The Planning and Evaluation Cycle - Case Study Example

Module 1 1. The planning and evaluation cycle entails planning, implementing, monitoring and evaluation processes for a program, or a project aimed at improving the performance of an organisation. The planning and evaluation processes are interconnected, ongoing, and cyclical as well as iterative in nature. In addition, the planning and evaluation cycle is important when changing, or altering, or initiating new ideas in healthcare such as the creation of new careers in institutions. Further, the planning-evaluation cycle is relevant in healthcare as evidenced by numerous domains that apply programs such as health service development, health promotion as well as clinical service enhancement. 2. Inadequate planning and evaluation process in the planning-evaluation cycle results to catastrophic consequences. Organisations that fail to adequately conduct the planning and evaluation process in the planning-evaluation cycle have a resultant large-scale loss of resources such as persons and finances. Consequently, the institutions lose reputations or ultimately close down. In the health sector, inadequate planning and evaluation process in planning and evaluation cycle is manifested in clinical and non-clinical failings that result to patient deaths via increased morbidity and mortality. For instance, the 1200 patient deaths at Stafford Hospital in the United Kingdom were blamed on ‘failings at every level’. 3. The components of the planning-evaluation cycle are planning, implementation monitoring and evaluation. Planning entails the predetermination in advance of the desired outcome by setting of clear objectives. The planning and evaluation cycle components are interconnected. Planning entails a problem being formulated, possible alternative actions to the problem being conceptualized and then detailed and there implications highlighted. Further, the alternatives are evaluated leading to selection of the best alternatives. Finally, the alternatives chosen are implemented. Evaluation entails evaluation questions being formulated. Module 2 4. Evaluation entails a systematic investigation of a program that utilizes data collection techniques such as interviews to collect data. The collected data is then used in comparing actual and desired program outcomes to determine whether a program needs modification, is worth replication, or has made a difference. Also, evaluation is characterized by value attribution, element of comparison and a constant practical intention. In addition, evaluation is important in the planning-evaluation cycle as it influences informed decision-making by users of the evaluated data of the program. Further, evaluation helps evaluation users to better comprehend causal mechanisms as well as general principles. 5. Evaluation components are subject, intervention target, purpose, users, evaluation perspective, design and methods. The evaluation subject is what requires evaluation such as service provision in healthcare. Intervention target refers to those whom the evaluation is to touch on such as service personnel. Evaluation users denote stakeholders in the intervention target. Evaluation perspective refers to the point of view an evaluator takes when evaluating such as an economic standpoint. Methods refer to either quantitative or qualitative data collection methods. Design adopted by an evaluator depends on purpose or program’s practical intention. For instance, audit is used to determine a program’s cost-efficacy. Module 3 6. The planning and evaluation cycle is a cycle of activities involved in engaging different activities associated with health care and planning for usage of resources and conduct of various health programs. Planning and evaluation cycle has a number of importances, such as enhancing success of health care programs and making it possible to utilize low level of resources to get success in health care programs. There is also the ability to meet various health care needs for the entire community after gathering the required information. The relevance of planning and evaluation cycle in healthcare settings is that, it makes health care programs successful by acquiring the intended outcomes. 7. Consequences of inadequate planning include acquisition of unexpected results whereby a project does not succeed as per the intention of the programmers. It also leads to poor usage of resources and wastage of time. The evaluation process becomes problematic because of changes in the expected program outcomes. The activities engaged in the program implementation are poorly undertaken in the achievement of the successful program. It also leads to conflict between the planners and people involved in program implementation. Very many problems come up in relation to management of the program and carrying out of various roles and poor implementation of healthy policy. 8. Approaches to planning comprises of the policy planning, operational planning, and strategic planning. The policy planning is where the government plays its functions as a public character and it includes the health policy, as well as public policies. The policy planning has to enhance establishment of norms and value and the desired actions and outcomes in administrative, legislative, and financial perspectives. Strategic planning entails the defined interventions and strategies enabling achievement of the set objectives and goals. This leads to organisational effectiveness and the organisational goals working at the functioning planning level. Operational planning comprises of detailing the plan strategies and they were focused in achievement of the personnel and financial objectives. This includes the program planning and tactical planning. 