Participants will…

1. Beginning with the End in Mind: Supporting the Development of Health Improvement Plans Designed for Action

2. Learning Objectives • Participants will… • Know important elements of an actionable CHIP that also enables ongoing monitoring and evaluation. • Be able to describe techniques for engaging partners in a participatory action planning process. • Know the major phases of implementation and ways to set a group up for successfully moving from planning to action.

3. Priorities have been selected based on having a picture of what is… Refer to the data related to Priority Issue. In some cases, more work on understanding the problem may be necessary. Illinois Public Heath Institute

4. Illinois Public Heath Institute Action planning to address priorities begins with the end in mind… Current Status of the Priority Issue What changes need to occur to achieve Vision? Vision for the Future with Improvements Related to the Priority Issue

5. Beginning with the End in Mind Facilitating Action Planning

6. Peer Sharing: Experiences with Action Planning & Implementation • What is your experience with community health improvement action planning and implementation? • Thinking about one such experience… • How would you describe the action planning process in one word? • What went well? What were the challenges? • How did you/they get ‘the ball rolling’ with implementation? • Where did the implementation process get ‘stuck’? • What should have been done differently?

7. Participatory Methods for Action Planning “Rather than trying to explain or teach what is needed, the facilitator attends to the process of change. To facilitate is to elicit, sustain, and enhance change. To facilitate is to let go of controlling others toward predefined results and to help them accomplish what they want.” -Jim Rough Dynamic of Facilitation

8. Facilitating Action Planning Participatory Action Planning… • Brings diverse experiences and ideas into the process • Helps ensure buy-in for implementation • Brings key stakeholders to the table; avoids the norm, ‘If you aren’t at the table, you are on the menu’ • Is more successful when guided by a skilled facilitator

9. Organization & Infrastructure • Organizing the Process • Identify up front what is known about resources and budgets available for creating and implementing the CHIP • Timeline • Schedule • Human resources • Review and feedback loops • Finalization and adoption decisions • Documentation of the process

10. Organization & Infrastructure • Organizing Human Resources • Engage a Steering committee (advisory group or coordinating council) in laying the foundation for the action plans • Connected to all parts of the community • Balance of thinkers, ‘do-ers’, and decision-makers • Engage action planning teams/workgroups in building the action plans • Ensure that those who are responsible for acting on the plan are involved in its creation • Identify a ‘lead’ or chairperson and other important roles • Every group needs a ‘mover and shaker’

11. Consulting on Key Elements of the CHIP • A high quality CHIP includes… • What, how, who, when are clearly delineated • Actions target multiple levels of the Socio-ecological Model • SMART objectives for each strategic priority • Alignment with Healthy People 2020 • Evidence-based health improvement strategies • Monitoring and evaluation activities, measures, timeline • PHAB requires: • Objectives • Time-framed targets for strategies • Evidence-based strategies • Policy changes needed to accomplish objectives • Accountable parties for each objective

12. Illinois Public Health Institute Levels of Objectives & Measurable Outcomes

13. Organization & Infrastructure Organizing the CHIP Structure: A Basic Model

14. Illinois Public Health Institute What can be done to create the necessary changes? Important questions to answer before writing the action plan • What are the existing resources, assets and strengths for this work? • Who is already engaged in this work? What are they doing to address this issue? Can we partner? • Who else needs to be engaged in this work? • What are the barriers? How can the barriers be overcome? • What has worked elsewhere(other communities, states etc.)? • What are the evidence-based approaches to create the change we seek?

15. Example: Action Planning Worksheet Sample from IPHI

16. Participatory Methods for Analysis • Facilitating Participatory Analysis of Issues • Root cause analysis: Why do these issues really exist? What is at the root of this issue? What should we really focus on? • Underlying contradictions (barriers and blocks): What may block us from addressing our strategic issues and moving toward our vision? • Stakeholder analysis: Who will be affected by our strategies and how can they be engaged? • Environmental scan: What currently exists in our community that may influence the success of our strategies?

