DDBA 8560 Week 9 Sequenced Implementation Plan Example

Seven Clearances, Eleven Steps: An Implementation Plan for Evening MRI Hours at Brookfield That Applies the Arithmetic of Joint Action, Orders Each Step by Its Dependencies and Marks Where Withdrawal Is Still Cheap

Student Name

Walden University

DDBA 8560: Seminar in Healthcare Managerial Decision Making

Instructor Name

Month Day, Year

Seven Clearances, Eleven Steps: An Implementation Plan for Evening MRI Hours at Brookfield That Applies the Arithmetic of Joint Action, Orders Each Step by Its Dependencies and Marks Where Withdrawal Is Still Cheap

The Chosen Option and Its Clearances

The option chosen for implementation is a four-hour evening session on Brookfield's 3 tesla scanner on four nights each week. The consent map identified five parties whose agreement is required. Two of them must clear the option twice, so the plan requires seven separate clearances: the radiology group's contract amendment for evening reading blocks; the radiology group's approval of which protocols may run in the evening; the technologists' bargaining unit's side letter on voluntary evening shifts; the budget holder's operating approval; the budget holder's approval of two added front desk positions through position control; the MRI safety officer's sign-off on evening safety staffing; and the central scheduling office's template release.

The Arithmetic of Joint Action

Pressman and Wildavsky (1973) followed a 1960s federal jobs program in a California city and showed that a program requiring many separate agreements can fail even when every party supports it, because the probability that all agreements hold is the product of the individual probabilities. Applied here: if each of the seven clearances has a 90 percent chance of being obtained on time, the chance that all seven are obtained on time is about 48 percent. At 95 percent each, it is about 70 percent. The lesson is not pessimism but sequencing. Steps that depend on many prior clearances should not be started until those clearances are in hand, and the plan should keep the option of withdrawing cheaply for as long as possible.

The Sequence

[after]

Dates are written as conditions rather than calendar dates, because the plan's timing depends on clearances whose timing no one controls.

Table 1

Implementation Steps

Where Withdrawal Is Still Cheap

Through step 5, withdrawal costs only staff time spent on negotiation. Step 6 is the last cheap point: once technologists have rearranged their lives around evening shifts and front desk staff are hired, stopping would cost money and goodwill. The plan therefore holds step 6 until steps 2, 4 and 5 are complete, even if that delays the first session.

What a Delay Would Do

If the radiology group's amendment, step 2, slips by four weeks, steps 5, 8 and 9 slip with it, and every later step follows. If the side letter, step 3, slips, steps 4 through 7 slip, but templates can still be built. The table's predecessor column lets the manager see these effects before they happen.

The Framework Used

Nilsen (2015) set apart process models, which lay out the stages by which a decision is put into effect, from determinant frameworks, which list factors that help or hinder implementation. This plan is a process model. It uses the Consolidated Framework for Implementation Research, a determinant framework developed by Damschroder et al. (2009), only as a checklist: its attention to the inner setting and to the characteristics of individuals prompted the plan to include staff volunteers and safety training. Calling the framework the plan's structure would misdescribe it.

Communication

Each clearance, once obtained, will be reported to the decision group in writing within a week, so that later steps start from confirmed agreements rather than assumed ones.

Limits

Probabilities of 90 and 95 percent are illustrative. The plan assumes the radiology group will negotiate in good faith.

References

Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4, Article 50. https://doi.org/10.1186/1748-5908-4-50

Nilsen, P. (2015). Making sense of implementation theories, models and frameworks. Implementation Science, 10, Article 53. https://doi.org/10.1186/s13012-015-0242-0

Pressman, J. L., & Wildavsky, A. (1973). Implementation. University of California Press.