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Assessment of Self-Evaluation Training for the Medical Reserve

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Overview of the Regional Training Sessions

Researchers conducted the training at each of the MRC regional meetings held between July and December 2007. Exhibit 1 provides a summary of the regional training sessions, including the number of training sessions and average number of participants in each session.

With the exception of Region 2, each training session was scheduled for two hours. In Region 2, only one hour was scheduled for each session. To adjust for this change, we significantly reduced the amount of time that the participants spent in their breakout groups to complete the logic model. In addition, the report back portion was shortened, leaving little time for questions. Generally speaking, the ideal length of time for the training was approximately 90 minutes.

Exhibit 1. Regional Training Sessions

Region Meeting date (2007) Number of training sessions Average number of people per session

1

October 25-26

2

20

2

October 11-12

2

25

3

November 14

2

20

4

November 9

2

22

5

August 27-28

2

23

6

December 12-13

2

25

7

December 5

1

30

8, 9, and 10

 July 17-20

3

30

The first regional meeting was held in July 2007 and was also the largest, with unit coordinators from Regions 8, 9, and 10 in attendance. Because this was our first opportunity to implement the evaluation training, we learned several critical lessons that we used to improve the training for future meetings. These lessons, and the subsequent changes that we made to the training, are described below.

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Lessons Learned and Adjustments to the Training

Many participants worked in a linear fashion through the logic model. They took each input or resource and worked straight across the page to come up with an activity and an outcome for that input rather than thinking about the desired outcomes of the unit as a whole (Exhibit 2).

Exhibit 2. Participant Approach to Logic Models

The exhibit depicts a logic model. The top row reads from left to right, 'Resource,' 'Activity,' 'Short-term outcomes,' and 'Long-term outcomes'. Below 'Resource,' a second row begins with 'Volunteers'; an arrow points right to 'Provide ICS Training' beneath 'Activity'; an arrow points right to 'Complete ICS 700 training for all volunteers' beneath 'Short-term outcomes'; an arrow points right to 'Volunteers are NIMS compliant' beneath 'Long-term outcomes.' The bottom row reads from left to right, 'Partnerships,' 'Form partnerships with other response organizations,' 'Bring on two new partners over the next year' and 'Get MRC integrated into community response plans.' Arrows point to the right between each item.

The exhibit above is representative of what many groups came up with for their logic model. Note that the purpose of the logic model is to visualize the pathway by which a program will operate to achieve its desired results. It should highlight the relationships that exist among resources, activities, and outcomes, since these rarely operate in a vacuum. In Exhibit 2, the stated outcomes (both short- and long-term) are not indicative of why the MRC unit exists. For example, the unit does not exist simply to have volunteers who are NIMS compliant. Rather, it exists for some greater purpose, such as the ability to minimize morbidity and mortality in an emergency by improving access to medical care. In a logic model, long-term outcomes usually will be synonymous with the unit's overarching goal. The tendency for participants to work linearly from one resource to one activity to one outcome was a problem we observed in almost every region.

We also found that many participants in the first meeting dwelled on the inputs or resources column of their logic model, trying to define specific quantities of resources they would need before defining activities and outcomes. This was not the intent of the exercise; we wanted participants to concentrate on how the activities they would engage in are connected to the outcomes they wanted to achieve. Therefore, we adjusted the training slightly and gave the participants specific information about the type and amount of resources that were available to them (Appendix B). The participants had to work within this set of pre-defined parameters and make assumptions about what they could realistically accomplish. This assured that they spent most of their time on the activities and outcomes.

Another observation from the initial meeting was that the participants did not always create performance measures for their activities and outcomes. Because the original logic model handout did not have a space to list performance measures, this step was often skipped. Therefore, we added a space below the activity and outcome columns in the modified handout (Appendix B) to remind participants to include performance measures.

Most participants found the interactive sessions to be a fun and very informative experience. They learned a great deal from the different experiences that each person contributed from his or her own community. At the same time, the diverse backgrounds of the participants (e.g., nursing, fire, law enforcement) influenced their perspectives on the strategic planning process. This diversity, while creating a rich learning environment, also created some challenges. For example, it was difficult for the participants to adhere to the hypothetical scenario they were given for the logic model. Instead, they routinely reverted to the resources, activities, or goals they knew from their unit. We addressed this by emphasizing the need for each group to make, and hold to, certain planning assumptions based on the hypothetical information they were provided.

Also, we spent extra time during the introductory presentation on key points and walking the participants through the sample logic models. It was particularly important to stress that a well-constructed logic model provides a visual pathway for how the entire unit is expected to operate, and not just one aspect of the unit. We wanted participants to think about what their unit seeks to accomplish beyond recruiting volunteers and providing training. Finally, we emphasized the importance of considering (and showing on a logic model) how the components of their unit work together and how some activities or outcomes may be necessary prerequisites to others.

In the next section we discuss some of the major themes that we observed from our work with MRC coordinators during the evaluation training sessions.

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Emerging Themes from the Training Sessions

Overall, participants at the regional meetings embraced the concepts of strategic planning, logic models, and performance measurement. They recognized the utility of these activities for building stronger and more sustainable MRC units. In addition, coordinators noted that grant applications increasingly require the use of logic models to show how a program will operate. This practical application for helping to secure funding was especially influential in getting participant buy-in.

