template implementation plan v1 0 chachip sites 081412
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TEMPLATE
IMPLEMENTATION PLAN*
A tool to help your communitys eforts to be
ocused and efective
Introduction
When it comes time to take action on a communitys chosen health priorities, sometimes it
is a challenge to move rom a broad goal to efective and strategic action. In the Action
Plan checklist o the Wisconsin !uidebookthere are several steps outlined to help ensure
efective implementation "" be sure to revie# those steps #hen using this tool.
$his document addresses one speci%c part o action planning or impact& a #ell thought"out
implementation plan. 'ou may have already created some o the critical parts o this plan&
priority areas and broad goals. $his template moves into more speci%city including&
(peci%c and measurable ob)ectives
(trategies that have a strong oundation in the evidence base
(peci%c action steps #ith accountabilities, deadlines and resources needed
*inks to national goals and strategies
$his template #ill help your community to create a plan that is ocused and evidence based
and that #ill help you stay on track. In addition, the tool #ill help hospitals and health
department to achieve some o their speci%c re+uirements related to community health
improvement. (ome o the sections o the template are there to assure those key
re+uirements are included. (See theAttachment 1below for a more detailed description of
the specic requirements.)
$o enhance the efectiveness o your eforts, be sure you are ully engaging the community
leaders and community members concerned #ith each issue at every stage, including this
planning phase. $heir involvement at this stage #ill help to assure chosen strategies %t the
target population and #ill leverage ongoing support o this #ork during implementation.
(ee the -ollaborate checklist in the Wisconsin !uidebookor more guidance on engaging
partners.
How to Use this Tool
'our community #ill have already selected top priority areas to address and may have
selected broad goals and some strategies or addressing those priority areas. /any times
$emplate Implementation Plan v 0.12 345105 67inal 8ersion 9ue (pring 510:;
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those elements are included in a %nal report to the community on the results o the
community health assessment process. @o# it is time to get more speci%c.
A e# things to keep in mind&
-onsider orming small, ocused teams to do this #ork. /any communities use
implementation teams #ith eBpertise and interest in the particular priority topics.
Cngaging those key partners in this planning process #ill help in maintaining
commitment and involvement over the long haul.
An implementation plan should describe the logical se+uence o events that #ill
result in the change you desire. It #orks like a logic model or strategy map, helping
you to drill do#n rom a broad goal to intermediate accomplishments or outcomes
and then to very concrete strategies and action steps. (SeeAttachment 2for a
description of the link between the template implementation plan and a logic model.)
67or more inormation on logic models, see the Dniversity o Wisconsin CBtension
resources;
$he most detailed level o your Implementation Plan E the Action Plan "" oten
becomes your implementations teams annual #ork plan. 'ou may #ish to cut and
paste it into an annual #ork plan document and have your teams use that to guide
their #ork.o When put into use, a #ork plan should be a dynamic tool. $arget dates may
need to be adapted. Actual results may be diferent than anticipated.o Dse this tool to document your progress.
@ote& (ome organiFations are re+uired to track and report on their progress in
their community health improvement plan. Dsing this tool can achieve that
end. (ee the Attachment 0belo# or more inormation on those
re+uirements.
Partner organiFations can eBtract the appropriate sections o this Implementation
Plan to insert into their organiFations strategic plan and4or perormance
management plan. 9oing that #ill help to document their commitment to the
collaboration and to track their eforts internally.
While this tool is primarily designed or #riting an entire implementation plan or a
community health improvement initiative, it can also be used on a smaller, more
speci%c scale. 7or eBample, a team or volunteer #orking on strategies to improve
healthy nutrition #ithin one particular school might use )ust the Action Plan portion
to organiFe and guide their #ork.
nce your plan is complete, your community #ill move into actual implementation #here
you #ill use this document as a oundation or monitoring, evaluation, and communicating
progress to community leaders and community members. 7or more inormation on these
steps, revie# the Implementation and Cvaluation checklists in the Wisconsin !uidebook on
Improving the
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Helpful ResourcesAs you complete this tool or your community, there are several resources that #ill be very
helpul.
(tate and @ational
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also choose to provide a link to any program sites as applicable.
Acti%ity utline the steps you #ill take to achieve each ob)ective. $he
activities are the ho# portion o the action plan. It is best to arrange
activities chronologically by start dates. Place each activity in a
separate ro# and add as many ro#s as you need to the template.
Ti"eline (tate the pro)ected start and end date or each activity.
Resources
Re)uired
Include all resources needed or this action step. CBamples& unding,staf time, space needs, supplies, technology, e+uipment, and key
partners.
Lead
Person
Or(ani+at
ion
Identiy by name the key person #ho #ill initiate the activity, provide
direction or the #ork, and monitor progress.
Anticipat
ed
Result
9escribe the direct, tangible and measurable results o the activity
eB& a product or document, an agreement or policy, number o
participantsPro(ress
Notes
$rack progress o completion o activities. Also note any uneBpected
outcomes, both positive and negative.Ali(n"en
t
(ho# the alignment bet#een your communitys priority area and both
state and national priorities. Also sho# the alignment to tribal
priorities #hen applicable. 'ou can cite the speci%c ob)ectives listed
at these sites above under esources.
