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Essay: Managing change in the implementation of the Childhood obesity programme

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The importance of managing change and evaluation in the implementation of the DoH’s ‘Childhood obesity; a plan for action’ programme.

Executive Summary

The childhood obesity epidemic is one of the major public health concerns facing the 21st century (WHO, 2019). For successful policies and project a key component is the effective management of change and the subsequent evaluation, which is what this report will cover. Theories and models that will be included are: Lewin’s model of change (Lewin K. , 1947), SWOT analysis, Force Field Analysis (FFA) (Lewin K. , 1951), TRT evaluation framework (Leeman, J. et al, 2012). Each of these models will be analysed, critiqued and subsequently related to the Childhood obesity programme. The conclusive recommendations will be about the programme in question but also for future public health initiatives.

Introduction

“Managing is an organ, and organs can be described by their function” (Drucker, Innovation and entrepreneurship: practice and principles, 1985).

Management matters and is the dynamic and life-giving element in majority of organisations including within healthcare (Drucker , 2011). Change managers are required to be competent at identifying the need for change and subsequently ensuring the changes are sustained in the future (Hayes, 2018). The management of change is controlling the complexity of the process, it includes planning, implementing and evaluation of change which involves certain strategies and tactics that will make it as successful as possible. Managers must also ensure that these changes are relevant and worthwhile (Al-Abri, 2007). The management of change within healthcare is one that is multifaceted as it is a combination of technological and people-focussed solutions (Al-Abri, 2007). It also includes the continual reweigh of an organisation’s direction, capabilities and structure in response to the constant change of customer’s needs (Moran & Brightman, 2000). We will investigate the changes proposed by the UK Government within the programme; Childhood obesity: a plan for action (HM Government , 2016). This report is designed to identify and evaluate the use of different models and theories that aim to aid the successful management of change. The main limitation of this report is the lack of publications published within the past 5 years, however majority of the theories and models used have been praised and shown to influence modern day management. It shall also explore the use of evaluation and provide recommendations for the DoH’s Childhood obesity: a plan for action programme and other future initiatives and programmes.

Lewin’s Model of Change

Majority of the most recent examples of change models are all adaptions of the Lewin’s Model (Lewin K. , 1947). Lewin’s model has received a mixture of feedback, with some criticising the simplicity of the step one; unfreezing. It has been suggested that this model is only effective with smaller scale changes and that it is unable to cope with larger more urgent changes (Pettigrew , 1990). However, others have disproven this criticism and deemed the ‘unfreezing’ stage as vital and researchers whom removed this step found significant problems (Allen , 2016). Therefore, Lewin’s model of change is recommended to use within the implementation of the Childhood Obesity: a plan for action as a basic framework. From using this model as a foundation, we can elaborate and expand so that it is more complex and relevant to the changes proposed.

Unfreeze – Change Preparation

Literature on the unfreezing stage indicates numerous processes to adopt. Initially, a situational analysis needs to be conducted, this will involve the identification for the need to change. Certain procedures and behaviours new to the organisation can alter the status quo of an organisation which thereby can induce the start of change.

A key stage in unfreezing is associated with the stakeholders of the programme. Initially, the first step is the identification stakeholders which uses the stakeholder analysis wheel (Figure 1). Along with the wheel multiple organisations including the NHS have reported using the nine C’s: Commissioners, Customers, Collaborators, Contributors, Channels, Commentators, Consumers, Champions and Competitors (NHS Institute for Innovation and Improvement , 2009).

With the identification complete these stakeholders (Figure 1), we can categorise them regarding their level of impact and power this is shown in Figure 2 above. Due to the complex nature of obesity it is important to identify all key stakeholders to increase the relevance, ownership and that will thereby increase the likelihood of implementation of changes. By prioritising them it ensures we can promote the majority of the efforts to stakeholders with the most power and impact, however stakeholders with a lesser impact needs some consideration (WHO, 2012).

