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Implementation and Evaluation Plan

Overview

The evaluation plan will appraise the initiatives for improving patient care and their successful management aimed at ensuring favorable outcomes while reducing mortality and morbidity. It will also analyze the implementation process and the evaluation of the progress using various methods and tools. The program that will be evaluated entails the effectiveness of the continuous training of the staff involved in Ventilator-associated Pneumonia, Selective Decontamination of the digestive tract being the solution program.

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Evaluation’s Rationale and Purpose

An evaluation plan is aimed at assessing the effectiveness of selective decontamination of the digestive tract (SDD) in reducing the prevalence of ventilator-associated pneumonia. This evaluation will construct the information and commitment to promoting the dissemination of skills and knowledge through the training of nurses on issues related to ventilator-associated pneumonia. The purpose of the evaluation will be to provide a theory to practice implementing research findings among the selected staff, administrators, and nurses participating in this project. For the evaluation plan to be effective, the process will be based on best practices for the development and implementation of new programs and services. The essence of the evaluation plan is to avoid variability in practices while providing assessment materials for the dissemination and implementation of research findings. Critical examination of the existence and evidence of up-to-date data classification is a prerequisite to the success of the evaluation process.

This process evaluation will also allow us to come up with more informed decisions that will lead to the improvement of patient outcomes. The outcome will enable the stakeholders to analyze if the improvements in outcome performance concerning pneumonia are the results of the program and the training. Finally, the findings will be applied to promoting outreach and improving the recruitment of the new members of the nursing industry while adhering to the requirements of the donors and other interested stakeholders. The study will evaluate the effectiveness and relevance of continuous training of physicians and staff in ventilator-associated pneumonia. This is selective decontamination of the digestive tract (SDD) solution program.

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Evaluation Stakeholders

Primary stakeholders in this evaluation:

  • Corporation/State Commission
  • Doctors and nurses from state and private hospitals.
  • Managers and administrators of health care institutions
  • Hospital workers
  • Patients

Evaluation Questions

Key Evaluation Questions to be answered by this evaluation:

After consulting the external evaluator, the following questions were identified. In addition, detailed questions will be determined after refining the evaluation plan.

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  1. Is the Selective Decontamination of the Digestive tract (SDD) cost-effective as compared to either no antimicrobial or systematic antibiotic only in the prevention of Ventilator-associated Pneumonia (VAP)?
  2. Is our training model being implemented with integrity and evidence-based practice by both the doctors, managers, and nurses?
  3. Does the government medical infrastructure support the program provided by our training? If yes, to what extent?
  4. Are there any new modifications that need to be incorporated into the program to make service delivery more significant?

Evaluation Design

The evaluation will combine three designs for it to arrive at concrete findings. The first design will be exploratory. In this design, the evaluator will conduct different assessments to verify the need for the workshop and training and who needs this service. The design will also entail a review of the literature on scientifically based training programs with results and the designs that are compared to the needs of the selected program. The findings of the review will enable us to choose the most effective performance measures and programs design to consider.

The second design that will be considered is the descriptive one. It will utilize the evaluation methods related to the research. This will include opinion polls, service utilization studies, outcome surveys, client satisfaction surveys, and best practice surveys. Along with the information from the exploratory study, the descriptive design will assist in responding to the intermediate outcome, process, and end outcome questions.

Finally, a quasi-experimental design will be applied through a selection of administrators, nurses, and workers using specified criteria for the evaluation. The chosen criteria will include the ability to establish a baseline, active participation in the program, and willingness to be a part of the training team. The design will also include a case study of the patient outcome in respect of the program and the possible effects of intervention using the selective decontamination of the digestive tract.

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Internal and External Validity

To ensure internal and external validity of the data, during the training sessions, each interview question was reviewed, practiced, and modified to remove any existing ambiguities. It was further changed to suit the length of the interview that would be conducted. Moreover, each interviewer will be accompanied by the research director, to ensure the consistency and accuracy of the data recorded. All data and reports presented for the analysis will be reviewed by the quality assurance department in the ministry of health to ensure accuracy. The data quality assurance process will include clarifying and acknowledging the receipt of data, the regular training of staff, and the provision of the outback to the evaluation team on time. There will be a routine check on the reliability and validity of data, level of completeness, adjustment, and quality assessment. The objective of the checks and validation will be to ensure that the evaluation data is valid and reliable.

Considering the number of participants, it will be necessary to include the application of the data/validation accuracy index into specific support for interviews and district health annual reports. This will also entail regular checks and reports before submission to the stakeholders. To ensure the internal validity and relevance of the data, the ministry of health in conjunction with health care providers will carry out training on the provision of reliable data.

Quality assurance of the data will be carried out at points of collation and analysis, data collection, and dissemination by the evaluation staff at the fields and training centers. To ensure reliability and validity, the evaluation team will create standardized tools of quality assurance, which will be applied at all levels of the data collection and analysis process. The training process and the data evaluation will be under the overall supervision of the research director who will also carry out the regular training of interviewers and provision of feedback on the reliability, completeness, and validity of the data.

In addition to the above validation and data checks, the quality sector under the implementation and evaluation will carry out daily rapid data quality assessment. This will entail assessing different managers and hourly workers. The rapid data quality assessment will also involve assessing the entire process of synthesis, analysis, and data collection. To ensure internal validity the evaluation team will carry out week evaluation and midweek evaluation hence comprehensive data quality outcome. This process will eliminate inaccuracies, incomplete reporting, and non-representational.

