Health Promotion Strategies:

Objectives
Week 9
Organization development, change &
improvement 1. To understand the role &
relevance of organizational
development, change &
Michael Goodstadt Ph.D., C.Psych. improvement in HP practice
MHSc. Program in Health Promotion 2. To understand how organizations
Dalla Lana School of Public Health
University of Toronto
develop, change and improve
3. To understand what makes for
PLEASE NOTE: Some slides have been downloaded (with appreciation) from the
Intervention Mapping Online Resource website (at
http://www.sph.uth.tmc.edu/chppr/interventionmapping/ ) effective organizations in HP
practice

Organizational
development Grounding our discussion
1. What did we What are some of the
key characteristics of
learn about OD organizations?
from the 1. Origins, purpose…
organizations 2. Life cycle…change..
3. Structure,
involved in organization
Assignment #1? 4. Processes….
5. Climate, culture…
Organizational Organizational 6. Capacity…functioning
change improvement 7. Performance,
success…
8. Resources…
9. Leadership…

Organizations involved in Assignment #1 Why should we care about

(2009) “organizations” in HP practice?
ORGANIZATIONS  HP practitioners work  Many organizations
Advance Market Commitment (re. PLAVAM: Addressing gender-based violence in and with are “communities”
pneumococcus disease) in Caracas, Venezuela
organizations
ASMARE: Waste Pickers in Brazil Power4Bones  Communities are
 Organizations “make or
CDSMP and Childhood onset disabilities President's Malaria Initiative organizations and/or
break” the work of HP
Depression Program for Older Adults (Chile) Rainbow Heatlh Ontario
practitioners
involve organizations
House of PainT Take Five
Maison Bleue The Behrhorst Foundation  Organizations can be
Mobile Health Clinic The Healing Journey Program: Princess change agents re.:
Margaret's Hospital
 External environment
Nobody's Perfect Parenting Program The Hostel Outreach Program
 Internal environment
Options Support Counselling Program The Student Body: Promoting Health at Any
Size  Organizations affect
ParticipAction The Surgical Wait Time Strategy members’ health
Physical Rehabilitation Services in Haiti WHIWH: "Thriving with Diabetes"
ZAPHA+ (Zanzibar)

1
Organizations & individuals:
Similarities & differences?
Similarities
1. Organizations are
made up of individuals 1.
2. Organizational change
depends on individuals
3. Organizations have 2.
motivation, resources,
feelings of efficacy,
pressures from
environment, etc.
4. Decision making can
be “arational”
Differences
Organizational development
Organizations are
more than the sum of
the parts/individuals
The enduring “culture”
of organizations can
make them historically
independent of
individuals

Organizational development: Organizational development: Concepts

Definition (Steckler, Goodman & Kegler, 2002)

the life history of organizations: 1. climate: mood or personality of

their formation,
and the transformations that occur
throughout the course of an
organization’s existence,
including the organization’s possible
termination
an organization (the “psychology”
of an organization)
2. culture: assumptions & beliefs
shared by members of an
organization, that operate
unconsciously (the “anthropology”
of an organization)
3. capacity: optimum functioning of
an organization’s subsystems

Organizational change: General

comments (Weick & Quinn, 1999)

Organizational change  Refers more specifically to

transformations that take place
in the course of an
organization’s existence
 Locus of change
 1st order change: change “in” the
system
 2nd order change: change “of” the
system

