation-B also encourages employees to

provide feedback on the implementation. Organisation-B cited no examples of employee

feedback or its associated intervention that was implemented in order to confirm that this

feedback does result in an improved rollout. Organisation-B will have to assess its

strength at aligning to Principle 1 when it pursues its second testing initiative scheduled

for November 2004.

6.2 Principle 2: Have ‘dual organisation’ capability

Organisation-A has recognised that they have a capacity constraint in terms of their

ability to rollout this implementation. More than a quarter of all the references to

principles within the Organisation-A story, refer to this capacity constraint. To date

however, Organisation-A has not addressed this issue. Organisation-B appears to have

adjusted for capacity by making their Human Resource consultants responsible for

motivating line management to actively participate in the programme by being tested.

Line management was then made responsible for motivating and influencing their

employees to participate in the programme.

Although neither organisation has a proper ‘dual organisation’ in place, as described by

Principle 2, Organisation-B’s use of the extended network increased the capacity of the

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implementation team and alleviated any capacity constraints they may have experienced.

Organisation-A should consider extending their implementation capacity in a similar

manner through the involvement of the Senior Line Management and Departmental Line

Management. This will extend the reach of the implementation team to a greater number

of employees. The Senior Line Management and Departmental Line Management’s

responsibility should be to focus on direct communication and a personal approach with

their employees, as they have the closest relationship and probably the highest potential

to influence their employees.

As highlighted by Principle 1’s analysis, Organisation-A’s ability to pursue ideas to

improve implementation seems to be constrained by existing capacity. There seem to be

funds available to pursue more initiatives, however, these are not being pursued due to

the limited resource to implement.

6.3 Principle 3: Create a fault tolerant environment

On reviewing the Organisation-A story, it is difficult to assess where a positive fault-

tolerance and acceptance of failure, becomes a negative state of apathy. It is our

perception that there is a close relationship between fault-tolerance and the ‘relentless but

reflective bulldozer driver’ as described by Principle 8. Organisation-A management

seems to accept failure to a point of not encouraging action to correct the known problem.

It is our opinion that in order to be a fault-tolerant environment, you need to be extremely

goal orientated, which requires the organisation and implementation team to set

measurable targets in outcome terms prior to beginning an implementation.

Organisation-B did not state their goal in specific outcome terms, they purely stated that

they wanted to test ‘as many people as possible’, which meant that irrespective of what

the outcome was, Organisation-B’s implementation initiative could not be cited as either

a failure or successful.

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Organisation-B encouraged feedback from their employees, which required the

implementation team to be open to criticism, as well as being prepared to respond with

corrective action. No statistics were provided on the amount of feedback that has been

received, or what interventions have occurred in order to address this feedback.

Receiving feedback does require both time and effort from the implementation team, and

the organisation will only continue to receive feedback as long as employees get a

response to their feedback. The fact that people are prepared to listen is directly related to

supportive behaviour, which is likely to determine the degree to which the outcome is

achieved. Organisation-A may find this feedback loop difficult given the organisation’s

capacity constraints.

6.4 Principle 4: Prepare a project plan

Both Organisation-A and Organisation-B prepared a detailed project plan for their

respective rollouts. Their implementation strategies however differed significantly.

Organisation-A structured their implementation to have ongoing testing, education and

awareness for an extended period of time. This was partly required due to the

organisational structure; as Organisation-A could be described as containing multiple

business units each with its own culture and physical building, which resulted in each one

requiring its own mini-implementation. Initially the complexity that this would create for

the rollout was not identified by Organisation-A, but, in time, it became evident to the

implementation team. Although Organisation-A had a project plan, it was not evident

that resource allocation was negotiated and contracted up front, but rather that employees

other than the Organisational Health Manager and the Health Management Solutions

Advisor from the Vendor, were expected to perform the extra activities almost as a

favour to the Organisational Health Manager when it became time to rollout to a specific

department. This issue could have been addressed more effectively during the project-

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planning phase. At this point it may have required Organisation-A to apply a stronger

use of Principle 6 in order to motivate participation in the implementation process.

The Organisation-B rollout was structured very differently to that of Organisation-A, in

that Organisation-B scheduled a specific three-day period to perform testing, with the

intention of ‘testing as many employees as possible’. It was made very clear to the

resource that this was the only time to be tested and that the employees would lose the

opportunity if they did not attend. Organisation-B did however schedule ongoing

education and awareness for an extended period of time.

It is extremely difficult to maintain momentum when performing an implementation over

such a long period, as is the case of Organisation-A. Further to this, it is an issue on how

to keep enthusiasm for both the implementers and the employees. Enthusiasm and energy

levels are inclined to decrease, particularly if issues that are hindering the implementation

process are not being addressed. These issues should be addressed and catered for as part

of the project planning exercise.

6.5 Principle 5: Surface the ‘force for effective implementation’

Depending on whom we spoke to within Organisation-A there were a number of

different reasons cited as to why the implementation of the HIV/AIDS Intervention

Programme was to be performed. Our perception is that given the number of different

opinions as to what exactly Organisation-A wanted to achieve, it resulted in a weakened

overall motivational force for Organisation-A’s implementation. There was a range of

varying objectives, rather than a single clear objective, to which all employees were

striving. Objectives ranged from considering having the HIV positive employees only

treated, to having 600 employees attending VCT, to the key driver, cited during the

decision to pursue this programme, that there was the external factor of society’s

perception that the organisation was seen to be doing something. Organisation-A

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effectively achieved the latter outcome as soon as they had signed for the programme,

which could have influenced management’s desire to take a more active role in the

rollout. It is mentioned that a great deal of debate occurred before the decision was taken

to pursue the programme. The question has to be asked as to whether there was really

total management commitment to ensure this initiative would succeed. Taking the above

into consideration, our assessment of Organisation-A’s ‘force for effective

implementation’ was only 20%.

Organisation-B was very clear that they cared unconditionally about their employees

and believed that each employee should know his or her status so that the appropriate

interventions could be taken. Organisation-B had also experienced a number of deaths,

which further heightened their resolve that this was the right thing to do. People are more

inclined to get things done when the motivation is strong. We therefore rated

Organisation-B’s ‘force for effective implementation ‘as being 64%.

6.6 Principle 6: Use the ‘force for effective implementation’ to elicit


In Organisation-A, while the implementation team recognised that there are key

stakeholders that have the potential to sabotage a successful implementation, little has

been done to influence these employees to support the HIV/AIDS Intervention

Programme. It was the responsibility of the Organisational Health Manager to elicit a

champion within each department prior to a rollout, and when no champion was

identified, the rollout was aborted. A more effective way would have been to put a

mechanism in place to intervene and elicit the appropriate supportive behaviour.

There appear to be two issues that are most negatively influencing Organisation-A in

this regard. Firstly in alignment with Principle 2, the need to review leadership’s desire to

address the issue of capacity that is currently constraining the implementation team’s

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chances of success, and secondly, in alignment with Principle 5, having an extremely

clear, measurable goal. It is imperative that if the leadership of Organisation-A is serious

about achieving the goal of testing 600 employees, then they actively need to start

intervening through the line management structure in order to gain greater motivation and

support. Further to this, the Human Resource department appears to be the only

department that was specifically given the responsibility for tasks pertaining to the

implementation. The Human Resource department, however, has little or no influence

over either the Senior Line Management and/or the Departmental Line Management.

In the early stages of Organisation-A’s implementation, the Employee Union did take an

active interest in the implementation but this does not seem to have been exploited to

assist in the encouragement and motivation of other employees to participate in the

education and testing. From the story, it is not clear as to how much effort has actually

been put into eliciting appropriate behaviour. We do recognise, however, that capacity

has been cited as an overwhelming constraint in terms of the implementation, making it a

reason for the lack of exploitation.

Organisation-A acknowledges in the story that when Senior Line Management or

Departmental Line Management has intervened with employees and made the attendance

of an information session compulsory, or the line management has taken an active

interest in encouraging their employees to attend information sessions, the participation

in testing has been improved. This is a strong example of the cascading of Principle 8,

where management leads by example.

Organisation-B tells of a very strong leadership commitment in ensuring this initiative

was successful. It is not clear whether it was the implementation team or the leadership

driving the process, but, irrespective of who it was, the allocation of roles and

responsibilities were clear. If employees did not attend the information session, it would

have been seen as a management failure.

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We acknowledge that in Organisation-A the geographical spread of the environment has

influenced the level of ease with which one could elicit the appropriate behaviour, this

however we believe could also be resolved if the Senior Line Management and the

Departmental Line Management took on the responsibility of motivating their own

employees. This concept is supported by the comment made by the Organisational Health

Manager that when she performs ‘walk about’ on the day of a departmental rollout, there

is improved participation. Obviously employees appreciate the more personal touch of

being spoken to directly. At present the Human Resource Department has to push for the

education and testing. The Senior Line Management and Departmental Line Management

should rather be motivating individual employees and requesting the Human Resource

department to provide the infrastructure to educate and test.

