PHC 6146 Session 4 - 7-21-13 Results-Based Management.ppteta.health.usf.edu/publichealth/PHC6146/Module4/PHC 6146... · 2013-08-05 · Results-Based Management is a participatory

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Check web links

Session Introduction What is Results-Based Management?Perspectives of International AgenciesResults-Based Management ModelsRBM ExamplesDecision TreesSix Sigma AnalysisAssumptionsApplying The Process To Your Organization

0. RBM Resources. Melamed et al - ‘Valuing development’: Could approaches to measurioutcomes in health help make development more accountable?

2. Appendices

Session Outline

1.Session Introduction

There are a lot of terms that are being substituted for Results-based Management.

Two of them are

“Evidence-based Management” and “Pay for Performance”.

Performance Measurement Planning is a third term

The concept simply means that you have to demonstrate that programs have an impact and that you have set up a system to demonstrate that after you have carried out a review of the literature and existing programs to determine that such programs have a good chance of making a difference.

The next two slides have articles in the notes below them that show US examples even though the US was late to the table with RBM programming. The second slide is a Decision Tree for doing RBM. We will discuss Decision Trees later in the session.

Key questions to ask are:

- Why does this organization exist?

- What would be lost if it did not exist?

- Whom does it serve?

- What is it supposed to deliver for them?

Results-Based ManagementResults-Based Management is coming to the fore since there are more organizations than are needed & many of them have such poor return on investment that stakeholder resources are wasted to a large extent.

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April 2012Managing for Development Results: Relevance, Responsiveness, and Results OrientationThis study assesses ADB’s achievement in mainstreaming the Managing for Development Results agenda within ADB, with a view to track progress, identify lessons, and make recommendations for ensuring better development effectiveness of operations in the future.

November 2011Learning Lessons: Managing for Development ResultsThis edition of Learning Lessons highlights the key lessons and issues in mainstreaming the Managing for Development Results Agenda within ADB, and makes recommendations for ensuring better development effectiveness of operations in the future.

This diagram makes the point that each objective addressed by RBM must be linked back to a goal which is tied to the Mission Statement of the organization.

http://tinyurl.com/dy3uj6u

Organizing for RBMRBM takes time. Development Projects may not show any results before 5 years. Some projects such as Reducing Maternal Mortality may take a decade before the infrastructure and other resources are in place to make a real change.

For the US government, where planning is usually the result of annual Congressional appropriations [at best], such long term planning probably is not possible. Think of the current US Congress’ decision-making capabilities

The next slide shows a framework that is needed for multi-year commitment to outcomes.

Overall managerial frameworkOverall managerial framework

Corporatestrategy

Strategicplanning

Type of ActivityElements

ProductsActivities

Areas of Work (35)GoalWHO Objective

TasksResources

Process

Implementation

Operationalplanning

Strategicplanning

Corporatestrategy

Strategic Orientations (4)Core Functions (6) Priorities(11)

Instruments

ProgrammeBudget

Operationalworkplans

Reports

GeneralProgrammeof Work

Expected Results

Evaluation cycle(spanning several

biennia)

Monitoring cycle(across one biennium)

Link lost

………the logical framework for Results-based Management is a planning process from top-down and a management process in the reverse direction.

Planning starts with defining objectives :

1) future end-states, 2) deciding what accomplishments are expected if the objective is to be

achieved, 3) determining which output will lead to those accomplishments,4) defining the activities necessary to produce those outputs and,5) finally, identifying the inputs that are necessary to carry out the

activities.

The Logical Framework For Results-based Management

http://www.un.org/Depts/oios/mecd/un_pparbm/images/7.jpg

The management process is exactly the opposite.

1) The inputs are acquired and deployed to carry out the activities,

2) the activities lead to the production of outputs and, if they are well designed and executed,

3) the output will lead to the expected accomplishments (or expected results).

The Logical Framework For Results-based Management


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Box 1: Lessons Learned from RBM Experience of Other Institutions:

The organization needs to set clear objectives for RBM itself: should RBM be areporting & classification system (results measurement) or should RBM be astrategic planning & management tool that can help improve organizationalperformance (results management)?

Any system must fit UNDP’s specific needs & culture. As an approach, RBMrequires that the culture & specific nature of the organisation be carefully takeninto account. In particular, the unique mandate & decentralized structure of UNDPrequires flexibility at the country level.

