Module 8: Bringing the Plan to Life

Module Introduction

The final module in this course discusses bringing the state plan to life. At this point, you will be putting into effect the implementation and evaluation plans that were produced during the planning process. 
The public health planning process never really ends. As described in Module 1, it remains a circular process that begins with data, the review of literature and existing practices to identify evidence-based solutions, the implementation and evaluation of these strategies and activities, and decisions about whether a course correction is needed or the work can proceed as planned. 

This module explains how organizational structures and processes keep the cycle turning with engaged and informed partners, and the monitoring of process and outcome results from evidence-based interventions. To follow the gardening analogy, this is the point when you continue to water and care for your garden so the plants will flourish.

Module 8 Learning Objectives:

Upon completion of this module, you should be able to:

• Understand how to use key elements of the planning process to engage coalition members in the implementation of the state plan
• Describe steps needed during the initial preparation phase of implementation
• Describe tactics to provide for sustainability for interventions
• Understand the cyclical nature of the planning process

Time Estimate for Completion:

Module 8, Section I: Infusing the Principles of Collaborative Planning into Implementation

Collaborative Processes

After a state plan is released, planning group members may disburse without transitioning to active participation in the implementation of the plan. It is important to remember that the state plan is your coalition’s charter for moving forward and creating change, not a document created just to satisfy funding requirements or to sit on a shelf. State department of health staff and coalition leadership must continue to communicate and demonstrate that the ongoing involvement of coalition and planning group members is needed to put into effect the implementation and evaluation plans that were produced during the planning process. 

Creating ongoing coalition member ownership of the implementation and evaluation of the evidence-based interventions in the state plan requires continuing commitment to the key collaborative processes used throughout the planning process. As described in Module 2, these processes include consensus building, conflict resolution, and group decision-making.  Supporting factors for collaboration while implementing the state plan include:

• Creating and following ground rules for group interaction
• Maintaining an equitable division of work, providing access to leadership opportunities
• Getting constituent feedback from members’ respective organizations, and
• Ongoing self-assessment of progress and members’ involvement.

Section I:Infusing the Principles of Collaborative Planning into Implementation cont'd

Transitioning from Planning to Implementation

As the planning group completes its work developing the state plan, changes in coalition composition will occur. Some of the stakeholders in the planning group agreed only to participate in developing the state plan document. Other stakeholders will want to continue as full-fledged members of the coalition.  This transition period provides an opportunity to determine what roles partners want to play in implementation and what resources they may want to contribute. It is important to remember that individuals participating in the coalition represent not just themselves but also their organization, agency, or professional association. Members must be provided with the time needed to consult with their leadership or membership when decisions or commitments of resources are required.  

As your coalition integrates new members, you can examine how your committee structure, your ongoing meeting schedule and meeting processes, and internal communications strategies can support ongoing member engagement in implementation of the state plan.

Section I: Infusing the Principles of Collaborative Planning into Implementation cont'd

Committee Structure

A critical component of the Planning Fundamentals approach is that the small workgroups that were formed to select appropriate evidence-based interventions continued to work together to develop detailed implementation and evaluation plans.

Your coalition may wish to form committees that grow organically out of these workgroups. Each of the committees would then function as the supervising and implementing entity for its set of coordinated interventions.

Members of these committees will meet separately and more frequently than the coalition as a whole. Since the implementation and evaluation plans cover multiple years, the first task before each committee would be to develop the first year’s work plan for each intervention, to include preparation and roll-out tasks.

Coalitions also may have committees that support management of the coalition such as membership, communications, events, and fundraising.  An Executive or Steering Committee comprised of elected officers and all committee chairs may direct coalition affairs.

Section I: Infusing the Principles of Collaborative Planning into Implementation cont'd

Coalition and Committee Meetings

Regular meetings of the entire coalition membership will be held at regular times during the year. It is important to reserve time during these meetings to receive progress reports from the members of the various committees, to welcome new members, and to make decisions about modifying implementation and the relevant sections of the state plan.

At least one meeting of the coalition each year should feature progress on key strategies.  Representatives from the initiative committees can make a formal presentation, including process and outcome evaluation results, if available. These presentations may also address any obstacles or barriers and describe possible solutions to overcome these problems. The entire coalition can weigh in with suggestions and follow-up questions. 

During these meetings it is important to celebrate successes and the progress made towards implementation of the state plan. Public acknowledgement of member contributions during an annual meeting of the coalition can contribute to keeping coalition members and the organizations they represent engaged in the implementation process. Also, rotating meeting places to different sites within the state provides coalition members and other stakeholders an opportunity to showcase their facilities and programs.

