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Learn how to make your vision concrete by describing the strategies that your organization will use to meet its goals and objectives. |
Developing an action plan can help changemakers turn their visions into reality, and increase efficiency and accountability within an organization. An action plan describes the way your organization will meet its objectives through detailed action steps that describe how and when these steps will be taken. This section provides a guide for developing and utilizing your group's action plan.
In some ways, an action plan is a "heroic" act: it helps us turn our dreams into a reality. An action plan is a way to make sure your organization's vision is made concrete. It describes the way your group will use its strategies to meet its objectives. An action plan consists of a number of action steps or changes to be brought about in your community.
Each action step or change to be sought should include the following information:
The action plan for your initiative should meet several criteria.
Is the action plan:
There is an inspirational adage that says, "People don't plan to fail. Instead they fail to plan." Because you certainly don't want to fail, it makes sense to take all of the steps necessary to ensure success, including developing an action plan.
There are lots of good reasons to work out the details of your organization's work in an action plan, including:
Ideally, an action plan should be developed within the first six months to one year of the start of an organization. It is developed after you have determined the vision, mission, objectives, and strategies of your group. If you develop an action plan when you are ready to start getting things done, it will give you a blueprint for running your organization or initiative.
Remember, though, that an action plan is always a work in progress. It is not something you can write, lock in your file drawers, and forget about. Keep it visible. Display it prominently. As your organization changes and grows, you will want to continually (usually monthly) revise your action plan to fit the changing needs of your group and community.
Determine what people and sectors of the community should be changed and involved in finding solutions.
If you have been using the VMOSA (Vision, Mission, Objectives, Strategies, Action Plans) model, you might have already done this, when you were deciding upon your group's objectives. Again, try to be inclusive. Most of the health and development issues that community partnerships deal with are community-wide, and thus need a community-wide solution. Possible sectors include the media, the business community, religious organizations, schools, youth organizations, social service organizations, health organizations, and others.
Some members of the community you might consider asking to join the action planning group include:
Let's consider some of the people who were involved with the planning group for the fictional Reducing the Risks (RTR) Coalition that hopes to reduce the rate of teen pregnancy. Some of the members of this planning group included teachers at the local high school, local teenagers and their parents, members of the clergy, counselors and school nurses, staff of the county health department, and members of youth organizations, service agencies, and other organizations that focus on youth issues.
Convene a planning group in your community to design your action plan . This might be the same group of people who worked with you to decide your group's strategies and objectives. If you are organizing a new group of people, try to make your planning committee as diverse and inclusive as possible. Your group should look like the people most affected by the problem or issue.
Once everyone is present, go over your organization's:
Develop an action plan composed of action steps that address all proposed changes. The plan should be complete, clear, and current. Additionally, the action plan should include information and ideas you have already gathered while brainstorming about your objectives and your strategies. What are the steps you must take to carry out your objectives while still fulfilling your vision and mission? Now it's time for all of the VMOSA components to come together. While the plan might address general goals you want to see accomplished, the action steps will help you determine the specific actions you will take to help make your vision a reality. Here are some guidelines to follow to write action steps.
Members of the community initiative will want to determine:
Example: RTR Coalition's Action Step (a sample) One community change sought by this coalition to prevent teen pregnancy was to increase publicity about contraception and unwanted pregnancy at the local high school. What action or change will occur: Hanging posters, displays, and other information about contraception and the facts about unwanted pregnancy in the hallways of the local high school. The posters and other information will become a permanent part of the high school. Posters and information will be regularly changed as new materials become available. Who will carry it out: A sub-committee comprised of parents and guardians, teachers, students, and coalition members will be responsible for maintaining the displays. The coalition as a whole will work towards finding funding to purchase the materials. Maria and Alex of the schools action group will be responsible for researching and ordering the materials. By when will it take place, and for how long: The coalition will try to have posters hanging and displays visible within six weeks of deciding on the action step (2/19/2013). What resources are needed to carry out the step: The coalition will approach the school district to request funding for the project. Otherwise, the group will seek funding from other sources such as foundations and local businesses to finance the program. Communication about the action step. The school principal and leadership of the Parent-Teacher Organization (PTO) should be given information about this planned change.
Things to note about this portion of the RTR action plan:
Review your completed action plan carefully to check for completeness. Make sure that each proposed change will help accomplish your group's mission. Also, be sure that the action plan taken as a whole will help you complete your mission; that is, make sure you aren't leaving anything out.
Follow through. One hard part (figuring out what to do) is finished. Now take your plan and run with it! Remember the 80-20 rule: successful efforts are 80% follow through on planned actions and 20% planning for success.
Keep everyone informed about what's going on. Communicate to everyone involved how his or her input was incorporated. No one likes to feel like her wit and wisdom has been ignored.
Keep track of what (and how well) you've done. Always keep track of what the group has actually done. If the community change (a new program or policy) took significant time or resources, it's also a good idea to evaluate what you have done, either formally or informally.
Keep several questions in mind for both yourself and others:
You can address these questions informally (ask yourself, chat with friends and other people), as well as formally, through surveys and other evaluation methods.
Celebrate a job well done! Celebrate your accomplishments; you and those you work with deserve it. Celebration helps keep everyone excited and interested in the work they are doing.
Every community organization has undoubtedly had this happen: you plan and you assign tasks to get everything you've planned to do accomplished. Everyone agrees (maybe they even offer) to do certain tasks, and you all leave with a great feeling of accomplishment. The problem? At the next meeting, nothing has been done. Besides tearing out your hair, what can you do?
Fortunately, there are several things you can try. It's particularly tricky in the case of volunteers, because you don't want to lean too hard on someone who is donating their time and energy to begin with. Still, you can make it easier for members to get things done (and harder to avoid work) without acting like the mean neighbor down the street. Some of these gentle reminders include:
Follow up on the action plan regularly. You are asking members to be accountable, and to get things done on a regular basis. If they have agreed, you should help them fulfill their commitment as best you can.
Online Resources
The Ruckus Society offers an Action Planning Manual that discusses strategies for nonviolent direct action.
Preventing Adolescent Substance Abuse: An Action Planning Guide for Community-Based Initiatives
Preventing Youth Violence: An Action Planning Guide for Community-Based Initiatives
Preventing Adolescent Pregnancy: An Action Planning Guide for Community-Based Initiatives
Promoting Child Well-Being: An Action Planning Guide for Community-Based Initiatives
Promoting Urban Neighborhood Development: An Action Planning Guide for Improving Housing, Jobs, Education, Safety and Health
Preventing Child Abuse and Neglect : An Action Planning Guide for Community-Based Initiatives
Reducing Risk for Chronic Disease: An Action Planning Guide for Community-Based Initiatives
Print Resources
Barry, B. (1984). Strategic planning workbook for nonprofit organizations . St. Paul: MN: Amherst H. Wilder Foundation.
Berkowitz, W. (1982). Community impact: creating grassroots change in hard times . Cambridge, MA: Schenkman Publishing.
Bryson, J. (1988). Strategic planning for public and nonprofit organizations: A guide to strengthening and sustaining organizational achievement . San Francisco: Jossey-Bass Publishers.
Fawcett, S., Paine, A., Francisco, V., Richter, K., Lewis, R., Williams, E., Harris, K., Winter, K., in collaboration with Bradley, B. & Copple, J. (1992). Preventing adolescent substance abuse: an action planning guide for community-based initiatives . Lawrence, KS: Work Group on Health Promotion and Community Development, University of Kansas.
Fawcett, S., Claassen, L., Thurman, T., Whitney, H., & Cheng, H. (1996). Preventing child abuse and neglect: an action planning guide for building a caring community . Lawrence, KS: Work Group on Health Promotion and Community Development, University of Kansas.
Kansas Health Foundation. VMOSA: An approach to strategic planning . Wichita, KS: Kansas Health Foundation.
Lord, R. (1989). The nonprofit problem solver . New York, NY: Praeger.
Olenick, A. & Olenick, P. (1991). A nonprofit organization manual . New York, NY: The Foundation Center.
Unterman, I., & Davis, R. (1984). Strategic management of not-for-profit organizations . New York, NY: CBS Educational and Professional Publishing.
Wolf, T. (1990). Managing a nonprofit organization . New York, NY: Prentice Hall.
Watson-Thompson, J., Fawcett, S., & Schultz, J. (2008). Differential effects of strategic planning on community change in two urban neighborhood coalitions. American Journal of Community Psychology, 42, 25-38.
The ultimate goal of creating a case study is to develop a feasible action that can solve the problem it raised.
One way to achieve this is by enumerating all the possible solutions for your case study’s subject. The portion of the case study where you perform this is called ACA or Alternative Courses of Action.
Are you struggling with writing your case study’s ACA? Do not worry; we have provided you with the most detailed guide on writing the Alternative Courses of Action (ACA) of a case study.
What are alternative courses of action (aca) in a case study.
Alternative Courses of Action (ACA) are the possible actions a firm or organization can implement to address the problem indicated in the case study. These are suggested actions that a firm can consider to arrive at the most feasible and effective solution to the problem.
This portion doesn’t provide the actual and optimal solution yet. Instead, it contains proposed alternatives that will still undergo an evaluation of their respective advantages and disadvantages to help you come up with the best solution.
The ACA you will offer and indicate will be based on your case study’s SWOT analysis in the “ Areas of Consideration ” portion. Thus, a SWOT analysis is performed first before writing the ACA.
Given the financial, logistical, and operational limitations, developing solutions that the firm can perform can be challenging. By enumerating and evaluating the ACA of your case study, you can filter out the alternatives that can be a potential solution to the problem, given the business’s constraints 1 . This makes your proposed solutions feasible and more meaningful.
Here are the steps on how to write the Alternative Courses of Action for your case study:
Using the SWOT analysis, consider how the firm can use its strengths and opportunities to address its weaknesses, mitigate threats, and eventually solve the case study’s problem.
Suppose that the case study’s problem is declining monthly sales, and the SWOT analysis showed the following:
Then, you may include an ACA about developing the digital marketing arm of the firm to attract more customers and boost monthly sales. This can also address one of the possible threats the firm faces, which is increasing direct marketing costs.
Once you have reviewed your SWOT analysis and come up with possible solutions, it’s time to write them formally in your manuscript. Each solution does not have to be too detailed and wordy. State the specific action that the firm must perform concisely.
Going back to our previous example in Step 1, here is one of the possible ACA that can be included:
ACA #1: Utilize digital platforms such as web pages and social media sites as an alternative marketing platform to reach a wider potential customer base. Digital marketing, together with the traditional direct marketing strategy currently employed, maximizes the business’ market presence, attracting more customers, and potentially driving revenues upward.
