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This essential resource shows how to effectively organize, implement, and evaluate health programs and projects. Managing Health Programs and Projects clearly defines and describes the work of managers in health programs and projects. The book explores the decision-making process, defines the process of communicating, probes the fundamentals of program planning, explains budgeting, covers staffing for programs and projects, and explains how leaders motivate participants in health programs and projects.

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Table of Contents

Read a Sample Chapter

Managing Health Programs and Projects

John Wiley & Sons

Chapter One

Health is often pursued through a variety of health programs and projects. For example, when a young adult achieves academic success and starts a promising career after overcoming a drug addiction, an effective treatment program may deserve much of the credit for the turnaround. When a person with type 2 diabetes leads an active and productive life, her health improvements may well be attributed to a program that helps her understand the disease and take an active role in controlling it. When a county health department mounts a project to enroll children in an innovative insurance plan, the impact on those children may be felt throughout a lifetime of better health.

One of the distinguishing characteristics of successful programs and projects is how well their managers perform. This book is about the work these managers do. This chapter provides an overview of management work in health programs and projects, as well as some key definitions and concepts, all of which serve as a framework for the remainder of the book. Management work is described in terms of the core activities-strategizing, designing, and leading-managers undertake in performing this work. After reading this chapter, the reader should be able to do the following:

Define health, health programs and projects, and management

Understand the core and facilitativeactivities of managers' work

Understand the roles managers play as they do management work

Appreciate the underlying skills and competencies used by managers in doing management work

Understand the importance of applying well-developed personal ethical standards in doing management work

As a backdrop for considering management work, it is important to know that three distinct types of work occur in health programs and projects (Charns and Gittell 2000). Direct work entails the actual provision of services or creation of products for which a program or project exists. This type of work is done by counselors, nurses, therapists, physicians, health educators, and others who form what Mintzberg (1983) terms the "operating core" of a program or project.

A second type of work done in health programs and projects is support work. This work is a necessary and facilitative adjunct to the direct work. In health programs and projects, people performing support work are involved in such activities as fund raising and development, recruiting patients for a clinical trial, providing legal counsel, marketing a program or enhancing public relations for a project, or providing accounting and financial services.

The third type of work done in health programs and projects is management work. This work involves establishing-often with the direct participation of others-the results a program or project is intended to achieve and creating the circumstances through which the direct work, aided by support work, can lead to the desired results.

An example will clarify the different types of work. A manager may establish the desired result of a project as enrolling one thousand children in an innovative insurance plan. The act of enrolling children in the plan is the direct work of the project. The manager may also arrange for publicity about the plan to increase awareness and encourage enrollment. The provision of publicity is support work. Establishing the desired result, assigning and training project staff to help parents or guardians enroll children, and arranging for publicity is management work.

As we will see in this chapter, there are two basic ways to assess and study management work. It can be approached in terms of the activities managers engage in as they do their work and in terms of the roles they play in performing this work. We will examine management work from both perspectives. We will also discuss the skills and competencies needed to do management work well. Before considering management work, however, it will be useful to define key terms such as health, health programs and projects, and management.

Health and Health Determinants

The World Health Organization (who.int.htm) provides a longstanding definition of health as the "state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity" (World Health Organization 1948, p. 100). Another version of this definition views health as a state in which the biological and clinical indicators of organ function are maximized and in which physical, mental, and role functioning in everyday life are also maximized (Brook and McGlynn 1991). The state of health in human beings is a function of many variables, or health determinants, as they are often called. The wide variety of determinants means that health programs and projects have an enormous range of possible foci.

Health determinants for individuals or populations include the physical environments in which people live and work; their behaviors; their biology (genetic makeup and the physical and mental health conditions acquired during life); a host of social factors that include economic circumstances, socioeconomic position in society, income distribution, discrimination based on factors such as race/ethnicity, gender, or sexual orientation, and the availability of social networks and social support; and the health services to which they have access (Evans, Barer, and Marmor 1994; Berkman and Kawachi 2000). Health programs and projects can be focused on any of these determinants, as well as on combinations of them.

Health Programs and Projects as Logic Models and as Organizations

The most useful way to get a clear picture of what a program is and does is to think of it as a theory (Patton 1997; Weiss 1998) or hypothesis. Like all theories, the theory of a program or project is simply a plausible, sensible model of how it is supposed to work (Bickman 1987). The way a program or project is intended to work can be described as a theory or hypothesis by developing a series of if, then statements about it. For example, a particular program or project can be characterized as follows: If resources a, b, and c are assembled; and then processed by doing m, n, and o with the resources; and if the processing is done well, then the results will be x, y, and z. Using its underlying theory or hypothesis as a guideline, any program or project can be described in terms of the inputs available for it to use, the processes it undertakes with the resources, and the results it achieves by processing the resources.

Implicit in the hypothesis or theory of a program or project is its underlying rationale or logic (Renger and Titcomb 2002). In fact, for any program or project, it is possible to draw a logic model of how it is supposed to work (W. K. Kellogg Foundation 2001). A logic model presents a schematic picture of the relationships among the inputs or resources available to a program or project, the processes undertaken with the inputs, and the results the program or project is intended to achieve. Figure 1.1 depicts a basic logic model for a program or project.

