Florida MAPP Field Guide
The Action Cycle
The Action Cycle links three activities - Planning, Implementation, and
Evaluation. Each of these activities builds upon the others in a
continuous and interactive manner. While the Action Cycle is the final
phase of MAPP, it is by no means the "end" of the process. During this
phase, the efforts of the previous phases begin to produce results, as the
local public health system develops and implements an action plan for
addressing priority goals and objectives. This is also one of the most
challenging phases, as it may be difficult to sustain the process and
continue implementation over time.
Recommended Participants and Roles:
- The MAPP Committee - oversees the Action Cycle.
- Subcommittees (and specific organizations where relevant) - oversee
specific strategies and elements of the Action Cycle.
- Broad community participation - community residents and
organizations not already involved should be recruited to participate in
planning, implementation, and evaluation activities. The broader the
participation, the more likely the process will be sustained.
A Step-by-Step Overview of the Action Cycle
Planning
1. Organize for action by convening the necessary participants,
establishing an oversight committee for implementation activities, and
preparing for implementation.
2. Develop realistic and measurable objectives related to each
strategic goal and establish accountability by identifying responsible
parties.
3. Develop action plans aimed at achieving the outcome objectives and
addressing the selected strategies.
Implementation
4. Review action plans for opportunities for coordinating and
combining resources for maximum efficiency and effectiveness.
5. Implement and monitor the progress of the action plans.
Evaluation
6. Prepare for evaluation by engaging stakeholders and describing the
activities to be evaluated.
7. Focus the evaluation design by selecting evaluation questions, the
process for answering these questions, the methodology and plan for
carrying out the evaluation, and a strategy for reporting results. 8.
Gather credible evidence that answers the evaluation questions. Justify
the conclusions. 9. Ensure that the results of the evaluation are used
and shared with others. Celebrate the successes of the process.
The Action Cycle MAPP's Action Cycle The Action Cycle links three
activities - Planning, Implementation, and Evaluation. Each of these
activities builds upon the others in a continuous and interactive manner.
The Action
Cycle can be a very satisfying phase, as the efforts of the previous
phases begin to produce results through the implementation of the action
plan. This is also a challenging phase, as it requires substantial effort
to sustain the process and continue implementation over time.
The
strategies identified in the previous phase form the foundation for the
Action Cycle. Clear strategic goals are another important element. Crisply
articulated goals will not only fuel the activities of practical work
plans, but will also prompt accountability and evaluation. For the local
public health system, such accountability will depend on the specific
objectives and components of a work-plan agreed upon by the necessary
participants.
The
evaluation component of the Action Cycle answers the following fundamental
questions: "With the implementation of activity X, what was accomplished?"
and "How does that compare what we said we would accomplish?" In essence,
these lead to four questions of practical utility:
1. What have you done? 2. How well have you done it? 3. How much
have you done? 4. How effective have you been?
There are
two focal points to MAPP evaluation activities: evaluation of the overall
process and evaluation of each strategy and action plan. Both evaluations
should rely on objective parameters (e.g., facts and figures), but should
also accommodate subjective value judgments. This interplay between
objective and subjective aspects provides the MAPP Committee with an
opportunity for a well-balanced evaluation process.
The Action
Cycle can be summarized as follows: Planning - Determining what will be
done, who will do it, and how it will be done. Implementation
- Carrying out the activities identified in the planning stage.
Evaluation - Determining what has been accomplished. The cycle
repeats itself, offering a sustainable method for the community to build
upon accomplishments and position itself for even greater achievements.
Introduction
How to Conduct the Action Cycle
The Action Cycle is a
continuous process. Each step is likely to be an ongoing activity that
keeps the process alive and sustainable.
Planning for Action
Through dialogue and
consensus, MAPP participants will have already selected a limited number
of high priority goals and strategies. These goals and strategies provide
grounding, direction, and a sense of unifying purpose to the Action Cycle.
In planning for
implementation, participants must be clear about what is being done, by
whom, and with what measurable result. Measurable objectives are
indicators of what is expected from the effort. In MAPP, measurable
objectives take on an increasing degree of detailed specificity as the
implementation steps proceed. Care should be taken to ensure that
measurable objectives:
- are valid and reliable,
- are directly associated with the
achievement of the strategy,
- link performance to the expected
improvement,
- tighten rather than diffuse
accountability,
- are responsive to changes in expected
results, and
- provide timely feedback at a reasonable
cost.