17. Participatory Methods for Analysis • Root Cause Analysis • Social Determinants Tree • The Five Whys • Health Problem Analysis worksheet • Role of the facilitator • Help the group gain a deeper understanding of the issues • Walk the group step-by-step through a process that links the identified issue to the root problem by asking ‘why’ and ‘how’ • Infuse social determinants of health and health equity into the conversation

18. Sample from IPHI

19. Participatory Methods for Analysis • Underlying Contradictions • Unquestioned assumptions, mindsets, beliefs, and practices that oppose the vision. • Not a ‘lack of’, but rather a log jam or kink in the hose • Images and attitudes, structures and patterns out of which people operate • Role of the facilitator • Create space for dialogue about clusters of barriers and underlying themes • Help the group recognize productive avenues for action that respond to, impact, or go around

20. Participatory Methods for Analysis Underlying Contradictions • Focus Question: What is blocking us from moving toward our vision? • NO DISCUSSION OF ‘LACK OF’ • Focus on one element of the vision: individual brainstorm obstacles (external policies, patterns or structures, internal images, perceptions or attitudes) • Share brainstorm with small groups, develop one list for small group • Bring ideas back to the large group, develop large group list • Form clusters of ideas, name the clusters • Review results and discuss: • What stands out about our obstacles? • What is the importance of each cluster? • What is the underlying contradiction (the block)? • Discuss actions that could deal with each cluster of contradictions • Prioritize the actions to address the contradictions

21. Participatory Methods for Analysis • Stakeholder Analysis • Identify and develop key relationships for successful implementation • Circles of Engagement • Role of the facilitator • Help the group understand each circle and identify stakeholders within each • Create a picture of the current situation, the ideal situation, and identify gaps

22. Participatory Methods for Analysis • Environmental Scan • Gain insight into community contextual factors related to the priority area, and that may drive or influence the implementation of the action plan. • ToP Wall of Wonder • Role of the facilitator • Create space for dialogue that clearly describes present and future assets, challenges, benefits, and dangers • Discuss plans for present and future trends, factors and events • Help identify synergistic linkages to and gaps in existing efforts

23. Participatory Methods for AnalysisToP Wall of Wonder

24. Sample from IPHI Example: Action Planning Worksheet

25. Example: Action Plan Template Sample from Wisconsin Association of Local Health Departments and Boards

26. Example: Action Plan Template Objective: Goal/Outcome: Monitoring/Evaluation Approach:

27. Example: Sustainability Planning Template Desired Outcome (product): Desired Outcome (product):

28. Sample from MPHI Example: Action Plan Template

29. Beginning with the End in Mind Facilitating Implementation

30. Participatory Methods for Implementation “Creativity is thinking up new things. Innovation is doing new things… A powerful new idea can kick around unused for years, not because its merits are not recognized, but because nobody has assumed responsibility for converting it from words into action. Ideas are useless unless used. The proof of their value is only in their implementation.” -Theodore Levitt

31. Transitioning from Action Planning to Implementation • How do you think of your action plan? If you think of your plan… • As a stack of paper: you will use it to fill up a file. • As a burden: you will use it to remind yourself and others of overwork. • As a carrot and stick: you will use it only on others less committed than yourself. • As a covert operation: you will use it yourself and keep it from others. • As a critical opportunity: you will pour all your energy into it, and burn out and get grumpy before long.

32. Transitioning from Action Planning to Implementation • If you think of your action plan as a roadmap for a momentous journey for your community, you will: • Move eagerly forward to each new step • Participate in and appreciate both the ups and downs of the road • Capture images of beautiful sights along the way • Notice and welcome changes in yourself and others as you move toward your destination.

33. Moving from Action Planning to Implementation • Implementation is… • A shift in the whole system. • Realizing the goals and milestones of the plan. • Engaging people as change forces. • Actively facilitating the whole journey to ensure intended results. • Actively monitoring the whole journey to ensure learning and growth. PHAB requires communities to implement elements and strategies of the health improvement plan, in partnership with others.

34. Moving from Action Planning to Implementation • The role of the facilitator during implementation is to… • Attend to the task, people, and process. • Set-up processes that are participatory and responsive. • Assess the situation on an ongoing basis, and facilitate processes to help the group retain or determine new focus. • Engage stakeholders in consensus building.