Implementing RBM is a learning process. RBM depends on many aspects oforganizational culture, policy & operational practice. Any system needs to be seenas a work in progress, evolving over a considerable period of time &incorporating flexibility to make changes as experiences are gained.

It is essential to keep the approach simple. RBM should not lead to an increasedworkload. The number of instruments must be limited & easy to understand.

http://www.undp.org/eo/documents/methodology/rbm/RBM-Overview-GP.doc

UNDP view of RBM


http://www.mhlw.go.jp/english/wp/other/councils/sukoyaka21/images/2.gif

The Precede-Proceed Framework is a good representation of that.

RBM & the Logframe

The introduction of RBM in UNFPA builds on & strengthens an already existing results-based programme planning & management tool -The Logframe*.

http://www.unfpa.org/public/

* My guess is that the words in yellow were probably written by the marketing section rather than the evaluation section.

RBM & the Logframe

The logframe shows the logical sequence of cause-effect relationships among four levels of aims, of which three (goals, purposes, & outputs) are results.

It shows what UNFPA is accountable for delivering (outputs).

Activities in the logframe are the process by which inputs are transformed to achieve outputs. The diagram shows the logframe as an "if-then chain of results.“

http://www.unfpa.org/public/

http://www.i4donline.net/articles/current-article.asp?articleid=750&typ=Columns

This diagram does a nice job of indicating what to put into each of the boxes in the RBM framework.

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Logical Framework MatrixIntervention Logic [why to do?]

Objectively Verifiable Indicators*

Sources & Means of Verification

Assumptions

Impact

Outcomes

Output

Activities

Here is a blank table that you can use to begin developing your own logical framework

* Just remember that the things that are easiest to measure are often the least important

Results-based Country Partnership Strategy Guidelines

These guidelines deal with the Results-based Management approach and detailed processes, which are involved in the preparation, implementation, monitoring and evaluation of the Country Partnership Strategy (CPS).

http://documents.worldbank.org/curated/en/2008/07/9857745/indonesia-country-partnership-strategy-fy09-12-investing-indonesias-institutions

Results-Based Management depends on manageable events that occur due to an organizational decision.

A term often used for such an event is a Milestone.

This could be legislation, a new marketing campaign, the development of a newly funded program, etc.

The Milestone has to be defined by a date, a location, & specific actors.

The next slide gives an example.

MILESTONES – EXAMPLE

Indicator:All Western Pacific Regional Office staff (RO & Country) trained in Logical Approach by the end of 2003.

Milestones:

Training Material & Manuals finalized by June 2002

20 Trainers trained by December 2003

2. What is Results-Based Management?

Q. What is Results-based Management?

A. Results-based management, or managing for results, means that managers keep the focus of all the organization's activities on the intended outcomes of the work.

It is very similar to what the Government Performance & Results Act is requiring now of U.S. Federal agencies

http://www.opm.gov/perform/articles/1999/jun99-3.htm#ITEM1

What is Results-Based Management?

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Results-Based Management is a participatory & team-based approach to management that seeks to focus on anorganization's or program's efforts on the achievement ofresults.

Results-Based Management involves:

1) defining realistic expected results, 2) assessing risk, 3) monitoring progress towards the achievement of results

(performance measurement),1) integrating lessons learned into management decisions, &2) reporting them in simple, understandable ways.

http://integration-net.ca/english/ini/caf-cipc/doc/J03.htm

Below is a link to a site that responds to the question: .pdf file in Power Point Format


The next slide provides a list of components regarding Preparation Of Programmes Using The Logical Approach. This is a good list to use if Results-Based Management is your focus.


http://www.fao.org/about/57743/en/

PREPARATION OF PROGRAMMES USING THE LOGICAL APPROACH

Situation analysis

Stakeholder analysis

Objectives analysis /Hierarchy of planning elements

Expected results

Indicators

Means of Verification

Assumptions & Risks

Operational work plans

Implementation

Monitoring & Evaluation

These are factors to consider in carrying out Results-based Management.

