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 PCTs We need a blend of two perspectives
Public Health
Hygeia
Daughter of Asklepios
Note: Asklepios had another daughter,
Panaceia (Pharmacy)

4. PCT Strategic Planning What to Do Based on Information & Knowledge
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.

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

6. Strategic Planning The 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 Cycle ABCs
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. The Strategy Change Cycle Ten Steps
7. Review and adopt the
Strategic Plan
8. Establish “Vision for
Success”
9. Develop implementation
process
10. Reassess
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

11. = 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 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 S 6
Strategy
Formulation 7
Strategy and
Plan review
and Adoption 8
Description
of Organisation
in the Future
(Vision
of Success)
Optional S 9
Implementation 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. Strategic Planning For PCTs
Diffusion of
Innovations

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

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

16. Diffusion of Innovations Key Constructs
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
Characteristics of Change

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

18. Health System Program Planning The PRECEDE/PROCEED Framework Lawrence W. Green & Marshall W. Kreuter
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

19. PRECEDE-PROCEED Framework*
Health
Education
Policy
Regulation
Organization
Program*
Phase 5
Administrative &
policy assessment
Predisposing
Factors
Reinforcing
Enabling
Phase 4
Educational &
ecological
assessment
Behavior
Environment
Phase 3
Behavioral &
environmental
assessment
Health
Phase 2
Epidemiological
assessment
Quality of
Life
Phase 1
Social
assessment
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/PROCEED Nine 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/PROCEED Behavioral 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