Changing Organizations & Policies
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Describe Ecological Model for Health Promotion Interventions.
Name the theories of change in communities and organizations.
- Stage Theory of Organizational Change
- Community Coalition Action Theory
Nationwide Children's Hospital - sugar sweetened beverage policy (from online training)
- Suppose you were working in a small health department and wanted to encourage your local hospital to adopt such a policy - where would you start?
- NCH - top down, CEO initiated
- Opposition research/justification
- Open lines of communication, liaison, identifies stakeholders (all organizations) - understand organizations
Describe the Stage Theory of Organizational Change.
- Organizations, like people, move through stages
- Organizations, like people, can be helped to the next stage
- Model more than theory
Describe the 4 organizational stages of change.
Stage Theory of Organizational Change
- Awareness: awareness building, evaluate alternatives
- Adoption: select alternative, plan, communicate
- Implementation: begin implementation, assess, adjust
- Institutionalization: change has become fixed in the organization
- Awareness building, evaluate alternatives
- Armed with research: convincing of problem/responsibility, evaluate alternatives, problems, effects
- Select alternative, plan, communicate
- Proposal A vs. B: who is involved, how to communicate
- Begin implementation, assess, adjust
- Checks, enforcement, evaluate success / progress, address issues
What would you do if you wanted the local hospital to adopt a SBB policy, but you work for the public health department.
What role can you play in helping the organization move through the stages?
- Health communicator
- Bring information
Describe how the model may apply in limited circumstances.
- Assumes a good understanding of the organization, what is within its purview
- Assumes that decision making structure is clear and can proceed through stages
- Fundamental role - understand what is in their control
- Personnel change - need to go back to beginning; get in writing is hard, but important
- Not all organizations are organized
- Unintended consequences
- Impact on others
Describe public / private organization decision making.
- A hospital modifying its policy about selling SSB's in its cafeteria
- A public park system modifying policy about selling SSB's on site and in its vending machines
- How would you approach these differently?
- Funders, i.e. 7Up
List some other aspects of organizational policy change.
- Importance of a champion (internal peron, promoting and advocating for policy)
- Involvement key constituency groups
- Top-down & bottom-up can both work
- Anticipate and plan for problems
- Check back to make sure changes are being implemented as planned
- Implement package (multi-level) = gathered research
Consider the problem of encouraging the adoption of bicycle friendly policies ...
- The issues presented were complex and really could not be addressed by a single organization
- Required city planners, traffic department, parks department, public health, possibly schools, neighborhoods, etc.
- This is where coalition theory comes in
Define a coalition.
Group / organization of individuals representing diverse organizations, factions, constituencies within community who agree to work together to acheive common goal
When would a coalition be useful?
Address a common problem; that is any problem that is larger than could be addressed by a single member / group
List the elements of Community Coalition Action Theory.
- Coalitions move through stages
- Some key players
- What does the coalition do?
- What is coalition succes?
Describe how coalitions move through stages.
- Coalition formation: a convener or lead agency brings together a core group to address a problem; this group may solicit additional members; one groube may take the lead initially
- Coalition maintenance: members are active, stay involved, identify resouces, and work toward initial successes
- Coalition institutionalization: group stays together even after intial action is accomplished, processes developed which allow the group to continue to work on the identified problem
Describe some key players.
- Lead agency or convener: organization which initially identified need for coalition, called first meeting, may provide initial leadership & resources
- Membership / representation: what groups and constituencies are represented; is anyone missing
- Leadership & staffing: usually, volunteer leadership, perhaps a steering committee, paid staff can be important in sustainability
Describe what the coalition does.
- Identifiers and pools resources
- Identifies roles for various organizational members
- Identifiers goals, plans and takes action
Describe what is coalition success.
- Acheivement of at least some of goals
- Builds from success to next step
- Develops processes to allow work to move forward even if personnel change
Example: Bicycle friendly community coalition.
Who should be the members?
What steps should the coalition take?
How can they get organized?
How can they set goals?
What actions could the group take?
- Anyone with an interest - police, neighborhood, city planning, traffic, schools, etc.
- Needs assessment / gaps
- Grassroots - highly motivated
- Initial plans / goal - advocate
- Long term plans / goal - facilitate change
List key concepts of Organizational Change Theory.
- Both Stage Theory of Organizational Change and Community Coalition Action Theory give guidance to how to work with groups and organizations toward policy change.
- Neither is a complete "theory" specifying exact components needed to bring about change.
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