Planning for Impact: Reflections on Program Implementation in Health Promotion

Earlier in my career, I was entrusted with the responsibility of launching a health promotion program at a prominent academic health system in New York. This initiative, like many others, was funded through philanthropic support and had well-defined, high-level deliverables. Despite its health promotion “program” title, it was actually a multi-program and project initiative that required comprehensive planning to meet and exceed the expectations of our donor partners, the academic health system, and the communities we served.

At the time, I hadn’t started my graduate work in health education, which would have been incredibly valuable in hindsight. However, I had the opportunity to leverage the skills and competencies I had developed through my graduate and undergraduate business degrees and my experience in operations, project management, and running integrative health and wellness programming. Despite this, I felt insecure and had a deep desire to prove to my younger self and those who had so generously mentored me that I could accomplish this significant opportunity I had been entrusted with. As with most of my work, I was fortunate to feel a profound sense of meaning and purpose around this project, and a genuine desire to make a positive impact on the lives of those we serve. This added pressure but also fire! 

 My initial step was to thoroughly evaluate all existing models for project management, program implementation, and health promotion. This task was extensive, and I was fortunate to have the guidance of a well-established sociologist who was leading the nursing research division at the time and I was also reporting to the Chief Nursing Officer, an accomplished leader and mentor. I reviewed what felt like close to 40 different models, frameworks, and theories. 

I wanted to share my experience with hopes it will help guide and support someone else’s! 

Tip 1: Familiarize Yourself with Theories, Frameworks, and Models: I have identified five prominent theories, frameworks, and models implemented by trusted organizations and programs that have helped guide many of my projects and large programs from preplanning to scaling. Although I ultimately adopted a hybrid approach for the health promotion program, I’ve recognized these as solid tools to support effective decision-making and implementation over the last 15 years. 

1.    Logic models (I prefer the W.K. Kellogg Foundation model) - a one-page diagram that clearly articulates the goals, what & who you need to achieve them (people, resources, actions) the levers required, and where you plan to go short, mid, and long term. It looks at the internal and external drivers at a high level. Example

2. Theory of Change Models: A Theory of Change is a roadmap model that sets the HOW and WHY a desired change is expected. You travel through the roadmap to get from where you are to where you want to go. Example1, Example 2

3. PRECEDE-PROCEED framework: Lawrence W. Green created this framework in the early 1970s to help leaders analyze programs in the health sector and designs programs efficiently. PRECEDE stands for Predisposing, Reinforcing, and Enabling Constructs in Educational/environmental Diagnosis and Evaluation. PROCEED, stands for Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development (Crosby & Noar, 2011). Example

4. Institute for Health Improvement (IHI) Driver Diagram: My mom was a nurse manager at a different large health system, and she introduced me to this template. It allows you to work through the drivers (or levers) that will help your team reach the desirable outcomes. Example 

5. Model for Improvement: Plan-Do-Study-Act (PDSA) Cycles:  this is an improvement model, which is used to document test of change, often used in quality improvement initiatives (another widely used process improvement model in Six Sigma is DMAIC method, a five-step process [Define, Measure, Analyze, Improve, Control]. Template Example 

Tip 2: Community Toolbox: For someone new in this work, I recommend starting with The Community Toolbox. This incredible work comes out of the University of Kansas and is developed and managed by the KU Center for Community Health and Development. They explain, “The Community Tool Box is a free, online resource for those working to build healthier communities and bring about social change.” 

Tip 3: My Text of Choice: Throughout my review, I engaged with the 7th edition of Planning, Implementing, and Evaluating Health Promotion Programs: A Primer by James F. McKenzie, Brad L. Neiger, and Rosemary Thackeray (2017). The texts offered both conceptual frameworks and practical strategy. It informed the model I ultimately utilized and followed to successfully implement the health promotion program over a 5+ year period.  There is an 8th edition available. 

TIP 4: Stakeholder Engagement: Active listening was crucial to our success. Even before we started this initiative, I realized that everyone I met through my work in a health system and in my volunteering could become future stakeholders. Their values, challenges, and perspectives could inform our future work. It’s important to listen to the voices of those served by our work, those delivering it, those leading it, those cutting red tape, those placing the red tape, funding it, and working adjacent to our work. I find it incredibly valuable to always include and considered students; they could play an important role in the sustainability of successful initiative. Consistent commitment to building strong relationships just from curiosity and compassion, was what led to the success of the listening tours, needs assessments, informational interviews, and survey responses that helped shape the strategy, plan, and the successful execution of it all! 

"I realized that everyone I met through my work in a health system and in volunteering could become future stakeholders. Their values, challenges, and perspectives could inform our future work. It’s important to listen to the voices of those served by our work, those delivering it, those leading it, those cutting red tape, those placing the red tape, funding it, and working adjacent to our work."

 Tip 5: Don’t be afraid of changing course. Many models and work explain how important it is to be flexible when starting new program. I’m not recommending losing sight of the mission, vision, and deliverables of the initiative rather I strongly recommend being comfortable with pivoting! This is why the PDSA model is so critical. 

 Tip 6: Getting the team on board and building shared value! Your team is truly the heartbeat of the work, build it wisely. They are a critical stakeholder.  Understanding what matters to the individuals on the team and why they are drawn to the work will help in tough times! Truly being able to say “we are all working towards the same outcomes” can create the shared value necessary to be successful. Many times, we don’t get to build out teams and so clear communication of vision, mission, deliverables and plan were important to meet and exceed expectations. 

The health promotion program has since evolved into something new to meet the demands of the current healthcare landscape, but I continue to be proud when I reflect back on this work. I learned the incredible lesson of investing the appropriate amount of time in preplanning to build in the critical elements to create successful, sustainable, and scalable programs! 

 Thank you for reading 🙏

References 

•  Center for Community Health and Development. (n.d.). Chapter 3, Section 10: Conducting Concerns Surveys. University of Kansas. Retrieved January 2, 2025, from the Community Tool Box: https://ctb.ku.edu/en/table-of-contents/assessment/assessing-community-needs-and-resources/conduct-concerns-surveys/main. 

• Crosby, R., & Noar, S. M. (2011). What is a planning model? An introduction to PRECEDE-PROCEED. Journal of public health dentistry, 71 Suppl 1, S7–S15. https://doi.org/10.1111/j.1752-7325.2011.00235.x

• Green, L. W., & Kreuter, M. (2005). Health program planning: An educational and ecological approach (4th ed.). McGraw Hill Higher Education.

• Kellogg, W. K. (2004). WK Kellogg Foundation Logic Model Development Guide. Battle Creek, MI: WK Kellogg Foundation.

• McKenzie, J. F., Neiger, B. L., & Thackeray, R. (2017). Planning, implementing, and evaluating health promotion programs: A primer (7th ed.).Pearson

• Quality Improvement Essentials Toolkit. Boston: Institute for Healthcare Improvement; 2017. (Available at ihi.org)

•  Weiss, C. H. (1995). Nothing as practical as good theory: Exploring theory-based evaluation for comprehensive community initiatives for children and families. In J. Connell, A. Kubisch, L. Schorr & C. Weiss (Eds.), New approaches to evaluating comprehensive community initiatives (pp. 65-92). New York: The Aspen Roundtable Institute.