In our example above, there is a clear statement of the firm’s action: to use web pages and social media sites to reach more potential customers and increase market presence. Notice how the ACA above provides only an overview of “what to do” and not a complete elaboration on “how to do it.”
After specifying the ACA, you must evaluate them by stating their respective advantages (pros) and disadvantages (cons). In other words, you must state how your ACA favors the firm (advantages) and its downsides and limitations (disadvantages).
Again, your evaluation does not have to be too detailed but make sure that it is relevant to the ACA that it pertains to.
Let’s return to the ACA we developed from step 2, utilizing digital platforms (e.g., social media sites) to reach more potential customers. What do you think will be the pros and cons of this ACA?
Let’s start with its potential benefits (advantages). Using digital platforms is cheaper than using print ads or direct marketing. So, this will save some funds for the firm. In short, it is cost-effective.
Second, digital platforms offer analytical tools to measure your ads’ reach, making it easier to evaluate people’s perceptions of your offering.
Third, using social media sites makes communicating with any potential customer easier. You can quickly respond to their queries, especially if they are interested in your product.
Lastly, you can reach as many types of people as possible by taking advantage of the internet algorithm.
Now, let us consider its disadvantages 2 . First, using digital marketing takes time and effort to learn, and you must be able to adapt quickly to the changes in trends and new strategies to keep up with the competition.
Second, you must deal with the increasing market competition, as many businesses already use digital platforms.
Third, you have to deal with negative feedback from your customers that are visible to the public and may affect their perception of your brand.
After pondering over the pros and cons of your ACA, it’s time to write them concisely in your manuscript. You can present it in two ways: by tabulating it or by simply listing them.
Example in Table Form:
| – Cost-effective – Provide analytical tools to evaluate ad reach and performance – A more accessible and more convenient platform to communicate with potential customers and address their queries and concerns – Maximize reach to potential customers anywhere – Time-consuming and challenging to learn due to changes in trends and strategies – Increasing market competition as many businesses also use digital platforms. – Negative feedback reflected in the digital platform could affect people’s perception of the firm |
Case Study Problem: Xenon Pastries faces a problem handling larger orders as Christmas Day approaches. With an estimated 15% increase in customer demand, this is the most significant increase in their daily orders since 2012. The management aims to maximize profit opportunities given the rise in customer demand.
ACA #1: Hire part-time workers to increase staff numbers and meet the overwhelming seasonal increase in customer orders. Currently, Xenon Pastries has a total of 9 workers who are responsible for the accommodation of orders, preparation, and delivery of products, and addressing customers’ inquiries and complaints. Hiring 2 – 3 part-time workers can increase productivity and meet the daily order volume.
Disadvantages
ACA #2: Increase the prices of Xenon pastries’ products to increase revenues . This option can maximize Xenon Pastries’ profit even if not all customers’ orders are accommodated.
Case Study Problem: Delta Motors has been manufacturing motorcycles for ten years. Recently, the business suffered a gradual shrink in its quarterly revenues due to the increasing popularity of traditional and newly-developed electric bikes. Delta Motors seeks a long-term strategy to attract potential customers to bounce back sales.
ACA #1: Develop a “regular installment payment” scheme to attract customers who wish to purchase motorcycles but have insufficient lump-sum money to acquire one. This payment scheme allows customers to pay an initial deposit and the remaining amount through smaller monthly payments.
ACA #2: Introduce new motorcycle models that can entice different types of customers. These models will feature popular designs and more efficient engines.
1. how many alternative courses of action (aca) can a case study have.
Sometimes your instructor or teacher will tell you the required number of ACA that must be included in your case study . However, there’s no “standard” limit to how many ACA you can indicate.
As mentioned earlier, the case study’s ACA aims to enumerate all possible solutions to the problem. It is not the stage where you state the “final” action you deem most appropriate to address the issue. The case study portion where you explicitly mention your “best” alternative is called the “Recommendation.”
To help you understand the point above, let’s return to our Delta Motors example. In our previous section, we have provided two ACA that can solve the problem, namely (1) developing a regular installment payment plan and (2) introducing a new motorcycle model.
Suppose that upon careful analysis and evaluation of these ACA, you came up with ACA #2 as the more fitting solution to the problem. When you write your case study’s recommendation, you must indicate the ACA you chose and your reasons for selecting it.
Here’s an example of the Recommendation of the case study:
Recommendation
Introducing new motorcycle models that feature popular designs and more efficient engines to entice different types of customers is the most promising alternative course of action that Delta Motors can implement to bounce back its quarterly revenues and keep up with the competitive market. This creates a strong impression on the public of the company’s dedication to promoting high-quality motorcycles that can withstand changes in consumer preferences and market trends. Furthermore, this action proves that the company is continuously evolving to offer a variety of alternative models to suit everyone’s tastes. With proper promotion, these models can rekindle the company’s popularity in the automotive and motorcycle industry.
Written by Jewel Kyle Fabula
in Career and Education , Juander How
Jewel Kyle Fabula is a Bachelor of Science in Economics student at the University of the Philippines Diliman. His passion for learning mathematics developed as he competed in some mathematics competitions during his Junior High School years. He loves cats, playing video games, and listening to music.
Browse all articles written by Jewel Kyle Fabula
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Written by: Raja Mandal
Since you're here, you might be struggling to achieve your personal, professional or company goals. And if you think an action plan is just what you need to help you create a clear path for reaching your goals, you're absolutely right!
An effective action plan is critical, whether sending out weekly email newsletters, putting together a presentation, or executing a marketing plan or business plan . However, creating an action plan from scratch can be even more troublesome if you don’t know how to do it.
Fortunately, with Visme’s action plan templates , anyone can create an effective action plan in minutes.
Continue reading to discover what exactly an action plan is, why you need one, how to create one and some template examples that you can use it for inspiration.
What is an action plan and why do you need one, why do you need an action plan, how to create an effective action plan.
10 Action Plan Templates To Help You Execute Projects
As the name suggests, an action plan is the set of tasks or activities you need to complete to achieve a goal or complete a project. You can think of it as a timeline, a list of actionable steps, people responsible for each of them and who follows the progress of each step to come up with the best results.
This single document can help you plan and monitor activities, identify the resources needed, and how and when they should be used to ultimately achieve your stated goal.
Now, you might be wondering the difference between an action plan and a to-do list. The most significant difference between these two is that to-do lists are ongoing and include tasks for different goals and projects. On the flip side, an action plan is focused on a specific goal within a limited time frame.
The purpose of creating an action plan:
According to a recent study, those who finish their business plan are twice as likely to succeed in their business than those who have no business plan. So, plan to be prepared for the obstacles ahead and keep yourself on track.
And an effective action plan helps you boost your productivity and keep yourself focused. Here are some of the reasons why you need an action plan.
An action plan highlights the steps you should take and the timeframe to complete them. Therefore, you will get a clear direction of what to do in order to achieve your goals. So, whenever you stress yourself about the next steps or the actions taken in the past, you have everything in hand.
An effective action plan can bring every team member or stakeholder on the same page. It can be an individual who is an expert in the area of work, the one who is experiencing the problem and stands to benefit from the change, or who can contribute towards the goal or project.
Every action in your action plan should have an exact completion date. Once you assign all the tasks that need to be done to achieve your goal and understand the requirements of resources for it, you can quickly figure out how long the overall action plan will take.
Measuring the success of the progress of your goal is another crucial benefit of using an action plan. For example, if an objective is to write an action plan, there may be many steps towards that goal, including understanding the design process, writing the text, branding and many others.
You can measure each of these steps to ensure you achieve the goals and contribute to the larger objective of creating an action plan.
Learning to create an action plan might seem daunting at first, but it’s worth the effort to keep yourself productive towards the goal later on. Though there is no universal formula to create an action plan, and they may differ in terms of tasks and timelines, you can follow the simple steps below to create one.
The most important ingredients you need to create an effective action plan are the goals you want to achieve. Since you are reading this, you might have already defined goals. But, if you haven’t, use the SMART method to create specific, measurable, attainable, relevant and time-bound goals.
Use the infographic below to understand a SMART goal and try to create yours accordingly.
Once you have set SMART goals, you are already halfway through achieving them. If you struggle with creating SMART goals, use the worksheet template below.
Additionally, read the article on how to create SMART goals to learn more about it.
Now, prepare a list of actions you need to take to reach your goal. It would be better to divide your main goal into smaller actionable steps to make the final goal less overwhelming and get closer to achieving your goal one step at a time.
However, make sure that the actions are realistic and relevant to your goal. For example, if you want to generate 30% more leads, some of your actions could be creating engaging content, optimizing your web pages, asking for referrals, and many others.
Before creating the action plan, you must identify all the resources required to complete the tasks. Some of the resources you need will include money, equipment, personnel, tools and others. And if you don’t have the resources available at the moment, you need to make a plan to acquire them.
Once you have your resources, allocate them to the right people. For example, suppose you are running a digital marketing campaign. In that case, you will need to have the applications and tools for content production, graphic design, and marketing analytics and hand them over to your content manager, social media manager and SEO manager.
As we have already discussed, the goals should be SMART. And here, T stands for time-bound, which means that you should have a start and finish date to achieve your goal. If you don’t do it, you are likely to never reach the goal.
Therefore, choose a specific deadline so the other team members involved can plan better for the execution of the action plan.
Additionally, you can break one large goal into smaller subgoals and set an individual deadline for each of them. For example, if you want to generate 30% more leads by the end of Q4 this year, you can set subgoals such as:
Now, let’s move to the part where you will actually materialize your action plan. Creating a visual representation of the action plan is the best way to engage your team so that everyone knows the plan well.
But designing an action plan from scratch is not an easy task. Visme is there to help you design the action plan without stressing yourself out for the design part. Follow the steps below to visualize your action plan.
Visme offers a wide range of professionally designed action plan templates for various business types and use cases. Choose a template from the library that suits your needs or that you can easily customize a little to create your very own action plan.
Now, edit the empty fields to fill in your objectives, tasks, deadline, budget, and many others. Click on one of the text boxes and start typing to insert your text or replace any pre-existing text with your own.
Customize the appearance of your action plan further by changing the colors and fonts. Select the element you want to change color for and use the color picker tool to change the color according to your need.
Once you are done with the colors, you can now change the font style, color and size. Double click on the text that you want to change the font for and use the editor on top to do it.
Use your brand colors and brand fonts in the action plan to perfectly represent your brand. Visme lets you save your brand assets so that you get customized templates according to your brand guidelines at your fingertips.
Watch the video below to learn more about setting up your brand identity kit in Visme.