Section I: Infusing the Principles of Collaborative Planning into Implementation cont'd

Communication and Information Flow

Regular, internal communication that accommodates member preferences for receiving information is key to keeping coalition members engaged during implementation.

An internal communication plan can be created to include how and when you and your partners will share routine information, such as committee and coalition meetings, and how you will solicit and circulate information about implementation activities.

Mechanisms to distribute and circulate information include e-newsletters, listservs, and posting information on partner websites.

Section I: Infusing the Principles of Collaborative Planning into Implementation cont'd

Communication Plans

Another component of your internal communication plan should be how you will relate to the media to release information about your coalition and state plan accomplishments. You can access internal and external resources that may be available, including staff at the state department of health that are in charge of website development, media relations, and materials development.  Additional resources can include representatives from your partners’ media relations departments, as well as concerned representatives from newspapers, radio, and television who serve as members of your coalition and champions for your cause.

Communication plans should also include how the state department of health program website will be managed.  The website serves multiple functions, including providing information to the general public about chronic disease, the state program, the coalition, and local resources for persons living with chronic disease.  The state program website should provide links to websites of coalition members as well as national resources.

Section I: Infusing the Principles of Collaborative Planning into Implementation cont'd

Roles of State Department of Health Staff

During the transition from planning to implementation, state department of health staff continue to perform several key functions to maintain the coalition and its activities. These could include:

• Providing technical assistance to committees and the coalition as a whole, including attending meetings, taking attendance, taking minutes, circulating minutes after meetings, and maintaining related records of decisions made and work performed.

• Managing meeting logistics for the committees and the coalition, including arranging for meeting space, preparing materials for meetings, notifying members of meetings dates, times, and locations, and paying vendors as needed.

• Initiating and managing interagency agreements and contracts that support implementation activities.
• Monitoring the participation of members in committee and coalition activities, working with the coalition’s membership committee to identify, recruit, and orient new members, and collecting assessment data annually from coalition members on their perceptions of how well the coalition is functioning.

Section I: Infusing the Principles of Collaborative Planning into Implementation

Module 8, Section I Summary & Activity

Section I introduced how collaborative processes, organizational structure and regular communication can keep coalition members engaged in implementation of the state plan. Watch the video below, in which state department of health staff and partners from Florida and Kentucky discuss how to keep the momentum going with partners, and then answer the questions that follow. Click here for a worksheet to record your answers.

1. In the video, a partner talks about giving coalition members “Oscar the Grouch” awards to recognize their contributions. What are two other strategies mentioned in the video for keeping partners involved and enthusiastic about implementing and evaluating the state plan?
2. How can reviewing the vision, goals, strategies, objectives, and activities laid out in the state plan at an annual meeting help the coalition ensure that the plan remains relevant – and not become just a document on the shelf?

Module 8, Section II: Moving to Implementation

Preparing for Implementation

To begin implementing the evidence-based interventions that are outlined in the state plan, coalition members and partner organizations will need to spend some time in a transition or preparation phase.

This phase includes:

1. Preparing for implementation, including firming up support for implementation and evaluation work
2. Preparing for evaluation and monitoring

Section II: Moving to Implementation cont'd

Preparing for Implementation – Activities

For each of the interventions in your state plan, you will need to develop the specifics of the intervention as it will be implemented in your specific settings with your populations.

Depending on the intervention, activities to prepare for implementation could include:

• Recruiting and training program deliverers
• Securing sites
• Obtaining program materials and other resources
• Developing promotional materials and referral networks to recruit participants
• Ordering supplies
• Securing transportation for participants

The coalition and partners also will be confirming and lining up support for implementation and evaluation work. Activities can include initiating and managing interagency agreements and finalizing contracts and consultant agreements

Section II: Moving to Implementation cont'd

Preparing for Implementation – Activities, cont'd

The interventions in your state plan may be:

• Completely new to your coalition and your partners and ready to implement as is
• Completely new to your coalition and your partners and in need of adaptation to serve populations in your state
• Already being implemented by organizations in the state and will be shared (disseminated) to partners working in other communities
• Already being implemented by organizations in the state and will be expanded in size or geographic scope by those organizations

When implementing an intervention that is new, or an intervention that is being adapted for populations, preparing for implementation may take longer. Also, you and your partners may wish to pilot the intervention before implementing it more widely.

If the coalition is implementing an existing intervention, sometimes referred to as “programs in a box” or “toolkits”, everything needed to implement the program already may be at your fingertips. You and your partners do need to review toolkit materials and determine whether anything needs to be modified based on your needs assessment. 

