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Chapter 12
Implementation: Strategies and
Associated Concerns
Defining ImplementationThe act of converting planning, goals,
and objectives into action through administrative structure,
management activities, policies, procedures, and regulations,
and organizational actions of new programs” (Timmreck, 1997,
p. 328)
Setting up, managing, and executing a project (Keyser et al.,
1997)
Program diffusion - adoption, implementation, sustainability
(Bartholomew et al., 2006)
ImplementationPlanners need to be flexible when implementing
a program
Phases of implementation
Adoption of the program - a part of marketing (chapter 11)
Identifying and prioritizing the tasks to be completed
Establishing a system of management
Putting the plans into action
Ending or sustaining a program
Phase 2 - Identifying & prioritizing the tasks to be
completedMany tasks need to be completed when implementing
a program (e.g., reserving space, ordering equipment, etc.)
Tasks need to be identified and prioritized
Planning timetables and timelines can help with this process
Types of timetables and timelines: key activity charts
(McDermott & Sarvela, 1999), Task Development Timelines
(Anspaugh et al., 2000), Gantt Charts, PERT charts, & CPM
Task Development Timeline
Gantt Chart
Program Evaluation & Review Technique (PERT)
00
10
20
23
25
27
30
40
50
60
70
80
90
1 wk
1 wk
5 wks
1 wk
1 wk
3 wks
0.5 wk
2 wks
1 wk
1 wk
3 wks
8 wks
3 wks
Time estimated 3 ways: optimistic (minimum possible time),
pessimistic (maximum possible time), & probabilistic (best
estimate time)
00. Start planning
10. Develop rationale
20. Needs assessment
23. Create instrument
25. Select sample
27. Collect & analyze data
30. Create goals/objectives
40. Create intervention
50. Pilot test
60. Identify & allocate resources
70. Marketing
80. Implement program
90. Evaluate (process, impact, & outcome)
Critical Path Method (CPM) or PERT/CPM
A
C
G
D
E
F
H
J
M
I
K
L
B
Items on critical path cannot be delayed without delaying the
program; time is important estimates are made for earliest &
latest start & finish times for each activity
A. Start planning
B. Develop rationale
C. Needs assessment
D. Create instrument
E. Select sample
F. Collect & analyze data
G. Create goals/objectives
H. Create intervention
I. Pilot test
J. Implement program
K. Identify & allocate resources
L. Marketing
M. Evaluate (process, impact, & outcome)
Phase 3 - Establishing a system of managementManagement –
“the process of achieving results through controlling human,
financial, and technical resources” (Johnson & Breckon, 2007,
p. 293)
“the efficient, satisfactory management of a health promotion
program is vital to its long-term success” (Anspaugh et al.,
2000, p. 124)
Phase 4 - Putting Plans into ActionMajor ways of putting plans
into action (Parkinson & colleagues, 1982)Inverted triangle
represents number of people involved
Pilot testing – trying the program out with a small group from
the priority population to identify any problems
Phased-in – limiting the number of people who are exposed then
gradually increasing the numbers; by offerings, by location, by
ability, by number
Total program – all in priority population exposed at same time
Putting Plans into Action
First Day of ImplementationAlso referred to as: program
launch, program rollout, or program kick off
Decide on a first day; consider launching to coincide with other
already occurring event (e.g., weight loss program and New
Year’s resolution)
Kick off in style
Seek news coverage, if appropriate
Consider a news hook; e.g., day in history
Special event; use of celebrities
Phase 5 - Ending or Sustaining a ProgramHow long to run a
program
Ending?Goals and objectives met?Resources available?Need to
re-focus?
