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Needs Assessment: A Practical Guide to Assessing Local Needs for Services for Drug Users
Chapter 7: Taking Action
After you have analysed the information gathered in the earlier stages of the needs assessment process, and have drawn conclusions, you should have a reasonably clear idea of the needs of your target population. Decisions about action will depend on several crucial and closely connected activities. These include:
Prioritisation: If there are not sufficient resources to meet all the identified needs, it may be necessary to rank them in some way - to decide which needs will be met first and which will be met later.
Option appraisal: There may be more than one way of meeting the needs identified. Various options should be considered, and the evidence in favour of each should be weighed carefully.
Implementation: When agreement has been reached about how the needs are to be met, an action plan and timetable should be drawn up, including a plan for resource allocation.
In practice, the tasks of prioritisation and option appraisal are inextricably linked. Both must be considered together.
Prioritisation
Where there are insufficient resources available to meet all the identified needs, prioritisation will be necessary.
Prioritisation is a strategic process, undertaken by those responsible for the commissioning of services. In some areas the DAAT itself has responsibility for commissioning, while in other areas a sub-group of the DAAT has this responsibility. In both cases, the DAAT has responsibility for implementing the decisions made through the commissioning process.
Those involved in prioritising should have access to the views of service users and carers, as well as service providers, about how needs should be prioritised. Service providers and service users may not agree about which needs should take priority. Areas where there is agreement could perhaps be given 'high' priority by the commissioners.
To a large extent, the way in which decisions are made about priorities will depend on local circumstances and the local configuration of existing services. National priorities and the availability of dedicated resources for an intervention may instigate the needs assessment process. The purpose of the needs assessment is then to determine specifically what should be done, how it should be done and in what order. For example, national and local policy may require that services should be provided for young people. In this case, the local needs assessment will focus on identifying the specific needs of young people in the local area, their prioritisation and
how to develop services that allow these priorities to be realised.
When
prioritising at the local level, DAATs may need to consider the following questions: Which of the needs emerging from the needs assessment fit in most closely with
the current DAAT priorities? Which needs can be met within the (relatively narrow)
remit of the DAAT? Is it within the
capacity of the DAAT to address these needs?
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Option appraisal
In most cases, there will be more than one way of responding to the needs that have been identified. The options available to you for meeting those needs might cover a broad range of activities, including:
setting up a brand new service
expanding or changing the focus of an existing service
addressing staff development to allow some staff to become specialists in certain subjects (e.g., young people, or psychostimulant use)
creating opportunities for better team working, or joint initiatives with other agencies
making changes in the working arrangements of individual staff members.
To a large extent, the options you choose will depend on several factors, including: how the needs are prioritised; what the likely impact of each option would be; and the availability of resources. The table below provides one way of thinking about the options for change following a needs assessment.
Considering the options for change - the relationship between impact and cost
| LIKELY IMPACT OF CHANGE |
COST / RESOURCES NEEDED TO MAKE CHANGE | LOW | HIGH |
LOW | Soft target - Wait | Quick win - GO! |
HIGH | Hold off | Challenging - Wait |
Source: Based on the PDSA Prioritisation Matrix.
Ultimately, the aim is to give first priority to actions that will have the greatest positive impact on your target population, and which will also require few additional resources, i.e., in the table above:
High Impact and Low Resources. These actions can be thought of as
"quick wins". At the other extreme, it would be better to avoid making changes that are likely to have low impact, but which require a high level of resources. In between are those actions that are likely to have high impact, but will also demand high resources. In most circumstances, these should not be selected for immediate action, but rather considered as longer term options. Similarly, "soft targets" are those actions that require little resource, but would also have little impact. It is tempting to want to go ahead with these actions, but they can prove to be a distraction from the more high impact actions, and it is usually better to wait until the "quick wins" have been implemented first.
Hooper and Longworth (2002) and Pallant (2002) suggest that a number of key questions should be addressed when appraising the options and prioritising needs following a needs assessment exercise. These questions focus on the
issues of Impact, Changeability, Acceptability and Resource Feasibility.
Key Questions to Ask When Appraising the Options and Prioritising Impact What changes would have the greatest positive impact in meeting the needs of your target population? Do the identified needs relate to a local or a national priority (e.g., children of drug-using parents, individuals with co-morbid mental health and substance misuse problems)? What would be the implications of not addressing the needs of your target population?
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Changeability Which things can be changed and effectively improved by partner agencies? What evidence is there of effective interventions for the target population? Can negative impacts be stopped or reduced? Are there national or local, professional or organisational policies that set out guidelines on what should be done (e.g. national service frameworks, Social Services Inspectorate, national guidance on prescribing, etc.)?
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Acceptability Which of the options for change are likely to be most acceptable to the target population, to the wider community, to service providers and practitioners, and to commissioners and managers? What might be the 'knock-on effects' or unintended consequences of making a change?
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Resource feasibility What resources are required to implement the proposed changes? Can existing resources be used differently? What resources will be released if ineffective actions are stopped? Are there other resources available that have not been considered before? Which of the actions will achieve the greatest impact for the resources used?
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Example Ardach Health Centre: Prioritising needs for a primary care-based pharmaceutical service An open forum meeting was held for all the professionals at the Health Centre. Feedback from the staff and patient interviews and surveys were presented and discussed. Consensual agreement was reached on the overall priorities of patients' and professionals' perceived needs. Service prioritisation was driven by the frequency of 'felt' need. This list of the agreed priorities was used in making decisions about the pharmaceutical services to be provided by the new Health Centre pharmacist. One of the constraints on the service was the time that the pharmacist was available each week. Therefore, 'sessional times' were attached to each of the items in the priority list. A sessional time was defined as 'the proportion of a session in which the pharmacist could provide useful output for that service', where one session was equal to four hours. Using the priority list, and the associated sessional times, a steering group of health centre personnel (two GPs, a nurse manager, a practice manager) and the pharmacist responsible for the needs assessment came to a final decision on the pharmaceutical services to be immediately implemented by the practice pharmacist.
(Source: Williams, Bond and Menzies, 2000) |
Drawing up an implementation plan
Once you have agreed your priorities and the best ways of addressing these priorities, you will need to draw up a plan for implementing action. The implementation plan should be realistic, achievable and adequately funded. It should clearly outline the various stages in the implementation process. It is important that service providers are included in discussions regarding the implementation plan and are supportive of it. At an operational level, they will be directly involved in the implementation and the introduction of the agreed changes to existing services.
A good implementation plan will include:
a statement of the aims and objectives of the planned action, and the specific steps and milestones required to achieve it
the names of the individuals responsible for carrying out each part of the plan, what they will do and when, and the skills and training they will need
details of the resources that will be required (including administrative, managerial, and IT systems) and where they will come from
a clear understanding of how the plan will be kept on track, how the implementation of each component of the plan will be measured, and how the relevant people will be kept motivated and involved
THINK ABOUT |
When planning for action think about: How to prioritise the different options, based on their impact, changeability, acceptability and resource feasibility. How to involve service commissioners and other people in strategic positions. How to ensure service providers are involved in the development of the implementation plan.
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