It appeared from Organisation-B that the culture was much more compliant, and thus

supportive, in pursuing an initiative that is deemed important by the leadership. In

Organisation-A, this does not seem to be the case as the implementation team

experienced passiveness and negativity, with a large number of employees asking why

the organisation was interfering in what they considered to be a personal matter. This was

a view that even the Organisational Health Manager ascribed to. The issue of motivation

is a complex one, as the choice to be tested ultimately remains the choice of the

individual employee. Organisation-A expected employees to come forward themselves

with little encouragement required. This was the assumption that led the Retirement Fund

Manager to think that the implementation would be easier than it has been to date.

6.7 Principle 7: Take the ‘first small steps’

Both Organisation-A and Organisation-B’s approach to the programme was to break it

down into small manageable steps, many of which were achieved. While Organisation-

B was able to maintain its approach due to its ability to solve the problem of capacity,

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Organisation-A was, at times, not able to maintain their approach due to the fact that

they lacked sufficient capacity.

In Organisation-A there appears to be a lot of effort put into ensuring the availability of

VCT on a monthly basis, even though very few people are coming to be tested. The

question has to be asked as to whether this is the most effective way of getting employees

tested. A further question has to be asked whether the current venue for testing is

necessarily the most effective given that employees had previously not been prepared to

do anything centrally. The venue for monthly testing, although providing a high level of

privacy, is extremely remote which could be a cause of few employees participating in

the monthly testing.

Organisation-A needs to review whether the current electronic mediums actually reach

the relevant target audience. It was not told in the story what method is used to assess if

the communication that is distributed is actually being distributed through the network or

is being read by the recipient.

6.8 Principle 8: Lead like a relentless but reflective bulldozer

While the employees in Organisation-A feel the pressure to meet their target testing

rates, the lack of formal review from senior management does hinder their ability to

formally communicate the problems that they are experiencing. This lack of ownership

limits the focus to drive out solutions to the identified problems. It is also of concern that

no one is really judging them, as this implies a lack of interest in achieving the end goal.

This is a key requirement in order to meet Principle 8.

In the Organisation-A story, when certain line management encouraged their employees

to attend the information session, they are showing a strong tendency to pursue a desired

target, namely strong alignment to Principle 8. This behaviour does not need to only

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reside with senior management; this behaviour should also be cascaded through the

management structure. Leading like a ‘relentless but reflective bulldozer driver’ is

usually most effective when the behaviour is first made evident by a senior manager

showing an intense passion to achieve a measurable goal.

From a rollout perspective the Organisation Health Manager in Organisation-A has

stated that there is little chance of her ranking the programme higher in her day-to-day

activities, given her other responsibilities. As the Organisational Health Manager is the

only resource focusing on the rollout, this limits the opportunity for greater overall

success for the programme. The issues of capacity and priority are very likely to

negatively influence the Organisational Health Manager’s ability to influence other

resources to actively participate in this implementation.

Organisation-B operates in a very competitive environment and is driven by the pursuit

of excellence. This behaviour is very likely to support goal achievement.

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7. LEARNING AND REFLECTIONS

7.1 Learning elicited from this research

It was evident in Organisation-A that the weak alignment to Principle 5, to surface the

‘force for effective implementation’, strongly influenced the focus of the organisation to

ensure there was alignment to Principle 2 to create implementation capacity through the

concept of a ‘dual organisation’. In addition the management and implementation team

used the ‘force for effective implementation’ to elicit the appropriate behaviour as

described by Principle 6. In Organisation-B there was strong evidence of alignment to

Principle 5 and Principle 6, which was used to create momentum to ensure that

implementation was achieved.

The structure of Organisation-A resulted in more implementation challenges than

Organisation-B. We believe that had there been a greater alignment to Principle 5 to

‘surface the force for effective implementation’ and the leadership had used this ‘force’

to align with Principle 8, to ‘lead like a relentless but reflective bulldozer driver’

continually pursuing the end goal, there would have been a greater possibility that the

necessary action would have been taken to overcome the challenges that the

implementation team was experiencing. The leadership of Organisation-A appears to

have failed the implementation team by not providing the appropriate support and

listening to the feedback provided by the implementation team through their strong

alignment to Principle 1 of ‘never stop asking the question’. The implementation team

within Organisation-A showed a strong commitment to critically reviewing what was

not working within the implementation, however, these cries for help seem to have been

ignored. This dissonance could be ascribed to the lack of clarity within Organisation-A

as to what exactly was to be achieved in measurable desired outcomes. As described in

the story, depending on who one spoke to, there were differences in opinion as to what

the desired outcome should be.

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Organisation-B perceived that their HIV/AIDS Intervention Programme was successful,

as 27.3% of their employees have been tested for HIV/AIDS. We agree that relative to

Organisation-A who has a comparative employee-testing rate of 9.6% for a similar

rollout time period, Organisation-B is more successful. We ascribe the improved

implementation success of Organisation-B to the commitment of the leadership within

Organisation-B to achieve the end goal of wanting every employee to ‘know your

status’. We ascribe behaviour to the strong evidence of alignment of Organisation-B to

both Principle 5 to surface the ‘force for effective implementation’ and Principle 6 to use

this ‘force for effective implementation’ to elicit the appropriate behaviour. We would

however like to comment on the fact that Organisation-B did not define their end goal in

measurable outcome terms, which meant that irrespective of what testing rate

Organisation-B achieved, the implementation could be deemed successful.

7.2 Additional factors not catered for by the principles

In analysing the story, we had difficulty allocating the issue of measurement to any

specific principle. The concept of measurement in any implementation is imperative in

order to assess not only the rate of progress but also how far one is from achieving the

desired outcome. Organisation-A was very effective at using measurement to assess

what had been achieved to date relative to the associated expectation as defined by their

project plan which showed alignment to Principle 4, as well as integrating the concept of

interim milestones, as defined by Principle 7. We discussed earlier, that Organisation-A

was not very effective at implementing the required interventions when it became evident

that the milestones were not being achieved.

On analysing the stories of Organisation-A and Organisation-B, it was extremely

evident as to how important clear allocation of roles and responsibilities are to improving

the possibility of implementation success. Although Principle 4 does cater for an action

plan that details exactly what activities need to occur in order to achieve the end goal, we

would recommend that the supporting explanation for this principle be extended to

explicitly include ‘who’ is going to be responsible for a specific activity.

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We acknowledge that Principle 6 talks about using the ‘force for effective behaviour’ to

motivate stakeholders to encourage the appropriate behaviour from the negative

stakeholders. Organisational culture also has a huge potential to influence the success or

failure of any implementation. The concept and power of organisational culture as a

whole, however, did not seem to align directly with Principle 6. Within Organisation-A,

it is difficult to assess if there had been strong alignment to Principle 6, whether their

issue of culture would have been resolved.

Organisation-B used the power and strength of the concept of product branding to

influence employees to participate in the HIV/AIDS Intervention Programme. We had

difficulty aligning the concept of Branding as used by Organisation-B within their

implementation of the programme.

Another consideration that we believe could have had the potential to influence the

perceived implementation success of Organisation-B is the fact that Organisation-B’s

Head Office is closely situated to that of the Vendor’s Head Office. There is tremendous

ease of access, which could have had an influence in the success of the implementation.

7.3 Considerations for future research

7.3.1 Proposed new relative strength rating scale

In our approach to the analysis we used a relative strength to rate each principle

occurrence as Weak, Neutral or Strong. During the course of the analysis phase, we

observed that a relative strength of Non-alignment, Weak or Strong would have been

more appropriate as one is inclined to have difficulty in rating an occurrence as neutral.

We therefore propose that future research of this nature should rather apply the new

rating scale when analysing a story.

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Table 6: Proposed new relative strength rating scale

Relative strength Description

Non-alignment An action that directly negates the requirements of a specific principle

Weak An action that aligns to a specific principle, but only slightly improves the chance for a successful implementation

Strong An action that shows alignment with a specific principle, positively improving the chance of implementation improvement

7.3.2 Complexity of individual choice

Throughout our research, we were aware of the fact that the implementation of an

HIV/AIDS Intervention Programme was not exactly the same as that of an operational

strategy implementation. We were constantly grappling with the complexity of how to

influence an employee on an issue that in no way could be associated with their job

description and as such, the organisation had no formal mechanism to ensure

participation.

The only option that is available to the organisation is to make attendance at information

sessions compulsory. This at least ensures that each employee becomes educated as to the

issues of HIV/AIDS, and through this awareness employees will take better care of

themselves.

7.3.3 Issues that specifically relate to HIV/AIDS

It was concerning that a measurement of success for Organisation-A is the number of

employees that have registered for the programme and are receiving treatment. During

our interviews with the vendor’s supplier, it was said that people who know that they are

HIV positive will self identify as they know they are at risk.

