Using Data to Drive Health System Performance Commissioned from Ovations by the National Primary and Care Trust Develo

1. Using Data to Drive Health System Performance Commissioned from Ovations by the National Primary and Care Trust Development Programme

2. Strategic Planning for PCTs We need a blend of two perspectives Medicine Asklepios First physician according to Greek legend

3. Strategic Planning for PCTsWe need a blend of two perspectives Public Health Hygeia Daughter of Asklepios Note: Asklepios had another daughter, Panaceia (Pharmacy)

4. Notice that “strategy” is embedded in the Progress Pyramid. Unlike “Vision & Mission” which are stable for many years, a typical strategy (especially in health care), is stable for 1-3 years. PCT Strategic PlanningWhat to Do Based on Information & Knowledge

5. Strategic PlanningWhere are you with your health care PCT planning? Outward Imagination & Innovation Forward Planning & Goals Backward History & Experience Inward Assessment & Correction

6. Strategic PlanningThe Strategy Change Cycle - Bryson & Alston Through a carefully aligned strategic plan, PCTs can: 1. Examine the health care environment in which they exist and operate. 2. Explore health care factors and trends that affect the way PCTs provide care and intervention from a medical and public health perspective.

7. The Strategy Change Cycle Through a carefully aligned strategic plan, PCTs can: 3. Seek to meet mandates and fulfill their mission consistent with National, regional and locally identified needs. 4. Frame strategic issues creatively to drive health care delivery and prevention/health promotion initiatives.

8. The Strategy Change CycleABCs • A • Who and what you are • What you do now • Why you do it Assess • B • What do you want to be in the future Goal • C • How do you get there Strategy

9. 1. Agree to a process 2. Clarify mandates 3. Identify stakeholders - mission & values 4. Conduct a SWOT 5. Frame strategic issues 6. Formulate strategies to manage the issues 7. Review and adopt the Strategic Plan 8. Establish “Vision for Success” 9. Develop implementation process 10. Reassess The Strategy Change CycleTen Steps

11. S = Places where the process typically starts = Places where the goal formulation may occur = Places where vision formulation may occur • Forces/Trends • Political • Economic • Social • Technological • Educational • Physical • Key Resource • Controllers • Clients • Customers • Payers • Members • Regulators • Competitors • Competitive • Forces • Collaborators • Collaborative • Forces G External Environment V 4A External Environmental Assessment S 2 National Mandates G G G G G G • 5 • Strategic Issues • Direct approach • Goals approach • Vision of success • approach • Indirect approach 1 Initial Agreement (Plan for Planning) S S • Stakeholders • External • Internal 6 Strategy Formulation S 7 Strategy and Plan review and Adoption 8 Description of Organisation in the Future (Vision of Success) Optional 9 Implementation S 10 Strategy and Planning Process Reassessment S V V V V Strengths/ Weaknesses V V • 3 • Mission/Values • By Stakeholders 4B Internal Environmental Assessment Internal Environment • Resources • People • Economic • Information • Competencies • Culture • Pres. Strategy • Overall • Departmnent • Bus. process • Functional • Performance • Indicators • Results • History Adopted from Bryson Strategic planning Management

12. Diffusion of Innovations Strategic Planning For PCTs

13. Diffusion of InnovationsEverett M. Rogers • Diffusion: The process by which an innovation is communicated through certain channels over time among members of a social system. • Innovation: An idea, practice, or object that is perceived as new by an individual or other unit of adoption.

14. Innovators: Venturesome Early Adopters: Get an opinion Early Majority: Deliberate Late Majority: Skeptical Laggards: Last to adopt, traditional Diffusion of InnovationsKey Constructs Adopter Categories

15. Diffusion of Innovations 34% 34% 14% 16% <3%

16. Relative Advantage: Is the program better Compatibility: Is it consistent with existing values Complexity: How difficult is it to understand and use Trialability: How does it stand up under experimentation Observability: How are results visible to others Diffusion of InnovationsKey Constructs Characteristics of Change

17. PRECEDE/ PROCEED Framework Health System Program Planning:Operationalising Your PCT Strategy Scenario Planning

18. PRECEDE P = predisposing R = reinforcing E = enabling C = constructs E = educational ecological D = diagnosis E = evaluation PROCEED P = policy R = regulatory O = organizational C = constructs E = educational E =environmental D = development Health System Program PlanningThe PRECEDE/PROCEED FrameworkLawrence W. Green & Marshall W. Kreuter

19. Phase 5 Administrative & policy assessment Phase 4 Educational & ecological assessment Phase 2 Epidemiological assessment Phase 1 Social assessment Phase 3 Behavioral & environmental assessment Predisposing Factors Health Program* Health Education Behavior Reinforcing Factors Quality of Life Health Policy Regulation Organization Environment Enabling Factors PRECEDE-PROCEED Framework* Formative evaluation & baselines for outcome evaluation* Intervention Mapping & Tailoring* Phase 6 Implementation Phase 7 Process evaluation Phase 8 Impact evaluation Phase 9 Outcome evaluation *New in 4th ed., Green & Kreuter, Health Promotion Planning, in press.

20. PRECEDE/PROCEEDNine Phases 1. Social Diagnosis: Identify social problems that impact quality of life, health care and priorities of individuals or populations. e.g., unemployment, absenteeism, crime, crowding, overall population health 2. Epidemiological Diagnosis: Determine health issues associated with the quality of life. e.g., morbidity, mortality, risk factors, disability, longevity, intensity, incidence, prevalence

21. Nine Phases con’t 3. Behavioral & Environmental Diagnosis: Identify health practices linked to the health problems. e.g.,compliance, consumption patterns,preventive actions,utilization, self-care, frequency, lifestyle 4. Educational Diagnosis: Predisposing factors: e.g.,knowledge, attitudes, values, beliefs Reinforcing factors: e.g., attitudes and beliefs of others Enabling factors: e.g., resources, accessibility, skills

22. Nine Phases con’t 5. Administrative and Policy Diagnosis: Administrative & organizational concerns prior to implementation. e.g., > The resources needed to launch and sustain your program > The organisational barriers that effect implementation > Policies that support the program or need to be changed 6. Implementation of the Program e.g., > Well thought out plan, budget, training, careful monitoring

23. Nine Phases con’t 7. Process Evaluation: tomorrow! 8. Impact Evaluation: tomorrow! 9. Outcome Evaluation: tomorrow!

24. PRECEDE/PROCEEDBehavioral Matrix More Important Less Important High priority Low priority for a program except for political reasons More Changeable Priority for No program innovations assessment is crucial Less Changeable

25. PRECEDE/PROCEED • Lets try a population health issue specific to your PCT and run it through the framework