FROM TO

Entitlements ResultsControl DelegationInputs Outputs/OutcomesBureaucratic SpeedRisk averse Opportunity driven

Introvert Partnerships

This slide provides a contrast between Management pre & post development of a Results-based Approach

The key to RBM is that all of the elements in program planning are chained together as can be seen in the matrix on the next slide http://www.undp.org/eo/documents/methodology/rbm/RBM-Overview-GP.doc

PLANNING ELEMENTS

INDICATORS MEANS OF VERIFICATION

ASSUMPTIONS

GOAL

OBJECTIVE

EXPECTED RESULT

PRODUCTS

ACTIVITIES

COMPONENTS

THE PROGRAMME PLAN MATRIX

3. Perspectives of InternationalAgencies

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As with any government funded program, it must fit with the political orientation of the government.

These next few slides look at RBM principles for programs carried out through different agencies and in specific countries with an initial slide about the role of Stakeholders since they are the ones who determine program orientation and the probable success of the program.

Being able to analyze the nature and role of Stakeholders is important in being able to design a program that is likely to gain the support of various stakeholder groups.

Stakeholder Analysis is carried out in order to identifyindividuals, groups, organizations, or any other body, who have a “stake” or interest in the area or field where the interventions are directed.

The results of the analysis will identify the interests & the ability of stakeholders to have influence or impact upon the programme.

STAKEHOLDER ANALYSIS

Describe stakeholders for your program and their interests in the program [identify the program] and enter your response in the Discussion Forum.

The next 2 slides look at the Pan American Health Association’s [PAHO’s] Output Goals related to Universal Access to Health Services:

1. Leadership & Public Health Infrastructure (PHI)2. Social Protection in Health (SPH)3. Health Services Delivery (OSD)4. Human Resources For Health (HRH)

Which of these seems relevant for your program and how? What do you think the application of these output goals means [enter your response in the Discussion Forum]?

Section 6: UNIVERSAL ACCESS TO HEALTH SERVICES

Leadership & Public Health Infrastructure (PHI)

Strengthening of the steering role of health authorities, developing public health infrastructure & public health systems, supporting health sector reform processes, & assessing & improving the overall performance of the health system.

Social Protection in Health (SPH)

Ensuring equitable access to health services through the reduction of social, economic & cultural exclusion related to health & by advancing schemes of financial protection & publicly-guaranteed portfolios of entitlements.

http://www.paho.org/english/gov/cd/bpb0405-annexes-e.pdf

PAHO’s STRATEGIC GOALS

Section 6: UNIVERSAL ACCESS TO HEALTH SERVICES [cont.]

Health Services Delivery (OSD)

Developing institutional capacity for the management of integrated networks of services based on the primary care strategy, including the implementation of quality improvement programs.

Human Resources For Health (HRH)

Promoting policies & interventions for enhancing the management & development of human resources of the health systems. Fostering professional development of the health workforce to attain the necessary competencies.

http://www.paho.org/english/gov/cd/bpb0405-annexes-e.pdf

PAHO’s STRATEGIC GOALSGlobal Health Indicators: The World Health Organization offers an interesting look at progress made in healthcare over a period of years. This infographic ranks different countries, and shows where the most improvement has been made.

The World’s Best Countries: An interactive infographic that allows you to see where different countries rank in various categories. One of them is health care. See where the U.S. stands in terms of healthcare in relation to other countries.

The world health report 2010

http://www.who.int/whr/2010/en/index.html

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4. Results-Based Management Models

Canada is the country in the World that seems to have taken the lead in Results-based Management [RBM].

CIDA, the Canadian International Development Agency, has committed itself fully to RBM. However, every new approach brings challenges.

“In CIDA’s case, use of results-based management (RBM) has evolved since the mid-1990s in an attempt to address both learning & accountability concerns in managing aid effectiveness.

Significant progress has been made by the Agency in defining concepts, frameworks & tools related to the effective use of RBM.”

The next slide portrays CIDA’s RBM graphically

http://www.sti.ch/fileadmin/user_upload/Pdfs/swap/swap051.pdf

Results-Based Management [CIDA]

http://www.acdi-cida.gc.ca/INET/IMAGES.NSF/vLUImages/Temp5/$file/figure1e.gif

Results-Based Management [CIDA] continued

…As a consequence of CIDA’s increased engagement in Capacity Development Initiatives (CDIs) & Program Based Approaches (PBAs), which appear to require somewhat different approaches to performance management, the Agency is beginning to feel increased tensions similar to those felt by other donors in balancing learning & accountability in pursuit of aid effectiveness.

In the interest of contributing to the process of Agency renewal for aid effectiveness, CIDA, in 2001, launched several studies aimed at examining the special challenges of, & important issues in, performance management & accountability for its investments in CDIs & PBAs.