The real problem that is of concerns to us, are those employees who are HIV positive and

are not yet aware of it. There is apathy with regard to becoming educated on the issues

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and risks of HIV/AIDS as people are inclined to think that ‘it cannot happen to me’. It is

imperative that this programme changes this view and gets as many employees as

possible to know their status so that if they are not yet HIV positive they can ensure that

their behaviour is such that they do not put themselves at risk. If they are HIV positive

and were not aware of the fact, it is critical that they immediately start taking precautions

and change their lifestyle in order that they do not obliviously spread the disease to

unsuspecting partners.

In discussions with both the vendor and the supplier to the vendor, it was mentioned that

organisations that are more successful with an HIV/AIDS Intervention Programme, are

those where the client actively drives the process. It was also highlighted that high testing

rates have been achieved, two examples being cited where testing rates had exceeded

50%. The explanation for this was that the people, who want to see treatment happen, are

actively in the driving seat. This shows strong alignment to Principle 8, ‘lead like a

relentless but reflective bulldozer driver’. We have also discussed whether the member of

the ’Stakeholder Board’ who actively pursued the agreement of Organisation-A to

commit to implementing an HIV/AIDS Intervention Programme should not be actively

involved in the rollout of the programme.

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8. CONCLUSION

The purpose of our research was to assess whether adherence to generic implementation

principles is associated with operational strategy implementation success. We chose to

review two HIV/AIDS Intervention Programme Implementations, given that HIV/AIDS

remains an epidemic of absolute urgency, and we hoped that the research findings would

be able to make a contribution to the understanding of how to implement an HIV/AIDS

Intervention Programme even more effectively.

We populated Organisation-A and Organisation-B’s implementation story using case

based methodology. Each story was then analysed by using a colour coding methodology

to highlight each occurrence of a principle from the Eight Principles of Effective

Implementation, including its associated strength. The findings from both Organisation-

A and Organisation-B’s stories were then tabulated in order to analyse and draw

comparisons on the differences between each organisations relative alignment to that

principle. These findings were then discussed per principle while considering each

organisation’s perceived implementation success.

We believe that the above research implies that there is a greater chance of operational

strategy implementation success when there is adherence to the Eight Principles of

Effective Implementation.

At a strategic level, it is evident that a key factor in implementation success is having a

clearly defined, measurable end goal, that there needs to be a strong ‘force for effective

implementation’, with a leadership team and implementation team that have confidence

about achieving the desired outcome and a strong conviction as to why this outcome

should be achieved. Both the leadership team and the implementation team must be

prepared to use this ‘force for effective implementation’ to elicit the appropriate

behaviour from any stakeholders who have the power to sabotage the implementation.

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At an operational level, it is imperative that a rigorous action plan is created that includes

all stakeholders who will be involved in the implementation of the action plan. The key to

this planning process is that it should ensure that all relevant stakeholders are aligned

with ‘what’ needs to be achieved, by ‘whom’, and by ‘when’ it needs to be achieved.

This action plan should include ‘first small steps’ to allow the implementation team to

test their implementation methodology. Throughout the rollout of this plan, management

must remain focused on the desired outcome and be prepared to ‘lead like a relentless but

reflective bulldozer driver’ constantly ensuring that progress is being made, that obstacles

are being overcome and that continuous pressure toward the targeted outcomes is

ensured.

At an organisational level it is also imperative that a mindset of continuous improvement

become imbedded and that throughout the implementation process, the question be asked

‘how can we improve our track record for the effective implementation of operations

strategy?’

Further to this, it is imperative that one is able to track the progress throughout the

implementation process using the appropriate measures to ensure that the organisation is

on track to achieve its desired end goal.

We recognise that it is easy to stand on the outside of an implementation and judge what

is perceived to be wrong, however, the real challenge is that of taking the required action

in order to address the recognised problems. This is extremely difficult to correct

especially given the competing priorities within an organisation balance.

We hope that this research will be used in order to gain some insights on how to improve

the effectiveness of operational strategy implementation, especially that of an HIV/AIDS

Intervention Programme.

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9. APPENDICES

9.1 Appendix A: Coding methodology used to perform the analysis

The following table provides a summary of the colour coding methodology used to

analyse each organisation’s story. The colour associated with each Principle has been

used to highlight each occurrence of that Principle throughout each organisation’s story.

A relative strength per Principle occurrence has also been allocated. The relative strength

has been assessed using a rating of weak, neutral or strong, and is recorded directly after

each occurrence of a highlighted Principle in brackets.

Principle Coding

1 Never stop asking the question

2 Have ‘dual organisation’ capability

3 Create a fault tolerant environment

4 Prepare a plan of action or project plan

5 Surface the ‘force for effective implementation’


7 Take the ‘first small steps’

8 Lead like a relentless but reflective bulldozer driver

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9.2 Appendix B: The Organisation-A story

9.2.1 Background

The question was raised to the ‘Stakeholder Board’ by one of its members as to what

Organisation-A intended to do about addressing HIV/AIDS. Although it was evident that

Organisation-A had a moral desire to assist those who were sick, there was a lot of debate

within the ‘Stakeholder Board’ as to why HIV/AIDS should receive preferential focus to

any other dreaded disease (Weak). Irrespective of the many different opinions,

Organisation-A was very aware of the need to be able to state that as an organisation it

was addressing the issue of HIV/AIDS as it was the socially responsible thing to do

(Weak). It also aligned with the branding concept of Organisation-A as being caring

(Weak). Organisation-A wanted acknowledgement for considering HIV/AIDS to be a top

priority and in that way also make a contribution to society (Weak).

The programme was considered to be critical in addressing education and training on the

floor. The ‘Stakeholder Board’ wanted to know that if there was any employee who was

already HIV positive, that they themselves knew this fact and were beginning to manage

their health (Strong) and thereby would stay as productive an employee for as long as

possible. This was to be achieved through the provision of ARV’s to those employees

who are HIV positive and who need them (Strong). Further to this, the ‘Stakeholder

Board’ wanted employees not yet infected to develop a heightened awareness of the issue

of HIV/AIDS and thus make a more informed choice (Strong).

After much debate, the ‘Stakeholder Board’ agreed that it wished to pursue the

implementation of an HIV/AIDS Intervention Programme (Weak). This decision aligned

with Organisation-A’s recent decision to focus on the implementation of an

Organisational Health Programme specifically to assist in attracting and retaining

employees. The programme’s motto is ‘productive people equal healthy people’. It was

agreed to outsource the management of the HIV/AIDS Intervention Programme for two

reasons. Firstly, it was considered to be too big to be handled internally, and secondly,

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management wanted to be able to guarantee employee confidentiality. An external

Organisational Health Consultant was contracted to assist in the tendering process for the

HIV/AIDS Intervention Programme.

Although the implementation of an HIV/AIDS Intervention Programme strongly aligned

with the reduction of risk and corporate governance, finances were never considered to be

the driver. From a Human Resource perspective, this initiative was a high priority as it

would inform them as to what risk they were dealing with and would enable them to plan

better (Strong). Currently they have risk reserves building up, as they are worried about

having to supplement for HIV/AIDS.

An actuarial valuation projected that Organisation-A would have a worst-case scenario

prevalence rate of 4%. This resulted in a worst case scenario costing model of

R1,500,000 per financial year. The costing structure can be reviewed when a 20 % VCT

testing rate has occurred.

In April 2003, the Organisation-A ‘Stakeholder Board’ accepted the proposal by the

Vendor and committed to pursuing this HIV/AIDS Intervention Programme (Strong).

The annual expense was unconditionally put on the budget as it was recognised as both

the ‘right thing to do’ and was deemed important enough to warrant separate funding.

The annual fee includes the costs of the following associated activities: communication,

promotional material, employee training and education, voluntary counseling and testing,

rollout to all employees, as well as the cost of ongoing Anti Retroviral Drugs (ARV’s) to

those who are infected.

Given that Organisation-A employees consist of both permanent and contractor

employees, it was a big decision to decide exactly which of those employees would be

eligible for the benefits of the HIV/AIDS Intervention Programme. After much debate,

Organisation-A finalised a very tight contract that included all permanent employees and

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long-term contractors. This equated to 3100 employees or about 78% of the total

employee compliment.

9.2.2 Assigned areas of responsibility

Although the decision making process occurred independently to any line function, the

responsibility for the implementation thereof was allocated to the Human Resources

Department. This was considered appropriate, as the Human Resource Department is

responsible for the Organisational Health Model, which strives to promote longevity of a

long healthy working life. The belief was that the HIV/AIDS Intervention Programme

would achieve maximum benefit if it were integrated with the rest of Health Care,

Disability, Retirement and the overall wellness of the employee.

The Deputy Chairman is ultimately responsible for the HIV/AIDS Portfolio and is

required to provide continuity. The Executive Director of Human Resources was given

the responsibility of overseeing the programme. He had also initially been overseeing the

tendering process before it was decided where the programme would reside.