Most of the coordinators were enthusiastic and receptive to the training guides that we developed. Some came to their regional meeting having already viewed the guides on the MRC national Web site. They were also appreciative of the volunteer satisfaction survey and felt that this would be a good resource to help them better gauge the acceptance of their program among volunteers.

In many instances, the groups developed very creative examples of activities, outcomes, and performance measures for their logic models. Examples of these are provided in Exhibit 3.

Exhibit 3. Sample Logic Model Components

Activities Outcomes Performance measures
  • Determine skill sets of volunteers and match these to expected roles of the MRC in staffing flu vaccination clinics
  • Work with public health officials to establish clear roles and responsibilities for the MRC in staffing special needs shelters
  • Actively participate with community partners in exercises and establish specific training objectives for the MRC
  • Develop "just-in-time" training for volunteers
  • Increase knowledge about the health risks associated with obesity and a sedentary lifestyle
  • Reduce the number of "walking wounded" who are treated in the acute hospital setting
  • Increase the overall flu vaccination rate by 15% over the previous year's rate
  • Increase the number of trained medical volunteers who are available to staff alternate care sites during an emergency
  • Number of presentations delivered on obesity over a six-month period (i.e., target = 15)
  • Number of community exercises participated in over the last 12 months
  • Number of partnerships formed and Memoranda of Understanding (MOU) established
  • Time it takes to process a mock patient through a point of dispensing during an exercise

Not surprisingly, we also encountered some challenges. As noted earlier, a logic model should depict relationships among the core components of a program that are essential for it to operate as intended. We found that many participants had a difficult time staying focused on the critical elements of their unit and instead got sidetracked by the details. One person described it as, "we started going real big, real fast." Overall, participants tended to be very task-oriented and interested in developing a work plan. It was important to remind them that a logic model is useful for getting a general sense of how a program operates, but it does not provide the same level of detail as a work plan.

It was apparent from our interactions with unit coordinators and program staff that the distinction between a strategic plan and a work plan is often blurred. When a person indicated that he or she had developed a strategic plan, further discussion revealed that they really had a work plan outlining the specific tasks they were going to conduct. It was common for coordinators to have developed a work plan without having a written strategic plan in place. In some instances, they stated that because the MRC was incorporated into their host organization's strategic plan, they did not require a strategic plan of their own.

Our findings from the needs assessment revealed that many MRC coordinators did not differentiate between the broad goal(s) of their unit and the more specific and measurable objectives that would help them achieve their goal(s). This was also observed during the evaluation training sessions. Participants used the terms interchangeably and often spoke of the short-term outcomes listed in their logic model as the "goals" of their unit.

Some groups did not illustrate linkages between activities and outcomes on their logic model, tending instead to simply generate lists of each. One of the benefits of developing a logic model is that it requires a person to constantly question the validity of the connections between activities and outcomes (or between multiple activities or multiple outcomes). For example, a coordinator could ask "is there a correlation between participating with my partner agencies in drills and exercises and gaining a better understanding of my unit's role in a disaster response?" By simply generating lists of activities and outcomes, this examination of correlation was not performed.

Defining realistic and reliable performance measures was also challenging. In some instances, groups specified performance measures that would have been exceedingly difficult to analyze using supporting data. For example, one of the scenarios involved using MRC volunteers to conduct outreach education on the benefits of healthy eating and exercise to help combat the obesity epidemic. A group with this scenario decided that they wanted to target school-age children and listed as one of their outcomes a 15% reduction in the number of obese children over a 12-month period. The performance measure chosen for this outcome was body mass index, measured among the target group prior to the intervention and again at 12 months. Obtaining and calculating these indices likely would have been time intensive and resource prohibitive for a volunteer organization like the MRC.

Throughout the training sessions, we emphasized that there is no "one way" to develop a logic model. Some might find it easier to start with their available resources and work left-to-right across the page through activities to outcomes. Others might choose to start with their desired outcomes and work backward to identify the appropriate activities and resources. We encouraged the groups to try both approaches and the feedback that we received suggested there are benefits to each. Generally speaking, participants seemed to favor starting with the outcomes and working backwards. From a teaching standpoint, this was good because participants spent more time thinking about their unit's activities and outcomes rather than dwelling on the resources they were given.

The breakout-group segment of the evaluation training provided a venue for informal discussions between the unit coordinators. These sidebar discussions often addressed such issues as recruiting, credentialing, and liability protection for volunteers. Other issues related to interoperable communications and activation procedures also were discussed. These conversations provided insight into what were "top of mind" issues for the coordinators. And more often than not these issues had to do with structural challenges rather than planning challenges (the latter including issues related to the development of program goals and objectives). It was evident from these conversations that most coordinators operate in an environment where structural challenges have priority. Given the time constraints of most coordinators, this can make it very difficult to ensure adequate attention is focused on strategic planning and evaluation.

A commonly asked question during the training sessions was, "where does the development of a logic model fit in terms of doing strategic planning and performance measurement?" There was some confusion regarding the correct "order" of conducting these activities. The development of a logic model is an essential part of strategic planning because it helps define the core components of a program and how they relate to each other. This knowledge helps guide the unit's coordinator in determining the best approach for achieving the program's long-term goals. Therefore, logic model development is part of, and not separate from, the strategic planning process. The training staff emphasized this point to participants.

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