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To enhance the credibility of the collected and evaluated data, compressive data quality adjustment and assessment will focus on assessing the accuracy of questionnaire data, the accuracy of coverage estimates concerning data collected, and systematic survey analysis. To ensure reliability and overcome bias, the evaluation team will adjust the indicator values through the application of a well-documented and transparent method. Finally, the team will involve external institutions like universities hence validating official data reports to be used.

Data Collection Methods and Tools

The data collection method will combine both the qualitative and quantitative methods. To ensure the reliability of the data and its validity, standardized data collection techniques and tools will be used. In this regard, data will be collected every week considering the survey-based indicators at baseline. To evaluate the progress of this policy initiative and its impact, attention to both outcomes and output is paramount. This includes the strategy of the program, contextual dynamics, and localized conditions that shaped its implementation. To bridge the gap between the observed and intended components of the evaluation framework, data collection methods and tools should be reliable. Therefore, the need for qualitative data sources will be necessary. This will include focus groups and in-depth field interviews. The use of them was considered necessary because they uncover the actual changes experienced by the participants after the training. This method will also enable understanding of hidden barriers to success regarding the program other than relying on the quantitative data. The other rationale behind this method is that the qualitative research method if well implemented can reveal factors that will lead to the success of the program.

The specific techniques and tools will among others include survey questionnaires, which will be created and designed to meet the expectation of the intended date for the program. This will be employed from time to time in the collection of data from the healthcare providers, managers, doctors, nurses, and other hourly workers. The questionnaires will be in a structured manner to enable us to collect qualitative data. Another method that will be applied is filed visits. In this method, the checklist will be designed and used from time to time while obtaining information that will be required in improving the performance of the participants in the implementation of the program. The review mission will aid in the interpretation of the results. During the training sessions, standardized meeting formats will be applied in guiding the participants and other stakeholder management meetings. They will assist in coordinating efforts, generating consensus, and reviewing the work plans and progress of the evaluation plan hence ensuring transparency, accountability, and ownership. In addition, the minutes of the meetings held will be kept for future analysis and reference.

Case studies and report formats were considered but will not be used in this evaluation plan. Report formats entail the presentation of the reports to various stakeholders and administrators while case studies are used to document the segments or life stages of events experienced by the target population or beneficiaries. Regarding this program, various tools are available but will not be used, this includes Human Resource Information System (HRIS), Output Budgeting Tool (OBT), Logistics Management Information System (LMIS), and Integrated Financial Management System (IFMS).

Sampling Information

A combination of convenience and purposeful sampling will be used in this research. Participants will be chosen while ensuring that they have the experience and knowledge of the information. This will include the selected managers, assistants, and hourly workers who will be trained on pertinent issues relating to this program. The sampling method also relied on the availability of the participants during the allocated training and discussion time allotted.

Individual managers, assistants, and hourly workers were identified early in the evaluation process as the primary units that will be used through filing interviews. The selected participants were cited as the locus of change because they bear the primary responsibility of implanting the nursing policy and procedure. The managers were sampled using the purposive sampling technique to ensure representation of the privately owned hospitals and the state hospitals. In addition, sampled participants took into consideration the need for middle-level managers and casual workers hence maximizing the number of hospital staff available. Each focus group and interview will be digitally recorded, but due to the high costs of transcribing audio files, the proportional random sample of 500 focus groups and interview sessions will be transcribed.

Analyzing Evaluation Data

Data synthesis and evaluation will be done at various levels of the evaluation plan. This will enhance evidence-based decision-making during the training in the dissemination of the results. The collected results will be summarized concerning trends and health situations of the patients while evaluating the consistency of the progress and performance of the program. The analysis focus will be on comparing actual results with planned results. This will entail performance at different levels and reasons for the divergence. Considering the research design, which is more of a qualitative design, thematic studies will be used to analyze the codes in each category and level. This process will calculate the proportion of the statements assigned to each category and review it to understand its accurate meaning and definition. This analytic method will enable the evaluators to determine major challenges, benefits, and recommendations associated with each level of the program implementation. The method is also significant in perceiving the opinions of the informants and participants while exploring patterns in the data assigned to a specific interview question.

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Forecasting Return on Investment

  • Average weekly sales for trained groups:

Managers: $19,500

Supervisors: $17,500

Hourly workers: $9,500

$46,500

  • Average weekly sales for untrained groups:

Managers: $18,650

Supervisors: $16,200

Hourly workers: $8,550

$43,400

Increase:

Managers: $850

Supervisors: $1300

Hourly workers: $950

$3100

Profit contribution: 2%

Managers: $17

Supervisors: $26

Hourly workers: $19

$62

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  • Total weekly improvement

Managers: (x48*) 816

Supervisors: (x149*) 3874

Hourly workers: (x720*) 13680

Total Annual Benefits (x 48 weeks)

Managers: $39,168

Supervisors: $185,952

Hourly workers: $656,640

$881,760

*remaining participants 3 months after training

  • Cost Summary

Facilitation Fees: 3 courses @

Managers: $23,450=$70,350

Supervisors: $52,700=$158,100

Hourly workers: $71,750=$ 215,250

$443,700

Program Materials: 950 @ $39/participant $37050

Meals/Refreshments: 3 days @ $31/participant/day $29450

Facilities: 7 days @ $600, 4200

Participant salaries plus benefits $ 150,000

Coordination/Evaluation $4,500

Total Costs $668,900

Cost Benefit Ratio (CBR) = $881,760/$668,900= 1.3:1

Return on Investment (%):

(ROI) = $881,760-$668,900 x 100 /$668,900= 31%

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