Understanding the stakeholders, building trust leading to their engagement with the proposed changes/initiative is important. There needs to be thought to how they are going to react to the project? How to communicate effectively with them? Involving them with the decision making, asking for their opinions which overall should lead to the building of a successful relationship. Trust is important and will help you understand the stakeholder’s goals or expectations thus shape the proposed changes to match the interest of the audience. The framing the message is very important and how they are delivered will ensure maximum engagement. This overall will lead to a more effective collaborative working. (ACT Academy, 2019)

What needs to be managed is identified through case development; useful tools include; SWOT and Force Field Analysis. SWOT is an acronym for Strengths, Weaknesses, Opportunities, Threats. External analysis identifies the opportunities and threats that is presented by the environment. Opportunities should be taken advantage of and implement into the design of the intervention’s action plan. Actions should be taken to avoid the threats that could harm the effective implementation of the changes. Internal analysis identifies weaknesses that should be limited as much as possible, and strengths that should be adopted and developed for maximum performance (Perera & Peiro, 2012). In a SWOT analysis by Ortega-Altamirano & Rodriguez-Oliveros, 2018, of prevention of overweight preschool children. They createtd a working example of a SWOT analysis in relation to obesity prevention (Appendix 1). This publication can be used and translated into the DoH’s programme as despite the sample being conducted in Mexico majority of the reccommendations can be related into a British location (Ortega-Altamirano & Rodriguez-Oliveros, 2018).
FFA is another important tool as it considers variables that are involved within the planning and implementing stage of a change/programme/initiative. This method of analysis is used at the clarification stage to clarify misconceptions and raise any doubts which can be addressed quickly. It identifies the driving and restraining forces which together will provide details on what the proposed changes would mean and how it can relate to the organisation. FFA can provide new ways identifying factors which may strengthen or weaken the change process and thus diagnosing interrelationships between the intervening variables. These forces can be weighed up and the priority measures adopted. This will lead the organisation to fully grasp the current problems facing them and all possible consequences have been paired with an effective solution (Baulcomb, 2003). Examples of driving forces for the childhood obesity programme include the known health implications caused by obesity with an example of restraining forces being the adverts of high fat/sugar foods.

Organisational readiness (OR) is important during the unfreezing stage. OR for change is defined as the extent to which organisational members are psychologically and behaviourally prepared to implement organisational change (Weiner, Amick, & Lee, 2008). Conditions have been identified that promotes the OR for change which are identified and elaborated on in Weiner, 2009. Other key steps in the unfreezing stage are: securing support, the formation of an implementation team and development of a communication plan (Allen , 2016).

Change/Implementation

This is the action of the current state of the organisation being changed into a desired state (Hussain, Lei, Haider, Hussain, & Ali, 2018). Within this stage it is vital that individuals are given the appropriate training to accommodate the proposed changes. The empowerment of the stakeholders is also very important; keeping them informed on the decision making, process of the change, and any short-term successes which may help reduce resistance to change. The two major factors for successful implementation of change are: dedicated support structures and the use of multiple tactics to implement change (Allen , 2016). To relate this to reduction of childhood obesity in the UK; a support structure would be Public Health England or the Department of Health whom are the organisers of change. Looking to the use of multiple tactics within the Government’s proposed action plan it contains multiple different changes including introduction of a soft drinks industry levy, taking out 20% of sugar in products, supporting innovation to help businesses to make their products healthier, development of a new framework by updating nutrient profile model plus many more. These changes collectively should be sufficient enough to make a significant reduction to childhood obesity. The more tactics used to achieve the target for the change, the more likely the change project is to be successful (Grol & Grimshaw, 2003).

Refreezing/Evaluation

This stage of Lewin’s model includes evaluation the changes and ensuring the changes are sustained over time. There are a number of different areas within the correct and effective evaluation of an implemented initiative. Effectiveness is the component of evaluation that majority of people think of when asked to evaluation a situation. It looks into whether the objectives have been achieved and the need is no longer apparent. Objectives in a successful implementation programme need to be explicit, specific, measurable, scheduled, prioritised and owned. In relation to childhood obesity their main broad aim of the programme is “to halve childhood obesity and significantly reduce the gap in obesity between children from the most and least deprived areas by 2030”, with the objectives being all the proposed changes being successfully implemented. Evaluating effectiveness gives a good impression to what has actually been achieved.