Icons and illustrations are the essential part of visually expressing actions and ideas. Add relevant icons and illustrations or swap out the ones included to ensure they match your action plan. Visme offers thousands of professionally crafted icons and illustrations that you can use in your design.
Additionally, take your design to the next level effortlessly by incorporating 3D animated assets in your action plan.
To make the most of your action plan, ensure that you include all the team members that you think can contribute to the success of your plan. Start collaborating with your team and effectively create stunning designs right inside Visme.
Check out the video tutorial below to learn more about it.
Once you are satisfied with your action plan, you can share it with your team members. Download the action plan as a high-resolution JPG or PNG image file or share it via a link. If you want to publish your action plan on a website to blog, generate an embedded link and paste it wherever you want.
Track your progress regularly and ensure that each step in your action plan is completed on time. You can use an internal reporting system or hold regular meetings to track progress. Mark tasks that are completed as done on the action plan to bring them to the attention of your team members.
This will help you better understand the pending or delayed tasks for which you need to find solutions. Finally, keep updating the action plan regularly according to your progress. With Dynamic Fields , it's easy to keep your action plan, and all other projects, updated. Once you input data into a dynamic field, it will change across all projects it’s used in.
If you are considering the action plan for a project, you can also opt for project management plan templates to keep track of your project progress and ensure a smooth operation.
Additionally, Visme offers a wide variety of other documents such as status reports , marketing plans , sales plans , project plans , organizational charts and many more.
1. marketing action plan.
Planning marketing and promotional activities are critical aspects of your business process as they help you achieve your business goals and grow your business. If you are a marketer, you should plan activities each month and compare them with your expected results.
This action plan template can help you track the actual results of those activities and help you with your future plans. Whether your marketing objective is increasing sales or brand awareness , you can use this template as a part of your overall marketing plan .
The position of C.E.O. comes with high expectations. With the unknowns of a new role in a new organization, the pressure to perform and the need to be accepted as a new leader by the team, it can be challenging to know where to start.
Use this 90-day action plan to understand your new organization, its target market, functional interdependencies, growth opportunities, and much more.
As a business owner, you need to take corrective actions when the goals and objectives are not in line with your expectations and the process starts experiencing flaws. An employee corrective action plan is one of the crucial ones of them.
This often happens when the employee lacks key skills or doesn’t understand your organizational processes or objectives. An employee corrective action plan template like the one below allows you to record the disciplinary action that needs to be taken and suggest improvements and comments.
When starting or running a new project like website designing or anything else, you need to juggle many things at once. Use this website design project action plan to ensure that the project goes more smoothly.
It gives you complete visibility of the objectives, tasks and the given timeframe, making it easier for you to organize teams, assign tasks, track performance and measure the execution of the project.
Additionally, learn more about how Visme can help you better manage projects .
You might already know that SMART goals push you further, giv1425287609es you a sense of direction and help you organize and reach your goals. Imagine what will happen if you combine your SMART goals with the action plan. Every action you take will be completely aligned with the specific goal.
This action plan template helps you do just that. Edit this template and add your SMART goal and the action steps altogether.
As a business owner, you must always be prepared for emergencies while running the business. These emergencies include hazardous materials spills, fires, natural disasters, and many others. The most effective way of handling a crisis situation is to prepare in advance by creating an emergency action plan.
The emergency action plan template helps you prepare the evacuation plan for your workplace in the event of a natural disaster. Edit this template or use it as is to do as much as possible to keep your employees safe in case of disaster.
The goal of a disciplinary action plan is to warn employees about what is and is not acceptable behavior in the workplace. This is mainly provided to employees during the onboarding process, but you can also use it for existing employees.
Edit this template by filling out the empty spaces with the necessary information and hand it over to the employee you want to warn of unacceptable behavior.
The 30 60 90 day action plan is a structured way of enlisting goals and strategies in 3 steps timeline. Project managers, new hires, sales executives, and many other professionals can use this template to plan the company’s objectives and ensure that the goals are met.
This action plan template includes a 90-day action plan for a tech project split into three parts. The first 30 days show the initial steps, such as discussing project breakdown and planning with clients. Similarly, the next 60 and 90 days include other crucial actions such as quality assurance, bug fixes, feature rollout, final launch, KPI tracking, updates and many more.
Like the 30-60-90 day action plan, the 30-day action plan is a set of steps that you need to take within 30 days to achieve the specific goal. If the project is going to take not more than 30 days or if you want to finish the project in 30 days, this action plan template is perfect for you.
This action plan template also lets you break down the project into three smaller parts to make the actions more realistic and effective. Edit this template to create the perfect 30-day action plan for any type of project you want.
Create a colorful sales action plan using this template. It will help you explain how you will operate and manage the sales process to skyrocket your sales. Set goals to manage your inventory, project sales, expenses, timeline and many others.
Furthermore, the template allows you to set different plans for online and in-store sales, making the template a must-have for your overall sales plan.
Learn more about how Visme can help you close more sales and take your business to the next level.
Are you ready to create an effective action plan and track your progress while executing and running projects? Choose your favorite action plan template from the list above and start editing it using Visme’s professional document creator .
Almost every part of these templates is editable and the easy-to-use drag and drop tool helps you create action plans in a few clicks.
Sign-up for a free account in Visme today and your action plans are just a few clicks away.
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Raja Antony Mandal is a Content Writer at Visme. He can quickly adapt to different writing styles, possess strong research skills, and know SEO fundamentals. Raja wants to share valuable information with his audience by telling captivating stories in his articles. He wants to travel and party a lot on the weekends, but his guitar, drum set, and volleyball court don’t let him.
Conservation planning.
The guidance supporting Conservation Action Planning provides you generic how-to information to guide you through the process of completing and iterating a conservation plan. However, that is not the whole story. Here you will find detailed stories about how a team tackled a step or steps in the process for their project.
To view all CAP related case studies, in the Find Resources box to the left, choose Case Study from the Resource Type drop-down menu and click Submit.
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Consultations with stakeholders helped create a well-rounded sustainable and consumption action plan with broad support.
Goal 12 of the Sustainable Development Goals (SDGs)—ensure sustainable consumption and production patterns—covers a wide range of topics that could facilitate the decoupling of economic growth from natural resource use. Complementary to the concept of sustainable consumption and production (SCP) is that of the circular economy (CE)—requiring the redirection of energy and material flows from a linear to a circular direction, the transformation of waste into productive inputs, and a reduction in pollution and greenhouse gas emissions.
In 2018, supported by an Asian Development Bank technical assistance , the National Economic and Development Authority (NEDA) of the Philippines started formulating an action plan for sustainable consumption and production that supports the country's long-term vision of AmBisyon Natin 2040 —for the average Filipino to have a strongly-rooted , comfortable, secure and peaceful life by 2040. Realizing this vision requires a healthy environment and the sustainable use of natural resources to be achieved whilst pursuing continuous economic progress. However, in talking about a sustainable future for Filipinos, many are still not clear what this looks like and what needs to be done, not only at an institutional level, but also at a community and individual level.
The resulting action plan is the product of a year of research and consultation that helped achieve the following:
1. Understand the issues related to consumption and production in the Philippines, and the applicability of a circular economy model;
2. Identify pathways for intervention, and draft the action plan; and
3. Consult with stakeholders in order to refine the action plan and facilitate its adoption.
Figure 1: Methodology for Development of the Action Plan on Sustainable Consumption and Production Plan
Source: National Economic and Development Authority. 2020. Inputs to the Philippine Action Plan for Sustainable Consumption and Production (PAP4SCP) – Consultant’s Report. Mandaluyong City.
The scoping study which informed the action plan identified that the Philippines faces five key challenges in relation to achieving sustainable consumption and production:
Decisions being made now are locking in resource-intensive consumption and production patterns for generations. The United Nation’s 2030 Agenda for Sustainable Development calls for fundamental changes in the way countries produce and consume goods and services in order to minimize the impact of economic progress on the environment.
An Asian Development Bank stocktake of national responses to the environmental dimensions of the SDGs in Asia and the Pacific, including consideration of SDG 12, notes that this is a complex goal with environmental, social, and economic targets. Achieving it will require collaboration between sectors, such as energy, water, industry, and urban development. The stocktake suggests the need for ministries of finance, economy, planning and industry to share responsibility for SDG 12 with environment ministries or agencies to achieve the necessary integration.
The Philippines is one of the countries in the region developing an appropriate institutional response to SDG 12 through the formulation of an action plan for sustainable consumption and production. The Philippine Development Plan 2017-2022 has sections that address environmental issues. However, the need for an integrated approach where these environmental issues are considered by different sectors alongside the need to address other development objectives remains to be addressed. Following a sustainable consumption and production approach to economic progress should reduce the threats to the state of the environment and natural resources in the Philippines in the long-term.
Figure 2: Aspects of SDG 12
It was envisioned by NEDA that the outcome of changes in the behavior of consumers and producers would result from the adoption of a sustainable consumption and production action plan, as captured in two sub-outcomes, namely: valuing the economic, social, and environmental impacts of production and consumption processes; and enhancing the efficient and equitable resource use of firms, households, and individuals.
The first sub-outcome has two intermediate outcomes: institutionalizing natural capital accounting, and determining ecological limits and negative externalities. It refers to the need for the internalization of the economic, social, and environmental costs and benefits from consumption and production processes, in order to accurately reflect the value of impacts—both costs and benefits—of economic activities on society and the environment. The environmental and social impacts of economic processes must be assessed, and the value of natural capital and ecosystem services recognized and accounted for in order to successfully reach this sub-outcome.
The second sub-outcome has two intermediate outcomes: increased innovation and investment in green technologies and systems, and the establishment of sustainable resource allocation and equitable sharing schemes. Its intent is to initiate and enhance current efforts to promote the efficient and equitable use of resources by different stakeholders, especially firms, households, and individuals. Renewable resources must be utilized within ecological capacities and with negative externalities from extraction minimized; and innovation and investments in green technologies and facilities, and business operations/systems must be increased in order to reach this sub-outcome.
Informed by the findings of a scoping study and a review of applicability of the circular economy model to the Philippines, NEDA identified pathways for intervention under four action types:
Actions and activities required to achieve sustainable consumption and production were then identified, and organized into the following thematic areas:
The actions and activities were further categorized in terms of time frame (short-term, medium-term, and long-term) for planning and budgeting purposes.
Figure 3. Sustainable Consumption and Production Action Plan
The action plan for sustainable consumption and production has received broad support from other national agencies, local governments, private sector, academe, and civil society organizations. Through consultations with stakeholders, the formulation of the action plan has heightened awareness of environmental issues in the Philippines, and galvanized sectoral support for the immediate integration of the action plan into the country’s development plan.
