Evidence–Based Health Evaluation and Application· Introduction.docx

Evidence–Based Health Evaluation and Application
· Introduction
· Scene 1
· Patient Assignment
· Scene 2
· Alicia Balewa
· Conclusion
Introduction
Public health improvement initiatives (PHII) provide invaluable
data for patient–centered care, but their research is often
conducted in a context different from the needs of any
individual patient. Providers must make a conscious effort to
apply their findings to specific patients' care.
In this activity, you will learn about a PHII, and explore its
application to a particular patient's care plan.
Back to top
Overview
You continue in your role as a nurse at the Uptown Wellness
Clinic. You receive an email from the charge nurse, Janie Poole.
Click the button to read it.
Good morning!
At last week's conference I spoke with Alicia Balewa, Director
of Safe Headspace. They're a relatively new nonprofit working
on improving outcomes for TBI patients, and I immediately
thought of Mr. Nowak. At his last biannual cholesterol
screening he mentioned having trouble with his balance. This

may be related to his hypertension, but he believes it's related to
the time he was hospitalized many years ago after falling out of
a tree, and expressed distress that this might be the beginning of
a rapid decline.
Ms. Balewa will be on premises next week, and I'd like to set
aside some time for you to talk.
— Janie
Back to top
Alicia Balewa
Director of Safe Headspace
Overview
Interview Alicia Balewa to find out more about a public health
improvement initiative that might apply to Mr. Nowak's care.
Interview:
I have a patient who might benefit from some of the
interventions for TBI and PTSD you recently studied. What
populations did your public health improvement initiative
study?
My father came home from Vietnam with a kaleidoscope of
mental health problems. That was the 1970s, when treatment
options for things like PTSD, TBI, and even depression were
very different. Since then there has been a lot of investment in
treatment and recovery for combat veterans. That's excellent
news for veterans in treatment now, but they're not looking at
my dad, and how his TBI and PTSD have affected him through
mid–life and now as a senior. That's why I started Safe
Headspace: to focus on older patients who are years or decades
past their trauma, and find ways to help them.
Which treatments showed the strongest improvement?
Exercise. We were able to persuade about half of our
participants — that's around 400 people, mostly men ages 45–80

— to follow the CDC's recommendations for moderate aerobic
exercise. Almost everyone showed improvement in mood,
memory, and muscle control after four weeks. After that a lot of
participants dropped out, which is disappointing. But of the 75
who stuck with it for another three months, muscle control
improved 15%, mood improved 22%, and short–to–medium term
memory improved 61%. We didn't specify what kind of
exercise, but we did ask them to record what they did every
week, so that data is available.
Second was medication and therapy. Most of our participants
didn't receive any kind of psychotherapy in the years
immediately following their trauma, so we had everyone
assessed by a team of psychotherapists. As a result of those
assessments, 40% of participants started on anti–depressant
medication and 9% started taking anti–psychotics. Those who
started taking medications now have regular contact with a
therapist to manage that care. With some help at home to stick
to the regimen, all but a few have successfully followed their
treatment plans. They've reported a 26% improvement in mood
over six months, and a 6% improvement in memory.
The third treatment I want to mention is meditation. We only
had a small group interested in trying it, but the results were
dramatic. We prescribed daily meditation at home, just 10 to 15
minutes, with a weekly hour–long guided group meditation for
all 23 participants. After three weeks we lost two to disinterest,
but the other 21 showed improvements of over 70% in mood and
memory, and 32% in muscle control.
Have you tried anything that hasn't worked?
Sure. There are memory exercises for patients in elderly care,
and things like Sudoku and crossword puzzles. We didn't see
any gains with those. Some of our participants preferred
strength training to aerobic exercise, and the only improvement
we saw in that group was in muscle control, but only 4%, which
is significantly less than the aerobic group.
I should also say that we were working with a willing group of
participants. They knew they needed help, and were motivated

to get it. One of the hurdles we see with veterans, especially in
older generations, is an unwillingness to acknowledge that they
have a problem. We haven't had to wrestle with that because
everyone who volunteers to participate wants to be there.
Your organization is intervening with people who have TBI and
PTSD simultaneously. We have a patient with moderate TBI
suffered almost 40 years ago, but no history of PTSD. Have you
separated your population and studied each separately?
We haven't, no. In some cases we could, for those who come in
with previous diagnoses and medical records. But we have
participants who either weren't diagnosed, were under–
diagnosed at the time, or don't have records to show us.
MBA 5101, Strategic Management and Business Policy 1
Course Learning Outcomes for Unit VI
Upon completion of this unit, students should be able to:
4. Analyze the processes for formulating corporate strategy.
4.1 Discuss Six Sigma and its use as a method of strategy
implementation.
5. Evaluate methods that impact strategy implementation, such
as staffing, directing, and organizing.
5.1 Identify the stages of the corporate life cycle.
5.2 Explain how a corporation’s life cycle may be extended.

