1. Program Evaluation Webinar Series Part 1: “Top Roadblocks on the Path to Good Evaluation– And How to Avoid Them” Presented by: Tom Chapel

2. Top Roadblocks on the Path to Good Evaluation– And How to Avoid Them Thomas J. Chapel, MA, MBA Chief Performance Officer (Acting) CDC/Office of the Director/OCOO Presented November 20, 2008 Tchapel@cdc.gov 404-498-6073

3. Objectives Program evaluation and typical “roadblocks” in doing good evaluation. CDC’s Evaluation Framework as way to surmount roadblocks.

4. Key Points In today’s session we will discuss: What is important about CDC’s framework? Why does it lead to better use of findings? Ensure use and share lessons learned Gather credible evidence Engage stakeholders Describe the program Focus the evaluation design Justify conclusions STEPS S tandards UtilityFeasibilityProprietyAccuracy

5. Why We Evaluate… “... The gods condemned Sisyphus to endlessly roll a rock up a hill, whence it would return each time to its starting place. They thought, with some reason…

6. Why We Evaluate… …there was no punishment more severe than eternally futile labor....” The Myth of Sisyphus

7. The Problem The stuff I do doesn't make a difference! Why don't things get better?!

8. Implementing Program Evaluation How do I motivate? What gets in the way? Not this…This…

9. Today’s Focus Top Roadblocks on the Road to Good Evaluation

10. Defining Evaluation Evaluation is the systematic investigation of the merit, worth, or significance of any “object”. Michael Scriven

11. Use the Findings! If the findings don’t get used… the program will not improve.

12. What is “Evaluation?” Evaluation is not… Evaluation is… A specific set of tools or techniques. An orientation to your program. The idea of continuous reflection.

13. Defining Evaluation Evaluation is the systematic investigation of the merit, worth, or significance of any “object”. Michael Scriven

14. What is a “Program”? Not only: Big training programs Community interventions But also: Recommendations and guidelines Surveillance systems In other words, a program is anything with an intended outcome.

15. Roadblock #6 Not understanding where evaluation “fits in” …

16. The “Silo” Model

17. The Integrated or “CQI” Model To achieve “continuous quality improvement” planners, performance measurers, and evaluators must communicate with each other.

18. The Customer is the Key Program evaluation must: See planning, performance measurement, and evaluation as being integrated. Start with the idea of having a customer or an intended user of findings. Direct the evaluation with the customer in mind.

19. Roadblock #5 Making the “perfect” the enemy of the “good”.

20. Roadblock #5 What if you said, “To be cardiovascularly fit, you must run a marathon.”?

21. Thanks, but… That's not me. I don't have that expertise. I don't have those skills. I don't have the money to do that.

22. Do What You Can! There’s always an evaluation worth doing. The biggest mistake is doing nothing because you can only do a little. Even a little bit is going to yield some benefit.

23. Roadblock #4 Evaluating only what you can “measure”… … because those are the things we can measure with validity, reliability and accuracy.

24. Upstream Questions How many brochures? How many trainees? How many people showed up? Did we get a lot of product out there?

25. Downstream Questions What have you done for me lately? How has it mattered? What have you done for public health?

26. Measuring the Right Thing… “…Sometimes, what counts can’t be counted. And what can be counted doesn’t count….” Albert Einstein

27. Evaluation Starts By Saying… What are the important things that need to be measured? Can I measure them with enough rigor to meet the needs of this situation this time? Sometimes the answer is “NO!”

28. You Get What You Measure… “…In Poland in the 1970s, furniture factories were rewarded based on pounds of product shipped. As a result, today Poles have the world’s heaviest furniture…” (New York Times, 3/4/99)

29. Roadblock #3 Neglecting Intermediate Outcomes…. Nothing has advanced the evaluation cause in public health more than preaching this idea of intermediate outcomes.

30. Intermediate Outcomes Contribute to Downstream Success How is it that my program will make a contribution to that downstream outcome? We call these “intermediate outcomes”.