The decision of NEDA to use a participatory approach to formulate the action plan increased awareness, reduced potential objections, and enhanced buy-in from stakeholders. Local governments were involved as NEDA realized early on the need to "localize" the action plan, requiring both horizontal and vertical policy coherence. In addition, it was important to include the private sector.
The creation of an inter-staff group within NEDA to spearhead the consultations and to facilitate the process of refining draft actions and activities enriched the action plan because it benefitted from the perspectives of different sectors. The Philippine Council for Sustainable Development (PCSD) was also reinstated and convened several times to provide overall guidance on, approval and endorsement of the action plan. It had been inactive for a long time, following its establishment to oversee the formulation of the Philippine Agenda 21 immediately after the 1992 Earth Summit, and formulation of the action plan provided a meaningful reason for its reinstatement.
ADB. 2019. Strengthening the Environmental Dimensions of the Sustainable Development Goals in Asia and the Pacific: Stocktake of National Responses to Sustainable Development Goals 12, 14 and 15. Manila: ADB.
ADB and the United Nations Environment Programme. 2019 . Strengthening the Environmental Dimensions of the Sustainable Development Goals in Asia and the Pacific: Tool Compendium . Manila: ADB.
Cruz, G. R. 2017. The Cultural Heritage-Oriented Approach to Economic Development in the Philippines: A Comparative Study of Vigan, Ilocos Sur and Escolta, Manila . Presented at the 10th De La Salle University Arts Congress, Manila.
National Economic and Development Authority. 2017. Philippine Development Plan 2017-2020 . Mandaluyong City: National Economic and Development Authority.
National Economic and Development Authority. 2020. Inputs to the Philippine Action Plan for Sustainable Consumption and Production (PAP4SCP) – Consultant’s Report. Mandaluyong City: National Economic and Development Authority.
United Nations Environment Programme. 2015. Indicators for a Resource Efficient and Green Asia and the Pacific–Measuring Progress of Sustainable Consumption and Production, Green Economy and Resource Efficiency Policies in the Asia-Pacific Region . Bangkok: United Nations Environment Programme.
United Nations Environment Programme. 2015. Sustainable Consumption and Production Global Edition, A Handbook for Policy Makers . Bangkok: United Nations Environment Programme .
Emma Marsden has over 20 years experience in the fields of environmental and sustainability assessment. Her current responsibilities include undertaking environmental safeguard compliance reviews for ADB projects, and managing preparation of the ADB Sustainability Report. Prior to ADB she worked in environmental consultancy, where she managed and coordinated environmental impact assessments, strategic environmental assessments and sustainability appraisals of policies, plans, and projects in the energy, water and urban sectors.
Agustin L. Arcenas obtained his PhD in Agricultural Economics from Michigan State University. He has worked for the World Bank and the World Food Programme. He is currently a professor at the University of the Philippines in Diliman. He has worked on and has written about various environmental and natural resource issues.
Amelia Dulce D. Supetran is an environmental management expert with more than 35 years of experience. She worked in various capacities for the Philippines’ Department of Environment and retired from the United Nations Development Programme after 15 years as team leader. She is currently a Senior Technical Adviser of the Climate Change Commission of the Philippines.
Lisa C. Antonio was executive director of the Philippine Business for the Environment. She also served as director and senior fellow of the Resource Center for Environment and Sustainable Development at the Development Academy of the Philippines, and as faculty of the Ateneo de Manila University Graduate Program on Environmental Management.
Jon Alan Cuyno has more than a decade of experience with Geocycle, the waste management unit of Holcim Philippines, Inc. He has led Geocycle teams handling pre-processing, logistics, strategy development, project and technical management. He holds a Chemical Engineering degree from the University of the Philippines in Los Baños.
The Asian Development Bank is committed to achieving a prosperous, inclusive, resilient, and sustainable Asia and the Pacific, while sustaining its efforts to eradicate extreme poverty. Established in 1966, it is owned by 68 members—49 from the region. Its main instruments for helping its developing member countries are policy dialogue, loans, equity investments, guarantees, grants, and technical assistance.
View the discussion thread.
The views expressed on this website are those of the authors and do not necessarily reflect the views and policies of the Asian Development Bank (ADB) or its Board of Governors or the governments they represent. ADB does not guarantee the accuracy of the data included in this publication and accepts no responsibility for any consequence of their use. By making any designation of or reference to a particular territory or geographic area, or by using the term “country” in this document, ADB does not intend to make any judgments as to the legal or other status of any territory or area.
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Home » Education » Difference Between Action Research and Case Study
Main difference – action research vs case study.
Research is the careful study of a given field or problem in order to discover new facts or principles. Action research and case study are two types of research, which are mainly used in the field of social sciences and humanities. The main difference between action research and case study is their purpose; an action research study aims to solve an immediate problem whereas a case study aims to provide an in-depth analysis of a situation or case over a long period of time.
1. What is Action Research? – Definition, Features, Purpose, Process
2. What is Case Study? – Definition, Features, Purpose, Process
Action research is a type of a research study that is initiated to solve an immediate problem. It may involve a variety of analytical, investigative and evaluative research methods designed to diagnose and solve problems. It has been defined as “a disciplined process of inquiry conducted by and for those taking the action. The primary reason for engaging in action research is to assist the “actor” in improving and/or refining his or her actions” (Sagor, 2000). This type of research is typically used in the field of education. Action research studies are generally conductors by educators, who also act as participants.
Here, an individual researcher or a group of researchers identify a problem, examine its causes and try to arrive at a solution to the problem. The action research process is as follows.
The above process will keep repeating. Action research is also known as cycle of inquiry or cycle of action since it follows a specific process that is repeated over time.
A case study is basically an in-depth examination of a particular event, situation or an individual. It is a type of research that is designed to explore and understand complex issues; however, it involves detailed contextual analysis of only a limited number of events or situations. It has been defined as “an empirical inquiry that investigates a contemporary phenomenon within its real-life context; when the boundaries between phenomenon and context are not clearly evident; and in which multiple sources of evidence are used.” (Yin, 1984)
Case studies are used in a variety of fields, but fields like sociology and education seem to use them the most. They can be used to probe into community-based problems such as illiteracy, unemployment, poverty, and drug addiction.
Case studies involve both quantitative and qualitative data and allow the researchers to see beyond statistical results and understand human conditions. Furthermore, case studies can be classified into three categories, known as exploratory, descriptive and explanatory case studies.
However, case studies are also criticised since the study of a limited number of events or cases cannot easily establish generality or reliability of the findings. The process of a case study is generally as follows:
Action Research : Action research is a type of a research study that is initiated to solve an immediate problem.
Case Study : Case study is an in-depth analysis of a particular event or case over a long period of time.
Action Research : Action research involves solving a problem.
Case Study : Case studies involve observing and analysing a situation.
Action Research : Action research studies are mainly used in the field of education.
Case Study : Case studies are used in many fields; they can be specially used with community problems such as unemployment, poverty, etc.
Action Research : Action research always involve providing a solution to a problem.
Case Study : Case studies do not provide a solution to a problem.
Action Research : Researchers can also act as participants of the research.
Case Study : Researchers generally don’t take part in the research study.
Zainal, Zaidah. Case study as a research method . N.p.: n.p., 7 June 2007. PDF.
Soy, Susan K. (1997). The case study as a research method . Unpublished paper, University of Texas at Austin.
Sagor, Richard. Guiding school improvement with action research . Ascd, 2000.
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BMC Public Health volume 24 , Article number: 2168 ( 2024 ) Cite this article
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Addressing socioeconomic inequalities in health and healthcare, and reducing avoidable hospital admissions requires integrated strategy and complex intervention across health systems. However, the understanding of how to create effective systems to reduce socio-economic inequalities in health and healthcare is limited. The aim was to explore and develop a system’s level understanding of how local areas address health inequalities with a focus on avoidable emergency admissions.
In-depth case study using qualitative investigation (documentary analysis and key informant interviews) in an urban UK local authority. Interviewees were identified using snowball sampling. Documents were retrieved via key informants and web searches of relevant organisations. Interviews and documents were analysed independently based on a thematic analysis approach.
Interviews ( n = 14) with wide representation from local authority ( n = 8), NHS ( n = 5) and voluntary, community and social enterprise (VCSE) sector ( n = 1) with 75 documents (including from NHS, local authority, VCSE) were included. Cross-referenced themes were understanding the local context, facilitators of how to tackle health inequalities: the assets, and emerging risks and concerns. Addressing health inequalities in avoidable admissions per se was not often explicitly linked by either the interviews or documents and is not yet embedded into practice. However, a strong coherent strategic integrated population health management plan with a system’s approach to reducing health inequalities was evident as was collective action and involving people, with links to a “strong third sector”. Challenges reported include structural barriers and threats, the analysis and accessibility of data as well as ongoing pressures on the health and care system.
We provide an in-depth exploration of how a local area is working to address health and care inequalities. Key elements of this system’s working include fostering strategic coherence, cross-agency working, and community-asset based approaches. Areas requiring action included data sharing challenges across organisations and analytical capacity to assist endeavours to reduce health and care inequalities. Other areas were around the resilience of the system including the recruitment and retention of the workforce. More action is required to embed reducing health inequalities in avoidable admissions explicitly in local areas with inaction risking widening the health gap.
• Reducing health inequalities in avoidable hospital admissions is yet to be explicitly linked in practice and is an important area to address.
• Understanding the local context helps to identify existing assets and threats including the leverage points for action.
• Requiring action includes building the resilience of our complex systems by addressing structural barriers and threats as well as supporting the workforce (training and wellbeing with improved retention and recruitment) in addition to the analysis and accessibility of data across the system.
Peer Review reports
The health of our population is determined by the complex interaction of several factors which are either non-modifiable (such as age, genetics) or modifiable (such as the environment, social, economic conditions in which we live, our behaviours as well as our access to healthcare and its quality) [ 1 ]. Health inequalities are the avoidable and unfair systematic differences in health and healthcare across different population groups explained by the differences in distribution of power, wealth and resources which drive the conditions of daily life [ 2 , 3 ]. Essentially, health inequalities arise due to the systematic differences of the factors that influence our health. To effectively deal with most public health challenges, including reducing health inequalities and improving population health, broader integrated approaches [ 4 ] and an emphasis on systems is required [ 5 , 6 ] . A system is defined as ‘the set of actors, activities, and settings that are directly or indirectly perceived to have influence in or be affected by a given problem situation’ (p.198) [ 7 ]. In this case, the ‘given problem situation' is reducing health inequalities with a focus on avoidable admissions. Therefore, we must consider health systems, which are the organisations, resources and people aiming to improve or maintain health [ 8 , 9 ] of which health services provision is an aspect. In this study, the system considers NHS bodies, Integrated Care Systems, Local Authority departments, and the voluntary and community sector in a UK region.