35. Moving from Action Planning to Implementation “We are all much more likely to act our way into a new way of thinking than to think our way into a new way of acting.” -R. Pascale, M. Millemann & L. Gioja Changing the Way We Change

36. Moving from Action Planning to Implementation Four Phases of Implementation • Getting started • Building & sustaining momentum • Making adjustments • Bringing closure Institute of Cultural Affairs, Technology of Participation (ToP) ‘Four Dimensional Model of the Implementation Journey’

37. Moving from Action Planning to Implementation: Getting Started • Elements of this Phase • Need to integrate into operations and existing demands • People work in unfamiliar ways; turf issues and changing roles • People feel excited, discouraged, challenged, anxious • ‘Implementation Dip’ • Need for coordination of structures, roles, and patterns of interacting • Need for high energy, rapid, visible ‘quick wins’

38. Moving from Action Planning to Implementation: Getting Started • Keys to Success in this Phase • Ensure the plan has potential for quick, highly visible results • High energy, Kick-Off event • ‘Catalytic actions’ to smooth out challenges of working together • Communicate the plan to all stakeholders • Decide on a guidance group and process • Set up a monitoring and communication system (process & products)

39. Moving from Action Planning to Implementation: Building & Sustaining Momentum • Elements of this Phase • Energy will ebb and flow, long term initiatives will tire people out • Leadership and staff may be in flux • The guidance group may struggle with how to hold themselves and others accountable • Organizational development and refinement of systems and technologies is likely needed • Support of individuals and building of capacities becomes critical • Steady and reliable monitoring and communication is the lifeblood

40. Moving from Action Planning to Implementation: Building & Sustaining Momentum • Keys to Success in this Phase • Celebrate small accomplishments • Make public displays of progress • Maintain regular, informal reports, feedback, and interchange • Keep stakeholders in the communication loop • Trainings for individual and team capacity building • Develop new leadership, rotate roles • Utilize unexpected leverage points

41. Example: Quarterly Action Plan Team Report

42. Example: Solutions Workshop

43. Moving from Action Planning to Implementation: Making Adjustments • Elements of this Phase • Significant learning about ‘what works’ and what does not work • Deep struggle and new resolve • Group capacity and camaraderie pays off • Moving toward self-sustaining initiatives • Deciding between a bump in the road and hitting a wall • ‘Failures’ become revised strategies • People will need help in being honest about reporting what did not get done

44. Moving from Action Planning to Implementation: Making Adjustments • Keys to Success in this Phase • Prepare for low points and high points • Develop short range action plans when you get stuck • Be prepared to change directions when your plans are no longer appropriate • Strengthen facilitation skills of the group • Reframe failures • Use a visual monitoring form (both on display and on paper) • Hold milestone meetings to mark turning points and plan to move ahead

45. Example: Re-Maneuvering Planning Session • Re-Maneuvering Planning Session • Bring back together the action planning team/workgroup • Review the vision, results of data gathering, and strategic priorities that lead to this strategy and action plan • Discuss what still seems on target and what is off • Brainstorm: • What has been accomplished? • What accomplishments have really moved us forward? • What blocks are we hitting? • What is needed right now to get on track? • Develop a 90-day action plan that coordinates with existing plans

46. Example: 90 Day Action Plan

47. Example: Quarterly Meetings

48. Moving from Action Planning to Implementation: Bringing Closure • Elements of this phase • Peer recognition of accomplishment begins to emerge • Reaching out to other similar efforts • Unanticipated outcomes, challenges, and consequences • The ‘new’ reality emerges • Victory needs to be celebrated and contributions affirmed and appreciated • The change effort needs to be recognized for its larger significance

49. Moving from Action Planning to Implementation: Bringing Closure • Keys to Success in this Phase • Write a powerful story of what happened • Build in unmistakable closure on tasks with an end date • Hold a highly visible celebration • Recognize and appreciate commitment and contributions • Articulate the learnings that occurred • Assess and propose improvements to the overall process used

50. Example: Implementation • Oklahoma Health Improvement Planning • http://www.ok.gov/health/Organization/Board_of_Health/Oklahoma_Health_Improvement_Planning_Team_(OHIP)_/OHIP_Work_Group_Quarterly_Reports/index.html