31. What is the Program Logic? What needs to happen to achieve the desired outcome? What is the “program logic”? My action Desired outcome

32. What are the markers that tell me I’m on the right road? Don’t just ask: Did it work? How many tomatoes did I get?

33. What are the markers that tell me I’m on the right road? Ask: Is it working? Are planting, watering, and weeding taking place? Have the blossoms “set”? Are there nematodes on the plants?

34. Research Model Develop Theory Measure Outcome Program Activities

35. Research Model Develop Theory Measure Outcome Program Activities If I achieved the outcome– great! If I didn’t achieve the outcome– why?

36. Evaluation Unpacks the “Black Box” My action Desired outcome

37. The World’s Best Children’s Soccer Program

38. But We Never Won a Game

39. Focus on Intermediate Outcomes Can we: pass the ball? spread out? spend more time on the opponent’s side of the field?

40. Forgetting Intermediate Outcomes  ScienceCartoonsPlus.com

41. What’s In the Box? My program: training technical assistance funding partnerships Desired outcome: less morbidity fewer mortalities

42. What’s In the Box? My program: training technical assistance funding partnerships Desired outcome: less morbidity fewer mortalities Intermediate outcomes

43. The Power of Evaluation Establishing intermediate outcomes allows you to determine if you are making progress in the right direction.

44. Diabetes Intermediate Outcomes

45. Why Intermediate Outcomes? I’m making progress in the right direction. I am contributing to the downstream outcome.

46. Identifying Intermediate Outcomes What is the ultimate outcome I’m seeking? Who (besides me) needs to take action to achieve it? What action do they need to take? These are the intermediate outcomes that populate the “black box” or the “program logic”.

47. Roadblock #2 Confusing attribution and contribution… “I can’t make the case that my program was responsible for that change.”

48. The Role of Public Health a mobilizer and convener Public health is not …Public health is… a direct deliverer of services Based on: The Future of Public Health, Institute of Medicine, 1988.

49. “Networked” Interventions Agency A Program A-n Program A-1 Agency B Program B-1 Agency C Program C-n Program C-1 Agency D Program D-n Program D-1 OUTPUTS SHORT-TERM OUTCOMES LONG-TERM OUTCOMES SYSTEM OUTCOME

50. Attribution Program A-n Program A-1 Agency B Program B-1 Agency C Program C-n Program C-1 Agency D Program D-n Program D-1 OUTPUTS SHORT-TERM OUTCOMES LONG-TERM OUTCOMES SYSTEM OUTCOME Agency A

51. Contribution Agency A Program A-n Program A-1 Agency B Program B-1 Agency C Program C-n Program C-1 Agency D Program D-n Program D-1 OUTPUTS SHORT-TERM OUTCOMES LONG-TERM OUTCOMES SYSTEM OUTCOME

52. Identify Your Contributions by Asking “Why?” Why fewer diabetes amputations ?

53. Identify Your Contributions by Asking “Why?” Because physicians are doing more timely foot exams. Why? Why fewer diabetes amputations ?

54. Identify Your Contributions by Asking “Why?” Because physicians doing more timely foot exams. Because the insurance reimbursement climate has changed. Why? Why fewer diabetes amputations ?”

55. Identify Your Contributions by Asking “Why?” Because physicians doing more timely foot exams. Because insurance reimbursement climate has changed. Because the standards of practice have changed. Why? Why fewer diabetes amputations ?”

56. A “Chain of Causation” Because: We formed a coalition. We helped incent those standards. We helped change the reimbursement climate.

57. Contributions Count! Attribution We formed a coalition. Contribution We helped change the standards. We helped incent reimbursement.

58. Establish the “Chain of Causation” Ask providers. Ask insurance reimbursers. Ask physicians. Was the coalition influential in making these changes?

59. Roadblock #1 Not asking: “Who (else) cares…..”

60. Ask the Right Questions Who matters for this intervention besides me? Who else needs the information from this evaluation? The stakeholders! Engage stakeholders Step 1