When the project started, no formal project team was constituted (Weak) and no new

resources were provided to assist in the implementation of the programme (Weak). The

Executive Director of Human Resources tasked two key resources with the

implementation of the programme, the Retirement Fund Manager and the Organisational

Health Manager. The Executive Director supports both these employees as being the

right employees for the job of implementation. In the Retirement Fund Manager he

acknowledges her passion with regard to the HIV/AIDS Intervention Programme and

with the Organisational Health Manager he acknowledges the need for her practical

background as a shop floor nurse (Strong). The responsibility of the implementation and

rollout of the HIV/AIDS Intervention Programme became an extra focus area over and

above their already full workload (Weak).

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The Retirement Fund Manager was not initially involved in Health Care. The Retirement

Fund Manager initially performed the role of Principal Officer of the Pension Fund. Then

the Retirement Fund Manager took over the Health Care and Retirement portfolio in

February 2003, just two months prior to the ‘Stakeholder Board’ agreeing to pursue the

HIV/AIDS Intervention Programme. The Retirement Fund Manager is responsible for the

employee rollout at an operational level. The Retirement Fund Manager acknowledges

that the Executive Director allows her to discuss new ideas with him (Strong). The

Retirement Fund Manager mentioned that her background on project management is not

very good (Weak), but she assumed that this implementation would be easy, as

employees would come forward to be tested. The Retirement Fund Manager also

mentioned that the implementation could have been treated more like a project, which it

was not. There should have been more resources assigned to the implementation, the use

of more deadlines and dates; opposed to treating it more like the administration of a

benefit (Weak).

The Organisational Health Manager started with Organisation-A in February 2003. The

Organisational Health Manager was initially employed to set up an Organisational Health

Department at which time the decision had not yet been made on the pursuit of an

HIV/AIDS Intervention Programme. When the ‘Stakeholder Board’ made the decision to

implement the HIV/AIDS Intervention Programme, driving the rollout was added to her

responsibilities. (Weak). The Organisational Health Manager currently spends about

20% of her time on the rollout of the programme (Weak), but realistically the

Organisational Health Manager acknowledges that she would probably need to spend at

least 30% of her time in order for it to be really successful. The Organisational Health

Manager is also responsible for the Employee Assistance Programme within the

organisation. On reviewing her portfolio workload the Organisational Health Manager

acknowledges that the HIV/AIDS Intervention Programme implementation definitely

comes second to other issues (Weak).

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The Vendor has their Senior Director, who is based in Johannesburg, overseeing this

account. He is responsible for the customer relationship management, financial

management and amendment of the Service Level Agreement. From a rollout perspective

he is not hands-on, this is the responsibility of the Health Management Solutions

Advisor, who is based in Stellenbosch. The Health Management Solutions Advisor is

responsible for the co-coordinating of all Voluntary Counseling and Testing on behalf of

the Vendor that is done at Organisation-A. The Health Management Solutions Advisor

mentioned that although she tries to always be available when Organisation-A requires

education and testing sessions, it is not her responsibility to force Organisation-A to have

extra education and testing sessions. Although believing that the initiative has to be

driven by Organisation-A, the Health Management Solutions Advisor also acknowledges

that both the Vendor and Organisation-A have to work as a team in order for this

implementation to be successful (Weak).

Also based in Johannesburg is the Vendor Administrator who supports the Organisational

Health Manager. The Vendor Administrator is responsible for sending the personalised

employee cards, discussing logos for caps and T-shirts, etc. Communication between the

Organisational Health Manager and the Vendor Administrator often takes a couple of

emails, calls and lots of follow up in either emails or calls (Weak). The Organisational

Health Manager mentioned that she sometimes lands up having to leave multiple

messages before getting a response as to where an employee HIV/AIDS Intervention

Card is.

9.2.3 Preparation for the rollout

After the programme was accepted, a number of workshops were held with key

stakeholders to decide on how to rollout the programme (Strong). Everyone within the

organisation that had an interest or involvement with HIV/AIDS was given the

opportunity to be involved in how best to roll out the programme (Strong). From the

beginning, the intention was to train all the Human Resource advisors, who could then

spread the word on the benefits of the HIV/AIDS Intervention Programme to their

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specific area of responsibility (Weak). The next area for communication was the

Employee Body. The intention was to intervene at different levels within the

organisation.

The Human Resource Director, Health Management Solutions Advisor and the

Organisational Health Consultant, who initially assisted in the tendering process,

performed the initial planning. They would discuss how it was going to happen, who

would be involved and how many information sessions would be required (Strong). The

desired target of the organisation was to have 20% or 600 people tested by 20 July 2004

(Strong). The Organisational Health Consultant, who is contracted for four hours per

week to Organisation-A, (Weak) and the Organisational Health Manager, provided VCT

targets per department based on employee numbers, as well as overall VCT targets per

month (Strong). These targets took into consideration the resource constraints of the

Organisational Health Manager and Health Management Solutions Advisor (Weak).

Taking the resource constraints into consideration, the new realistic target for 31 July

2004 was a total of 490 employees taking VCT (Weak). Anything more would have been

unrealistic based on implementation capacity (Weak). The Organisational Health

Manager did not think that they would reach these goals (Weak) because of the size of

the task that the implementation team had to deal with. The Organisational Health

Manager was well aware that she was the only resource to implement (Weak) (Weak).

Everyone who was closely involved in the programme rollout was very committed. It was

with the employees that they experienced an element of passivity and some negativity

(Weak). The Health Management Solutions Advisor also mentioned that sometimes

information sessions would be held with no one attending, sometimes even a whole

department would just not attend. The Health Management Solutions Advisor mentioned

that employees seemed to be lethargic with regard to attendance and she wandered if they

also believed that it ‘would just not happen to me’ (Weak).

The planning and organisation of the Wellness Week was left up to the Organisational

Health Manager with the support of Health Management Solutions Advisor (Weak). The

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Organisational Health Manager and the Health Management Solutions Advisor felt that

there was no one to turn to during this preparation period and no direct assistance was

available to provide support during this process (Weak). The fact that the implementation

of this programme remains primarily the responsibility of these two people, results in an

element of frustration for both these parties (Weak).

Communication methods have been predominantly in the written form. Prior to going

into a department, the Organisational Health Manager would deal with the Senior Line

Manager’s Administration assistant to understand whether the logistics could be put in

place. The Health Management Solutions Advisor would provide the dates that she was

available to perform testing to the Organisational Health Manager. Once these dates had

been agreed, communication with the employees would begin. Each employee would

receive a personalised email explaining what would be happening. The employee would

also receive some general information emails and electronic posters highlighting the

occasion. The secretary or administrator to the department would also be asked to hang

posters up in the vicinity of where VCT would occur. Other means of communication

have also been used: articles in Monday papers, information sharing via the employee

association website and the employee union website and newsletter.

Other activities that have to be performed in preparation for a departmental rollout are

reviewing the venue as to the level of privacy that can be achieved (Neutral), access to a

telephone, how many nursing staff are required and whether the key resources that are

required for the rollout are available (Strong). The Health Management Solutions

Advisor then arrives on the day and presents the information sharing session, followed by

the testing. Initially the Organisational Health Manager attended all the information

sessions but time constraints now limit her attendance.

The Organisational Health Manager does not have to consult anyone with regard to the

rollout as it was decided up front how a department rollout would take place (Strong).

The Organisational Health Manager is now just running with it. When the Organisational

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Health Manager needs to discuss a new idea with someone, the Retirement Fund

Manager is always there to listen and discuss (Strong).

The Organisational Health Manager also often sits down with the Organisational Health

Consultant, who has been involved with the Programme on a retainer basis (Weak) since

the tendering process. Together they brainstorm options and see if the action plan is

realistic before starting a rollout (Strong). This same Organisational Health Consultant

also sometimes assists the Organisational Health Manager in plotting, planning (Strong)

and asking the question “what do you think” (Strong).

9.2.4 The launch

In July 2003, postal communication was sent to each employee providing him or her

with a personal Access Health Card with the unique telephone number for Disease

Management for Organisation-A, as well as an information brochure.

The official launch of the programme took place from 3 to 6 September 2003, as part of

Wellness Week. The HIV/AIDS Intervention Programme was one of the exhibitors at the

event. About 100 people, including representation by Senior Line Management and

Departmental Line Management, attended the launch (Strong). Industrial theatre was

used as the medium in order to create awareness and present the message. This medium

was in some instances perceived to be inappropriate in nature for this type of organisation

as it was ‘very in your face’. The first 58 employees were tested at the Wellness Week

using the Elisa HIV Test (Strong).

The launch of the AIDS InSite Interactive Website also occurred during Wellness Week.

This Curricula Learning Programme includes push marketing, information on HIV/AIDS

and the ability to link to an HIV/AIDS portal. The technology department however did

not seem to realise what this initiative was trying to achieve, and blocked all AIDS InSite

communication as it was considered to be negatively influencing the network response. It

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took eight months before agreement could be reached between HR and IT such that the

monthly emails could again be sent to employees (Weak).