9. The relationship between planning and evaluation is found where evaluation process is applied by planner to understand implementation of a program as expected and its ability to achieve the defined goals. The two are part of an incorporated program cycle. There is always the need of evaluating some planned processes. A new plan has to develop through program evaluation. Evaluation has to take place before any program plan implementation. Evaluation process is applied in addressing the need of a new and appropriate program plan. In addition, program evaluation process is used in the assessment of whether a certain program and it is a common action undertaken for government planning. Module 4 10. Need is described in dissimilar fashion due to incorporation of varying assumptions and values on what constitutes desirable objectives and those whom shortcomings in these objectives should be addressed. Approaches to defining need are: against an ideal standard such as the World Health Organisation standard of basic nutritional requirements, terms to a minimum level, and comparison with standards attained by other persons or groups. Individuals falling short of the ideal standard, or minimum level terms, or achieved standards of other persons or groups are considered to be in need. The approaches are equally important as each is suitable to particular situations. 11. Needs assessment is important in the planning and evaluation processes as it helps in the determination of gaps, deficiencies and wants pertinent to the program. Also, the problems and the areas that need prioritisation in the program are identified and addressed. The needs assessment provides vital information that helps in gauging the prioritised areas by considering the trade-offs associated with each problem area. In addition, it forms the basis for commencement of a program via offering the justification for committing resources towards addressing a problem. Further, a need assessment offers a concrete rationale for making of acceptable decisions to all stakeholders. 12. In the normative need, an actual situation is measured against a set standard. Then individuals below the set standard are considered to be in need. A felt need is an individual want that has not been acted upon and results from an individual’s limited knowledge or viewpoints. An expressed need is a felt need that has been acted upon and the total need manifested in demand of a service such as a waiting list. A comparative need is deciphered by singling out a person who has similar characteristics as others receiving a particular service but is not receiving the same service. 13. Needs assessment is useful in the contemporary approaches in planning as knowledge of the needs of the population is vital when planning on how to address a problem through setting up of a program. Needs assessments helps in guiding and informing decision-making that is pertinent to priorities as well as program development. Also, data that describes the population needs and strengths is collected in the course of needs assessment. Further, needs assessment is imperative as it ensures that planning results to a program that suits the target populace. Also, the resulting program has characteristics that match the target audience. 14. Knowledgeable key informant entails knowledgeable community members identifying priority concerns. Rates Under Treatment entails users offering the shortcomings and needs as a result of having firsthand knowledge of those needs. Community forums that entail members of the community raising questions or filling questionnaires that help highlight needs. Social and health status indicators such as census data may provide data that presents a problem that need to be addressed. Survey utilizes a representative sample of the population in collecting data by using various data collection tools such as interviews. Focus groups entail use of group sessions in identifying problems or issues. 15. The first step is clarifying the purpose of the needs assessment and planning on how to conduct it. The second step is identifying the target population. In the second step, all the people who are identified or a representative sample used if they are too many. The third step is determining the type of method that can be used for data collection. The fourth step is collection of data from both primary and secondary sources. The fifth step is the analysis of the data collected to determine areas that need improvement and the final step is the utilization of the results. 16. Data, information, and evidence are very important in planning and evaluation in the health care. This is because they enhance making judgements associated with health services and they are applied to enable implementation of any proposed change in the health services. Information is useful when there is any need of assessment of a certain health care report. Use of data especially the demographic data makes it possible to effectively plan for any health care service to be offered to the community. Evidence is applied when providing support to the needy people and when planning for means of funding healthcare services. Module 5 17. Purpose is the practical intention of a program. Vision is the desired end product that the program seeks to achieve. Mission offers justification for the program’s existence. Feasibility in the planning-evaluation cycle seeks to establish whether a program is capable of being executed which establishes the practical intention of the program. Consequently, the justification of the program being undertaken is established. In addition, feasibility in project planning-evaluation cycle determines the capability of a program being implemented as planned. Therefore, the aspect of determining the feasibility of implementing a program as planned portrays the feasibility of the program’s vision. 