This review [click on the link below] is one of those studies.”

http://www.sti.ch/fileadmin/user_upload/Pdfs/swap/swap051.pdf

The model on the right is of the Canadian International Develop-ment Agency’s approach to RBM.

The next slide depicts RBM by the Treasury Board of Canada.

http://dspace.col.org/handle/123456789/128

Results-Based Management - A Life Cycle Approach

Analysis of the current environment, past perf., emerging priorities & significant risks to achievement of desired results.

Developing Strategic & Operational Plans –identify & plan to achieve key results & mitigate risk

Action taken to achieve

results

Ongoing performance measure-ment & periodic evaluation to determine progress & allow for corrective action

Providing integrated Financial & non-financial information on: results & accountabi-lity for internal & external use

The next slide views RBM as the third step in the planning process http://www.tbs-sct.gc.ca/rma/rbm-gar_e.asp

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Phases of Results-Based Management

StrategicPlanning

Monitoring results

Reporting & reviewing resultsPerformancemanagement

Integrating evaluation

Using performance information for decisions

Analysing problems

Formulating objectives

Identifying indicators

Setting baselines & targets

Results-Based Management

Link losthttp://dashboardspy.wordpress.com/2006/10/

Dashboard Analysis facilitates RBM by putting input, output, & outcome data in the same visual.

This next slide lists milestones to be achieved in improving water supplies.

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EXAMPLEGOAL

Eliminating illnesses caused by drinking impure water

OBJECTIVE Hygienic practices adopted by rural population

EXPECTED RESULTSIncreased knowledge among health workers & the community on water treatment & hygienic practices

PRODUCTS/SERVICESTraining curriculum developedHealth workers trainedCommunity informed about water treatment techniques

ACTIVITIES Develop curriculaConduct training courses for health workers in watertreatmentDisseminate water treatment techniquesConduct community workshops

Example

500 Smallholders in Ermita [could be Philippines, Dominican Republic, Nicaragua, or Spain] increase their rice yield by 50% between October 2002 & October 2003, maintaining the same quality of the harvest as 2001 crops.

The next slide shows the elements of an objective

Example:

1. Identify the main indicators: increased rice yield

Increased agricultural production

2. Specify target group: smallholders (cultivating 3 acres or less)

3. Quantity: 500 smallholders increase production by 50%

4. Set quality: maintaining same quality of harvest as 2001

5. Specify time frame: between Oct. 2002 & Oct. 2003

6. Set location: Ermita district

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The next slide shows how objectives can be specified hierarchically with inputs at the bottom, then outputs, then impact, and finally outcomes.

http://www.ifad.org/events/past/impact/presentation/wg3/sld003.htm

Results-Based Diagramming

(outcomes)

Here is a diagram that is an outline of how to make sure that RBM elements are in the correct relation to one another [during the planning process, the arrows point in the opposite direction].

Link lostOPERATING PLAN

Project: Eliminate illnesses caused by untreated drinking water.

TASK 06: FINAL REPORT PREPARED

ER 03: HEALTH WORKERS TRAINED

Prod. 01: TRAINING COURSE DEVELOPED

Act 01: CURRICULUM DEVELOPED

Act 02: A/V MATERIALS PREPARED

TASK 03: TRAINERS TRAINED

TASK 04: TRAINING COURSES DONE

TASK 05: COURSES EVALUATED

TIME LINE Jan Feb Mar Apr May Jun

XXX

XXX

XXXXXXXXX

XXX

XXX

XXX

Here is a timeline for the Ermita program

SEMESTER FIRST SECOND THIRD FORTH TOTAL

ER 01

ACT 01

TSK 01

TSK 02

ACT 02

TSK 01

TSK 02

$ 45,000

$ 20,000

$ 9,500

$ 10,500

$ 25,000

$ 12,000

$ 13,000

$ 5,000 $ 3,000 $ 1,500

$ 1,500 $ 6,000 $ 3,000

$ 4,000 $ 3,000 $ 5,000

$ 6,000 $ 2,000 $ 2,000 $ 3,000

OPERATING BUDGET

This budget is based on specific tasks For the British Department for International Development in health, the performance targets are stated as improvements in child, maternal & reproductive health in the ‘top ten’ recipients of DFID health care assistance demonstrated by

•a decrease in the average under-5 mortality rate from 132 per1,000 live births in 1997 to 103 on the basis of data availablein 2004;

•an increase in the proportion of births assisted by skilledattendants from a baseline established in 2000 of 43% to 50% on the basis of data available in 2004; &

•improved access to reproductive health care.

