Manual Determinants of the Performance of Strategic Initiatives

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They should also ensure that all of the planning processes are transparent and that there is widespread engagement in the process. While many presidents may be tempted to divest themselves of the planning process and allow the "planners" to take the lead, this is a mistake. A president must be the leader of the planning process and use the designated "planner" as a key resource. While many campuses believe periodic email updates about the plan are sufficient, it is important to use a variety of communication vehicles that include both high-touch and high-tech ….

Utilizing a variety of communication tools enables participants to choose their most comfortable level of engagement and increases the likelihood you will hear from a variety of perspectives. This also contributes to optimizing resources, focusing them on what really matters and stopping those initiatives that lead nowhere and to concentrate talents and efforts in the goals that truly make a difference. Furthermore, it is often so dated as to reduce its value.

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In the private sector, sales, stock prices and other standard business measurements can be tallied on a monthly, weekly or even daily basis. Carruthers says. Successful organizations seek continuous improvements, but some are faster than others, and colleges and universities can be among the most reluctant to embrace change or move away from tradition. This myth is driven by the belief that facts, data and quantitative information are all you need to create a strategic plan. But many fail to realize their vision and fail to deliver the expected strategic results.

Unfortunately, executive teams cannot pinpoint the reasons for this dilemma so they repeat the strategic planning cycle over and over, always hoping that the next strategic planning session will bring better results. In our experience, there are 5 critical factors that will ensure your strategic plans are successfully implemented. Strategic Planning is a process not an event. A key element in the process is the engagement of all levels of staff throughout the organization.

Staff engagement generates additional input and helps build their commitment to the end plan. It is essential to involve employees in the planning of strategy and direction for the organization. The senior management team will not execute the strategies — staff will.

Engage them and your strategy execution success rate will increase dramatically. Harvard Business School. Strategic Planning processes are successful when a bottom up and top down communication approach is taken. It starts off with a communication to all levels of employees informing them that a Strategic Planning process will be undertaken. It includes how they will be involved in this process. This is the bottom up communication.

Employees will provide input to the strategic planning process through feedback surveys, focus groups, meetings, etc. It is followed by the top down communication. Senior management will share the strategic plan with employees. They will communicate to all employees how their engagement will help ensure success in the execution of these strategies. Yet if they try something that is a little dangerous and new, they will realize true innovation. Some strategic plans include strategies to develop a new product or deliver a new service or re-structure a department, etc.

They put teams of individuals together to work on these major initiatives and give them investment money to ensure success. This is wrong!! However, the more upstream and broad-scale an intervention is i. Initiatives that address the social determinants of health in order to impact the population at a broad level can extend beyond the scope of a particular community organization, whose on-going population reach and resource availability are limited.

Health equity interventions can also require more direct action from government - for example, an initiative that would help to balance the distribution of wealth in Canada is a more progressive taxation structure or an increase in minimum wage to account for inflation and provide a higher standard of living. These are initiatives which cannot be undertaken by individuals and communities. As the word 'structural' implies, they need to be acting directly on the structures economic, social, political, etc.


Instead, communities that do not have that capacity are more likely to receive this responsibility - in the form of grants, training workshops for program planning, or resource directories. These initiatives are framed as supporting communities in building their own initiative that addresses the social determinants of health.

However, the pressure that it places on communities is enormous, and allows the public health system to abdicate its responsibility to address the social determinants of health directly and in a concrete manner. Instead it can point to these initiatives and claim that they are focussing on the social determinants of health - this is essentially the provinces of ON and BC "passing the buck". Given the fact that policy documents on chronic disease prevention and healthy living at the provincial level in both BC and ON acknowledge the importance of the social determinants of health, why is the health sector not acting on them?

An explanation can be found in the context of Canada's political and economic policy over the past several decades. A neoliberal approach to the economy that favours freedom of the market has resulted in the retraction of government intervention in the areas that are crucial to the health and well-being of Canadians. Research based in Toronto has demonstrated this trend of polarization starting from the s [ 54 ]. Urban poverty is also becoming more concentrated in peripheral areas - areas that have the highest rates of new immigrants and visible minorities.

Not surprisingly, child poverty in Canada has also deepened in the s [ 55 ]. Other determinants of health have also been affected by government policy. The public education system has suffered cutbacks and labour conflicts that reduce its ability to provide quality education [ 56 ]. Stricter immigration policy that went into effect as of December will increase social exclusion of immigrants and refugees, while cutbacks to legal aid aggravate the situation [ 57 ].

Job insecurity is rising, with the percentage of people in full-time jobs decreasing and the number of people working part-time, in shift work, temporary contracts or self employed increasing [ 58 ].