Reading Assignment
In order to access the following resources, click the links
below:
Bowersox, D. J., & Daugherty, P. J. (1995). Logistics
paradigms: The impact of information technology.
Journal of Business Logistics, 16(1), 65-80. Retrieved from
https://libraryresources.columbiasouthern.edu/login?url=http://s
earch.ebscohost.com/login.aspx?direc
t=true&db=bth&AN=9509300849&site=ehost-live&scope=site
College of Business – CSU. (2016, January 12). MBA5101 Unit
VI lesson video [YouTube video]. Retrieved
from
https://youtu.be/G2GQV6iN8QY?list=PL08sf8iXqZn54RIuJs-
skgp4omxG-UOu5
Click here to access a transcript of the video.
Crough, C. (2012). Lean Six Sigma value - industry ready for
it? Concrete Products, 115(3), 6-8. Retrieved
from
Hahn, W., & Powers, T. L. (2010). Strategic plan quality,
implementation capability, and firm performance.

Academy of Strategic Management Journal, 9(1), 63-81.
Retrieved from
http://link.galegroup.com.libraryresources.columbiasouthern.ed
u/apps/doc/A235406994/ITOF?u=oran
95108&sid=ITOF&xid=48e6c4ae
Raps, A. (2005). Strategy implementation - an insurmountable
obstacle? In Emerald Group (Eds.), Strategic
management (pp. 141-145). Retrieved from
https://ebookcentral.proquest.com/lib/columbiasouthern/reader.a
ction?ppg=42&docID=282919&tm=1
507645002311
Smith, B. D. (2010). Discretion is the better part of value: Five
research-based rules for ensuring that strategy
implementers implement. Journal of Medical Marketing, 10(3),
259-266. Retrieved from
http://link.galegroup.com/apps/doc/A229720007/AONE?u=oran
95108&sid=AONE&xid=73b220a6
Yadav, R. (2015). A roadmap for implementing total quality
management practices in medium enterprises.
IUP Journal of Operations Management, 14(4), 7-23. Retrieved
from

UNIT VI STUDY GUIDE
Strategy Implementation
earch.ebscohost.com/login.aspx?direct=true&db=bth&AN=9509
300849&site=ehost-live&scope=site
https://youtu.be/G2GQV6iN8QY?list=PL08sf8iXqZn54RIuJs-
skgp4omxG-UOu5
https://online.columbiasouthern.edu/bbcswebdav/xid-
76034823_1
u/apps/doc/A235406994/ITOF?u=oran95108&sid=ITOF&xid=48
e6c4ae
u/apps/doc/A235406994/ITOF?u=oran95108&sid=ITOF&xid=48
e6c4ae
http://link.galegroup.com/apps/doc/A229720007/AONE?u=oran
95108&sid=AONE&xid=73b220a6

UNIT x STUDY GUIDE
Title
Unit Lesson
Once a strategy is designed, created, and accepted by people in
an organization, the next step is
implementation. With careful planning and consideration, the
implementation phase can be made smoother
and easier. This does not account for the real world possibility
of mistakes, problems, and issues.
The strategy implementation phase, which is merely the act of
putting strategy into action, only involves
three steps:
1. Programs and tactics
2. Budgets
3. Procedures
This simplicity belies the difficulty involved in a company
successfully and continuously implementing all three
effectively. In this unit lesson, the importance of
implementation, as well as the difficulty successful firms

will encounter, will be discussed.
Strategy implementation is about achieving the goals
developed and set forth in the company’s strategic plan.
The CEO, top management, and the cross-functional
strategic planning committee have all taken great care in
developing a strategic plan that demonstrates a conscious
effort to create a kind of future the firm sees in which it
would like to compete. Only with a good long-term strategy
and consistent implementation will a company be able to
compete against rival companies in meeting customer
wants and needs (Finnie, 1997). Discipline in implementing
each step is critical to success. In his article published in
Strategy and Leadership, the author discussed interactive
organizations who wish to control their own futures.
Finnie (1997) stated that organizations can use strategic
thinking to plan for the future and establish long-term
goals based on factors that may drive change in their industry.
When the completed strategic plan is approved and ready for
implementation, it is up to the firm’s middle
managers to ensure its successful execution. At this point, the
role of top management shifts to provide two
types of leadership: constancy of purpose (i.e., a clear, constant,
motivating vision) and an environment that
encourages everyone to work together to achieve the vision.
Within that leadership structure, top
management ensures that individual goals and goal
measurements are clear. The role of the cross-functional
teams operating across the organization at all levels is still
necessary to coordinate actions and information
gathering to ensure progress towards these goals (Finnie, 1997).
Managers, employees, and firm infrastructure must be brought
together in a way that culminates in a high