Step 1 - Organize for
Action
The first step in this
phase is organizing for action. During this step, participants address the
following questions:
- Are the right people included? Who are
they?
- What should the structure be for
facilitating accountability?
- What committees should be convened?
Participants in the Action Cycle should include the participants,
organizations, and groups that will play a key role in implementing and
evaluating the strategies. The selection of strategies in the previous
phase may have identified necessary players who have, thus far, not been
participants. Careful thought should be given to who needs to be included
in each strategy and these participants should be recruited. In addition,
because organizations will be asked to devote their resources to the
action plans that are developed, this step should involve individuals who
can make budgetary or broad policy commitments for their agencies, groups,
or coalitions.
The MAPP Committee should also give careful thought to how
implementation activities will be overseen. While specific organizations
or groups will be accountable for each objective, there should also be an
entity responsible for ensuring that the MAPP process is sustained.
Several options may be considered: 1) Have the MAPP Committee, as a
whole, play this role. 2) Establish a subcommittee to oversee the three
components of the Action Cycle. 3) Establish a subcommittee to oversee
implementation, while a separate subcommittee oversees evaluation.
The committee overseeing implementation -- the Implementation
Subcommittee -- oversees the function of assuring sustainable
implementation by addressing the following questions:
What do we expect from the leaders of this process in terms of
commitment, presence, coordination, etc.? What kinds of communication
mechanisms need to be in place among participants (including quality,
frequency, breadth, depth)? What products should result from evaluation
and monitoring activities (e.g., evaluation model, reports, recognition,
etc.)?
The Implementation Subcommittee also considers how work will be
completed and how connections will be made throughout the planning and
implementation process. To undertake the following steps, MAPP recommends
that participants form small subcommittees around each goal and its
selected strategies. Include appropriate representatives and key
implementers in the relevant groups. The small groups develop objectives
and establish accountability, and then bring recommendations back to the
MAPP Committee for refinement.
Step 2 - Develop
Objectives and Establish
Accountability
For successful
implementation, it is important to know where you are headed, who has
agreed to be responsible for getting you there, and how you are going to
get there. To accomplish this, MAPP participants should develop a
measurable outcome objective or set of outcome objectives for each
identified strategy. The small groups then agree on accountability for
each objective. The recommended sequence for this step is shown in Figure
2 below.
Revisit the
analysis of strategic issues and the results of the strategy selection to
determine the appropriate objectives. After objectives are developed, an
agreement should be reached about who will be accountable. One of the most
common failings in collaborative planning is ambiguity about who is
responsible for what. Achieving consensus on accountability through
dialogue goes a long way toward building the foundation for sustainable
implementation. Because there may be several outcome objectives associated
with each strategic goal and strategy, it is likely that there will be a
number of agencies, groups, and organizations committed to each. If more
than one group is committed to a specific outcome objective, efforts
should be made to identify those with primary responsibilities and those
with supportive roles. As suggested earlier, this step is most
easily accomplished by forming small subcommittees around each goal and
its selected strategies. Using brainstorming processes and dialogue,
develop the objectives and identify a plan for accountability. The small
groups then bring their recommendations back to the MAPP Committee for
discussion. Periodic discussions among all participants are useful in
identifying linkages, addressing gaps, and ensuring that the small groups
are working effectively. Once accountability for each
objective is identified, each participating organization should
individually identify how the goals, strategies, and outcome objectives
can be incorporated into their organizational mission statements and
plans. This helps to ensure that the strategies developed are
institutionalized throughout the local public health system and that each
organization is more effectively addressing the identified goals and
priorities of the community.
Step 3 - Develop
Action Plans
The outcome objectives
must now be translated into specific action plans and activities to be
carried out by the accountable MAPP participants. Action planning will
help to determine specific activities, implementers, timeframes, and
needed resources. Action plans may be organization-specific or may call
for collective action from a number of organizations. An example action
plan for a goal of creating accessible health care for all persons in a
community might read:
Goal: All persons living in our
community will have access to high-quality, affordable health care.
Strategy: Develop
the capacity to provide culturally and linguistically appropriate
services.