Sustaining?Work to institutionalizeAdvocating for the
programPartnering with othersRevisiting and revising the
rationale
Concerns Associated with ImplementationSafety & Medical
ConcernsMost programs are to improve health, thus do not put
participants in danger
Informed consentExplain nature of programInform participants
of risk and discomfortExplain expected benefitsInform of
alternative programsIndicate that they are free to discontinue
participation at any timeAllow participants to ask questions
Example Informed Consent Form
Concerns Associated with Implementation (cont.)Safety &
Medical Concerns (continued)Informed consent (waive of
liability or release of liability) do not protect planners from
being sued
Medical clearance signed by a physician
Ensure safety and healthProgram location; appropriate
securityBuilding codes met and facilities free from any
hazardsQualified instructorsPlan in case of emergency
Sample Medical Clearance Form
Checklist to Consider when Developing an Emergency Care
PlanDuties of staff...Staff members are trained...Participants
instructed what to do in an emergencyParticipants with high
risks are known to staffEmergency care supplies and equipment
are availableAccess to phoneStanding orders are availablePlan
to notify othersResponsibility for transportationInjury
(incident) report formUniversal precautionsResponsibility for
financial costsEmergency plan is approved Emergency plan is
reviewed and updated regularly
Concerns Associated with Implementation (cont.)Ethical
IssuesWhere competing values are at play and judgment must be
made on what is the most appropriate course of action
Code of Ethics for the Health Education Profession to guide the
work of health educators; highest standards
The Belmont Report: Ethical Principles & Guidelines for the
Protection of Human Subject ResearchRespect for
personsBeneficence – maximizing benefits and minimizing
harmJustice – fairness
Concerns Associated with Implementation (cont.)Legal concerns
Negligence – failing to act in a prudent (reasonable)
mannerOmissionCommissionReducing liability – key to
avoiding liability Aware of legal liabilitiesQualified
instructorsGood judgmentInformed consentMedical
clearanceLimit work to expertiseSafe environmentInsurance
Concerns Associated with Implementation (cont.)Program
Registration & Fee Collection – need a system
Procedures for Recordkeeping – HIPAA; anonymity/
confidentiality
Procedure and/or participants manuals – 1) make sure all
understand, 2) standardize, avoid Type III error (failure to
implement intervention properly), 3)ideas for facilitation, 4)
provide additional background information, and 5) provide
additional resources
Concerns Associated with Implementation (cont.)Training of
facilitators – if it is not possible to hire qualified instructors,
may need to train
Dealing with problems – try to anticipate
Reporting and documenting – for 1) accountability, 2) public
relations, 3) motivation of participants, 4) recruitment of new
participants
Class Activity – Informed ConsentDevelop an informed consent
form for college freshmen to participate in a 12 week exercise
program.

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Chapter 12Implementation Strategies and Associated Co.docx

  • 1. Chapter 12 Implementation: Strategies and Associated Concerns Defining ImplementationThe act of converting planning, goals, and objectives into action through administrative structure, management activities, policies, procedures, and regulations, and organizational actions of new programs” (Timmreck, 1997, p. 328) Setting up, managing, and executing a project (Keyser et al., 1997) Program diffusion - adoption, implementation, sustainability (Bartholomew et al., 2006) ImplementationPlanners need to be flexible when implementing a program Phases of implementation Adoption of the program - a part of marketing (chapter 11) Identifying and prioritizing the tasks to be completed Establishing a system of management Putting the plans into action Ending or sustaining a program Phase 2 - Identifying & prioritizing the tasks to be
  • 2. completedMany tasks need to be completed when implementing a program (e.g., reserving space, ordering equipment, etc.) Tasks need to be identified and prioritized Planning timetables and timelines can help with this process Types of timetables and timelines: key activity charts (McDermott & Sarvela, 1999), Task Development Timelines (Anspaugh et al., 2000), Gantt Charts, PERT charts, & CPM Task Development Timeline Gantt Chart Program Evaluation & Review Technique (PERT) 00 10 20 23 25 27 30 40 50 60 70 80 90 1 wk 1 wk
  • 3. 5 wks 1 wk 1 wk 3 wks 0.5 wk 2 wks 1 wk 1 wk 3 wks 8 wks 3 wks Time estimated 3 ways: optimistic (minimum possible time), pessimistic (maximum possible time), & probabilistic (best estimate time) 00. Start planning 10. Develop rationale 20. Needs assessment 23. Create instrument 25. Select sample 27. Collect & analyze data 30. Create goals/objectives 40. Create intervention 50. Pilot test 60. Identify & allocate resources 70. Marketing 80. Implement program 90. Evaluate (process, impact, & outcome) Critical Path Method (CPM) or PERT/CPM A C