18. The general environmental is composed of external and internal factors affecting the role of a health planner. The internal factors such as the organisational structure can be controlled by the health planner. For instance, an organisation could modify its current organisation structure to attain efficiency. The external factors such as inflation cannot be controlled by the health planner. Influences from general environment on health planning can present opportunities or threats to planning of health. However, health planners with a good understanding of both the internal and external forces are better able to optimally match internal capabilities and environmental trends. 19. SWOT analysis entails a planning entity analysing its strengths, opportunities, weaknesses and threats. Strengths and weaknesses analyse internal environment while threats and opportunities analyse external environment of an organisation. The organisation builds on its strengths, utilizes opportunities, confronts weaknesses and avoids threats when planning. Stakeholder analysis is a portion of current position assessment. It entails identifying prospective stakeholders and making assumptions on their direction of support as well as their relative power in decision-making. TELOS entails analysing external environment factors such as technology, economics and legality as well as internal environment factors such as operations and schedule to influence decision-making. Module 6 20. Firstly, current position assessment appraises objectives of the program in relation to strategic organisational objectives reflecting the entity’s vision and reason of existence. Secondly, environmental analysis to establish the environmental nature of the planning entity through using techniques in environmental analysis is conducted. Thirdly, internal audit is conducted to take stock of internal resources. Fourthly, likely plans to be utilized in goal attainment are identified. Fifthly, best plan from among the possible plans is selected. Sixthly, plan is prepared. For instance, the best plan is documented. Seventhly, proposed plan gets acceptance from all stakeholders. Finally, proposed plan is put into practice. 21. Planning Approach to Community Health (PATCH) model on empowering communities through planning of health education (Green et al., 1980). Assessment Protocol for Excellence in Public Health (APEXPH) model is utilized in appraising management of health departments and offers a structure for working with members of the community. Mobilizing for Action through Planning and Partnership (MAPP) is used by public health leaders when prioritizing public health issues in communities and allocating necessary resources to the issues. Model for Health Education Planning (MHEP) and Comprehensive Health Education Model (CHEM) are both used in planning of health education for health professionals such as nurses. Module 7 22. Project management is characterised by defined outcomes, definite timeframe, risk, specific resource allocation and conflict. Projects are initiated to tackle specific concerns where objectives are defined on the onset of the project. The timeframe is definite due to projects having particular commencing dates and a definite end date. Risk in projects emanates from the uncertainty linked with a likelihood of the project altering the prevailing situation. Resources such as funds are always tailored to meet specific project goals. The project is bound to have conflicts when stakeholders to the project may hold dissimilar standpoints regarding what should constitute the project objectives. 23. Defining stage entails a felt need being identified leading and a project idea conceptualized then a feasibility study conducted. Project goals are then set and pertinent resources indentified. Subsequently, planning stage entails development of plans pertinent to the project such as project management plans. In addition, project scheduling, budgeting, risk analysis and resource occurs. Then, execution stage entails majority of the project being executed and comparison of actual results to desired outcomes as well corrective action being taken where applicable. Finally, delivering stage signifies the project end and a post implementation review conducted to identify lessons used for making beneficial recommendations. 24. A project manager is responsible for the whole project. The Project Manager leads the project and the project team for the entire project duration. The Project Manager also ensures that the project’s objectives are attained within the stipulated timeframe and budget. A Steering Committee is tasked with making decisions regarding resources and policies imperative to attaining the project goals. Project working group executes the various activities that are outlined in the project and denotes the hands on project aspect. Finally, project sponsors role is optional and they advocate for the project or help in solving project related issues with stakeholders. 25. Project scope and objectives components denotes the extent of the project in terms of its magnitude, those to be involved as well as affected and what the project seeks to achieve. Project structure and governance components depict the various roles in project management and their importance. Major project stages and anticipated milestones components show manner in which project is to be conducted. Other project components are project schedule, funding strategy showing allocation of funds to activities, risk management, change management strategy, project resources, communication mechanisms to be adopted for the project and manner in which project is to be evaluated. 