9.2.5 The rollout

The focus of the HIV/AIDS Intervention Programme is on voluntary counseling and

testing, the aim of which is to have as many people educated as possible (Strong).

Encouraging participation is extremely difficult (Weak), as by law the organisation is not

allowed to incentivise testing, it has to be strictly voluntary. Organisation-A has however

attempted to encourage employees to attend information and training sessions by

providing incentives on occasion. The initial model required you to go in your individual

capacity to a lab however counseling proved to be a limitation. They now use onsite VCT

(Strong).

Management sessions, Human Resource sessions and rollout sessions were held, but

when it got to the employees there was an element of passiveness, very few were coming

for education and testing (Weak). It is then that the rollout strategy had to be reviewed

and thinking began on different ways of getting the employees to attend the information

sessions (Strong). Nobody seemed to want to attend anything set up centrally, which

meant that the rollout had to get taken to the individual department’s buildings (Strong).

Each building also requires different treatment (Strong). A further complexity for the

rollout that was highlighted by the Health Management Solutions Advisor is the fact that

Organisation-A is not situated in a single building, but rather a widely spread over a

number of buildings. The Health Management Solutions Advisor mentioned that this

structure had provided a great deal of complexity to the rollout (Weak). Both the Health

Management Solutions Advisor and the Managing Director of the Vendor also

highlighted the fact that in Organisation-A they were expected to always communicate

with the Organisational Health Manager irrespective of where the rollout was going to

occur. The Vendor mentioned that it would be a great deal easier if there were more than

one contact point within an organisation when preparing for a rollout. This was

particularly problematic with Organisation-A, given the organisational structure (Weak).

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When rolling out to a department, the Organisational Health Manager is heavily

dependant on the assistance of a champion from that department, as the Organisational

Health Manager does not have time to perform all the legwork herself (Weak). Normally

the Senior Line Manager’s Administrator is fairly helpful. In some areas however, a

champion has not been identified and then the rollout to that area has been aborted

(Weak).

On the actual day, the Organisational Health Manager walks the relevant corridors and

offices to personally request employees to come and join in the process of VCT. The

“walk about” is definitely believed to improve the response that they get.

After a rollout to a specific department, statistics are provided to the relevant Senior Line

Manager or Departmental Line Manager (Measurement of Outcomes – Strong).

Monthly statistics are also reported per department in the Organisational Health

Newsletter which is received by all employees who are on Organisation-A’s Medical

Aid. (Measurement of Outcomes – Strong)

There has been a mixed response from employees. Some employees have been

assertively negative, considering this to be a personal issue. Others however believe that

Organisation-A is doing the right thing and say ‘hey, it is great’. There has been very

positive feedback from those employees who are HIV positive (Weak). Those employees

have been tested HIV positive are actively participating. The odd HIV positive employee

remains in denial, but those that are not are finding it to be a very positive experience.

The expectation of the implementation team was that this kind of implementation would

happen quite easily as it was thought that people from this kind of environment would be

motivated to come forward and know their status. The Retirement Fund Manager has

been quite surprised that more employees have not actively participated in the VCT. The

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Retirement Fund Manager thought that every employee would have wanted to know his

or her status; as it is the sensible and right thing to do.

The Vendor makes ongoing Voluntary Counseling and Testing available on the last

Friday of every month (Strong). The location is always Cambria House and although a

little out of the way, after five months, the response seems to be picking up.

An early show of commitment to the HIV/AIDS Intervention Programme was when the

Employee Union Members had their tests done and put articles and photos about the

experience in the newspaper to promote the Programme (Strong). One of the

complexities of the HIV/AIDS Intervention Programme is the confidentiality afforded to

each person who gets tested. Because of this, it is not easy to know who from the top

structure has actively taken part in the testing process, unless they actively choose to

communicate it themselves (Weak).

9.2.6 Information sharing

Organisation-A has a Service Level Agreement with the Vendor to report back on a

monthly and quarterly basis. The statistics are reported by each department in order to

attempt to create an element of competitiveness among the various departments and

hopefully generate greater employee participation. Measurements that are reported on

include: attendance at information sessions, how many people have been tested, and calls

to the AIDS InSite call centre (Measurement of Outcomes – Strong).

One measure of success would be having all the employees on the programme, as we

want to keep people as healthy for as long as possible. Another measure is the voluntary

counseling and testing (Strong). The voluntary counseling goes a long way to awareness

and education and the testing highlights how many people are HIV positive as well as

providing an opportunity for them to pursue treatment. The VCT is telling the

organisation that people are taking responsibility and listening to how HIV/AIDS could

affect their life.

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On a monthly basis the Retirement Fund Manager and Organisational Health Manager

review these statistics and discuss ‘what we are going to try next in terms of getting

people to come forward to be tested’ (Strong) (Measurement of outcomes – Strong).

The monthly statistics show when activity has not been that great, and it is Human

Resource’s responsibility to assess how much they have initiated for that month

(Measurement of Outcomes – Strong). When little has been initiated it has usually been

the result of resource limitations (Weak). If one reviews the Organisational Health

Manager’s portfolio, the HIV/AIDS Intervention Programme has to be performed as a

sideline (Weak), over and above all the other responsibilities. They really need someone

focusing on the HIV/AIDS Intervention Programme all the time (Weak).

The only structured report back meeting focusing specifically on the HIV/AIDS

Intervention Programme Implementation is the Service Level Agreement meeting held

every second month with the Vendor. For the rest, the Organisational Health Manager

keeps the Retirement Fund Manager updated on which departments are being targeted.

On an annual basis, high-level statistics are populated by the Retirement Fund Manager

and provided to the Deputy Chairman, who is ultimately responsible for the HIV/AIDS

Portfolio. These statistics are then integrated into a multifaceted report which includes

information on other issues as well, and these are then reported to the ‘Stakeholder

Board’ (Measurement of Outcomes – Strong).

Feedback is provided to a number of forums. This includes the Aids Management

Advisory Group (AMAG), which is constituted by all parties that have an interest or an

involvement in HIV/AIDS. This includes the Risk Department, Human Resources, the

Teaching Unit, Student Health and the Department for Masters Degree in HIV/AIDS.

AMAG was constituted specifically to avoid duplication of effort in terms of HIV/AIDS

initiatives and is chaired by the Deputy Chairman. This group is particularly beneficial as

it gives feedback, both positive and negative, with regard to the implementation (Strong).

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Although meetings are not always well attended (Weak), minutes of each meeting are

distributed to all its members for review. The Organisational Health Consultative Forum,

whose responsibility is to advise on decisions pertaining to health, also receives feedback

every quarter.

9.2.7 Evaluation and self assessment

The HIV/AIDS Intervention Programme has only been going sixteen months and given

the sensitive nature of the type of implementation, the Human Resource Department has

been reticent to drive the HIV/AIDS Intervention Programme too hard in the first year

(Weak). The desired target of the organisation was to have 20% or 600 people tested by

20 July 2004, which unfortunately, has not been achieved. The deadline to achieve this

target has now been moved to December 2004. As at August 2004, 297 employees had

been tested. It is imperative that the 20% target is achieved in order for the

business/costing model to be reassessed. Unfortunately the only way there is to measure

success is by the number of people who have attended VCT sessions. We are obviously

also able to see how many employees are being provided with ARV’s relative to the

number of employees who have tested HIV positive (Measurement of Outcomes -

Strong).

The Vendors measurement of success is based on the VCT uptake within an organisation

(Strong?). This is marketed to a prospective Client in the sales cycle as a benefit and

contracted within the Service Level Agreement between the Vendor and the Client. The

Vendor feels that it is a dual responsibility to make sure the HIV/AIDS Intervention

Programme is a success.

Every two months, review meetings are held between the Vendor and Organisation-A.

The Senior Director (Vendor), the Retirement Fund Manager (Organisation-A), the

Organisational Health Manager (Organisation-A) and Health Management Solutions

Advisor (Vendor) attend these sessions. Sometimes the Organisational Health Consultant

also attends. The purpose of the meeting is to review progress in terms of their goals

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(Strong). The Senior Director for Health Management Solutions is purely high level and

is responsible for overseeing the overall progress of the programme. He comes up with

wonderful ideas that the Health Management Solutions Advisor and the Organisational

Health Manager must then implement. The Senior Director does not always understand

the Organisation-A environment in that you cannot just be spontaneous, but rather when

implementing something new, it needs to be integrated into the annual organisational

schedule a year in advance (Weak).

The biggest issue remains as to how to get people to come for testing. The Human

Resource department is currently reviewing the existing implementation methodology

(Future Strong?). The area of ownership has been recognised as an area for

improvement. The opinion is that the organisational culture and structure has a high

influence on the success of the rollout (Weak). At Organisation-A there is a culture of

noncompliance and a desire to challenge any new initiative (Weak). Employees do not

see the need to come to information sessions. This reticence has been experienced when

communication sessions have also been provided with regard to the Medical Aid

structure (Weak).