To conduct a successful evaluation, a logic model is needed. Logic models are a method of systematically collecting outcome data for programmes based within the community. It allows the development of graphic representations of a program that will outline the important components and the relationships establish between the programme’s goals, objectives, activities and outcomes (Linda & Hulton , 2007). An evaluation framework developed by Centre TRT has produced a systematic approach in evaluating and producing public health interventions, which has been used effectively in the targeting of environmental and behavioural causes of obesity. The TRT framework involves the application of a review by experts of the programme’s tools and criteria. The experts will produce a summary of the potential of the identified programme in relation to its effect on pubic health; relating it to significant evidence. This will lead to a production of a template that organizes practice – relevant content, any specific materials required and the summery of significant evidence. The framework is adaptable and therefore can be related to the government’s programme for childhood obesity. The end result would be the production of an evaluation plan which will include suggested questions for the formative, process and outcome evaluations (working example refer to Appendix 2) (Leeman ,. et al, 2012). However, as this is a framework based on educational methods, it is difficult to quantify the outcome of the policies and their effectiveness in reducing childhood obesity. It would therefore be logical to suggest a more quantitative evaluation framework. As TRT is, currently, not a universally accepted framework then it is difficult to estimate its true impact on this particular policy as the sample size is limited. I would therefore suggest the TRT framework as it has been established to work effectively in regard to obesity prevention policies, however, it will be in use in conjunction with another framework, in order to produce the most effective evaluation.

Conclusion

The management of change and evaluation is an important in the successful implementation of polices, programmes or projects. This report confirms this is the case for the DoH’s childhood obesity programme and future public health interventions. This report highlights three recommendations

  1. The use of Lewin’s 3 step model, as it is a good basic framework for successful implementation of changes.
  2. The use of SWOT analysis by Ortega-Altamirano & Rodriguez-Oliveros, 2018.As it demonstrated that it was an effective tool and must be considered when developing childhood obesity prevention interventions.
  3. The use of TRT’s evaluation framework as a model to evaluate the Childhood obesity programme in question but in conjunction with a more quantifiable evaluation method.

References

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  • Allen , B. (2016). Effective design, implementation and management of change in healthcare. Nursing Standard, 31(3), 58-68. doi:10.7748/ns.2016.e10375
  • APM. (2019, March 11). Stakeholder management. Retrieved from Association for project management: https://www.apm.org.uk/body-of-knowledge/delivery/integrative-management/stakeholder-management/
  • Baulcomb, J. S. (2003). Management of change through force field analysis. Journal of Nursing Management, 11(4), 275-280. doi:10.1046/j.1365-2834.2003.00401.x
  • By, R. T. (2005). Organisational Change Management: A Critical Review. Journal of Change Management, 5(4), 369-380.
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  • Grol, R., & Grimshaw, J. (2003). From best evidence to best practice: effective implementation of change in patients’ care. Lancet, 362(9391), 1225-1230. doi:10.1016/S0140-6736(03)14546-1
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  • HM Government . (2016). Childhood Obesity: A Plan for Action. London: HM Government.
  • Hussain, S. T., Lei, S., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123-127. doi:10.1016/j.jik.2016.07.002
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  • Lewin, K. (1951). Field Theory in Social Science. New York: Harper & Row.
  • Linda, J., & Hulton , R. (2007). An Evaluation of a School-Based Teenage Pregnancy Prevention Program Using a Logic Model Framework. The Journal of School Nursing, 23(2), 104-110. doi:10.1177/10598405070230020801
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  • Ortega-Altamirano, D. V., & Rodriguez-Oliveros, G. (2018). Perceptions of childcare staff for preventing overweight in Mexican preschool children: A SWOT analysis. Salud Publica de Mexico, 60(2), 166-174. doi:10.21149/8897
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  • Weiner, B. J. (2009, October 19). A theory of organisational readiness for change. Implementation Science, 4(1), 67. doi:10.1186/1748-5908-4-67
  • Weiner, B. J., Amick, H., & Lee, S.-Y. D. (2008, August). Review: Conceptualization and Measurement of Organizational Readiness for Change: A Review of the Literature in Health Services Research and Other Fields. Medical Care Research and Review, 65(4), pp. 379-436.
  • WHO. (2012). Prioritizing areas for action in the field of population-based prevention of Childhood Obesity. Geneva: WHO.
  • WHO. (2019, March 10). Global Strategy on Diet, Physical Activity and Health – Childhood oveweight and obeisty . Retrieved from WHO: https://www.who.int/dietphysicalactivity/childhood_why/en/

Appendix 1 –

A SWOT analysis of Perceptions of childcare staff for preventing overweight in Mexican preschool children (Ortega-Altamirano & Rodriguez-Oliveros, 2018)

2019-4-9-1554808738

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