A plethora of theories [ 10 ], recommended policies [ 3 , 11 , 12 , 13 ], frameworks [ 1 , 14 , 15 ], and tools [ 16 ] exist to help understand the existence of health inequalities as well as provide suggestions for improvement. However, it is reported that healthcare leaders feel under-skilled to reduce health inequalities [ 17 ]. A lack of clarity exists on how to achieve a system’s multi-agency coherence to reduce health inequalities systematically [ 17 , 18 ]. This is despite some countries having legal obligations to have a regard to the need to attend to health and healthcare inequalities. For example, the Health and Social Care Act 2012 [ 19 ], in England, mandated Clinical Commissioning Groups (CCGs), now transferred to Integrated Care Boards (ICBs) [ 20 ], to ‘have a regard to the need to reduce inequalities between patients with respect to their ability to access health services, and reduce inequalities between patients with respect to the outcomes achieved for them by the provision of health services’. The wider determinants of health must also be considered. For example, local areas have a mandatory requirement to have a joint strategic needs assessment (JSNA) and joint health and wellbeing strategy (JHWS) whose purpose is to ‘improve the health and wellbeing of the local community and reduce inequalities for all ages' [ 21 ] This includes addressing the wider determinants of health [ 21 ]. Furthermore, the hospital care costs to the NHS associated with socioeconomic inequalities has been previously reported at £4.8 billion a year due to excess hospitalisations [ 22 ]. Avoidable emergency admissions are admissions into hospital that are considered to be preventable with high-quality ambulatory care [ 23 ]. Both ambulatory care sensitive conditions (where effective personalised care based in the community can aid the prevention of needing an admission) and urgent care sensitive conditions (where a system on the whole should be able to treat and manage without an admission) are considered within this definition [ 24 ] (encompassing more than 100 International Classification of Diseases (ICD) codes). The disease burden sits disproportionately with our most disadvantaged communities, therefore highlighting the importance of addressing inequalities in hospital pressures in a concerted manner [ 25 , 26 ].
Research examining one component of an intervention, or even one part of the system, [ 27 ] or which uses specific research techniques to control for the system’s context [ 28 ] are considered as having limited use for identifying the key ingredients to achieve better population health and wellbeing [ 5 , 28 ]. Instead, systems thinking considers how the system’s components and sub-components interconnect and interrelate within and between each other (and indeed other systems) to gain an understanding of the mechanisms by which things work [ 29 , 30 ]. Complex interventions or work programmes may perform differently in varying contexts and through different mechanisms, and therefore cannot simply be replicated from one context to another to automatically achieve the same outcomes. Ensuring that research into systems and systems thinking considers real-world context, such as where individuals live, where policies are created and interventions are delivered, is vital [ 5 ]. How the context and implementation of complex or even simple interventions interact is viewed as becoming increasingly important [ 31 , 32 ]. Case study research methodology is founded on the ‘in-depth exploration of complex phenomena in their natural, or ‘real-life’, settings’ (p.2) [ 33 ]. Case study approaches can deepen the understanding of complexity addressing the ‘how’, ‘what’ and ‘why’ questions in a real-life context [ 34 ]. Researchers have highlighted the importance of engaging more deeply with case-based study methodology [ 31 , 33 ]. Previous case study research has shown promise [ 35 ] which we build on by exploring a systems lens to consider the local area’s context [ 16 ] within which the work is implemented. By using case-study methodology, our study aimed to explore and develop an in-depth understanding of how a local area addresses health inequalities, with a focus on avoidable hospital admissions. As part of this, systems processes were included.
This in-depth case study is part of an ongoing larger multiple (collective [ 36 ]) case study approach. An instrumental approach [ 34 ] was taken allowing an in-depth investigation of an issue, event or phenomenon, in its natural real-life context; referred to as a ‘naturalistic’ design [ 34 ]. Ethics approval was obtained by Newcastle University’s Ethics Committee (ref 13633/2020).
This case study, alongside the other three cases, was purposively [ 36 ] chosen considering overall deprivation level of the area (Indices of Multiple Deprivation (IMD) [ 37 ]), their urban/rural location, differing geographical spread across the UK (highlighted in patient and public feedback and important for considering the North/South health divide [ 38 ]), and a pragmatic judgement of likely ability to achieve the depth of insight required [ 39 ]. In this paper, we report the findings from one of the case studies, an urban local authority in the Northern region of the UK with high levels of socioeconomic disadvantage. This area was chosen for this in-depth case analysis due to high-level of need, and prior to the COVID-19 pandemic (2009-2018) had experienced a trend towards reducing socioeconomic inequalities in avoidable hospital admission rates between neighbourhoods within the local area [ 40 ]. Thereby this case study represents an ‘unusual’ case [ 41 ] to facilitate learning regarding what is reported and considered to be the key elements required to reduce health inequalities, including inequalities in avoidable admissions, in a local area.
The key informants were identified iteratively through the documentary analysis and in consultation with the research advisory group. Initially board level committee members (including lay, managerial, and clinical members) within relevant local organisations were purposively identified. These individuals were systems leaders charged with the remit of tackling health inequalities and therefore well placed to identify both key personnel and documents. Snowball sampling [ 42 ] was undertaken thereafter whereby interviewees helped to identify additional key informants within the local system who were working on health inequalities, including avoidable emergency admissions, at a systems level. Interview questions were based on an iteratively developed topic guide (supplementary data 1), informed from previous work’s findings [ 43 ] and the research advisory network’s input. A study information sheet was emailed to perspective interviewees, and participants were asked to complete an e-consent form using Microsoft Forms [ 42 ]. Each interviewee was interviewed by either L.M. or C.P.-C. using the online platforms Zoom or Teams, and lasted up to one hour. Participants were informed of interviewers’ role, workplace as well as purpose of the study. Interviewees were asked a range of questions including any work relating to reducing health inequalities, particularly avoidable emergency admissions, within the last 5 years. Brief notes were taken, and the interviews were recorded, transcribed verbatim and anonymised.
The documentary analysis followed the READ approach [ 44 ]. Any documents from the relevant local/regional area with sections addressing health inequalities and/or avoidable emergency admissions, either explicitly stated or implicitly inferred, were included. A list of core documents was chosen, including the local Health and Wellbeing Strategy (Table 1 ). Subsequently, other documents were identified by snowballing from these core documents and identification by the interviewees. All document types were within scope if produced/covered a period within 5 years (2017-2022), including documents in the public domain or not as well as documents pertaining to either a regional, local and neighbourhood level. This 5-year period was a pragmatic decision in line with the interviews and considered to be a balance of legacy and relevance. Attempts were made to include the final version of each document, where possible/applicable, otherwise the most up-to-date version or version available was used.
An Excel spreadsheet data extraction tool was adapted with a priori criteria [ 44 ] to extract the data. This tool included contextual information (such as authors, target area and document’s purpose). Also, information based on previous research on addressing socioeconomic inequalities in avoidable emergency admissions, such as who stands to benefit, was extracted [ 43 ]. Additionally, all documents were summarised according to a template designed according to the research’s aims. Data extraction and summaries were undertaken by L.M. and C.P.-C. A selection was doubled coded to enhance validity and any discrepancies were resolved by discussion.
Interviews and documents were coded and analysed independently based on a thematic analysis approach [ 45 ], managed by NVivo software. A combination of ‘interpretive’ and ‘positivist’ stance [ 34 , 46 ] was taken which involved understanding meanings/contexts and processes as perceived from different perspectives (interviewees and documents). This allowed for an understanding of individual and shared social meanings/reasonings [ 34 , 36 ]. For the documentary analysis, a combination of both content and thematic analysis as described by Bowen [ 47 ] informed by Braun and Clarke’s approach to thematic analysis [ 45 ] was used. This type of content analysis does not include the typical quantification but rather a review of the document for pertinent and meaningful passages of text/other data [ 47 ]. Both an inductive and deductive approach for the documentary analysis’ coding [ 46 , 47 ] was chosen. The inductive approach was developed a posteriori; the deductive codes being informed by the interviews and previous findings from research addressing socioeconomic inequalities in avoidable emergency admissions [ 43 ]. In line with qualitative epistemological approach to enquiry, the interview and documentary findings were viewed as ‘truths’ in themselves with the acceptance that multiple realities can co-exist [ 48 ]. The analysis of each set of themes (with subthemes) from the documentary analysis and interviews were cross-referenced and integrated with each other to provide a cohesive in-depth analysis [ 49 ] by generating thematic maps to explore the relationships between the themes. The codes, themes and thematic maps were peer-reviewed continually with regular meetings between L.M., C.P.-C., J.L. and S.S. Direct quotes are provided from the interviews and documentary analysis. Some quotes from the documents are paraphrased to protect anonymity of the case study after following a set process considering a range of options. This involved searching each quote from the documentary analysis in Google and if the quote was found in the first page of the result, we shortened extracts and repeated the process. Where the shortened extracts were still identifiable, we were required to paraphrase that quote. Each paraphrased quote and original was shared and agreed with all the authors reducing the likelihood of inadvertently misinterpreting or misquoting. Where multiple components over large bodies of text were present in the documents, models were used to evidence the broadness, for example, using Dahlgren’s and Whitehead’s model of health determinants [ 1 ]. Due to the nature of the study, transcripts and findings were not shared with participants for checking but will be shared in a dissemination workshop in 2024.
Four public contributors from the National Institute for Health and Care Research (NIHR) Research Design Service (RDS) North East and North Cumbria (NENC) Public and Patient Involvement (PPI) panel have been actively engaged in this research from its inception. They have been part of the research advisory group along with professional stakeholders and were involved in the identification of the sampling frame’s key criteria. Furthermore, a diverse group of public contributors has been actively involved in other parts of the project including developing the moral argument around action by producing a public facing resource exploring what health inequalities mean to people and public views of possible solutions [ 50 ].
Sixteen participants working in health or social care, identified through the documentary analysis or snowballing, were contacted for interview; fourteen consented to participate. No further interviews were sought as data sufficiency was reached whereby no new information or themes were being identified. Participant roles were broken down by NHS ( n = 5), local authority/council ( n = 8), and voluntary, community and social enterprise (VSCE) ( n = 1). To protect the participants’ anonymity, their employment titles/status are not disclosed. However, a broad spectrum of interviewees with varying roles from senior health system leadership (including strategic and commissioner roles) to roles within provider organisations and the VSCE sector were included.