26. Planning and evaluation is not a linear process. This is because they planning and evaluation occurs in a cycle format and the project life cycle is divided into a number of phases, which comprises of definition stage, planning stage, execution stage, and delivering stage. It is apparent that planning and evaluation is explained in a linear chronological way, but the represent a cyclical route because it occurs in a series of activities, which occur in a cyclical manner. From the planning and evaluation cycle, activities occur in varying degrees and by having a look at the cycle; it is in a linear fashion. Module 8 27. There are different principles and strategies that are applied in managing risk projects and they comprises of; avoiding risk. This is where one cancels the part of the project that was likely to be affected by some danger to avoid affecting the entire project. Reducing risk; One reviews the process and applies all means possible to influence the acceptable outcomes. Protect risk; It involves having a cover against a certain risk. Managing risk; this is where there is preparation to deal with a risk. Transfer risk; this is where one transfers risky task to another organisation with more experience in that field. 28. There are various tools that are used to estimate project costs and time and they include the following; risk registers and the risk logs. There is also the analogous estimation, bottom-up-estimation, supply cost charge estimation, and number of workers. The analogous estimation estimates the cost of the new project. In addition, there are some timeframes that are available and they enhance measurement of project time since they prevent error in time allocation. The amount of time allocated to a specific task and the number of people to play that task enables estimation of the cost involved in a specific task. 29. This chart shows the major stages of the primary care trust project and the period taken in each stage. Through this chart, it is possible to understand the steps involved in the primary care trust and how they follow each other, as well as how they have been undertaken to enhance success of the project. It is clear from the chart that, there are steps that take more time compared to other steps, which take less time to be accomplished. 30. Project implementation, monitoring and control are principles applied in the process of project conduct. Project implementation entails taking course of action and applying the set time and resources to do certain activities. The involved teams play their responsibilities and everyone is accountable for his or her problem. There is reporting of the progress of the work to the authority. Monitoring and control are principles that entail collection of any information associated with activities carried out and comparing with the project plan. In case of identification of any variances during the project implementation, some decisions regarding address of certain variances are made. Module 9 31. There are different types of evaluations and they include the following. Before any intervention, there is feasibility evaluation, which involves assessment of all costs and consequences of an intervention. Evaluability assessment used in making decision of carrying out an evaluation. Formative evaluation, which is a quantitative way of informing the design of an intervention. During the evaluation, there is process evaluation showing how a program is employed and the outcomes. Formative evaluation providing response to the program development. Pluralist evaluation takes opinions of varying stakeholders regarding a program. There is the impact evaluation, outcome evaluation, and summative evaluation after a specific intervention. 32. The four main evaluation perspectives include; managerial, experimental, developmental, and economic evaluations. Managerial evaluations look at matters concerning the policy makers and managers and allows managers make informed decisions for public protection and effective implementation of policies. Experimental evaluations identify availability of effects and the factors causing the effects in an intervention through scientific experimental method. The developmental perspective enhances understanding of an intervention and usage of evaluation to have some changes. They can be local inductice or have no control and used to evaluate health services. Economic perspective evaluated the used resources in a certain program. They include; cost benefit and cost utility. 33. The four perspectives identified above are based in certain principles. Managerial evaluation is applied to enhance improvement of resource use and performance and to ensure the projects are carried out as per the plan. Experimental evaluation is applied in increase of the intervention control and other likely influences and testing of certain hypothesis. The principles of developmental perspective are used to identify a certain change that might occur during evaluation process. Economic evaluation principles are applied in describing the cost of evaluation, minimising the cost and checking the effectiveness of the cost involved in evaluation, as well as showing utility and benefit of studies. Module 10 34. Six basic evaluation designs; Descriptive entails description of program’s features, such as patients or clients or the consumers or the entire population. Audit design is where evaluator what is done by the program and what it is expected to do, such as the objectives, procedures, and standards. Before-after design is where evaluator examines impact of target group from the intervention. Comparative-experimentalist design is where evaluator examines effects of intervention comparing with identical intervention. Randomised controlled trial (RCT) where evaluator examines effects of intervention comparing with a control group. Before-after impact of intervention to a health organisation on: organisation/personnel and/or and client/consumers where evaluation of impact of intervention to health organisation is done. 35. Strengths of Descriptive design are that it is cheap and quick, capable of being conducted in association with clients and service providers and enhance identification of problems. Weaknesses