Evaluating International Cooperation [cont.]

http://www.dfid.gov.uk/aboutdfid/psa-targets.asp

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This is similar to the concepts of Healthy People 2010 objectives

Activity # Indicator Goal

16-19. Increase the proportion of mothers who breastfeed their babies.

Target and baseline:

Objective Increase in Mothers Who Breastfeed

1998 Baseline 2010 Target

Percent

16-19a. In early postpartum period 64 75

16-19b. At 6 months 29 50

16-19c. At 1 year 16 25

http://www.healthypeople.gov/document/html/objectives/16-19.htm

5. RBMExamples

This is an RBM framework between the Government of Canada and the Inuit Nation [a First Nations tribe].

http://www.hrsdc.gc.ca/eng/publications_resources/evaluation/2010/sp_ah_938_03_10_eng/page07.shtml

To ensure high-quality sexual & reproductive health services for millions of people in Latin America & the Caribbean, IPPF/WHR provides focused technical assistance & support to 31 grant-receiving member associations. These associations delivered more than 10.6 million sexual & reproductive health services in the year 2001.

The four principles that guide the IPPF’s efforts include 1) organizational capacity building in financial & programmatic management, 2) incorporating a rights & gender perspective into all aspects of programs, 3) promoting a culture of evaluation & results-based management, & 4) ensuring adult & youth client participation in program design, health promotion & service delivery.

International Planned Parenthood Federation

http://tinyurl.com/bmjfvt7

The Results-Based Management system was introduced in 1998 in the United Nations Development Programme [UNDP] based on a comprehensive review of experience of the organisation, a long consultative process within UNDP, & a pilot phase testing the system. Since then, UNDP has internalized RBM considerably & aligned its planning, reporting, monitoring, evaluation & performance assessment systems to results

Results Based Management

http://www.undp.org/

There is a broad trend among public sector institutions towards Results-Based Management--RBM.

Development agencies, bilaterals such as Canada, the Netherlands, UK, & the US as well as multilaterals such as UNDP, UNICEF & the World Bank, are adopting RBM with the aim to improve programme & management effectiveness & accountability & achieve results.

Results-Based Management at UNFPA

http://www.unfpa.org/results/

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What is UNFPA Results-Based Management (RBM)?

UNFPA defines a result as a describable or measurable Change in

State that is derived from a cause & effect relationship[1].

Results-Based Management (RBM) is an approach to improve programme & management effectiveness & accountability & is oriented towards achieving results. It uses results as a basis for planning, management & reporting, & aims to improve performance by comparing & analyzing actual results against planned results through regular monitoring, evaluation, reporting, feedback & adjustments.

[1] Definition used by Canadian International Development Agency (CIDA).


From the beginning of the RBM exercise, it was decided that animportant benefit would be in trying to address the question ofwhat the organisation does best or where its strength potentiallylies in the areas of its work.

It was felt that RBM should help in identifying the organization’sFlagship Activities & Priority Outcomes.

This focus carries, as an implication, an equally importantemphasis on clarifying the role of partners both within & outsidethe UN system.


6. Decision Trees

Decision TreesDecision Trees can be very useful in laying out what steps are needed to bring about change.

For each arrow in the next slide, there are a variety of different decisions that can be taken.

The best way of making the Decision Tree useful is to review literature and case studies and determine the probability of success, the cost, and the length of time for impact to occur.

The first step, however, is to draw a diagram like the one on the next slide and to continue to enhance it and adjust it.

PROBLEM TREE

CENTRAL PROBLEM

EFFECTS

CAUSES

Disabled children

High morbidity/mortality

High incidence ofvaccine preventable diseases

Inadequate vaccinationcoverage

Cold chain notoperational

Untrained healthpersonnel

Community lacksknowledge

Lack ofVaccines

Inadequate health services coverage

Decision Trees

The following slide is the antithesis of the previous one.

Here, steps are given that should lead to increased immunization coverage.

To what extent do you feel that this decision tree has identified variables where failure is most likely and why?