1. Engagement

Unionization rates have also dropped across the country [ 59 ]. Disproportionate spending on necessities such as housing comes hand in hand with increasing poverty and job insecurity. Canada is experiencing a national housing and homelessness crisis. When such a high amount of income is being devoted to shelter, not enough is left over for nutritious food, leading to food insecurity [ 60 ]. The effects are felt as a result of inadequate policy and public expenditures on social programs, which are key characteristics of the neoliberal model. Minimum wage, although it has increased in absolute terms, has fallen behind the inflation rate and made living above the poverty line more difficult to achieve.

The fall of unionization in BC and ON can be attributed to policies put into place by Conservative governments that made unionization more difficult [ 53 ]. Within the context of a national and provincial neoliberal climate, it is not surprising that the health sectors of BC and ON have not attempted to implement widespread structural change to improve healthy living [ 62 — 64 ].

Even though well aware of the necessity to address the social determinants of health, they may feel powerless to do so in the face of conservative policies initiated by other sectors. As Alvaro et al. Those in the health sector face barriers to encouraging other sectors to effect policy change to improve the social determinants of health, and may resort to individual or intermediate behaviour change because they are able to effect that change either through their own department or allied with other de-prioritized departments such as the Ministry of Education or the Ministry of Environment.

For example, partnering with schools to increase the amount of healthy foods sold in vending machines may be significantly easier than convincing the Department of Finance to raise the province's minimum wage. We would argue that the ultimate goal of healthy living programs should be to improve the social determinants of health and eliminate health inequities. It is recognized that it is out of the scope of the health care sector to effect those changes on its own, and it faces barriers in partnering with sectors for collaborative, cross-sectoral action.

However, public health should be constantly attempting to move towards those goals. It should not settle for programs that bring about changes in lifestyle and the immediate environment while only addressing the social determinants model at a conceptual level. If programs cannot directly affect lasting, broader societal conditions, interventions should be focused around advocacy and education about the social determinants of health - advocacy at the level of the population, service providers, health organizations, and government in order to build political will to address them.

The structural interventions listed in Additional file 1 and Additional file 2 are already taking the initiative to do this and more should be added. One barrier for public health professionals to address the social determinants of health is a lack of understanding of how to do so; although there is a wealth of theoretical understanding of how these determinants affect health, there have been few examples to date that illustrate how to effectively change them [ 62 , 65 ].

In an environmental scan of the integration of the social determinants of health with public health practice, the National Collaborating Centre for Determinants of Health noted that implementation of programs that dealt with the social determinants of health in Canada was relatively scarce and, when extant, in early phases [ 66 ]. Some of the barriers noted to mounting programs that focused on social determinants included gaps in the existing evidence base on the social determinants of health and on interventions that were effective in addressing them, difficulties public health professionals faced in conceptually differentiating individual-level and population-level approaches, a lack of clarity on where in the path from determinants to outcomes public health is expected to act, and limitations in current public health practice methods, which rely mostly on quantitative data.

Even in a conservative political climate, it is clear that there are improvements that can be made within public health to foster a greater understanding of how to focus programming on the social determinants of health. The WHO Commission on the Social Determinants of Health notes that a comprehensive health equity surveillance system would capture the most upstream structural drivers of health inequities the unequal distribution of power, money, goods and services as well as more intermediate ones that encompass the daily conditions in which people live and work.

Such a system could monitor health equity by stratifying morbidity and mortality data by indicators such as income, occupation, gender, region, ethnicity and immigration status [ 2 ]. Some such initiatives already exist, for example the EU Health Monitoring Programme, which could be used as a model for Canada [ 67 ]. Solid data on health inequities and the social determinants of health serve a dual purpose: not only do they allow public health professionals and provincial health care systems to understand inequities and design effective initiatives that address structural determinants, they can also be used as tools to advocate for change at a broader level, which may be outside the scope of the public health system.

For example, data on the health effects of social exclusion faced by new immigrants and refugees could be used to advocate for progressive immigration policies. It is equally important that health organizations and professionals know how to use evidence on inequities and the social determinants of health to create meaningful initiatives. To do this, there must be a comprehensive understanding among the healthcare force of the social determinants of health and how they affect populations.

Determinants of the Performance of Strategic Initiatives - Wolfgang Kaltenbrunn - Google книги

This includes awareness of the social, political and historical context of how these inequities are generated and continue to be maintained. The provincial health services authority in BC has a program modeling this principle called the Indigenous Cultural Competency Online Training Program [ 68 ]. This program consists of a series of online modules and discussions designed to educate health professionals across the province on the context surrounding Aboriginal health issues, including the history of colonization in BC, Indian residential schools and hospitals, structural and interpersonal racism, and their impacts on Aboriginal peoples and their health.

