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

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

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

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.

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

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.

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.

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

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

= 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

Strategic Planning For PCTs Diffusion of Innovations

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.

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

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

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

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

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

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.

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

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

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

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

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

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