75 documents were reviewed with documents considering regional ( n = 20), local ( n = 64) or neighbourhood ( n = 2) area with some documents covering two or more areas. Table 2 summarises the respective number of each document type which included statutory documents to websites from across the system (NHS, local government and VSCE). 45 documents were named by interviewees and 42 documents were identified as either a core document or through snowballing from other documents. Of these, 12 documents were identified from both. The timescales of the documents varied and where possible to identify, was from 2014 to 2031.
The overarching themes encompass:
Facilitators to tacking health inequalities: the assets
Figure 1 demonstrates the relationships between the main themes identified from the analysis for tackling health inequalities and improving health in this case study.
Diagram of the relationship between the key themes identified regarding tackling health inequalities and improving health in a local area informed by 2 previous work [ 14 , 51 ]. NCDs = non-communicable diseases; HI = health inequalities
Understanding the local context was discussed extensively in both the documents and the interviews. This was informed by local intelligence and data that was routinely collected, monitored, and analysed to help understand the local context and where inequalities lie. More bespoke, in-depth collection and analysis were also described to get a better understanding of the situation. This not only took the form of quantitative but also considered qualitative data with lived experience:
‛So, our data comes from going out to talk to people. I mean, yes, especially the voice of inequalities, those traditional mechanisms, like surveys, don't really work. And it's about going out to communities, linking in with third sector organisations, going out to communities, and just going out to listen…I think the more we can bring out those real stories. I mean, we find quotes really, really powerful in terms of helping people understand what it is that matters.’ (LP16).
However, there were limitations to the available data including the quality as well as having enough time to do the analysis justice. This resulted in difficulties in being able to fully understand the context to help identify and act on the required improvements.
‘A lack of available data means we cannot quantify the total number of vulnerable migrants in [region]’ (Document V).
‛So there’s lots of data. The issue is joining that data up and analysing it, and making sense of it. That’s where we don’t have the capacity.’ (LP15).
Despite the caveats, understanding the context and its data limitations were important to inform local priorities and approaches on tackling health inequalities. This understanding was underpinned by three subthemes which were understanding:
the population’s needs including identification of people at higher risk of worse health and health inequalities
the driving forces of those needs with acknowledgement of the impact of the wider determinants of health
the threats and barriers to physical and mental health, as well as wellbeing
Firstly, the population’s needs, including identification of people at higher risk of worse health and health inequalities, was important. This included considering risk factors, such as smoking, specific groups of people and who was presenting with which conditions. Between the interviews and documents, variation was seen between groups deemed at-risk or high-risk with the documents identifying a wider range. The groups identified across both included marginalised communities, such as ethnic minority groups, gypsy and travellers, refugees and asylum seekers as well as people/children living in disadvantaged area.
‘There are significant health inequalities in children with asthma between deprived and more affluent areas, and this is reflected in A&E admissions.' (Document J).
Secondly, the driving forces of those needs with acknowledgement of the impact of the wider determinants of health were described. These forces mapped onto Dahlgren’s and Whitehead’s model of health determinants [ 1 ] consisting of individual lifestyle factors, social and community networks, living and working conditions (which include access to health care services) as well as general socio-economic, cultural and environmental conditions across the life course.
…. at the centre of our approach considering the requirements to improve the health and wellbeing of our area are the wider determinants of health and wellbeing, acknowledging how factors, such as housing, education, the environment and economy, impact on health outcomes and wellbeing over people’s lifetime and are therefore pivotal to our ambition to ameliorate the health of the poorest the quickest. (Paraphrased Document P).
Thirdly, the threats and barriers to health included environmental risks, communicable diseases and associated challenges, non-communicable conditions and diseases, mental health as well as structural barriers. In terms of communicable diseases, COVID-19 predominated. The environmental risks included climate change and air pollution. Non-communicable diseases were considered as a substantial and increasing threat and encompassed a wide range of chronic conditions such as diabetes, and obesity.
‛Long term conditions are the leading causes of death and disability in [case study] and account for most of our health and care spending. Cases of cancer, diabetes, respiratory disease, dementia and cardiovascular disease will increase as the population of [case study] grows and ages.’ (Document A).
Structural barriers to accessing and using support and/or services for health and wellbeing were identified. These barriers included how the services are set up, such as some GP practices asking for proof of a fixed address or form of identification to register. For example:
Complicated systems (such as having to make multiple calls, the need to speak to many people/gatekeepers or to call at specific time) can be a massive barrier to accessing healthcare and appointments. This is the case particularly for people who have complex mental health needs or chaotic/destabilized circumstances. People who do not have stable housing face difficulties in registering for GP and other services that require an address or rely on post to communicate appointments. (Paraphrased Document R).
A structural threat regarding support and/or services for health and wellbeing was the sustainability of current funding with future uncertainty posing potential threats to the delivery of current services. This also affected the ability to adapt and develop the services, or indeed build new ones.
‛I would say the other thing is I have a beef [sic] [disagreement] with pilot studies or new innovations. Often soft funded, temporary funded, charity funded, partnership work run by enthusiasts. Me, I've done them, or supported people doing many of these. And they're great. They can make a huge impact on the individuals involved on that local area. You can see fantastic work. You get inspired and you want to stand up in a crowd and go, “Wahey, isn't this fantastic?” But actually the sad part of it is on these things, I've seen so many where we then see some good, positive work being done, but we can't make it permanent or we can't spread it because there's no funding behind it.’ (LP8).
The facilitators for improving health and wellbeing and tackling health inequalities are considered as assets which were underpinned by values and principles.
Being values driven was an important concept and considered as the underpinning attitudes or beliefs that guide decision making [ 52 ]. Particularly, the system’s approach was underpinned by a culture and a system's commitment to tackle health inequalities across the documents and interviews. This was also demonstrated by how passionately and emotively some interviewees spoke about their work.
‛There's a really strong desire and ethos around understanding that we will only ever solve these problems as a system, not by individual organisations or even just part of the system working together. And that feels great.’ (LP3).
Other values driving the approach included accountability, justice, and equity. Reducing health inequalities and improving health were considered to be the right things to do. For example:
We feel strongly about social justice and being inclusive, wishing to reflect the diversity of [case study]. We campaign on subjects that are important to people who are older with respect and kindness. (Paraphrased Document O).
Four key principles were identified that crosscut the assets which were:
Shared vision
Strong partnership
Asset-based approaches
Willingness and ability to act on learning
The mandated strategy, identifying priorities for health and wellbeing for the local population with the required actions, provided the shared vision across each part of the system, and provided the foundations for the work. This shared vision was repeated consistently in the documents and interviews from across the system.
[Case study] will be a place where individuals who have the lowest socioeconomic status will ameliorate their health the quickest. [Case study] will be a place for good health and compassion for all people, regardless of their age. (Paraphrased Document A).
‛One thing that is obviously becoming stronger and stronger is the focus on health inequalities within all of that, and making sure that we are helping people and provide support to people with the poorest health as fast as possible, so that agenda hasn’t shifted.’ (LP7).
This drive to embed the reduction of health inequalities was supported by clear new national guidance encapsulated by the NHS Core20PLUS5 priorities. Core20PLUS5 is the UK's approach to support a system to improve their healthcare inequalities [ 53 ]. Additionally, the system's restructuring from Clinical Commissioning Groups (CCGs) to Integrated Care Boards (ICBs) and formalisation of the now statutory Integrated Care Systems (ICS) in England was also reported to facilitate the driving of further improvement in health inequalities. These changes at a regional and local level helped bring key partners across the system (NHS and local government among others) to build upon their collective responsibility for improving health and reducing health inequalities for their area [ 54 ].
‛I don’t remember the last time we’ve had that so clear, or the last time that health inequalities has had such a prominent place, both in the NHS planning guidance or in the NHS contract. ’ (LP15). ‛The Health and Care Act has now got a, kind of, pillar around health inequalities, the new establishment of ICPs and ICBs, and also the planning guidance this year had a very clear element on health inequalities.’ (LP12)
A strong partnership and collaborative team approach across the system underpinned the work from the documents and included the reoccurrence of the concept that this case study acted as one team: ‘Team [case study]'.
Supporting one another to ensure [case study] is the best it can be: Team [case study]. It involves learning, sharing ideas as well as organisations sharing assets and resources, authentic partnerships, and striving for collective impact (environmental and social) to work towards shared goals . (Paraphrased Document B).
This was corroborated in the interviews as working in partnership to tackle health inequalities was considered by the interviewees as moving in the right direction. There were reports that the relationship between local government, health care and the third sector had improved in recent years which was still an ongoing priority:
‘I think the only improvement I would cite, which is not an improvement in terms of health outcomes, but in terms of how we work across [case study] together has moved on quite a lot, in terms of teams leads and talking across us, and how we join up on things, rather than see ourselves all as separate bodies' (LP15).
‘I think the relationship between local authorities and health and the third sector, actually, has much more parity and esteem than it had before.' (LP11)
The approaches described above were supported by all health and care partners signing up to principles around partnership; it is likely this has helped foster the case study's approach. This also builds on the asset-based approaches that were another key principle building on co-production and co-creation which is described below.
We begin with people : instead of doing things to people or for them, we work with them, augmenting the skills, assets and strength of [case study]’s people, workforce and carers. We achieve : actions are focused on over words and by using intelligence, every action hones in on the actual difference that we will make to ameliorate outcomes, quality and spend [case study]’s money wisely; We are Team [case study ]: having kindness, working as one organisation, taking responsibility collectively and delivering on what we agreed. Problems are discussed with a high challenge and high support attitude. (Paraphrased Document D).
At times, the degree to which the asset-based approaches were embedded differed from the documents compared to the interviews, even when from the same part of the system. For example, the documents often referred to the asset-based approach as having occurred whilst interviewees viewed it more as a work in progress.
‘We have re-designed many of our services to focus on needs-led, asset-based early intervention and prevention, and have given citizens more control over decisions that directly affect them .’ (Document M).
‘But we’re trying to take an asset-based approach, which is looking at the good stuff in communities as well. So the buildings, the green space, the services, but then also the social capital stuff that happens under the radar.’ (LP11).
A willingness to learn and put in action plans to address the learning were present. This enables future proofing by building on what is already in place to build the capacity, capability and flexibility of the system. This was particularly important for developing the workforce as described below.
‘So we’ve got a task and finish group set up, […] So this group shows good practice and is a space for people to discuss some of the challenges or to share what interventions they are doing around the table, and also look at what other opportunities that they have within a region or that we could build upon and share and scale.’ (LP12).
These assets that are considered as facilitators are divided into four key levels which are the system, services and support, communities and individuals, and workforce which are discussed in turn below.