2
Organizational change: General comments
(Weick & Quinn, 1999)
 “Planned change is usually triggered by the
failure of people to create continuously
adaptive organizations”
 Usual process: “Losses…plan change
…implementation…unexpected results”
 “Change is a phenomenon of time”…
but “tempo of change is important”
 Episodic vs continuous change: but depends on
perspective
 Macro: looks routine, with occasional revolutionary
episodes
 Micro: ongoing adaptation & adjustment
Status of organizational change
research (Weick & Quinn, 1999)
 "the reason American businessmen
talk about gurus is because they
can't spell the word charlatan"
(Micklethwait & Wooldridge, 1996)
 Recent attempts to improve
research/evidence
Understanding organizational change
Fullan, M. (2004)
 Most change is a response to
disturbances in the system’s
external or internal environment
 Change is rapid and nonlinear
 Messiness (arational factors)
inherent in organizations
Status of organizational change
research (Weick & Quinn, 1999)
 “continuing debate about whether change
research is developing as a cumulative
and falsifiable body of knowledge”
 "A few theoretical propositions are
repeated without additional data or
development; a few bits of homey advice
are reiterated without proof or disproof;
and a few sturdy empirical observations
are quoted with reverence but without
refinement or explication." (Kahn, 1974;
Macy & Izumi, 1993)
Understanding organizational change
Michael Fullan, M. (2004)
“Change cannot be managed, but it
can be understood, and led, but
not fully controlled”
Michael Fullan (2004). Leading in a culture of change: Personal action
guide and workbook. San Francisco: Jossey-Bass.)
Understanding organizational change (cont.)
Fullan, M. (2004)
 Key stakeholders & the
organizational culture are primary
considerations in organizational
change
 Complex & often unclear or
contradictory advice on how to
effect organizational change
 Leadership makes a difference
3
 Governing model of change: Three
stages of organizational change
(Kurt Lewin (1951)
Models of organizational
change
Unfreezing
Moving
1. Kurt Lewin (1951) Refreezing
2. Steckler et al. (2002) ************
3. Fullan (2004) “Indeed it has been said that the whole
theory of change is reducible to this one
idea of Kurt Lewin's“
(Hendry 1996 quoted in Weick & Quinn, 1999)

Models of organizational development Unclear or contradictory advice re.

& change (Steckler et al., 2002) organizational change (Fullan, 2004)
Stages of organizational Action research Top-down Bottom up
change (Beyer & (Steckler et al. (Kotter, 1996): (Beer et al.1990):
Trice) (2002)
Sensing of unsatisfied 1. Establishing sense of 1. Mobilize commitment to
1. 1. Diagnosis urgency change through joint
demands on the 2. Action planning diagnosis…
system 2. Creating guiding
coalition 2. Develop shared vision re.
2. Search for possible 1. Identification of competitiveness
responses possible 3. Developing vision & 3. Foster concerns for new
3. Evaluation of interventions strategy vision, competence…, &
alternatives 2. Selection of 4. Communicating the cohesion…
4. Decision to adopt intervention change vision 4. Spread revitalization to all
Empowering broad- departments without
action 3. Intervention
5.
pushing from top
Initiation of action based action
5.
3. Evaluation 5. Institutionalize
within system 6. Generating short-term revitalization through
6. Implementation of the wins formal policies, systems &
Consolidating gains & structures
change 7.

7. Institutionalization of producing more change 6. Monitor & adjust strategies

Anchoring new in response to problems in
the change 8.
revitalization
approaches in culture

Organizational competence required to overcome

barriers & effectively serve communities [at risk for
STDs] (Thach et al., 2002)
Effective organizations: Capacities
re. community development 1. Committed to serve the at-risk
communities
 Organizational commitment to serve: (e.g.,
(a) organizations see it as their responsibility
to prevent and control STDs in the
community, and (b) high staff morale
1. Thach et al. (2002) facilitates good client care)
2. Germann & Wilson (2004) 2. Works with communities
3. Canadian Heart Health  Community participation: (e.g.,
representatives of the target community
Initiative have decision-making power in planning &
evaluating services)

4
Organizational competence required to overcome Organizational competence required to overcome
barriers & effectively serve communities barriers & effectively serve communities
[at risk for STDs] (cont.) (Thach et al., 2002) [at risk for STDs] (cont.) (Thach et al., 2002)

3. Understands and appropriately responds to 4. Advocates on behalf of communities

needs of communities
 Assessment: (e.g., an organization works with
other agencies to collect, analyze, and make
available epidemiological data & information
about community needs)
 Cultural competence: (e.g., policies,
procedures, & staff training help an organization
to adapt services to the perceptions,
communication style, & norms of the cultural
groups it serves)
 Community outreach: (e.g., [STD] services are
targeted to individuals and communities not using
services and high-risk communities)
 Access to prevention & care: (e.g., an
organization assures availability of high-priority
services by encouraging other entities to provide
services or providing services directly)
 Interagency collaboration: (e.g., an
organization works with other agencies to
assess community health needs, ensure
provision of those needs, and promote
health-enhancing policies….)
 Policy development: (e.g., an organization
promotes development of scientifically sound
public health policy; strategic links are
developed to foster public support for STD
control)
 Resource acquisition: (e.g., organizations
with secure operational funding & the ability
to garner additional resources for the needs
they identify are in better positions to act to
prevent and control STDs)