The Retirement Fund Manger feels that Organisation-A has achieved an element of

success as the some of the employees who need to be on the programme are on the

programme. What the Retirement Fund Manager does however feel is lacking is that

Organisation-A needs the awareness raised at both a management and an employee level.

The programme does include this and this is where Organisation-A now needs to work.

The implementation team are trying different ways to get to the people, if they are sitting

at the PC, we are sending them emails on what is happening on HIV/AIDS in the world

etc (Strong). Organisation-A are even looking at highlighting World Aids Day by using

Industrial Theatre in 2004 (Strong).

The Retirement Fund Manager was a bit disappointed that more employees had not come

forward and taken responsibility for finding out their personal status. She acknowledges

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that some employees may already know their status. She thinks that maybe some

employees are just too busy. The Retirement Fund Manager does believe that the

commitment is there and that Senior Line Management and Departmental Line

Management do care (Neutral). Where Senior Line Management or Departmental Line

Management commitment and encouragement has been extremely visible, there has been

a perceived higher response to VCT (Strong). They seem to have the verbal buy-in but

the “action is lacking” (Weak). Currently line management participation and enthusiasm

is purely dependant on an individual’s desire to encourage participation. This is not to say

that there is resistance to encouraging participation, but rather an apathy to actively

participate in the motivating of employees to participate (Weak). To try to get a certain

category of employees to come has been virtually impossible. This category may not feel

vulnerable with regard to the risk of HIV/AIDS, however their employees may be, so

there is a responsibility to encourage education in this regard.

Human Resources is considering discussing with the Senior Line Management and

Departmental Line Management, as to how best to extend ownership to them as this is

deemed to possibly be a more appropriate level of ownership in driving out the VCT at a

practical level (Future strong?). The responsibility to get tested should be with line

management as they have the close relationship with their employees and have the

greatest opportunity to influence and encourage their employees to be tested (Future

strong?). The majority of Senior Line Management and Departmental Line Management

however seem to have a conflict in opinion, as they perceive it to be the responsibility of

Human Resources. This is not saying that the Senior Line Management and Departmental

Line Management have not bought into the HIV/AIDS Intervention Programme, the

perception however is that some of the Senior Line Management and Departmental Line

Management are relieved that it is not their responsibility to encourage their employees to

go for counseling (Weak). This is not always the situation, as in one department the line

manager made attendance to the information sharing session compulsory for all his

employees within his department (Strong).

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The Organisational Health Manager is frustrated that she has not been able to meet the

targets that she committed to achieve. This is however a very small part of the

Organisational Health Manager’s job (Weak), but she acknowledges that it is still part of

her job. The Organisational Health Manager also feels a constant pressure from

management to get the goals achieved (Weak). That is why the Organisational Health

Manager sometimes turns to the Organisational Health Consultant as he gives her

perspective as to what is achievable.

Both the Retirement Fund Manager and the Organisational Health Manager acknowledge

that they definitely have the freedom to pursue any ideas they have but not always the

capacity (Weak). What they have done is what they had capacity to do. Anymore and

they just would not have been able to do it. There is limited capacity to drive out the

implementation (Weak). Even though there are finances available, the freedom does not

exist to employ extra capacity. They could have more road shows but there is just not the

resource to pursue this (Weak). The Human Resource Department has been given the

freedom to implement in whatever manner they deem appropriate, as long as it does not

require any extra resource (Weak).

Employee bodies to date have not picked up much on the HIV/AIDS Intervention

Programme, which is an area that needs to be reviewed (Weak).

Further to this, it is time to critically review the programme with the Vendor to review

whether the benefits that were originally proposed through the management formula are

actually being achieved (Future strong?). A meeting has been scheduled for the end of

November to review the costing model. With such a diverse employee base, it is not easy

to estimate what an accurate prevalence rate would be. Given the low expected

prevalence rate within Organisation-A, an assessment needs to occur as to whether the

current costing model is justified. The question needs to be answered as to whether

HIV/AIDS is really a problem for Organisation-A employees (Future Strong?) and what

will really work for Organisation-A in the future (Future Strong?).

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No one is saying that we have failed or providing feedback on their perception of the

implementation (Weak).

Within the Human Resource Department, they do not believe that they have failed as they

have put the infrastructure in place (Strong) and if we at least managed to get the HIV

positive employees on the programme, then it is at least an element of success (Strong).

Given that the prevalence is so low, they believe that they have captured those employees

who need to be on the programme. This assessment is self-assessment based on the goals

and targets the Human Resource Department set internally. There are currently no criteria

within anyone’s performance contract that results in any repercussions if there is non-

delivery, either within the Human Resource Department or any of the Senior Line

Managers or Departmental Line Managers.

Some unforeseen benefits have been achieved as a direct result of the implementation of

the HIV/AIDS Intervention Programme. The Vendor and the Organisational Health

Consultant negotiated a reduction in premium rates for the Retirement Fund, the

Disability Cover and the Employee Life Cover for Organisation-A. This benefit was not

taken into consideration at the time of the decision to pursue the implementation of the

programme.

The Retirement Fund Manager acknowledges that it is Organisation-A’s responsibility to

make the money work.

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9.3 Appendix C: The Organisation-B story

Organisation-B has not to date reviewed and confirmed the contents of this story as being

a true representation of the implementation.

9.3.1 Background

Organisation-B cares about its people (Strong). When they experienced a number of

deaths within the organisation, it heightened their awareness of the HIV/AIDS disease

and the potential consequences of this disease became very real (Strong). Consequently

management decided to embark on an awareness campaign within Organisation-B

(Strong). This decision was not seen as an economic one.

Organisation-B’s initial considerations focused on which firms to approach and what

implementation programme to consider. Two reasons underpinned these decisions.

Firstly, they were concerned about ensuring the confidentiality of their employees and

secondly, Organisation-B did not see themselves as HIV/AIDS experts. The choice of

who to approach was a logical one. Organisation-B had a strong business relationship

with an existing Vendor who already managed both their Medical Aid and Pension

Funds. They therefore decided to continue this relationship with the Vendor by

implementing their HIV/AIDS Intervention Programme (Strong).

9.3.2 Assigned areas of responsibility

The Human Resource Department in Johannesburg was responsible for the rollout of the

HIV/AIDS Intervention Programme nationally.

The responsibility to rollout the programme was considered to be an Employee Relations

function. The implementation of the HIV/AIDS Intervention Programme was to be

performed in addition to their regular workload (Weak). Overseeing the rollout was the

Executive Personal Assistant to the Head of Human Resources who is based at the Head

Office of Organisation-B, Johannesburg. The Executive Personal Assistant was actively

involved at all times and was afforded as much time as required in order to ensure a

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successful launch and rollout (Strong) (Strong). If there were any times when resolution

of issues was needed, the Executive Personal Assistant had the continual support of her

superiors (Strong).

The monitoring of the action plan was jointly and severally the responsibility of

Employee Relations within Human Resources as well as the Group HIV/AIDS Forum,

which was established in February 2004(Strong). The Group HIV/AIDS Forum

consisted of the Head of Human Resources South Africa, the Employee Relations

Manager, employees representing each Business Unit within Organisation-B, as well as

the Deputy Chairman of Organisation-B who chairs the forum. Meetings are held every

two months and are also attended by the Managing Director of the Vendor.

Each department in Organisation-B has an allocated Human Resource Consultant. This

consultant was responsible for encouraging line management to assist in the promotion of

the rollout by being tested (Strong). The act of the line managers going for testing was

then to be used to encourage their employees to also be tested (Strong).

9.3.3 Preparation for the rollout

Organisation-B in conjunction with the Vendor prepared a detailed plan for the rollout

(Strong). The Vendor’s HIV/AIDS Intervention Programme was launched as ‘The

Organisation-B HIV/AIDS Intervention Programme’. Organisation-B is extremely

conscious of its brand and therefore chose to personalize all related branding to this

programme. All related material has to align with the Organisation-B brand as a whole, in

order to demonstrate to its employees that ‘Organisation-B cares about its people’ as this

is synonymous with the Organisation-B brand. All mediums of communication were

aligned with both the culture and values of Organisation-B as well as ratified for brand

alignment.

HIV/AIDS was further formalised within Organisation-B through the creation of an

HIV/AIDS Policy (Strong). Once this was completed, the natural progression was to

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encourage people to learn exactly what their personal status was (Strong). HKLM

Advertising Agency was engaged to help with the preparation of the rollout material.

Organisation-B created a slogan to support the rollout, which was ‘Know your Status’

(Strong).

Following the initial implementation of the HIV/AIDS Intervention Programme, an

action plan was designed which focused on both ongoing education and awareness

programmes and VCT Testing (Strong). Organisation-B also reviewed the AIDS InSite

Website to ensure alignment with the Organisation-B brand before rollout. On an annual

basis, Organisation-B also takes the opportunity of highlighting World Aids Day

(Strong). This is provided with good coverage.