Firstly, the system within this case study was made up of many organisations and partnerships within the NHS, local government, VSCE sector and communities. The interviewees reported the presence of a strong VCSE sector which had been facilitated by the local council's commitment to funding this sector:
‘Within [case study], we have a brilliant third sector, the council has been longstanding funders of infrastructure in [case study], third sector infrastructure, to enable those links [of community engagement] to be made' (LP16).
In both the documents and interviews, a strong coherent strategic integrated population health management plan with a system’s approach to embed the reduction of health inequalities was evident. For example, on a system level regionally:
‘To contribute towards a reduction in health inequalities we will: take a system wide approach for improving outcomes for specific groups known to be affected by health inequalities, starting with those living in our most deprived communities….’ (Document H).
This case study’s approach within the system included using creative solutions and harnessing technology. This included making bold and inventive changes to improve how the city and the system linked up and worked together to improve health. For example, regeneration work within the city to ameliorate and transform healthcare facilities as well as certain neighbourhoods by having new green spaces, better transport links in order to improve city-wide innovation and collaboration (paraphrased Document F) were described. The changes were not only related to physical aspects of the city but also aimed at how the city digitally linked up. Being a leader in digital innovation to optimise the health benefits from technology and information was identified in several documents.
‘ Having the best connected city using digital technology to improve health and wellbeing in innovative ways.’ (Document G).
The digital approaches included ongoing development of a digitalised personalised care record facilitating access to the most up-to-date information to developing as well as having the ‘ latest, cutting edge technologies’ ( Document F) in hospital care. However, the importance of not leaving people behind by embedding digital alternatives was recognised in both the documents and interviews.
‘ We are trying to just embed the culture of doing an equity health impact assessment whenever you are bringing in a digital solution or a digital pathway, and that there is always an alternative there for people who don’t have the capability or capacity to use it. ’ (LP1).
The successful one hundred percent [redacted] programme is targeting some of our most digitally excluded citizens in [case study]. For our city to continue to thrive, we all need the appropriate skills, technology and support to get the most out of being online. (Paraphrased Document Q)
This all links in with the system that functions in a ‘place' which includes the importance of where people are born, grow, work and live. Working towards this place being welcoming and appealing was described both regionally and locally. This included aiming to make the case study the place of choice for people.
‘Making [case study] a centre for good growth becoming the place of choice in the UK to live, to study, for businesses to invest in, for people to come and work.’ (Document G).
Secondly, a variety of available services and support were described from the local authority, NHS, and voluntary community sectors. Specific areas of work, such as local initiatives (including targeted work or campaigns for specific groups or specific health conditions) as well as parts of the system working together with communities collaboratively, were identified. This included a wide range of work being done such as avoiding delayed discharges or re-admissions, providing high quality affordable housing as well as services offering peer support.
‘We have a community health development programme called [redacted], that works with particular groups in deprived communities and ethnically diverse communities to work in a very trusted and culturally appropriate way on the things that they want to get involved with to support their health.’ (LP3 ).
It is worth noting that reducing health inequalities in avoidable admissions was not often explicitly specified in the documents or interviews. However, either specified or otherwise inferred, preventing ill health and improving access, experience, and outcomes were vital components to addressing inequalities. This was approached by working with communities to deliver services in communities that worked for all people. Having co-designed, accessible, equitable integrated services and support appeared to be key.
‘Reducing inequalities in unplanned admissions for conditions that could be cared for in the community and access to planned hospital care is key.’ (Document H)
Creating plans with people: understanding the needs of local population and designing joined-up services around these needs. (Paraphrased Document A).
‘ So I think a core element is engagement with your population, so that ownership and that co-production, if you're going to make an intervention, don't do it without because you might miss the mark. ’ (LP8).
Clear, consistent and appropriate communication that was trusted was considered important to improve health and wellbeing as well as to tackle health inequalities. For example, trusted community members being engaged to speak on the behalf of the service providers:
‘The messenger is more important than the message, sometimes.’ (LP11).
This included making sure the processes are in place so that the information is accessible for all, including people who have additional communication needs. This was considered as a work in progress in this case study.
‘I think for me, things do come down to those core things, of health, literacy, that digital exclusion and understanding the wider complexities of people.’ (LP12)
‘ But even more confusing if you've got an additional communication need. And we've done quite a lot of work around the accessible information standard which sounds quite dry, and doesn't sound very- but actually, it's fundamental in accessing health and care. And that is, that all health and care organisations should record your communication preferences. So, if I've got a learning disability, people should know. If I've got a hearing impairment, people should know. But the systems don’t record it, so blind people are getting sent letters for appointments, or if I've got hearing loss, the right provisions are not made for appointments. So, actually, we're putting up barriers before people even come in, or can even get access to services.’ (LP16).
Flexible, empowering, holistic care and support that was person-centric was more apparent in the documents than the interviews.
At the centre of our vision is having more people benefiting from the life chances currently enjoyed by the few to make [case study] a more equal place. Therefore, we accentuate the importance of good health, the requirement to boost resilience, and focus on prevention as a way of enabling higher quality service provision that is person-centred. [Paraphrased Document N).
Through this [work], we will give all children and young people in [case study], particularly if they are vulnerable and/or disadvantaged, a start in life that is empowering and enable them to flourish in a compassionate and lively city. [Paraphrased Document M].
Thirdly, having communities and individuals at the heart of the work appeared essential and viewed as crucial to nurture in this case study. The interconnectedness of the place, communities and individuals were considered a key part of the foundations for good health and wellbeing.
In [case study], our belief is that our people are our greatest strength and our most important asset. Wellbeing starts with people: our connections with our friends, family, and colleagues, our behaviour, understanding, and support for one another, as well as the environment we build to live in together . (Paraphrased Document A).
A recognition of the power of communities and individuals with the requirement to support that key principle of a strength-based approach was found. This involved close working with communities to help identify what was important, what was needed and what interventions would work. This could then lead to improved resilience and cohesion.
‛You can't make effective health and care decisions without having the voice of people at the centre of that. It just won't work. You won't make the right decisions.’ (LP16).
‘Build on the strengths in ourselves, our families, carers and our community; working with people, actively listening to what matters most to people, with a focus on what’s strong rather than what’s wrong’ (Document G).
Meaningful engagement with communities as well as strengths and asset-based approaches to ensure self-sufficiency and sustainability of communities can help communities flourish. This includes promoting friendships, building community resilience and capacity, and inspiring residents to find solutions to change the things they feel needs altering in their community . (Paraphrased Document B).
This close community engagement had been reported to foster trust and to lead to improvements in health.
‘But where a system or an area has done a lot of community engagement, worked really closely with the community, gained their trust and built a programme around them rather than just said, “Here it is. You need to come and use it now,” you can tell that has had the impact. ' (LP1).
Finally, workforce was another key asset; the documents raised the concept of one workforce across health and care. The key principles of having a shared vision, asset-based approaches and strong partnership were also present in this example:
By working together, the Health and Care sector makes [case study] the best area to not only work but also train for people of all ages. Opportunities for skills and jobs are provided with recruitment and engagement from our most disadvantaged communities, galvanizing the future’s health and care workforce. By doing this, we have a very skilled and diverse workforce we need to work with our people now as well as in the future. (Paraphrased Document E).
An action identified for the health and care system to address health inequalities in case study 1 was ‘ the importance of having an inclusive workforce trained in person-centred working practices ’ (Document R). Several ways were found to improve and support workforce skills development and embed awareness of health inequalities in practice and training. Various initiatives were available such as an interactive health inequalities toolkit, theme-related fellowships, platforms and networks to share learning and develop skills.
‛We've recently launched a [redacted] Fellowship across [case study’s region], and we've got a number of clinicians and managers on that………. We've got training modules that we've put on across [case study’s region], as well for health inequalities…we've got learning and web resources where we share good practice from across the system, so that is our [redacted] Academy.’ (LP2).
This case study also recognised the importance of considering the welfare of the workforce; being skilled was not enough. This had been recognised pre-pandemic but was seen as even more important post COVID-19 due to the impact that COVID-19 had on staff, particularly in health and social care.
‛The impacts of the pandemic cannot be underestimated; our colleagues and services are fatigued and still dealing with the pressures. This context makes it even more essential that we share the responsibility, learn from each other at least and collaborate with each other at best, and hold each other up to be the best we can.’ (Document U).
Concerns were raised such as the widening of health inequalities since the pandemic and cost of living crisis. Post-pandemic and Brexit, recruiting health, social care and third sector staff was compounding the capacity throughout this already heavily pressurised system.
In [case study], we have seen the stalling of life expectancy and worsening of the health inequality gap, which is expected to be compounded by the effects of the pandemic. (Paraphrased Document T)
‘I think key barriers, just the immense pressure on the system still really […] under a significant workload, catching up on activity, catching up on NHS Health Checks, catching up on long-term condition reviews. There is a significant strain on the system still in terms of catching up. It has been really difficult because of the impact of COVID.’ (LP7).
‘Workforce is a challenge, because the pipelines that we’ve got, we’ve got fewer people coming through many of them. And that’s not just particular to, I don't know, nursing, which is often talking talked [sic] about as a challenged area, isn't it? And of course, it is. But we’ve got similar challenges in social care, in third sector.’ (LP5).
The pandemic was reported to have increased pressures on the NHS and services not only in relation to staff capacity but also regarding increases in referrals to services, such as mental health. Access to healthcare changed during the pandemic increasing barriers for some:
‘I think people are just confused about where they're supposed to go, in terms of accessing health and care at the moment. It's really complex to understand where you're supposed to go, especially, at the moment, coming out of COVID, and the fact that GPs are not the accessible front door. You can't just walk into your GP anymore.’ (LP16).
‘Meeting this increased demand [for work related to reducing ethnic inequalities in mental health] is starting to prove a challenge and necessitates some discussion about future resourcing.’ (Document S)
Several ways were identified to aid effective adaptation and/or mitigation. This included building resilience such as developing the existing capacity, capability and flexibility of the system by learning from previous work, adapting structures and strengthening workforce development. Considerations, such as a commitment to Marmot Principles and how funding could/would contribute, were also discussed.
The funding’s [linked to Core20PLUS5] purpose is to help systems to ensure that health inequalities are not made worse when cost-savings or efficiencies are sought…The available data and insight are clear and [health inequalities are] likely to worsen in the short term, the delays generated by pandemic, the disproportionate effect of that on the most deprived and the worsening food and fuel poverty in all our places. (Paraphrased Document L).
Learning from the pandemic was thought to be useful as some working practices had altered during COVID-19 for the better, such as needing to continue to embed how the system had collaborated and resist old patterns of working:
‘So I think that emphasis between collaboration – extreme collaboration – which is what we did during COVID is great. I suppose the problem is, as we go back into trying to save money, we go back into our old ways of working, about working in silos. And I think we’ve got to be very mindful of that, and continue to work in a different way.’ (LP11).