Model for organizational capacity

Organizational capacity for community for community development (Germann & Wilson,
development (Germann & Wilson, 2004) 2004)

“…is the potential ability of a health 1. Organizational 2. Organizational

organization commitment to level
to develop CD (interpretative  Structures and
scheme) processes
an empowering and democratic partnership  Shared values &  flexibility in planning
with a community, beliefs that support  collaboration
through which the community’s CD  evaluation
 Leadership mechanisms
capacity to identify and address job design
 Shared 
its priority health understanding  Resources
concerns  What is CD?  Material: Funding,
How does CD fit in Information, Time
is enhanced” 
the organization’s  People: Diverse skill
spectrum of mix; Training;
services? Outside experts

Model for organizational capacity

for community development (cont.) (Germann &
Wilson, 2004)
Canadian Heart Health
3. Work unit level 4. Individual level Initiative
(Modelling community
development  Empowered and
internally) autonomous
 Building trusting front-line workers
relationships
 Supportive leadership  Individual
 Shared vision for the resources 1. Nova Scotia (Joffres et al.)
team
 Professional skills 2. Ontario (Riley et al.)
 Participation in
decision-making and knowledge
3. National (Robinson et al.)
 Sense of community  Personal qualities
 Critical reflection and
learning
 Communication and
dialogue

5
 Facilitators & barriers to heart health promotion (a) capacity building,
Capacity building for implementation of heart (b) implementation & (c) research/evaluation
(Integration of Robinson et al. 2006 & Riley et al., 2001, 2003)
health promotion: Definition
Canada Heart Health Initiative: Nova Scotia (Joffres et al.)
Internal
facilitators& barriers

“The extent to which

skilled/committed
people
funds &/or

organizations within
resources
priority &/or interest Organizational
leadership&/or
Predisposition

communities use and build

champion
[research interest &/ Evaluation/
or support] research

on their knowledge, skills,

resources and abilities to Implementation

take action on heart health External facilitators&

barriers
Organizational
Capacity

promotion”
strong partnerships
communication
supportive
structures &/or
coordination
geography

Factors influencing public health agency implementation

of heart health promotion activities Factors influencing implementation of
(Riley et al., 2001, 2003)
heart health initiatives (Canadian Heart Health Initiative:
Ontario (Riley, et al.))

Internal Organizational
Factors
human & financial 1. Organizational 1. Internal factors
resources
structures predisposition 1. Human & financial
processes Organizational resources
leadership Predisposition
2. Organizational 2. Structures
capacity 3. Processes
4. Leadership
Implementation
2. External factors
Influence each 1. Partnerships
other, & are 2. Support from
External System
Organizational influenced by resource system
Capacity Contextual factors
Factors
partnerships internal & 3.

support from
resource system external factors
contextual factors

Capacity building for implementation of heart

Capacity building for implementation of heart
health promotion: Model
health promotion: Model (cont.) Canada Heart Health
Canada Heart Health Initiative: Nova Scotia (Joffres et al.)
Initiative: Nova Scotia (Joffres et al.)

1. Baseline 2. Two
assessment environmental
contexts
through
 external
 Survey of  political climate/health
community agencies reform
 community awareness &
 Organizational interest
survey  existing inter-
organizational
 Organizational partnerships
interviews  internal
 Results re. baseline  leadership
 existing infrastructures
capacity for heart (human & financial
health promotion resources)
 existing policies &
organizational processes
 existing knowledge &
skills for heart health
promotion

6
Capacity building for implementation of heart
Change in individuals, organizations &
health promotion: Model (cont.) Canada Heart
Health Initiative: Nova Scotia (Joffres et al.) communities
3. Action plan for
building capacity 2. Long term
1. intermediate outcomes Individuals Individuals
outcomes  Improved heat
organizations
 partnership health within
development population communities
 leadership  Provincial capacity
 partnerships for heart health
 community  Sufficient
activation leadership and
 organizational organizational
change
capacity to deliver organizations communities
 organizational comprehensive
development heart health
 advocacy programs at
 technical support community level
 action research