ALIGNMENT OF STRATEGY : LEARNING AS AN INSTRUMENT OF IMPLEMENTATION

1. ALIGNMENT OF STRATEGY : LEARNING AS AN INSTRUMENT OF IMPLEMENTATION B.V.L.NARAYANA

2. Structure of presentation • Problem identification—trigger • Literature review– motivation for study • Methodology • The case • Findings • Discussion • Conclusion and Contribution • Limitation and future research avenues

3. Problem identification--Trigger • Disparity in distribution of mortality and morbidity • Between developed and developing countries • Between states in India • Conditions preventable • Proven cost effective interventions available • Common health care programmes • Why the disparity in India • Reason : low usage of interventions

4. COMPARISION OF HEALTH CARE INDICES Source : National health profile 2006, NFHS 3(2005-06)

5. India and other developing countries Investments and funding (Bajpai, Dholakia and Sachs 2006; CMH 2001) Mediated through good governance (Wagstaff and Claeson 2004 ) Institutional factors (NCMH 2005; Wagstaff and Claeson 2004) Service delivery mechanisms (Mavalankar 1999; Seshadri rao 2001; Wagstaff and Claeson 2004) Problem identification--Trigger Implementation is one of the key issues

6. Literature review – Strategy implementation • Neglected subject in research (Hutzschenreuter and Kleindienst 2006; Hrebiniak and Joyce 2001) • 21/991 articles looked at implementation issues • Extreme emphasis on formulation (Hutzschenreuter and Kleindienst 2006) • Non consideration of implementation variables (Ginsberg and Venkatraman 1985) • Lack of processual studies (Pettigrew et al 2002) • lack of cumulation of theory

7. Literature review –Strategic alignment • Used for alignment of IT systems with business strategy ( Henderson and Venkatraman 1999) • Alternatively called as “Fit” (Chandler 1962) • Researched as a static concept with poor operationalisation (Venkatraman and Prescott 1990; Hrebiniak and Joyce 2001) • As bivariate relationships in cross sectional studies ( Ginsberg and venkatraman 1985) Call to use fit as a dynamic concept And link to implementation (Hrebiniak and Joyce 2001)

8. Literature review --RBV • Alignment between VRIN resources and business activities (Barney 1991) • RBV is static , must look at evolution of resources( Priem and Butler 2001) • Resource allocation process Model (Bower and Gilbert 2005) • Realized strategy is outcome of iterative allocations of resources • Is a strategy process implementation framework • Not linked process to performance

9. Literature review -Learning • Knowledge –resource with VRIN characteristics (Grant 2003) • Role of Knowledge in ensuring competitive advantage is not clear (Amin and cohendet 2004) • Learning not linked to implementation (Moingeon and Edmondson 1996) How does learning influence the process of implementation

10. Methodology • Implementation –Non linear, dynamic (Hrebiniak and Joyce 2001) • Study aiming to answer “How” and “Why” questions– Qualitative methods • Requires processual study (Pettigrew 1997) • Context – Public health care systems of states • Choice of programmes –(CGDEV2007) RCH,NVBDCP,NBCP,RNTCP • Embedded case study design and multiple units of analysis (Yin 2003)

11. Methodology • Choice of units for study- purposeful sampling (Patton 2002) Exemplar units • State level– (NCMH 2005) • District and field unit level • Data collection: • Retrospective histories from Interviews of key informants • Documents • Data analysis • Contextualizing strategies (Maxwell 1993) • Case study, displays

12. Methodology • Formal approval for participation taken • Field work driven by concurrent analysis • Appropriateness of data collected • Adequacy • New insights arising from data • Triangulation by • Secondary documents • Independent key informants • Cases sent to liaison officer for verification of data • Peer reviewed for reliability of analysis • Study based on RCH programme implementation in Tamil nadu

13. The Case • CONTEXT • PROGRAMME OBJECTIVES (NHP2002) • IMR of < 30/ 1000 live births • MMR of <100/ Lakh live births • Service utilization >75% at FRU level • Tamil nadu achieved these in 2006

14. The case

15. The Case Prioritized based on states problems– Dr Jayanti consultant UNICEF

16. The Case • Identification of key resources • “People link availability of doctors and medical services. Availability of doctors for services is most important. In case of staff nurses and ANMs, not just availability but they must be skilled to provide services”. Dr Padmanabhan • Identification of key resources linked to • Service delivery • Management of key resources • Initiatives designed to ensure adequacy • Skill up gradation and development • Effectiveness and efficiency of services • Introduction of new services

17. The Initiatives– Up gradation of infrastructure

18. The initiatives –Up gradation of infrastructure

19. The Initiatives • Facilitation of staff working • Minimal vacancies • VHN mobility • Recognition and rewards– training • Management of shortage of key staff • Development of staff– posting of Staff nurses • MOs trained in anesthesia • Training and flow of skills • System strengthened under DANIDA (1996-2002) • Managerial and technical skills • Strengthening of feed back and correction systems • verbal autopsies • Vital events surveys

20. The initiatives– Flow of Management skills

21. Findings • Focused approach • Management of key Resources • Initiatives designed in line with objectives of each phase • Phase I -- increase reach of services • Phase II– • strengthen feed back and monitoring systems • Increase number of services • Phase III— Further extension of services • Consistent correction of processes based on feed back • Increase and align services in line with community needs-

22. Discussion • Organisation is an arrangement of people for facilitating achievement of some agreed purpose (Selznick 1949)— • Economic system which determines internal availability of scarce resources • Is an adaptive system reacting to environmental influences • Alignment of strategy– strategic change necessitated by changing environment and/or business opportunities

23. Discussion—Service delivery systems

24. Discussion • Key resources– have VRIN Characteristics • VALUABLE– multiple uses • RARE– Skills for designated services in them only • INIMITABLE– no alternatives • NON SUBSTITUTABLE– no substitutes • Are crucial for achievement of objectives • Learning -mechanism for correction and alignment of processes linked to management of key resources • Verbal autopsy systems, process monitoring • Focus of the administrators– manage key resources • Skill development • Openness to suggestions • Consistent development, monitoring and evaluation of systems

25. Strategy process and cognitive architecture

26. TENTATIVE OPERATIONAL FRAMEWORK SERVICE/GOODS DELIVERY CHAIN LEARNING Sensing, Monitoring, Evaluation Development RESOURCES REQUIRED STRATEGIC ALIGNMENT CUSTOMER NEEDS STRATEGIC RESOURCES PERFORMANCE MAINTAIN STRATEGIC RESOURCES OTHER RESOURCES

27. Conclusion and Contributions • Learning – instrument used in Achieving strategic alignment • Contributions • Clarified role of learning in achieving performance over time

28. Limitations and Future Research • Single case study based study • Limited to context of health care and RCH programme • Needs further testing to validate frame work • Can perhaps assist in development of an integrated model of organisational learning

29. THANK YOU