9.3.4 The launch

The launch of the Organisation-B HIV/AIDS Intervention Programme took place in

August 2003. On the day of the launch, the Deputy Chairman of Organisation-B

appeared on a video clip. This was used to show his endorsement for the programme, and

position and promote the entire Organisation-B HIV/AIDS Intervention Programme

(Strong).

Each employee was also sent various emails, a copy of the updated HIV/AIDS Policy, a

customised brochure and an Organisation-B branded personal card for their wallet. This

card also has the Organisation-B Employee Assistance Programme number on it.

9.3.5 The rollout

Another communication session was held in March 2004 that was poorly attended. This

has been ascribed to the fact that employees already knew about the programme through

Divisional Meeting updates and presentations (Strong), internal emails, information

letters and general peer discussions.

During June and July 2004, testing occurred at the following offices: Johannesburg,

Cape Town, Durban, Pretoria and Port Elizabeth. Although the rollout occurred on

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different days depending on the locality of the office, a uniform offering and presentation

was offered throughout South Africa (Strong).

Each employee was required to book a slot at which the test would be administered

(Strong). This booking was achieved by contacting a central Call Centre that was located

at the Organisation-B Head Office in Johannesburg. The process was not department

based but it was up to each employee concerned to select a slot that would be most

convenient for him or her.

The testing for the Johannesburg Head Office was performed over a period of 3 days

(Neutral). The Elisa HIV Test was administered at this testing session. During this time

three nurses were exclusively assigned to perform the testing. Each of them had a

capacity to test approximately twenty people per day. There was also an independent

counselor on site throughout the duration of the testing to provide the employees with

counseling if required. This counselor also performs the counseling for employees on the

Employee Assistance Programme.

9.3.6 Information sharing

The Group Aids Forum is provided with statistics usually every 2 months (Measurement

of Outcomes - Strong).

9.3.7 Evaluation and self assessment

The Organisation-B HIV/AIDS Intervention Programme has now been running for just

over a year. Total support has been shown for the programme by both management and

employees throughout this time (Strong). Of the 2800 employees, 765 employees had

been tested as at the end of August 2004.

Although to date Organisation-B has not scheduled any formal reviews of the

programme, regular and continuous feedback is encouraged about the HIV/AIDS

Intervention Programme from its employees (Strong).

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As for the target test rate, no target was set as to the number of employees to be tested but

rather the aim was to test as many employees as possible (Strong).

Follow up testing is scheduled for October/November 2004 for the Cape Town and

Johannesburg office (Future Strong) (Strong).

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9.4 Appendix D: Working papers per principle

Having reviewed each organisation’s story, and identified the occurrences per principle

with an associated relative strength, we have created a table per principle detailing the

specific occurrences for that principle for each organisation as well as the associated

strength. This provides an easier reference and summary for analysis to be performed.

9.4.1 Principle 1: Never stop asking the question

Weak Neutral Strong




Strong • Asking the question ‘what do you think’ • Organisation-A actually changed strategy

in the following occurrences: • Testing brought onsite • Moved from central testing to

department specific • Different buildings seem to require

different treatment • Recognising that employees were not

attending led to thinking ‘what needed to be changed’.

• The Organisational Health Manager and Retirement Fund Manager review the statistics monthly and discuss ‘what are we going to do next in terms of getting people to come forward and be tested’.

• The Organisational Health Manager explained that AMAG is quick to provide feedback on what is going well and not going well.

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9.4.2 Principle 2: Have ‘dual organisation’ capability

Weak Neutral Strong




Weak • No formal project team was constituted for

implementation. • No new resources were provided to assist

in the implementation. • Both key resources mentioned that they

were already at full capacity when they were expected to now implement the HIV/AIDS Intervention Programme over and above their existing responsibilities.

• The Vendor Administrator does not always respond the first time to requests.

• The Organisational Health Manager spends a maximum of 20% of her time on the HIV/AIDS Intervention Programme.

• Implementation targets were adjusted to cater for the resource constraints.

• The Organisational Health Manager is well aware of the fact that she is the only resource to rollout the implementation.

• Planning and organisation of The Wellness Week was the responsibility of only one person in Organisation-A and one person from the Vendor. This was cited as being an issue as they felt limited support during the preparation period and the duration of Wellness Week.

• The Organisational Health Manager is heavily dependant on departmental resources, e.g. a champion, secretary or an administrator to assist with the rollout.

Weak • Implementation was to be performed in

addition to the Executive Personal Assistant’s regular workload.

Strong • The Executive Personal Assistant was

afforded as much time as required in order to ensure a successful launch and rollout.

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Organisation –A Organisation-B

Weak (continued) • When rolling out to a department, the

Organisational Health Manager does not have the capacity to perform all the ‘legwork’ herself.

• The Organisational Health Manager stated that within her portfolio, the HIV/AIDS Intervention Programme has to be performed as a sideline.

• It was stated that a fulltime resource is required to focus on this initiative if the organisation wants to achieve the required targets.

• It was mentioned that AMAG meetings were not always well attended, however all members do receive the minutes.

• Both the Organisational Health Manager and the Retirement Fund Manager mention that they have the freedom to pursue any ideas to assist implementation, they just do not have the capacity to pursue.

• Organisation-A could have more road shows there is just no capacity to pursue any.

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9.4.3 Principle 3: Create a fault-tolerant environment

Weak Neutral Strong




Strong • The Retirement Fund Manager

acknowledges that the Executive Director allows her to discuss new ideas with him.

Strong • When resolution of issues was needed, the

Executive Personal Assistant had the continual support of her superiors.

• Regular and continuous feedback is encouraged about the HIV/AIDS Intervention Programme from its employees.

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9.4.4 Principle 4: Prepare a plan of action or project plan

Weak Neutral Strong




Weak • A comment was made that the

implementation should be handled more like a project with more resources allocated, more deadlines and dates, as opposed to being treated like the administration of a benefit.

• Clear targets were created by the Organisational Health Manager per department based on the employee numbers for that department, as well as targets per month based on implementation capacity.

• The new realistic target for 13 July 2004 was a total of 490 employees.

Neutral • Preparation occurs before a departmental

rollout.

Strong • Availability of key resources is considered

before finalising a rollout date. • It was decided up front how a departmental

rollout would take place. • The Organisational Health Manager and

Organisational Health Consultant plot plan and review the rollout plan to check if it was realistic.

• Project plan monitoring was achieved by reviewing how many people had been tested.

• Progress is reviewed against targets.

Neutral • The testing for Johannesburg was

performed over a three-day period.

Strong • A detailed plan was created in conjunction

with the Vendor. • Testing occurred at five different offices

around South Africa, although on different days the offering and presentation was uniform.

• Following the initial implementation, an action plan was designed that focused on both ongoing education and awareness and VCT testing.

• Each employee was required to book a slot at which the test would be administered.

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Organisation-A (continued) Organisation-B • New implementation ideas needs to be

planned for long in advance, little spontaneity is possible due to the annual schedule.

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9.4.5 Principle 5: Surface the ‘force for effective implementation’

Weak Neutral Strong




‘W’ Clarity about what – Strong • They definitely want to ensure that HIV

positive employees receive the correct treatment and ARV’s if required.

• They want any HIV positive employee to know their status and begin to manage their health.

• They wanted employees not yet infected to have a heightened awareness of HIV/AIDS and be able to make a more informed choice.

• Organisation-A chose the HIV/AIDS Intervention Programme to provide the solution.

• Organisation-A had a desired target of 600 employees to be tested.

• The focus of the programme was to be voluntary counselling and testing in order to have as many people educated as possible.

• They wanted to keep people healthy for as long as possible.

• They wanted to put the infrastructure in place to enable to above to be achieved.

‘H’ Confidence in knowing how – Strong • Stakeholders were given the option to

attend initial workshops to decide on how to rollout the programme.

‘Y’ Conviction about why – Strong • No reference.

‘W’ – Strong • Aim was to test as many employees as

possible. • Encouraged people to learn exactly what

their personal status was.

‘H’ – Strong • Decided to embark on an awareness

campaign. • Decided to continue relationship with the

Vendor. • Had clear determination to ensure a

successful launch and rollout.

‘Y’ – Strong • Cares about its people. • Having experienced a number of deaths, it

heightened their awareness of the disease and the potential consequences.

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Organisation-A (continued) Organisation-B

‘W’ – Weak • Much debate, no initial consensus.

‘H’ – Weak • The Retirement Fund Manager

acknowledges that she has limited project management experience.

• The Organisational Health Manager did not think that they would reach the targets set by the organisation.

‘Y’ – Weak • Desire to help the sick. • They wanted to be able to show that they

were addressing HIV/AIDS, as it was the socially responsible thing to do.

• Aligned with the branding of the organisation, namely caring.

• Be able to show society that they were addressing the issue.

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9.4.6 Principle 6: Use the ‘force for effective implementation’ to elicit


Weak Neutral Strong




Strong • The Human Resource director believes in

his two employees who have been tasked with the implementation.