Hover your mouse over the types of interventions below to see what a “toolkit” might contain:

• Training or education programs
• Health communications interventions
• Policy interventions
• Organizational interventions
• Environmental interventions

Section II: Moving to Implementation cont'd

Preparing for Evaluation - Activities

The coalition should have written evaluation plans to share with all partners and contractors involved in the implementation and evaluation of interventions. Most of the work designing evaluation tools and developing monitoring systems must be completed during the preparation phase. Activities to prepare for evaluation can include:

• Developing and training program implementers or other staff on data collection and reporting methods
• Collecting baseline data prior to implementation
• Developing data collection instruments
• Having evaluators design and build a database to serve as a monitoring and evaluation system
• Deciding on a data analysis plan and the standard reports that the database should produce regularly

Sufficient time needs to be set aside during the preparation phase to train those responsible on the use of the data collection instruments and data reporting requirements. A reporting calendar, complete with reminder messages and deadlines should be developed and circulated to everyone involved, including implementing organizations and external evaluators.

Section II: Moving to Implementation cont'd

Dissemination and Expansion

During the preparation phase, the coalition and its partners may plan for future dissemination or expansion of the interventions being implemented. Many coalitions do not begin creating their dissemination and expansion plans until they have gone through their first phase of implementation, though, in order to examine how their interventions were received, whether circumstances surrounding implementation went as planned, and whether expected results were achieved.

Dissemination refers to taking interventions to other areas, through existing or new stakeholders. In dissemination, the intent is to ensure that the product or practice remains the same in the new context. Dissemination can also be called diffusion, although dissemination usually means a directed or intentional process, while diffusion also refers to new practices or products moving from one population to another through voluntary adoption.

Expansion means increasing the reach of an intervention. This may mean increasing the number of participants at an existing site or adding new sites. These new sites may be in the same geographic area or new areas and may be operated by existing partners or new partners.

Adequate preparation for both dissemination and expansion involves the creation of dissemination and expansion plans modeled on existing implementation and evaluation plans. Planning for dissemination and expansion helps determine what tasks and additional resources will be required. Dissemination may involve enlarging your coalition to include additional partners, obtaining additional resources, or developing tools to enable others to independently implement your program, such as training guides, program materials, evaluation instruments and analysis plans.

The state department of health’s role in dissemination and expansion may include recruiting and preparing new organizations to implement the interventions, providing ongoing technical assistance during implementation, and supporting mentoring relationships between existing intervention sites and new sites. The time required to support communication and coordination will increase and may require additional staff.

Section II: Moving to Implementation cont'd

Institutionalization and Sustainability Strategies

During the preparation phase, the coalition and its partners can also plan for future sustainability of the interventions.

Institutionalization means to have a practice or program adopted as standard or continuing practice of another organization. Institutionalization usually requires some changes in policy and practice in the organization. It also implies that the organization institutionalizing the intervention assumes full responsibility for funding, staffing, assuring quality of implementation, recruitment of participants, and monitoring and evaluating the intervention. 

Types of organizations that may institutionalize an intervention include health care agencies, educational institutions, worksites, professional associations, and government agencies. With institutionalization, it is important to consider whether or not you and your partners will continue to have access to reach and other participant data and outcome data. 

The term sustainability refers to finding the resources to continue to maintain and/or expand the interventions and the coalition itself. Sustainability usually refers to finding and securing financial and in-kind resources to support programs (financial sustainability) and establishing processes and structures within an organization/coalition to support its continuing functioning (organizational sustainability).

Section II: Moving to Implementation cont'd

Sustainability Plans

Although long-term sustainability planning must include a focus on funding, sustaining an initiative also requires non-fiscal resources such as leadership from management and board members, technical expertise, strong management systems, and broad-based support from the communities served by the initiative. If you have dedicated time, energy, and attention to building and maintaining your coalition and partnerships and fully engaging your partners in the planning process for the state plan, then you and your partners have already completed much of the work required to be included in a sustainability plan. 

The Finance Project (http://www.financeproject.org/special/engage/workbook.cfm) is a nonprofit organization that has developed several resources on sustainability planning and provides a template that can be used to prepare a sustainability plan. The Finance Project’s approach to sustainability planning encompasses both financial and organizational sustainability. The Finance Project’s template for a sustainability plan is approximately one to two pages long, consisting of short paragraphs summarizing major points. When working with private foundations and the business sector, a concise plan can be much more effective and persuasive than a longer document.

Click here to download a document to read more about key principles of sustainability frameworks.

Section II: Moving to Implementation cont'd

Module 8, Section II Summary & Activity

Section II discussed how to prepare to implement the state plan, or bring the plan to life.  Consider the following questions. Click here for a worksheet to record your answers.

1. Why is it important to prepare for implementation of the interventions in the state plan?
2. What are some of the activities that take place in the preparation phase?
3. How can careful work done by the work groups during the planning phase contribute to or help make the preparation phase much easier?