Outcome Objective:
By 2010, increase to 50 percent the proportion of health care providers
serving the community that are culturally and linguistically-competent.
Local Public Health System Action Plan
Process Objective (collective action plan overseen by the
county health department):
1.
Create an incentive program to attract minority health professionals to
the area.
2. Establish a program to train the existing workforce in
specified languages.
Hospital Action Plan
Process Objective-
1. Improve interpreter services available to
clients through the hiring of bilingual providers or through subscription
to a telephone assistance language line (i.e., AT&T Language Line).
Each outcome objective
may generate a number of specific impact and process objectives that will
direct the development of activities in the work-plan. The Tip Sheet - Description of Terms Used in Objective-Setting
describes the different types of objectives that may be related to a
strategic goal. The agencies, organizations, or groups who
have agreed to be responsible and accountable for specific outcome
objectives should develop the impact and process objectives and assign
specific tasks for developing a work plan and budget for the activities.
There are many program planning models available to assist the
participants in the process of developing specific action plans. The
planning model described in APEXPH is a helpful resource that uses the
same terminology as MAPP. Other program planning models may be used as
well.
Implementation: With agreed-upon priority goals, related
outcome objectives and a system of accountability, and the appropriate
action plans, the participants in MAPP are ready to achieve results
- improvement in the health status of the community and in the performance
of the local public health system.
Step 4 - Review
Action Plans for
Opportunities for Coordination
After individual and
collective action plans have been developed, the MAPP Committee should
review them to identify common or duplicative activities and seek ways to
combine or coordinate the use of limited community resources.
This activity can be conducted in a large meeting setting where all of the
goals, objectives, and action plans are presented and discussed. At that
same meeting, the implementation plan (strategies, objectives,
accountability) should be reviewed so that all participants understand
their role in the implementation of the MAPP plan. Through discussion and
presentation of the various components of the MAPP action plan,
opportunities to coordinate and collaborate will emerge. A brief review of
the four MAPP Assessments may also be useful for exploring assets,
strengths, and opportunities. Identification of opportunities
to coordinate should not end here. As activities are implemented,
accountable parties should continue to look for opportunities to connect
to other action plans or build upon available resources.
Step 5 - Implement and
Monitor Action
Plans
All MAPP participants
should be involved in implementing a minimum of one strategy. MAPP
participants should regularly consider whether other organizations or
individuals should be brought on board to more effectively implement the
strategies. Consider including consumers of the strategy - such as
clients, community residents, or members of targeted subpopulations - to
ensure that action plans are appropriately and effectively implemented.
Key leaders should also be recruited, including elected officials, faith
leaders, key community representatives, etc. Each
participating organization's staff should be well informed about the
process and the action plans that are being implemented. This helps to
ensure that the implementation activities are institutionalized at all
levels within the organizations. The broad community should be
made aware of the strategic goals that are being addressed. For such a
process to be successful, community residents must be aware of the
prioritized issues and the actions that are being taken to correct them.
In this way, community residents can better take responsibility for
improving the health of their community. Media, such as newspapers,
newsletters, radio, and television, should be used to educate the
community about the strategies and the progress that is being made on an
ongoing basis. See the Tip Sheet-Engaging the Media for suggestions.
The Implementation
Subcommittee plays an especially important role in ensuring that
implementation moves forward. The subcommittee should maintain contact
with each action plan leader to ensure that activities are ongoing and
that barriers are being addressed.
Evaluation
Evaluating the
implementation of strategies and assessing what was accomplished is an
important piece of the Action Cycle. The steps below are based upon a
framework developed by the Centers for Disease Control and Prevention
Evaluation Working Group. The CDC Evaluation steps have been adapted for
inclusion in MAPP. Other evaluation frameworks may be used with equal
success.
Two types of evaluation should occur:
Evaluation of the
entire MAPP Process - The implementation of MAPP should be evaluated to
identify areas or activities that worked well and those that didn't. Such
an evaluation provides useful input for designing and implementing
a second round of the MAPP process or for other community-driven
processes.
Evaluation of each
strategy - The strategies, goals, and action plans should each be
assessed and evaluated. Evaluation of each of these pieces provides
important results that can be used for improving and refining action
plans, thus ensuring that the resources used are well targeted.