• They attempted to elicit buy-in by providing a forum for everyone to express their opinions and views on the best way to rollout the programme.

• The union showed early commitment by going to be tested and then placing articles and photos in the newspaper.

• One department line manager made attendance at the information session compulsory.

Weak • The Organisational Health Manager

acknowledges that given her workload, the programme comes second to other issues.

• Passiveness and negativity when it came to attending education and testing was experienced from the employees.

• The Organisational Health Manager and Vendor resource voiced frustration that they have been pretty much left alone to implement.

• The Technology Department blocked all AIDS InSite communication, limiting access of monthly emails to employees for a period of eight months.

• Encouraging participation is extremely difficult.

Strong • The associated Human Resource consultant

was responsible for encouraging line management to be tested.

• Line managers were tasked to encourage their employees to be tested. They also discussed this issue at divisional meetings and presentations.

• They created hype through having a slogan of ‘know your status’.

• On the day of the launch, the Deputy Chairman appeared on a video clip. This was used to show his endorsement of the programme, and position and promote the entire Organisation-B HIV/AIDS Intervention Programme.

• They highlight World Aids Day on an annual basis.

• Total support by both management and employees has been shown for the programme throughout this time.

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Weak (continued) • There appears to be apathy from line

management to actively participate in motivating employees.

• It is up to the Organisational Health Manager to get a champion to assist in the rollout. This has not always been achieved, at which point the rollout to that department is aborted.

• It is not easy to know who from the top structure has actively taken part in the testing process unless they actively choose to communicate it themselves.

• The Human Resource department has been reticent to drive the programme too hard in the first year, given the sensitive nature of the topic.

• Employees do not automatically perform activities if they are asked to, but will rather assess for themselves and even challenge new initiatives.

• There seems to be management buy-in but the ‘action is lacking’.

• Employee bodies have also not picked up much on the programme.

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9.4.7 Principle 7: Take the ‘first small steps’

Weak Neutral Strong




Weak • The intention was to train the Human

Resource Advisors who could then assist in spreading the word with regard to the benefits of the HIV/AIDS Intervention Programme.

Strong • The first 58 employees were tested at

Wellness Week. • The Vendor makes ongoing VCT testing

available on the last Friday of every month.

Strong • The Group HIV/AIDS Forum was

established. • HIV/AIDS was formalised within the

organisation by creating an HIV/AIDS Policy.

9.4.8 Principle 8: Lead like a relentless but reflective bulldozer driver

Weak Neutral Strong




Weak • The Organisational Health Manager feels a

constant pressure from Management to get the goals achieved.

• No one is saying that they have failed or are providing feedback on the perception of the implementation

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9.5 Appendix E: Summary of statistic measures per organisation

The following table reflects a summary of key measures used to assess the success rate of

the HIV/AIDS Intervention Programme.

Table 7: Measurement statistics per organisation

Organisation-A Organisation-B Measurement

Percent Number Percent Number Number of active employees that are able to participate on the programme 3100 2800

Target number of employees to be tested prior to VCT beginning 20 % 600

‘As many as

possible’ Projected prevalence within the organisation prior to VCT beginning 4 % 124 No

projection Employee number tested for VCT up till 31 August 2004 297 765

Employee number tested HIV positive up till 31 August 2004 9 17

Employee number on ARV’s up till 31 August 2004 6 9

Employee number registered for Disease Management up till 31 August 2004 11 17

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9.6 Appendix F: Summary of findings per organisation

Organisation-A W N S Total W N S Total W N S Total

1 Never stop asking the question 0 0 8 8 0.0 0.0 8.2 8.2 0.0 0.0 100.0 100.02 Have ‘dual organisation’ capability 24 0 0 24 24.7 0.0 0.0 24.7 100.0 0.0 0.0 100.03 Create a fault tolerant environment 0 0 1 1 0.0 0.0 1.0 1.0 0.0 0.0 100.0 100.04 Prepare a plan of action or project plan 4 1 8 13 4.1 1.0 8.2 13.4 30.8 7.7 61.5 100.05 Surface the ‘force for effective implementation’ 7 0 11 18 7.2 0.0 11.3 18.6 38.9 0.0 61.1 100.0

6Use the ‘force for effective implementation’ to elicit appropriate behaviour 20 1 7 28 20.6 1.0 7.2 28.9 71.4 3.6 25.0 100.0

7 Take the ‘first small steps’ 1 0 2 3 1.0 0.0 2.1 3.1 33.3 0.0 66.7 100.0

8 Lead like a relentless but reflective bulldozer driver 2 0 0 2 2.1 0.0 0.0 2.1 100.0 0.0 0.0 100.0

58 2 37 97 59.8 2.1 38.1 100

Organisation-B W N S Total W N S Total W N S Total

1 Never stop asking the question 0 0 0 0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.02 Have ‘dual organisation’ capability 1 0 1 2 3.8 0.0 3.8 7.7 50.0 0.0 50.0 100.03 Create a fault tolerant environment 0 0 2 2 0.0 0.0 7.7 7.7 0.0 0.0 100.0 100.04 Prepare a plan of action or project plan 0 1 5 6 0.0 3.8 19.2 23.1 0.0 16.7 83.3 100.05 Surface the ‘force for effective implementation’ 0 0 7 7 0.0 0.0 26.9 26.9 0.0 0.0 100.0 100.0

6Use the ‘force for effective implementation’ to elicit appropriate behaviour 0 0 7 7 0.0 0.0 26.9 26.9 0.0 0.0 100.0 100.0

7 Take the ‘first small steps’ 0 0 2 2 0.0 0.0 7.7 7.7 0.0 0.0 100.0 100.0

8 Lead like a relentless but reflective bulldozer driver 0 0 0 0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

1 1 24 26 3.8 3.8 92.3 100

Key On Track Action required to mitigate Problem. Corrective actionrequired.

Relative Strength As A % To Total StrengthPrinciple Occurrence Relative Strength Occurrences As A

% To Total Occurrences

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9.7 Appendix G: Contact log

The following table details the dates, attendees, purpose, and duration of all communication held between the researchers and

Organisation-A, Organisation-B, the Vendor and an associated Supplier.

Researcher Meeting

Date MM LW Organisation Attendees Data Gathering Method Used Meeting

Duration Contact

Time 27/8/2004

10:30 – 11:30 X X • Vendor • Health Management Solutions Advisor Unstructured interview (Face to face) 2hrs 4hrs

27/8/2004 11:30 – 12:00 X X • Organisation-A • Organisational Health

Manager Unstructured interview (Face to face) 0.5hrs 1 hr

7/9/2004 10:00 – 11:30 X X • Organisation-A • Organisational Health &

Retirement Fund Manager Unstructured interview (Face to face) 1.5hrs 3hrs

8/9/2004 08:30 – 09:30 X X • Organisation-A • Executive Director of Human

Resources Unstructured interview (Face to face) 1hr 2hrs

16/9/2004 11:00 – 12:30 X X • Vendor • Managing Director Unstructured interview (Face to face) 1.5hr 3hrs

16/9/2004 12:30 – 13:45 X X • Vendor • Senior Director Unstructured interview (Face to face) 1hr 2hrs

16/9/2004 14:00 – 15:30 X X • Supplier to

Vendor • Executive Director Unstructured interview (Face to face) 1.5 hrs 3hrs

17/9/2004 12:45 – 14:00 X X • Supplier to

Vendor • Managing Director and

Chairman Unstructured interview (Face to face) 1.15hrs 2.5hrs

17/9/2004 16:00 – 17:30 X X • Organisation-B • SA Head of Human Resource

• Executive Personal Assistant Unstructured interview (Face to face) 1.5 hrs 3hrs

1/10/2004 10:30 – 11;30 X X • Organisation-B • Organisational Health

Consultant to Organisation-A Unstructured interview (Face to face) 1hr 2hrs

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Researcher Meeting

Date MM LW Organisation Attendees Data Gathering Method Used Meeting

Duration Contact

Time

8/10/2004 15:30 – 17:00 X • Vendor • Health Management Solutions

Advisor

Percentage Semi Structured / Percentage Structured interview (Face to face)

1.5hrs 1.5hrs

15/10/2004 11:00 – 12:30 X • Organisation-A • Organisational Health

Manager


1.5 hrs 1.5hrs

15/10/2004 12:30 – 14:00 X • Organisation-A • Organisational Health &

Retirement Fund Manager


1.5 hrs 1.5hrs

8/11/2004 X • Vendor • Senior Director Structured Interview (Email) Not applicable

Not applicable

12/11/2004 X • Organisation-B • Executive Personal Assistant Structured Interview (Email) Not applicable

Not applicable

16/11/2004 X • Organisation-B • Executive Personal Assistant Structured Interview (Email) Not applicable

Not applicable

18/10/2004 X • Organisation-A • Organisational Health & Retirement Fund Manager Structured Interview (Telephone) Not

applicable Not

applicable

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