Module 8, Section III: Conclusion: The Planning Cycle

Modifying the State Plan

After the coalition has completed the preparation phase, the implementation phase now begins. While the state plan is being “brought to life”, the coalition will continue to meet to analyze and review progress, and process and outcome results, and determine if modifications to the state plan or to implementation strategies are needed.

For example, the coalition may decide to redirect resources from strategies and activities that are not achieving progress to strengthen or expand strategies and activities that are, or completely new strategies and activities may be proposed for addition to the state plan. These additions may reflect lessons learned or new evidence-based strategies.

When considering potential changes, the coalition can use the collaborative, participatory processes described in this course to make decisions, and potential changes in direction should reflect the vision and goals laid out in the state plan.

Section III: Conclusion: The Planning Cycle cont'd

A Note on External Circumstances

Change will occur over time in the external circumstances that affect your coalition and the implementation process. External circumstances include changes in the socioeconomic and political environment in your state or at the national level. Research may also demonstrate the effectiveness of new methods of screening, diagnosing, and referring individuals with or at risk for chronic disease.

One way to identify changes in external circumstances is to perform environmental scans at intervals, using the format developed in Module 2.  The availability of resources as well as the amount of change occurring should determine the frequency of collecting the environmental scan. A committee can be charged with oversight of the environmental scan and producing a summary report of the results to be distributed to coalition members. If external changes affect implementation, then the state plan and the respective intervention implementation and evaluation plans can be modified accordingly.

Section III: Conclusion: The Planning Cycle cont'd

The Planning Cycle

As described in the introduction to this module, public health planning is a cyclical process. While implementing and evaluating the strategies in the plan, decisions will be made about whether a course correction is needed or the work can proceed as planned.

Decisions about what to change, whether we change a small aspect or the greater part, is based on what we have learned, documented, tested and established as evidence.  A wheel that keeps moving forward with each turn captures how we apply what we learn in each cycle to the next one.

As we repeat the cycle, our work leads to greater refinement in interventions and greater improvement in the underlying problems we are trying to address.

Section III: Conclusion: The Planning Cycle cont'd

Accountability, Transparency, Efficiency, and Effectiveness

The cyclical planning process described in this course helps us to deliver services and programs that are evidence-based, effective in achieving results, and efficient in using resources.

Following systematic and replicable processes of implementation, data collection, analysis, and interpretation, which are completely documented and accessible, produces the accountability and transparency that are critical to the ethics of science, public health, and democratic governance.

Whether the terminology used is derived from business or health care (continuous quality improvement, performance management), laboratory science (the experimental method), applied research (program evaluation, implementation science), or public health (health planning, epidemiology), all of these fields employ an approach that is based on:

• Forming hypotheses by inferring relationships among observed and measured phenomenon
• Collecting additional data to test these hypotheses and determine whether they are falsifiable or true so far as we know it
• Continuing to collect additional data, form new hypotheses, and test them to advance our knowledge

The evidence determines whether what we have done has achieved the results intended, whether it was an efficient use of resources, and whether we can explain the value of what has been accomplished to those who have vested their trust in us to act on their behalf.

Section III: Conclusion: The Planning Cycle cont'd

The Planning Fundamentals Approach

The Planning Fundamentals approach involves:

• Describing public health problems and their context using demographic, socio-economic, environmental, and epidemiologic data
• Identifying and selecting appropriate evidence and practice-based interventions to address these problems
• Planning the implementation and evaluation of these interventions
• Documenting this work in a publicly-available and accessible state plan

From the planning process and the development of the plan, to the implementation and evaluation of the interventions proposed in the plan, the approach emphasizes a commitment to full participation and collaboration in the planning process from diverse stakeholders representing many perspectives on the problems and solutions.

Whether we use the phrases “Plan, Do, Study, Act” or “Assess, Plan, Implement, Evaluate,” or the CDC Framework for Program Evaluation, we are describing a cyclical pattern that is repeated in order to improve both processes and outcomes of the work performed.  The cyclical nature of the planning process means that good planning will produce good “doing” and even better planning for the next time.

Section III: Conclusion: The Planning Cycle cont'd

Module 8, Section III Summary & Activity

Watch the video below, in which state department of health staff and partners reflect on important lessons that they learned during the planning process, and then answer the questions that follow.

Click here for a worksheet to record your answers.

1. One of the people in the video said that the collaborative planning process is “not a single event” where people come together to create a plan and then are finished, but it is an ongoing process that starts before you develop the plan and continues afterward. List three strategies for keeping the momentum going, along with your partners, throughout this process?
2. The coalition member in the video states that once the planning group has selected goals, it is important to continue to review those goals as the process continues. What type of things might change during the planning process that may require some flexibility in your state plan?