Before embarking upon an evaluation process, it is important to understand
the elements of an effective evaluation. These include:
-
Utility - The evaluation
should be useful to the individuals and communities involved in the
activity being implemented.
-
Feasibility - The
evaluation should be realistic, prudent, diplomatic, and frugal. Use
existing resources and expertise.
-
Propriety - Evaluation
activities should be ethical and legal and conform to community standards,
thereby adhering to community understanding of acceptability.
-
Accuracy - Evaluation
results should reveal and convey technically accurate information. If the
results are questionable or the data gathered are inaccurate, the
evaluation is of little value to the local public health system.
Step 6 - Prepare for
Evaluation
Activities
This step addresses the
first two steps in the CDC Evaluation Framework: engage stakeholders and
describe the program. Because of the progress made during the planning and
implementing components of the Action Cycle, much of the work in
preparation for evaluation has been completed.
When preparing for evaluation, consider
the following:
Who needs to be
involved?
MAPP recommends that a subcommittee oversee the evaluation
activities. This role may be carried out by the subcommittee convened in
the Organize for Action step or by a separate evaluation subcommittee.
The subcommittee should considerother stakeholders that should be
involved. These may include individuals who manage or work on the
activity being implemented, or people who will be affected by its
implementation.
What is being
evaluated?
Strategies - Evaluation
participants should identify and describe the activity or strategy being
evaluated. This entails revisiting and understanding the goals,
strategies, and action plans being implemented, as well as the components
of the vision that connect to each strategy.
Entire MAPP Process - The subcommittee should frame the evaluation
of the entire MAPP process. Evaluation of MAPP should address issues such
as level of community engagement, comprehensiveness of participation, and
results and activities from each phase of MAPP. The indicators of success,
outcomes from each MAPP phase, and shared vision and common values are
useful here.
Step 7 - Focus the
Evaluation Design
After engaging
stakeholders and describing the activity, the next step is to focus the
evaluation design. At this stage, the evaluation team should select: the
questions that the evaluation will answer, the process for answering these
questions, the methodology to be used in collecting answers, a plan for
carrying out the evaluation activities, and a strategy for reporting the
results of the evaluation. Input from the entire evaluation team ensures
that this process is not a burden to any one individual and that the
evaluation meets the needs of all participants in the process.
Common questions include:
-
How well was the
activity performed? How effective was the activity?
-
How well did the
activity meet our stated goals (i.e., the shared community vision)?
-
What could be
changed to improve the activity next time?
It is important that the
questions related to the activity have a measurable outcome. (Example: "By
how much did morbidity decline after the activity was implemented?" or "Do
our strategies connect to every element described in our shared vision?")
These concrete measures, assessed before and after the activity was
implemented, become the solid evidence necessary to a valid evaluation.
Step 8
- Gather
Credible Evidence and
Justify Conclusions
The next step is to
collect data about the activity in order to answer the evaluation
questions using credible evidence and then justify the conclusions.
Gathering credible evidence means using trustworthy, acceptable
information to answer the evaluation questions. Information may come from
a variety of sources, including participants, community health indicators,
and other sources of data that demonstrate what happened after the
implementation of the activity.
Having credible data to
evaluate the activity, the evaluation team must decide what the data
demonstrate about the implementation of the activity. Did the activity do
what it set out to do? How effective was it?
Information collected in
the "gathering" step should be used to justify the evaluation team's
conclusions. Without justification, the results of the evaluation may be
questioned, undermining the entire evaluation process. Justification also
means that recommendations and implications of the evaluation are based on
an analysis of the data gathered, not just the team's opinions or feelings
about how the activity was implemented.
Step 9 - Share
Lessons Learned and
Celebrate Successes
Results of the
evaluation then must be used and shared with others. Nothing is more
frustrating than shelving evaluation results that could improve an
existing process, or help create new strategies and activities.
The importance of
positive thinking and the momentum it fosters cannot be underestimated in
sustaining successes. Reward participants for their hard work. Recognize
volunteers and develop a resource pool of people who can be called upon to
help out. Use frequent, on-going, and creative approaches to celebrate
successes and recognize the efforts of the community. Celebrating the
process will not only have a great impact on sustaining the process and
ensuring that results continue to be achieved, but will also have long
term benefits for the community and public health system as a whole.
References:
Terms Used in Objective Setting