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OBJECTIVES TREE

Less disabledchildren

Low morbi-mortality

Low incidence ofvaccine preventable diseases

Adequate vaccinationcoverage

Cold chainoperation

Trained healthpersonnel

Communitywell informed

Vaccinesavailable

Adequate healthservices coverage

Means

Ends

This slide shows Structured Decision Analysisusing computer modeling & nominal group process.

A Delphi approach [see next slide] may be involved when the organization and the problem are complex in nature.

Delphi Approach in dealing with clinical trial outcomes for Childhood Arthritis and Rheumatology.

The next couple of slides describe the Nominal Group Process.

Delphi approach for establishing pediatric rheumatology research priorities.Ota et al. Pediatric Rheumatology 2008 6:5 doi:10.1186/1546-0096-6-5Download authors' original image

Individual listing of ideas on paper. In HSR courses, participants of a team each write one, at most two priority problems for research on a piece of paper. This is done in complete silence to prevent the group from becoming judgmental about the ideas too soon. The sheets are collected.

Display of lists produced, followed by discussion. The facilitator takes each sheet of paper and displays all sheets on the board so that all team members can see them. The leader requests the members to briefly explain their ideas and why they suggested them.

No comments are made by the group at this time, but as the ideas for research topics are presented the rest of the group should study them and see whether they understand what the ideas are and why they are important. If clarification is needed, this is done after all ideas have been presented. Then the participants may attempt to combine overlapping ideas (for example, two almost similar research topics could be combined into one).

Nominal Group Process

Voting and ranking. After the ideas have been clarified, the facilitator asks the participants to select a certain number of ideas on the display (for example, five) that they consider most important, write them on a sheet of paper and rate them. The rating system used can vary but should be fixed in advance: for instance, 5 for the most important idea, 4 for the next most important, etc. The sheets of paper are then collected. For ranking the proposed research topics we would use the criteria and scales presented in the previous section.

Summarising the results. The facilitator writes each individual rating on the display, next to the idea. All scores are added, resulting in a total score for each idea. The ideas are then ranked, according to the score they received.

* Some of the ideas in this process are adapted from Williamson JW et al. (1981) Health Accounting for Quality Assurance. American Occupational Therapy Association.

Nominal Group Process [continued]

Nominal Group Process Links:

http://www.rand.org/pubs/monograph_reports/MR1267/mr1267.appe.pdf

http://horizon.unc.edu/projects/seminars/nominal_group_process.html

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1839832

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http://www.riskworld.com/Nreports/2002/Litigation/NR02a2.gif

This chart describes a process that can be carried out for decision analysis.

It is quite vague and considerable detail needs to be added to each decision stage.

This is where consultants might be useful.

We used to call this Operations Research

The chart to the right presents a situation that occurs daily for health workers in developingcountries.

Quite often, the ability to test is limited and expensive and thedelay in getting results is considerable. Thus, for suspected malaria, the decision is usually to treat. Here, of course, the chart is looking at the potential for strep infection.

Decision Analysis usually is based on a mix of science and politics and includes cultural factors.Further, people are quite poor judges of risk. Some individualsfear flying and drive in dangerous situations daily. While very few people die in commercial flights in the US every year, over 40,000 die in vehicle crashes.

[Sic!]The next series of slides tries to address some of the tools listed in the previous slide:

Objective Hierarchies Strategy TablesMulti-attribute Evaluation Decision Modeling Preference Assessment

Tools Definition

ObjectivesHierarchies

Setting clear objectives is an essential, and often overlooked, component of sound resource management. Objectives hierarchies take this one step further by expressing how all the pieces fit together from broad vision or mission statements down to specific objectives. Tiered sets of management goals or objectives are not uncommon in organizations, but seldom are they used to their full potential for strategic planning. They also seldom cross over disciplinary boundaries so as to make the connection among resource management, planning, and science; although, recent efforts at Kruger National Park, South Africa has made great strides in such an endeavor. http://www.greateryellowstonescience.org/topics/sciencemanagement/tools/ObjHier

Strategy Tables See the next slide for an example

Multi-Attribute Evaluation

See the slide after next

Decision-Modeling

See the third slide for an overview of all that is included

Preference Assessment

This Strategy Table helps in making decisions as to how many spare parts to maintain in inventory since storage costs but it costs more to order parts at the last minute if they are available.

http://www.clockwork-solutions.com/tec_sparopt.php

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The chart below is an example of Multi-Attribute Evaluationin nursing care. This flow chart suggests what actions nurses should take depending on the differential mobility of apatient.

http://lopes1.fov.uni-mb.si/crii/ses.htm

Microcomputers and decision support software could help Management Information Systems do what they are expected, to support management decision-making.