It would be extremely useful to have such programs implemented in all provinces, ideally with specific sections that focus on chronic disease, as rates of chronic diseases such as diabetes and cardiovascular disease are much higher in Aboriginal populations. With solid evidence and a comprehensive understanding of inequities, there are many ways that public health can begin to address the social determinants of health in programming.

One possibility is using public health planning models that integrate the social determinants of health into the planning process. The model is called Evidence and Practice-based Planning Framework: with a focus on health inequities.

Performance Management: Implementing Strategic Initiatives

In the first two steps of program planning 1. Define Issue, 2. Situational Assessment , planners are encouraged to consider the following: community health needs, the OPHS mandate on the social determinants of health, and the association between health status and the determinants of health. Further, they are asked to engage stakeholder perspectives [ 69 ]. Another model developed by the National Public Health Partnership in Australia makes the determinants of health even more central to the planning process [ 70 ].

This framework bases the intervention on the determinant that is causing the health problem, rather than the health problem itself. Public health teams are to identify the determinants of the health problem and their context, assess how determinants may be detrimental or protective, appraise different intervention options, decide on an option - taking into consideration its impact on health equity, then implement and review it [ 70 ]. When consistently implemented province-wide these types of planning models will help public health teams incorporate the equity and the social determinants of health into practice in a systematic manner.

Information and programs generated within the public health sector can be used to advocate for structural change to improve healthy living. Boards of health are required to survey local supermarkets and grocery stores in order to calculate the cost of basic healthy eating for individuals and families. This program is ideal for a number of reasons. It links what is normally considered a behaviour healthy eating to greater structural determinants such as income and regional differences in food accessibility.

Because the survey is taken annually, it can keep pace with larger economic trends such as inflation and food cost patterns, and because it is performed systematically using a detailed protocol it presents reliable data. The data, as mentioned in the Nutritious Food Basket Protocol, can be used for program planning, policy decisions, and advocating for accessible, affordable foods.

The Nutritious Food Basket can be used as powerful evidence for the necessity of income redistribution policies ensuring that families make enough money to maintain a healthy diet [ 71 ]. Certain boards of health, for example in the Cities of Hamilton and Sudbury, have used this tool for this purpose [ 72 — 74 ]. Although individual public health units are to be commended for their leadership, coordinated action at the provincial level would be much more influential.

External evidence from other countries can also be used as leverage - for example healthy living and chronic disease policy in Northern European countries such as Sweden and Norway. Sweden initiated a public health policy in which stressed improving employment conditions and decreasing poverty as primary goals for improving health [ 76 ]. Elizabeth Fosse has pointed out that Norway focuses on structural measures that function to redistribute resources within society, which is characteristic of a social democratic welfare state [ 78 ].

In a health policy document, the Norwegian government outlined a number of strategies to combat health inequities, including reducing inequalities that contribute to poor health [ 78 ]. The government pledged to work to provide safe childhood conditions, fair income distribution, and equal opportunities in work and education. It was also recognized by the Norwegian government that individual behavioural choices which impact healthy living are influenced by broader structural determinants, and therefore the government must work to address those determinants by influencing cost and availability of resources to healthy living [ 78 ].

Lastly, a strategy employed to reduce inequities was to develop all initiatives to maximize social inclusion of all citizens. These types of policies could be used as models for health inequity reduction strategies advocated by the health sector in BC and ON. This study is not without limitations. For example, the focus on provincial-level initiatives excluded initiatives happening at regional, municipal and community levels. This selection was strategic in that it attempted to maximize the likelihood of finding initiatives which addressed the social determinants of health - conditions that require multi-sector, systemic change.

It was assumed that this type of change more likely to happen at the provincial level as opposed to in a city or region, but it is possible that initiatives that address the social determinants of health at a more local level were overlooked. Secondly, our search strategy was limited to initiatives that focused explicitly on healthy eating and active living and did not seek to identify social programs in other sectors for example housing that may address the social determinants of health and impact healthy eating and active living indirectly.

We would like to emphasize, however, that our focus was on what is occurring within public health at a provincial level to improve healthy eating and active living. The presence of social programs in other sectors does not reduce public health's obligation or commitment to addressing the social determinants of health. Finally, our analysis did not attempt to document whether desired outcomes related to the social determinants of health were achieved by the searched initiatives; such outcomes require many years to manifest themselves.

Addressing the social determinants of health necessarily means moving away from depoliticized frameworks that emphasize biomedical factors in disease. Attention to the social determinants and inequities has been growing, as health promotion movements evolve - movements that were initially led by Canada. However it is necessary that health be seen for what it is: a political matter. As such, the health sector needs to diversify to a more political approach in finding solutions for health inequities.

Until this occurs, it is debatable how much progress can occur on improving the social determinants of health. Commission on Social Determinants of Health: Closing the gap in a generation: health equity through action on the social determinants of health. Can Med Assoc J. Brit J Cancer. BMC Public Health.

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