level of implementation capability which, when accomplished,
will provide a firm with a core competence. The
value of these middle managers is in how they work through
their employees to accomplish the goals set forth
in the strategic plan (Hahn & Powers, 2010). This is why these
managers need buy in to the changes being
implemented in the company. Top leadership would be wise to
include managers in the planning phases. This
also helps to ensure managers appreciate and understand the
goals of the top management.
The goals in a strategic plan must be specific and measurable to
enable employees to know they are
continuing to perform in line with the plan requirements. A set
of metrics need to be set up, but care should be
done to ensure these metrics measure 1) what needs to be
measured, and 2) what is being measured is
accurate and reliable. An example of an overall goal might be to
achieve certain top line revenue targets. Top
management must insist that reaching the goal itself without
adhering to plan strategies is not acceptable.
This enables the manager's role to be specific in focusing
employees and their activities toward achieving the
specific targets set forth in the plan.
In this case, that might mean not only reaching the overall
revenue target, but also each of those revenue
production targets within the overall revenue goal. This type of
focused effort enables better communication at
Marine Institute Ireland, strategic planning symbol.
(Marine Institute, 2006)

UNIT x STUDY GUIDE
Title
the functional level, enabling employees to make important,
qualitative judgments in their everyday activities.
Again, implementation is important for performance because
strategies do not add value unless properly
implemented (Hahn & Powers, 2010). A company must also be
flexible to make changes when necessary.
Similar to the action research model, a process might be
implemented under expertise opinion and
consideration, but once implemented, more data may suggest or
show change is necessary. The question of
changing or staying the course must have a decision maker with
the power to resolve such issues.
To review, top management's job is far from over once the
strategic plan has been approved for
implementation. They must continue to provide leadership and
set the tone in the organization that will
enable employees to believe they can follow and implement
their firm’s strategic plan. The creation of an
open and supportive culture and environment is critical.
Reaching goals without fulfilling the strategy
requirements does not provide a clear picture of company
performance or its plan implementation. If the
strategic plan encompasses the vision and future the company
sees for itself, then to achieve that stated
vision requires the company to implement and rigorously adhere
to its plan. That enables the company to
better understand the effectiveness of its leadership, planning,

and plan implementation process. Achieving
optimum performance in all three of these areas creates a
distinctive competency and competitive advantage
(Hahn & Powers, 2010).
The managers within this leadership environment must engage
and lead their employees, not just to achieve
plan goals, but they must also achieve those plan goals within
the framework of the plan. Companies that
perform at this level consistently tend to earn a higher return on
investment (ROI) (Hahn & Powers, 2010). In
this type of implementation environment, top management and
managers pay special attention to the
communication and resource needs of their employees. They
clearly recognize the value of discretionary
decisions employees make daily in their work. Therefore, the
company mission, plan vision, and implemented
goals must be made clear and be fully understood at the
functional level. It becomes a manager's primary
responsibility to ensure their communication is clear and
focused with regard to the needs of successful plan
implementation. They must enable employees to feel that
reaching the functional goals according to the
strategies set forth in the plan is not only preferred, but is
achievable. Goal setting may change over the
course of implementation because of new data received and
analyzed by management.
By employees clearly understanding their role and value in their
daily implementation of the company
strategic plan, their confidence increases, which yields higher
productivity and increased plan performance. It
also increases employee morale, which can later translate into
improved contributions during the planning
process (Smith, 2010). Employees on the front line develop
first-hand experience on any given company

process. Their feedback should be considered when making
changes, but within the context of change and
ideas from multiple levels of management.
Managers must be sensitive not only to the quantitative
measurements required for successful plan
implementation, they must also be sensitive to qualitative
measurements in the spirit of achieving
implemented results within the plan strategy requirements.
Consistent and constant feedback, training, and
resource provisioning at all levels must come together in the
correct manner to form an infrastructure and
culture to make that happen (Smith, 2010). With change will
come many challenges, thus the need for
support of management for workers, and vice versa. Change
may not always be made easy, but teamwork
and support of one another can remove many barriers and
challenges to the change process.
Rather than making strategy implementation an additional, but
important task on top of the employees’ and
managers’ daily work, successful strategy implementation must
become everyone’s daily job. Only through
focused leadership, communication, demonstrated
understanding, and dedication at all levels can strategy
implementation be most effective, enabling the company and its
employees to reap their hard-won rewards.
References
Finnie, W. C. (1997). A four-cycle approach to strategy
development and implementation. Strategy &
Leadership, 25, 24.