The same software tools which business and industry use for planning and analysis could be used in primary health care (PHC).

Commercially available software uses:

simulation, optimization, sensitivity analysis, forecasting, projection, "what if" models, linear programming, and project management, scheduling, and resource allocation.

Such software could help define and resolve problems in PHC programs even though they are not specifically designed for PHC. http://www.k4health.org/blog/post/promise-integrated-family-planning-stronger-health-systems-stronger-communities

Five Steps in an Uncertainty Analysis

(1) Identify the parameters that contribute to the uncertainty model predictions

(2) Construct, for each parameter, a Probability Density Function (PDF) to define a range of values and reflect the likelihood of values within that range.

(3) Account for dependencies (correlations)

(4) Propagate the uncertainties through the model and generate a distribution of predicted outcome values.

(5) Derive the PDFs of predicted outcome variables

www.cdc.gov/ncidod/EID/ vol8no10/02-0389-G.htm

This decision chart looks at a problem that has been facing the US in the last few years – anthrax.

7. Six Sigma Analysis

Another tool that must be mentioned in relation to Results-based Management is Six Sigma. The concept is based on the normal curve and reducing errors to 3 standard deviations from the mean.

The diagram shows the typical steps.

http://www.qualitygurus.com/courses/mod/forum/discuss.php?d=1447

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http://www.itil-itsm-world.com/sigma.htm

The Six Sigma Curve

Six Sigma as a Tool:

http://en.wikipedia.org/wiki/Six_Sigma

http://www.ge.com/en/company/companyinfo/quality/whatis.htm

http://books.google.com/books?hl=en&id=ly7iBGNVGe8C&dq=%22Six+Sigma+%22&printsec=frontcover&source=web&ots=T8Xgm3Wniu&sig=d3GQxj4TrlkLxYqd0LbjRrIEOpU&sa=X&oi=book_result&resnum=8&ct=result

http://books.google.com/books?hl=en&id=s5abSW-exREC&dq=%22Six+Sigma+%22&printsec=frontcover&source=web&ots=24lnRxSxIh&sig=BW1wjOeWsBXAtZXXVdmoX-rh7rs&sa=X&oi=book_result&resnum=9&ct=result

This chart looks at 4 stakeholder groups [columns 2-5] and compares their responses with a six sigma ranking of items.

Why do you think perceptions are so different between groups?

Link lost

Tools How you would use

Objectives Hierarchies

Strategy Tables

Multi-Attribute Evaluation

Decision-Modeling

Uncertainty Techniques

Preference Assessment

Six Sigma Assessment

Based on the previous series of slides, begin to think how you would apply the tools [if relevant] to your organization/program.

8. Assumptions

ASSUMPTIONS

EXTERNAL CONDITIONS WHICH ARE BEYONDTHE CONTROL OF THE PROGRAMME MANAGER, BUT WHICH MUST EXIST FOR THE CAUSE-EFFECTRELATIONSHIP BETWEEN VARIOUS LEVELS OF THE HIERARCHY OF PLANNING ELEMENTS.

The next slide presents assumptions upon which an increased rice crop yield is based.

http://www.google.com/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=1&ved=0CCIQFjAA&url=http%3A%2F%2Fwww.oecd.org%2Fdataoecd%2F17%2F1%2F1886527.pdf&ei=XKOZT7M9hZD1BM6shKAG&usg=AFQjCNGjNjB5l-lOj1usukKeh4W65ljBsA

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ASSUMPTIONS

KEY CONDITIONS THAT MUST EXIST IF THE PROGRAMME IS TO SUCCEEDBUT WHICH ARE NOT UNDER THE DIRECT PROGRAMME CONTROL

OBJECTIVE:INCREASED RICEPRODUCTION

EXPECTED RESULTS:

1. HIGH-YIELD,VARIETIES PLANTED2. FERTILIZERAPPLIED

ASSUMPTION:24” INCHES OFRAIN BY JUNE 30

A KEY CONDITIONOVER WHICH THEPROJECT MANAGERHAS LITTLE OR NO

CONTROLhttp://tinyurl.com/cfas4ej

This chart shows that there are assumptions that link every level of Results-based Management to the level below and above.