$emplate Implementation Plan v 0.12 345105 67inal 8ersion 9ue (pring 510:;
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E,a"ple
ABC County Health Improvement Process
Implementation Plan
-ate .reated -ate Re%iewedUpdated
PRIORIT/ AREA utrition ! "h#sical Acti$it#
!OAL
A%& &ount# will implement policies that support residents in achie$ing a health# diet and
increased ph#sical acti$it#.
PER0ORMAN.E MEA1URE1
How 2e 2ill 3now 2e are Ma'in( a -i4erence
1hort Ter" Indicators 1ource 0re)uen
cy
%# 'A* decrease the percentage of adults engaging in no ph#sical
acti$it# from +, to #,
-/%S Annual
%# 'A* decrease the percentage of adults eating less than $e
ser$ings of fruits and $egetables dail# from +, to #,
-/%S Annual
%# 'A* increase the percentage of -& infants e$er breastfed
from +, to #,
-/'S
("edSS)
Annual
Lon( Ter" Indicators 1ource 0re)uen
cy%# 'A* decrease the percentage of o$erweight adult from +, to #
,
-/%S Annual
%# 'A* decrease the percentage of obese adults from +, to #, & Annual
O&5E.TI6E 78
Gy 9A$C, increase the number o AG- -ounty municipalities that are #orking to#ards adopting
local complete street policies rom J to J
&A.3!ROUN- ON 1TRATE!/
1ource &omplete Streets "rogram http344www.completestreets.org4
E%idence &ase: 56rban design and land use policies7 recommended b# he 8uide to &ommunit#
"re$enti$e Ser$ices
Policy .han(e 9/N: 9esA.TION PLAN
Acti%ity Tar(e
t
Resources
Re)uired
Lead Person
Or(ani+ation
Anticipated
Product or
Pro(ress
Notes
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-ate ResultAttend training on WIs
complete street legislation
and assess eBpected impact
on AG- -ounty by
discussing #ith
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-ate Result
O&5E.TI6E 7
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$emplate Implementation Plan v 0.12 345105 67inal 8ersion 9ue (pring 510:;
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Te"plate
_______ Health Improvement Process
Implementation Plan
-ate .reated -ate Re%iewedUpdated
PRIORIT/ AREA
!OAL
PER0ORMAN.E MEA1URE1
How 2e 2ill 3now 2e are Ma'in( a -i4erence
1hort Ter" Indicators 1ource 0re)uency
Lon( Ter" Indicators 1ource 0re)uen
cy
O&5E.TI6E 78
&A.3!ROUN- ON 1TRATE!/
1ource
E%idence &ase:
Policy .han(e 9/N:
A.TION PLAN
Acti%ity Tar(e
t
-ate
Resources
Re)uired
Lead Person
Or(ani+ation
Anticipated
Product or
Result
Pro(ress
Notes
O&5E.TI6E 7;
$emplate Implementation Plan v 0.12 345105 67inal 8ersion 9ue (pring 510:;
Wisconsin -evised ?45105 or @A--
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&A.3!ROUN- ON 1TRATE!/
1ource
E%idence &ase
Policy .han(e 9/N:
A.TION PLAN
Acti%ity Tar(et
-ate
ResourcesRe)uired
Lead PersonOr(ani+ation
AnticipatedProduct or
Result
Pro(ressNotes
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Attach"ent 8
Hospital > Pu#lic Health Re)uire"ents related to
I"ple"entation Plannin(
Not?for?pro@t hospitalshave particular re+uirements related to community health
improvement. In terms o an Implementation (trategy, those re+uirements include&
Adopt a #ritten Implementation (trategy to address the community health needs
identi%ed during the assessment 9escribe ho# the hospital #ill address the needs
Adopt a budget or the provision o services that address the identi%ed needs
9escribe any planned collaboration to address the needs
CBecute the implementation strategy
Pu#lic health depart"entsseeking national accreditation need to meet the speci%c
re+uirements or an implementation plan outlined in Public
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S otice 2011/>2 (D42>411) http&44###.irs.gov4pub4irs"drop4n"00"5.pd"ublic ealth Accreditation %oard ("A%)http&44###.phaboard.org4
-isconsin State Statutes ! Administrati$e ules http344legis.wisconsin.go$4rsb4Statutes.html
http&44legis.#isconsin.gov4rsb4code.htm
Attach"ent ;
Lin' &etween Te"plate I"ple"entation Plan and Lo(ic
Model
$he template implementation plan provided here is intended to ollo# a typical logic model
by providing a structure to move rom a broad goal to intermediate accomplishments or
outcomes and then to very concrete strategies and action steps. Gecause diferent
models4tools use diferent language, this cross#alk is provided to illustrate the link bet#een
the language used in this template implementation plan and that used in a logic model.
$emplate Implementation Plan -ategory
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*ong $erm Indicators
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(hort $erm
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b)ectives
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Anticipated Product4>esults
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*ogic /odel -ategory
*ong $erm utcome
/id"$erm utcomes
/id"$erm utcomes
(hort"$erm utcomes
utputs
Inputs
Ac'nowled(e"ents
$his template dra#s heavily on the #ork o the
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-onsultation on this tool #as provided by members o the -