include; inability to judge effectiveness, unscientific, relies on skills of evaluators. Audit; strengths- cheap and quick suitable for evaluation need, makes it possible to understand reason of service failure and success, and cost effective. Weaknesses; cannot judge effectiveness, relies on objectives, assumes standard followed beneficiary results. Before-after strengths; quick and save resources. Weaknesses; sampling bias, sample attrition, sole outcome focus, and confounding factors. Comparative-experimental strength; able to suggest the most effective intervention. Weaknesses; expensive, sample attrition, sole result focus, and difficulties. Randomised controlled trial (RCT) strengths; gold standard, high credibility, more reliable information. Weaknesses; expensive, outcome focus, sample attrition, and measure only 1-2 outcomes. Before-after impact of intervention to a health organisation strengths; cheap and quick. Weaknesses; outcome focus and no patient outcome consideration. 36. There are various factors that are likely to influence the choice of an evaluation design. These factors include; the cost of an evaluation because some of the evaluations are very expensive. There is also consideration of the speed whereby the quickest evaluation is the best. One should also consider the effectiveness of the evaluation design and chose the one which is more effective compared with others. There is also consideration of the strengths and weaknesses of these evaluation designs whereby one should chose the evaluation design with more strengths compare to its respective weaknesses. It is also necessary to consider the credibility and reliability of an evaluation design. Module 11 37. Careful evaluation planning is very important in that it enhances proper utilisation of finances and other resources. It gives direction on the further requirements for an evaluation to be complete. It limits wastage of time and allows collection of data effectively and on time. Sampling is adequately done with proper solving of data issues. It enhances achievement of the project objectives and focus to the right objectives where poor objectives are addressed to eliminate the error. It enhances solving of the political issues, practical problems, scientific problems, ethical issues, and problems associated with reporting and utilisation of findings. 38. In planning and managing a program evaluation there are the key issues that require being considered and they include the following; political issues, practical problems, scientific problems, ethical issues, and reporting and utilisation of findings. Some of the practical problems are funding, timeliness, access to people and unrealistic expectations. Scientific problems comprises of; unclear program objectives and boundaries, inadequate data, and unintended impact on outcomes. Political issues are associated with evaluation and program, which are set for political reasons. Ethical issues relate to objectivity, roles of evaluator’s values, and findings implications. Reporting issues are associated with accountability and being clear to client. Module 12 39. There are various ‘theoretical’ and ‘scientific’ issues, which can be faced when planning or evaluating a healthcare program. These issues include; lack of pre-program, such as baseline information, unclear or fuzzy programs, or occurrence of boundaries that are the same, having a changing program that is very constant or he one known as the Wobby interventions, and not having any agreement or clarity regarding certain objectives of a program or the ghostly goals. These issues affect the approach and conduct of an evaluation in relation to methods and the design applied. This leads to achievement of less compared to the expectations. 40. Different practical issues may prove problematic. These issues comprises of; insufficient funding whereby due to unexpected events like data collection problems or requirement of more evaluation time in an analysis, money becomes less. Inability to acquire data because of political and ethical or bureaucratic reasons. Delay in time used to access interviewers leading to some budgetary implications. Not having people or documents when they are required. Conflict and role confusion among the evaluators and members of a steering committee and evaluation team members. Unintended effects from the evaluation to the program outcomes and processes. expectation that are unrealistic to the evaluation sponsor. 41. Political issues can influence evaluations in different ways. When the programs and evaluators are political in nature, their underlying values look like the ones initiated by them and this is because of wanting to meet the wishes of a lobby group and win some votes. Political pressure may also result from program evaluation to justify program abolition, create impression of something happening, and show some accountability. It becomes possible to cope with resistance from the stakeholders and the staff, such as termination of the program, lack of results. Staff gets much involved in their program roles, thus having impracticable expectations to good evaluation results. 42. Some of the ethical considerations that need to be taken into account when planning and conducting an evaluation include; protection of the entire well-being, that is, social, physical, and psychological to all evaluation participants or stakeholders. Roles of having conflict of interest, having bad results from the evaluation procedure, and distinguishing duties of personal values within the evaluation process, as well as findings’ implications. The ethical dilemmas influence usage and interpretation of findings and ways and design of conducting evaluation. Presentation of the research findings might be problematic because of the ethical problems and challenges faced hindering accuracy and completion of findings. Read More