  • 4. G D E F H J M I K L B Items on critical path cannot be delayed without delaying the program; time is important estimates are made for earliest & latest start & finish times for each activity A. Start planning B. Develop rationale C. Needs assessment D. Create instrument E. Select sample F. Collect & analyze data G. Create goals/objectives H. Create intervention I. Pilot test J. Implement program K. Identify & allocate resources L. Marketing M. Evaluate (process, impact, & outcome) Phase 3 - Establishing a system of managementManagement – “the process of achieving results through controlling human, financial, and technical resources” (Johnson & Breckon, 2007, p. 293) “the efficient, satisfactory management of a health promotion
  • 5. program is vital to its long-term success” (Anspaugh et al., 2000, p. 124) Phase 4 - Putting Plans into ActionMajor ways of putting plans into action (Parkinson & colleagues, 1982)Inverted triangle represents number of people involved Pilot testing – trying the program out with a small group from the priority population to identify any problems Phased-in – limiting the number of people who are exposed then gradually increasing the numbers; by offerings, by location, by ability, by number Total program – all in priority population exposed at same time Putting Plans into Action First Day of ImplementationAlso referred to as: program launch, program rollout, or program kick off Decide on a first day; consider launching to coincide with other already occurring event (e.g., weight loss program and New Year’s resolution) Kick off in style Seek news coverage, if appropriate Consider a news hook; e.g., day in history Special event; use of celebrities Phase 5 - Ending or Sustaining a ProgramHow long to run a program Ending?Goals and objectives met?Resources available?Need to
  • 6. re-focus? Sustaining?Work to institutionalizeAdvocating for the programPartnering with othersRevisiting and revising the rationale Concerns Associated with ImplementationSafety & Medical ConcernsMost programs are to improve health, thus do not put participants in danger Informed consentExplain nature of programInform participants of risk and discomfortExplain expected benefitsInform of alternative programsIndicate that they are free to discontinue participation at any timeAllow participants to ask questions Example Informed Consent Form Concerns Associated with Implementation (cont.)Safety & Medical Concerns (continued)Informed consent (waive of liability or release of liability) do not protect planners from being sued Medical clearance signed by a physician Ensure safety and healthProgram location; appropriate securityBuilding codes met and facilities free from any hazardsQualified instructorsPlan in case of emergency Sample Medical Clearance Form
  • 7. Checklist to Consider when Developing an Emergency Care PlanDuties of staff...Staff members are trained...Participants instructed what to do in an emergencyParticipants with high risks are known to staffEmergency care supplies and equipment are availableAccess to phoneStanding orders are availablePlan to notify othersResponsibility for transportationInjury (incident) report formUniversal precautionsResponsibility for financial costsEmergency plan is approved Emergency plan is reviewed and updated regularly Concerns Associated with Implementation (cont.)Ethical IssuesWhere competing values are at play and judgment must be made on what is the most appropriate course of action Code of Ethics for the Health Education Profession to guide the work of health educators; highest standards The Belmont Report: Ethical Principles & Guidelines for the Protection of Human Subject ResearchRespect for personsBeneficence – maximizing benefits and minimizing harmJustice – fairness Concerns Associated with Implementation (cont.)Legal concerns Negligence – failing to act in a prudent (reasonable) mannerOmissionCommissionReducing liability – key to avoiding liability Aware of legal liabilitiesQualified instructorsGood judgmentInformed consentMedical clearanceLimit work to expertiseSafe environmentInsurance Concerns Associated with Implementation (cont.)Program Registration & Fee Collection – need a system Procedures for Recordkeeping – HIPAA; anonymity/
  • 8. confidentiality Procedure and/or participants manuals – 1) make sure all understand, 2) standardize, avoid Type III error (failure to implement intervention properly), 3)ideas for facilitation, 4) provide additional background information, and 5) provide additional resources Concerns Associated with Implementation (cont.)Training of facilitators – if it is not possible to hire qualified instructors, may need to train Dealing with problems – try to anticipate Reporting and documenting – for 1) accountability, 2) public relations, 3) motivation of participants, 4) recruitment of new participants Class Activity – Informed ConsentDevelop an informed consent form for college freshmen to participate in a 12 week exercise program.