This logic model shows how inputs and resources are processed in attempting to accomplish the program or project's desired results in the form of outputs, outcomes, and ultimately impact. In effect, the logic model provides a road map of how a program or project is intended to work. There is a feedback loop from desired results to inputs and resources and processes indicating that adjustments will be necessary in them in an ongoing program or project. Very importantly, it shows the program or project existing within a larger external environment.

The external environment of a program or project includes many variables that can influence its performance. These are illustrated in Figure 1.1 by the arrow that flows from the environment into the program or project's logic model. These external variables include everything from the cultural milieu of the community in which the program or project is undertaken to its physical climate. It also includes economic conditions, the state of health of the population the program or project might serve, housing patterns, demographic patterns, political environment, background and experiences of program participants, media influence, public policies, and the priorities and resources of the larger organization in which a program or project may be embedded.

External variables can influence almost everything about a program or project including whom it seeks to serve, the extent of recipients' needs for the program or project's services, the resources available to the program or project, the quality of its staff and volunteers, how smoothly implementation occurs, and the pace at which results are seen. A program or project cannot be completely separated from its external environment. All programs and projects are affected by and affect their external environments.

The results of a program or project flow out into its external environment. This is shown in Figure 1.1 by the arrow that flows outward into the external environment. This arrow means that the outputs, outcomes, and impact of a program or project flow outward and affect the individuals and populations that it serves. The concept of the logic model of a program or project will be useful throughout this book, beginning with how we think about programs and projects as organizations.

A program or project cannot exist as a theory or hypothesis. Actual programs and projects take the form of groups of people and other resources formally associated with each other through intentionally designed patterns of relationships in order to pursue some pre-established results. That is they exist as organizations, albeit rather small ones. Organizations can be very large, involving thousands of participants. Expansive integrated health care systems or state health departments, for example, are large organizations. Even though programs and projects are typically much smaller than such organizations, they meet the definition of organizations. Programs and projects can be defined as groups of people and other resources formally associated with each other through intentionally designed patterns of relationships in order to pursue desired results.

Programs or projects that pertain to any of the determinants of health noted previously are health programs or projects. Thus health programs and projects address some aspect of the physical environments in which people live and work, as well as their behaviors, their biology, the social factors that affect them, and health services.

Programs and projects differ in only one major respect, although this difference is important in managing them. Projects are a subset of programs that are time-limited. That is, a project has a pre-determined life cycle, and a program has an indeterminate life cycle. The duration of a project is scheduled at its beginning, although some run for longer or shorter durations than originally planned because of changing circumstances. Projects have specific beginning and ending points (Frame 2003). Programs have indeterminate life expectancies in that they are expected to go on indefinitely.

Figure 1.2 graphically depicts a project life cycle. Assume that the project is intended to conduct diabetes screenings at an annual health fair. The curve reflects the consumption of human, financial, and material resources during the life cycle of the project. A gradual build up of activity during which arrangements are made for the conduct of the screenings precedes the peak of activity when the actual conduct of the screenings occurs. The peak is followed immediately by the project's conclusion and termination.

Examples of health programs include those in cancer care, cardiac rehabilitation, data and statistics, geriatrics, health education, home care, palliative care, prevention, promotion, research and development, substance abuse, wellness, and women's health. Less obvious examples of health programs include housing programs, job training, or programs to clean up the physical environment, as well as programs aimed at reducing ignorance, discrimination, or poverty. These less obvious examples are also health programs because they also address one or another health determinant. Appendix A provides a brief description of a health program embedded in the Glendale Adventist Medical Center, Hearts N' Health. Note the ongoing nature of this program reflected in the final paragraph of the description.

Examples of health projects include research or demonstration projects pertaining to a health determinant, as well as projects to promote seat belt use, healthier eating, or safe sex practices. Projects also may be designed to achieve some specific physical or intellectual purpose within a larger program or organization, such as designing and equipping a laboratory, training staff members in a new protocol or how to use some new technology, designing an information system, or developing a strategic plan or a new accounting system. Appendix B provides a brief overview of a project embedded in the Office of Minority Health, U.S. Department of Health and Human Services, to develop a set of national standards for culturally and linguistically appropriate health services. Note that the project terminated with the publication of the standards as reflected in the final paragraph of the overview.

Typically, health programs and projects are embedded within larger organizational settings or homes, such as health departments, hospitals, health plans, nonprofit organizations or agencies, long-term care organizations, or large integrated health systems. Both the program and the project illustrated in Appendices A and B are embedded in larger organizations; one is embedded in a public health agency of the federal government and the other in a private health care organization. It is possible for a program, however, to be freestanding from any other organization, perhaps having its own governing board. When health programs and projects are embedded within larger organizations like departments and other sub-divisions of the larger organizations, it is useful to think of these programs and projects as organizations within organizations.

Program and Project Management

Program or project management is defined as the activities through which the desired outputs, outcomes, and impact of a program or project are established and pursued through various processes using human and other resources. Following the basic logic model of a program or project shown in Figure 1.1

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Excerpted from Managing Health Programs and Projects by Beaufort B. Longest, Jr. Excerpted by permission.
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