Link lost

This type of decision tree diagram can be useful for determining what should and what should not be in the plan.

Do a decision analysis [decision-tree diagram] for the likelihood of increasing health care access and coverage in the US or a topic of your own choosing.

Link lost

There are risks in making assumptions.

This slide shows how to address risk through assessment, management, and communi-cation.

https://buildsecurityin.us-cert.gov/swa/acqwg.htmlHere is a similar link

9. Applying The Process To Your Organization

http://www.emeraldinsight.com/Insight/viewContentItem.do;jsessionid=0A30F8F2644D9293B28D7BC2E91E0CE0?contentType=Art

icle&hdAction=lnkhtml&contentId=1602674

This chart does a great job of showing the actual indicators for each step in the RBM process.

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APPLY THE RBM PROCESS TO YOUR ORGANIZATION

Internal Organizational Control

Products/Services Reaching Clients

Areas Outside of the Control of the Organization

Inputs Activities Outputs Immediate Outcomes

Inter-mediate Outcomes

Final Outcome

Your Organization: _______________________________________

10. RBM Resources

Results-based Participatory Monitoring & Evaluation 1 Bywww.mosaic-net-intl.ca/documents/article-PME.pdfSimilarYou +1'd this publicly. UndoFile Format: PDF/Adobe Acrobat - Quick Viewof participatory development and evaluation. Relevant Web Sites and List-Serves. Participatory Monitoring and Evaluation: ▪ www.web.net/pdforum ...[PDF] Results Based Monitoring and Evaluationunpan1.un.org/intradoc/groups/public/.../un/unpan032495.pdfYou +1'd this publicly. UndoFile Format: PDF/Adobe Acrobat - Quick ViewResults-based Participatory Monitoring & Evaluation 1 ... Branch as part of a special series on Participatory Evaluation. ..... Relevant Web Sites and List-Serves ...Monitoring and evaluation - OVC Toolkitinfo.worldbank.org/etools/docs/library/162495/.../monitoring.htmCached - SimilarYou +1'd this publicly. UndoParticipatory Monitoring and Evaluation (PME) web site ... that stronger interest groups will try to use OVC projects as a vehicle to serve their own interest. ... some of the documents in the “RelevantReading” list for this section (see left column).Specialist Monitoring and Evaluation websites

Relevant Web Sites & List-Serves Participatory Monitoring & Evaluation:National Library of Medicine PubMed Search Strategy

The Public Health Foundation worked with librarian staff of the National Library of Medicine to develop a PubMed search strategy to capture public health performance management literature.

The URL for the search strategy appears below.

http://tinyurl.com/2j3yr

To view recent (past five years) abstracts for articles in PubMed related to public health performance management,simply copy & paste the URL into any Internet browser.

For an alternative search method,you can visit the Healthy People 2010 Information Access Project at http://nnlm.gov/partners/hp/infrastructure.html

& use their search feature.Click the red button by Healthy People 2010 objective 23-11 to search PubMed for journal articles related to public health performance.

11. Melamed et al - ‘Valuing development’: Could approaches to measuring outcomes in health help

make development more accountable?

Melamed et al - ‘Valuing development’: Could approaches to measuring outcomes in health help make development more accountable?

09/16/13 Results-Based Management

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It is good to have a conceptual model in mind.

See the next 2 slides.

http://www.sciencedirect.com/science/article/pii/S0959378011000045

A Social Wellbeing Approach

Describe how this approach would apply to your business plan.



Melamed et al -‘Valuing development’: Could approaches to measuring outcomes in health help make development more accountable?

09/16/13

Results-Based Management

The EQ-5D can be used to measure QALYs.



Patient-reported Outcome Measures (PROMs)

Describe how PROMs is relevant for your business plan based on the 6 aspects in the list below:



Here are characteristics to consider in selecting evaluation tools.

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Here are issues which arise when assessing QALYs and DALYs.

11. Appendices

http://www.pitt.edu/~super7/13011-14001/13451.ppt

The link below will take you to a power point presentation on a team effort in Cameroon in using Results Based Management in working with disadvantaged populations

The Basics Project focusing heavily on RBM can be found here:

http://www.basics.org/

The End

Documents

PHC 6146 Session 4 - 7-21-13 Results-Based Management.ppteta.health.usf.edu/publichealth/PHC6146/Module4/PHC 6146... · 2013-08-05 · Results-Based Management is a participatory