Hahn, W., & Powers, T. L. (2010). Strategic plan quality,
implementation capability, and firm performance.
Academy of Strategic Management Journal, 9(1), 63.
UNIT x STUDY GUIDE
Title
Marine Institute. (2006). Strategic planning symbol [Image].
Retrieved from
https://commons.wikimedia.org/wiki/File:Strategic_
Planning_Symbol.jpg
Smith, B. D. (2010). Discretion is the better part of value: Five
research-based rules for ensuring that strategy
implementers implement. Journal of Medical Marketing, 10(3),
259.
Suggested Reading
In order to access the following resources, click the links
below:

This article provides further information regarding
organizational change.
Goksoy, A., Ozsoy, B., & Vayvay, O. (2012). Business process
reengineering: Strategic tool for managing
organizational change an application in a multinational
company. International Journal of Business
and Management, 7(2), 89-112. Retrieved from:
http://www.ccsenet.org/journal/index.php/ijbm/article/view/116
55
This book provides further information regarding organizational
change.
Hammer, M. (1997). Beyond reengineering: How the process-
centered organization is changing our work and
our lives. New York, NY: Harper-Collins.
The article below discusses total quality management. The best
information is on pages 3055-3059 and
3068-3069.
Wiengarten, F., Fynes, B., Cheng, E. T., & Chavez, R. (2013).
Taking an innovative approach to quality
practices: Exploring the importance of a company’s
innovativeness on the success of TQM practices.
International Journal of Production Research, 51(10), 3055-
3074. Retrieved from .

http://www.ccsenet.org/journal/index.php/ijbm/article/view/116
55
Patient-Centered Care Report Scoring Guide
CRITERIA
NON-PERFORMANCE
BASIC
PROFICIENT
DISTINGUISHED
Evaluate the outcomes of a population health improvement
initiative.
Does not describe the outcomes of a population health
improvement initiative.
Describes but does not evaluate the outcomes of a population
health improvement initiative.
Evaluates the outcomes of a population health improvement
initiative.
Evaluates the outcomes of a population health improvement
initiative. Identifies knowledge gaps, unknowns, missing
information, unanswered questions, or areas of uncertainty
(where further information could improve the evaluation).
Propose a strategy for improving the outcomes of a population
health improvement initiative, or for ensuring that all outcomes
are being addressed, based on the best available evidence.
Does not propose a strategy for improving the outcomes of a
population health improvement initiative, or for ensuring that
all outcomes are being addressed, based on the best available

evidence.
Proposes a strategy that is not useful for improving outcomes or
ensuring that all outcomes are being addressed, or the strategy
is not based on the best available evidence.
Proposes a strategy for improving the outcomes of a population
Proposes a strategy for improving the outcomes of a population
Acknowledges challenges in the proposed strategy.
Develop an approach to personalizing patient care that
incorporates lessons learned from a population health
Does not develop an individualized personal care approach that
improvement plan.
Develops an approach to personalizing patient care that does not
clearly incorporate lessons learned from a population health
improvement plan.
Develops an approach to personalizing patient care that
Develops an approach to personalizing patient care that
improvement initiative, and identifies assumptions on which the
approach is based.
Justify the value and relevance of evidence used to support an
approach to personalizing patient care.
Does not justify the value and relevance of evidence used to
support an approach to personalizing patient care.
Presents a weak justification of the value and relevance of
evidence used to support an approach to personalizing patient
care.
Justifies the value and relevance of evidence used to support an
approach to personalizing patient care.

Justifies the value and relevance of evidence used to support an
approach to personalizing patient care. Identifies knowledge
gaps, unknowns, missing information, unanswered questions, or
areas of uncertainty (where further information could improve
the personalized concept map).
Propose a framework for evaluating the outcomes of an
approach to personalizing patient care and determining what
aspects of the approach could be applied to similar situations
and patients.
Does not propose a framework for evaluating the outcomes of
an approach to personalizing patient care and determining what
and patients.
Attempts to propose a framework for evaluating the outcomes of
an approach to personalizing patient care, but proposed criteria
are not measurable or not relevant, or aspects of the approach
are not likely to be transferable to other cases.
Proposes a framework for evaluating the outcomes of an
and patients.
Proposes a framework for evaluating the outcomes of an
and patients. Acknowledges the limitations of the proposal.
Write clearly and logically, with correct grammar and
mechanics.
Does not write clearly and logically, with correct grammar and
mechanics.
Writing is not consistently clear and logical, or errors in
grammar and mechanics detract from the message.
Writes clearly and logically, with correct grammar and
mechanics.
Writes clearly, logically, and persuasively; grammar and
mechanics are error-free.
Integrate relevant and credible sources of evidence to support

assertions, correctly formatting citations and references using
APA style.
Does not integrate relevant and credible sources of evidence to
support assertions; does not correctly format citations and
references using APA style.
Sources lack relevance or credibility, are poorly integrated, or
are incorrectly formatted.
Integrates relevant and credible sources of evidence to support
APA style.
Integrates relevant and credible sources of evidence to support
APA style. Citations are error-free.

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