Monday, 7 October 2013

Paper: The concepts of scalability...

A new paper is out which looks at the concepts of scalability - what is meant by it and how to health promotion interventions consider scalability.

"Increased focus on prevention presents health promoters with new opportunities and challenges. In this context, the study of factors influencing policy-maker decisions to scale up health promotion interventions from small projects or controlled trials to wider state, national or international roll-out is increasingly important. This study aimed to: (i) examine the perspectives of senior researchers and policy-makers regarding concepts of 'scaling up' and 'scalability'; (ii) generate an agreed definition of 'scalability' and (iii) identify intervention and research design factors perceived to increase the potential for interventions to be implemented on a more widespread basis or 'scaled up'. A two-stage Delphi process with an expert panel of senior Australian public health intervention researchers (n = 7) and policy-makers (n = 7) and a review of relevant literature were conducted. Through this process 'scalability' was defined as: the ability of a health intervention shown to be efficacious on a small scale and or under controlled conditions to be expanded under real world conditions to reach a greater proportion of the eligible population, while retaining effectiveness. Results showed that in health promotion research insufficient attention is given to issues of effectiveness, reach and adoption; human, technical and organizational resources; costs; intervention delivery; contextual factors and appropriate evaluation approaches. If these issues were addressed in the funding, design and reporting of intervention research, it would advance the quality and usability of research for policy-makers and by doing so improve uptake and expansion of promising programs into practice.

Health Promot Int. 2013 Sep;28(3):285-98. doi: 10.1093/heapro/dar097. Epub 2012 Jan 12.

Friday, 7 June 2013

Business learning from walking: 7. What to do when you reach your goal

Every project needs a plan of what to do when the project reaches its goal.

When I've finished a 14 mile walk I need to know how and where I'm going to rest my feet, dry off or warm up depending on the weather, going to get a meal etc.  The end of the walk is the not the end of the entire process. Just as I'm unlikely to organise a dinner party for the evening of a long walk, I'd like to know when I end a project that there's going to be a time of rest, recuperation and celebration.

Wednesday, 5 June 2013

Business learning from walking: 6. All time is not equal

You've seen the plans that show a pleasant linear progress of tasks that are planned to be completed as a constant pace over the duration of the project. We know that plans are not the change process itself but we still tend to think of things happening over time in a nice equal and fair sort of way.

To understand how all time is not equal, take a walk up your nearest steep hill. A mile on the flat might take you 20 minutes to walk. Add in a quarter of a mile uphill and you could end up adding ten minutes to your time to walk a mile. Add in a grassy field with no clearly marked path and a broken stile and a mile could end up forty minutes. Alternatively, add a field of nervous cows and you may run through it, matching an Olympic qualifying time for a mile.

Change projects are no different. While the measurement of months stays the same unfortunately the tasks, even if simple, may end up taking far more time than expected.  I good project management adage is to look at the final plan and add in 30-50% extra time. Then go back and check where this time may be needed.

Timing is not the same as pacing. When walking, it's good to know your own pace - how many steps it takes to cover a certain distance. This is an individual measure. In projects, it's useful to agree as a team the pace for certain tasks and then from that build up the overall timescales.

Tuesday, 4 June 2013

Business learning from walking: 5. Beware Groupthink

groupthink  (ˈɡruːpˌθɪŋk)
— n
a tendency within organizations or society
to promote or establish
the view of the predominant group
Collins English Dictionary - Complete & Unabridged 10th Edition
2009 © William Collins Sons & Co. Ltd. 1979, 1986 © HarperCollins
Publishers 1998, 2000, 2003, 2005, 2006, 2007, 2009
Cite This Source

The trouble with groupthink is it's easily understood in theory and spotted in others. It's like a cloak that everyone can see from the outside but from your own perspective it's invisible.

I've been in walking groups where we've all agreed on the route we're taking. We stop and check - and we continue to agree that the mast over the is the mast on the map and therefore the path we take is this one over here... The fact that none of us spotted there were two masts about a quarter of a mile apart is groupthink.  Basically one person suggested the visual markers and pointed them out on the map and we all agreed, enthusiastically. And we ended up retracing our steps about a mile and a steep hill later...  We've also ALL walked past a path closed sign because we didn't want to believe the path was really, really closed, despite a couple of people questioning the route.

Would you fly with an airline where the pilots were subject to groupthink?
Would you like to undergo surgery where there is groupthink in the operating theatre?

Speaking up is not all about whistleblowing and making a drama out of an everyday moment. It's about pointing out the obvious, not allowing yourself to conform, being unafraid to ask a question and to hold out for a considered answer. The responsibility for avoiding groupthink is with the self - not with others.

Monday, 3 June 2013

Business learning from walking: 4. Teamwork trumps individual heroism

Walking alone is as about much fun as doing a change project on your own. Even if you like your own company, working alongside others will enhance the process in both cases. Sometimes it's enough on a walk to have someone to chat with, to help you put a blister on the heel of your foot or to give you a second opinion on the choice of path to take.

Walking in a group is a bit like working in a project team. You go at the pace of the slowest - there's no point in rushing ahead to a milestone to then sit and wait for someone to catch up. It's far easier to support the slower person as you go along as it may increase their confidence and fitness. Same goes for project teams.

The "hero" who strides ahead and out of sight of the group is no hero at all.

The Isle of Wight Coastal path is a moving feast and as we gathered on a group walk recently, it is collapsing  on a daily basis. Out group was faced with a section of path that had fallen away leaving no clear route forward. Do we retrace our steps (see previous post) or find a way around? One member of te group who has climbing experience assessed the risks and found a way for us to clamber around holding onto a fence while he supported us from underneath! It was not very dignified, but it worked and we were soon continuing down the path, adrenaline leaving us slightly elated.

Change projects will reach those points where it seems impossible to go on. Things happen that could not have been predicted. That's the time to check the skills of the group. If you can help then it's time to step up and take the lead. Assessing the risks is important.

Teamwork means giving up some control, allowing others to take the lead as their skills fit the task, and giving each other the physical, intellectual and emotional support required to reach the agreed goal.

Friday, 31 May 2013

Business learning from walking: 3. Never fear turning back or retracing your steps

I learnt an important lesson last week when walking on the Isle of Wight. Well, I learnt many lessons, but one of them was that sometimes it's easier to turn back and retrace your steps, than to go into unplanned territory.

We'd walked for a hour or so, it was hilly and we'd just headed down a steep hill that was so steep in places there were steps. Popping out between the hedges we realised something was wrong. After much deliberating and map checking, we had two options:( a) take a new, unplanned path that would get us back to where we wanted to be that was longer, less scenic and involved riskier road walking, or (b) hike the half mile back to the last decision point, even if it mean a steep 200ft climb back up the hill. After some whimpering and puffing from me, we got back on our planned track.

All change projects reach dead ends or go off track - often due to enthusiasm for trying new ideas. It's important to keep the goals in  mind and to assess any difficult situations. In my experience we tend not to have the courage to go back a few project steps and start again. Instead we blunder on and end up taking a longer and more tortuous route to get to where we need to be.  In future, I'll be asking more questions and keeping in mind the possibility of going backwards to go forwards.

Part of knowing when to turn back and when to go on is an important skill, and this is covered in the next post in this series.