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This article explores the importance of implementation and monitoring in public health nursing (PHN) practices. It discusses different approaches to implementation, the role of governance and intervention management committees, risk management, partnership satisfaction, monitoring milestones, and evaluability assessment.
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Action Implementation and Monitoring • A risk in PHN practice is that so much attention can be devoted to development of objectives and planning to address the problem that the success of intervention implementation can be overlooked • Monitoring the progress of implementation is important and includes: • regular intervention management/ steering group meetings • risk management • partnership satisfaction analysis • intervention milestone monitor • evaluability assessment Implementation and Monitoring
Types of Implementation • There are several approaches to implementation that can be taken: • Pilot approach – involves gaining feedback from a sub-group of the target group about strategies, resources etc • Phased-in approach – implementation of an intervention across different sites, communities or regions • Immediate implementation – interventions that have been affective in the past or have a standard approach • It is recommended to implement the pilot approach because it serves to further engage the target group which can further secure their vital role Implementation and Monitoring
Governance • Intervention governance is essentially about shared decision making and managing the project throughout its life • Key components to effective governance include: • Clearly defined roles and responsibilities • A representative intervention management committee • Well defined risks and issues • Regular reporting of implementation progress • It is important to all players know how and agree withhow the intervention governance structure will operate Implementation and Monitoring
Intervention Management Committee • A management or steering committee is primarily responsible for ensuring delivery of intervention activities and appropriate risk management • The intervention management committee responsibilities involve 5 mains functions: • Approval of changes to the intervention and its supporting documentation • Monitoring and review of the intervention • Providing assistance to the intervention when required • Resolving intervention conflicts • Formal acceptance of intervention deliverables Implementation and Monitoring
Intervention Management Committee • For management committees to work effectively the right people must be involved • Management committee appointments should be based on individual skills and attributes rather than on their formal roles • Representatives from key stakeholder groups and the project manager should form part of the committee • The steering/ management committee should meet regularly throughout the course of the intervention to monitor implementation and risks or issues Implementation and Monitoring
Risk Management • Many situations in PHN can be seen as high risk as a result of making decisions with imperfect information or based on personal preferences. • A risk consists of two parts; • an undesirable outcome • the probability of its occurrence • People have different risk profiles based on previous analysis and personal preferences • → having risks identified and reviewed by a group of people can ensure a more objective approach Implementation and Monitoring
The five steps of risk management Implementation and Monitoring
Partnership Satisfaction • Partnerships are important for bringing together a diversity of skills and resources for more effective outcomes • Most partnerships move along a continuum: degree of commitment, change required, risk involved, levels of interdependence, power, trust and a willingness to share ground • Successful partnerships have a clear purpose, add value to the work of the partners and are carefully planned and monitored • The partnership analysis tool is a useful tool to assess, monitor and maximise its ongoing effectiveness and is designed to provide a focus for discussion between organisations Implementation and Monitoring
Monitoring Milestones • Milestones are significant scheduled events that act as a progress marker in the life of an intervention • The project team should regularly review and assess achievement of each milestone in the implementation plan • The planned achievement dates of milestones can change overtime but a milestone history monitor can be used to show milestones rescheduling during the intervention Implementation and Monitoring
Example - Milestone history chart Implementation and Monitoring
Evaluability Assessment • Evaluability assessment Involves assessing whether or not the intervention is ready for evaluation • Evaluability assessment should avoid premature or inappropriate evaluation • Evaluability assessment determines whether the critical pre-conditions for evaluation are present: • Rational relationships between intervention activities and goal • Intervention is properly implemented • Partners agree on evaluation questions and methodology • → If an intervention does meet these pre-conditions it should not be evaluated Implementation and Monitoring