Another area identified as requiring action, was the collection, analysis, sharing and use of data accessible by the whole system.
‘So I think there is a lot of data out there. It’s just how do we present that in such a way that it’s accessible to everyone as well, because I think sometimes, what happens is that we have one group looking at data in one format, but then how do we cascade that out?’ (LP12)
We aimed to explore a system’s level understanding of how a local area addresses health inequalities with a focus on avoidable emergency admissions using a case study approach. Therefore, the focus of our research was strategic and systematic approaches to inequalities reduction. Gaining an overview of what was occurring within a system is pertinent because local areas are required to have a regard to address health inequalities in their local areas [ 20 , 21 ]. Through this exploration, we also developed an understanding of the system's processes reported to be required. For example, an area requiring action was viewed as the accessibility and analysis of data. The case study described having health inequalities ‘at the heart of its health and wellbeing strategy ’ which was echoed across the documents from multiple sectors across the system. Evidence of a values driven partnership with whole systems working was centred on the importance of place and involving people, with links to a ‘strong third sector ’ . Working together to support and strengthen local assets (the system, services/support, communities/individuals, and the workforce) were vital components. This suggested a system’s committed and integrated approach to improve population health and reduce health inequalities as well as concerted effort to increase system resilience. However, there was juxtaposition at times with what the documents contained versus what interviewees spoke about, for example, the degree to which asset-based approaches were embedded.
Furthermore, despite having a priori codes for the documentary analysis and including specific questions around work being undertaken to reduce health inequalities in avoidable admissions in the interviews with key systems leaders, this explicit link was still very much under-developed for this case study. For example, how to reduce health inequalities in avoidable emergency admissions was not often specified in the documents but could be inferred from existing work. This included work around improving COVID-19 vaccine uptake in groups who were identified as being at high-risk (such as older people and socially excluded populations) by using local intelligence to inform where to offer local outreach targeted pop-up clinics. This limited explicit action linking reduction of health inequalities in avoidable emergency admissions was echoed in the interviews and it became clear as we progressed through the research that a focus on reduction of health inequalities in avoidable hospital admissions at a systems level was not a dominant aspect of people’s work. Health inequalities were viewed as a key part of the work but not necessarily examined together with avoidable admissions. A strengthened will to take action is reported, particularly around reducing health inequalities, but there were limited examples of action to explicitly reduce health inequalities in avoidable admissions. This gap in the systems thinking is important to highlight. When it was explicitly linked, upstream strategies and thinking were acknowledged as requirements to reduce health inequalities in avoidable emergency admissions.
Similar to our findings, other research have also found networks to be considered as the system’s backbone [ 30 ] as well as the recognition that communities need to be central to public health approaches [ 51 , 55 , 56 ]. Furthermore, this study highlighted the importance of understanding the local context by using local routine and bespoke intelligence. It demonstrated that population-based approaches to reduce health inequalities are complex, multi-dimensional and interconnected. It is not about one part of the system but how the whole system interlinks. The interconnectedness and interdependence of the system (and the relevant players/stakeholders) have been reported by other research [ 30 , 57 ], for example without effective exchange of knowledge and information, social networks and systems do not function optimally [ 30 ]. Previous research found that for systems to work effectively, management and transfer of knowledge needs to be collaborative [ 30 ], which was recognised in this case study as requiring action. By understanding the context, including the strengths and challenges, the support or action needed to overcome the barriers can be identified.
There are very limited number of case studies that explore health inequalities with a focus on hospital admissions. Of the existing research, only one part of the health system was considered with interviews looking at data trends [ 35 ]. To our knowledge, this research is the first to build on this evidence by encompassing the wider health system using wider-ranging interviews and documentary analysis. Ford et al. [ 35 ] found that geographical areas typically had plans to reduce total avoidable emergency admissions but not comprehensive plans to reduce health inequalities in avoidable emergency admissions. This approach may indeed widen health inequalities. Health inequalities have considerable health and costs impacts. Pertinently, the hospital care costs associated with socioeconomic inequalities being reported as £4.8 billion a year, mainly due to excess hospitalisations such as avoidable admissions [ 58 ] and the burden of disease lies disproportionately with our most disadvantaged communities, addressing inequalities in hospital pressures is required [ 25 , 26 ].
Improvements to life expectancy have stalled in the UK with a widening of health inequalities [ 12 ]. Health inequalities are not inevitable; it is imperative that the health gap between the deprived and affluent areas is narrowed [ 12 ]. This research demonstrates the complexity and intertwining factors that are perceived to address health inequalities in an area. Despite the evidence of the cost (societal and individual) of avoidable admissions, explicit tackling of inequality in avoidable emergency admissions is not yet embedded into the system, therefore highlights an area for policy and action. This in-depth account and exploration of the characteristics of ‘whole systems’ working to address health inequalities, including where challenges remain, generated in this research will be instrumental for decision makers tasked with addressing health and care inequalities.
This research informs the next step of exploring each identified theme in more detail and moving beyond description to develop tools, using a suite of multidimensional and multidisciplinary methods, to investigate the effects of interventions on systems as previously highlighted by Rutter et al. [ 5 ].
Documentary analysis is often used in health policy research but poorly described [ 44 ]. Furthermore, Yin reports that case study research is often criticised for not adhering to ‘systematic procedures’ p. 18 [ 41 ]. A clear strength of this study was the clearly defined boundary (in time and space) case as well as following a defined systematic approach, with critical thought and rationale provided at each stage [ 34 , 41 ]. A wide range and large number of documents were included as well as interviewees from across the system thereby resulting in a comprehensive case study. Integrating the analysis from two separate methodologies (interviews and documentary analysis), analysed separately before being combined, is also a strength to provide a coherent rich account [ 49 ]. We did not limit the reasons for hospital admission to enable a broad as possible perspective; this is likely to be a strength in this case study as this connection between health inequalities and avoidable hospital admissions was still infrequently made. However, for example, if a specific care pathway for a health condition had been highlighted by key informants this would have been explored.
Due to concerns about identifiability, we took several steps. These included providing a summary of the sectors that the interviewees and document were from but we were not able to specify which sectors each quote pertained. Additionally, some of the document quotes required paraphrasing. However, we followed a set process to ensure this was as rigorous as possible as described in the methods section. For example, where we were required to paraphrase, each paraphrased quote and original was shared and agreed with all the authors to reduce the likelihood to inadvertently misinterpreting or misquoting.
The themes are unlikely to represent an exhaustive list of the key elements requiring attention, but they represent the key themes that were identified using a robust methodological process. The results are from a single urban local authority with high levels of socioeconomic disadvantage in the North of England which may limit generalisability to different contexts. However, the findings are still generalisable to theoretical considerations [ 41 ]. Attempts to integrate a case study with a known framework can result in ‘force-fit’ [ 34 ] which we avoided by developing our own framework (Fig. 1 ) considering other existing models [ 14 , 59 ]. The results are unable to establish causation, strength of association, or direction of influence [ 60 ] and disentangling conclusively what works versus what is thought to work is difficult. The documents’ contents may not represent exactly what occurs in reality, the degree to which plans are implemented or why variation may occur or how variation may affect what is found [ 43 , 61 ]. Further research, such as participatory or non-participatory observation, could address this gap.
This case study provides an in-depth exploration of how local areas are working to address health and care inequalities, with a focus on avoidable hospital admissions. Key elements of this system’s reported approach included fostering strategic coherence, cross-agency working, and community-asset based working. An area requiring action was viewed as the accessibility and analysis of data. Therefore, local areas could consider the challenges of data sharing across organisations as well as the organisational capacity and capability required to generate useful analysis in order to create meaningful insights to assist work to reduce health and care inequalities. This would lead to improved understanding of the context including where the key barriers lie for a local area. Addressing structural barriers and threats as well as supporting the training and wellbeing of the workforce are viewed as key to building resilience within a system to reduce health inequalities. Furthermore, more action is required to embed reducing health inequalities in avoidable admissions explicitly in local areas with inaction risking widening the health gap.
Individual participants’ data that underlie the results reported in this article and a data dictionary defining each field in the set are available to investigators whose proposed use of the data has been approved by an independent review committee for work. Proposals should be directed to [email protected] to gain access, data requestors will need to sign a data access agreement. Such requests are decided on a case by case basis.
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Thanks to our Understanding Factors that explain Avoidable hospital admission Inequalities - Research study (UNFAIR) PPI contributors, for their involvement in the project particularly in the identification of the key criteria for the sampling frame. Thanks to the research advisory team as well.
Informed consent was obtained from all subjects involved in the study.
The manuscript is not currently under consideration or published in another journal. All authors have read and approved the final manuscript.
This research was funded by the National Institute for Health and Care Research (NIHR), grant number (ref CA-CL-2018-04-ST2-010). The funding body was not involved in the study design, collection of data, inter-pretation, write-up, or submission for publication. The views expressed are those of the authors and not necessarily those of the NIHR, the Department of Health and Social Care or Newcastle University.
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Faculty of Medical Sciences, Public Health Registrar, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
Charlotte Parbery-Clark
Post-Doctoral Research Associate, Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
Lorraine McSweeney
Senior Research Methodologist & Public Involvement Lead, Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
Joanne Lally
Senior Clinical Lecturer &, Faculty of Medical Sciences, Honorary Consultant in Public Health, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
Sarah Sowden
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Conceptualization - J.L. and S.S.; methodology - C.P.-C., J.L. & S.S.; formal analysis - C. P.-C. & L.M.; investigation- C. P.-C. & L.M., resources, writing of draft manuscript - C.P.-C.; review and editing manuscript L.M., J.L., & S.S.; visualization including figures and tables - C.P.-C.; supervision - J.L. & S.S.; project administration - L.M. & S.S.; funding acquisition - S.S. All authors have read and agreed to the published version of the manuscript.
Correspondence to Charlotte Parbery-Clark or Sarah Sowden .
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The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board (or Ethics Committee) of Newcastle University (protocol code 13633/2020 on the 12 th of July 2021).
The authors declare no competing interests.
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Parbery-Clark, C., McSweeney, L., Lally, J. et al. How can health systems approach reducing health inequalities? An in-depth qualitative case study in the UK. BMC Public Health 24 , 2168 (2024). https://doi.org/10.1186/s12889-024-19531-5
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DOI : https://doi.org/10.1186/s12889-024-19531-5
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Background: Short-term exposure to particulate matter air pollution has been associated with the exacerbations of COPD, but its association with COPD mortality was not fully elucidated. We aimed to assess the association between short-term particulate matter exposure and the risk of COPD mortality in China using individual-level data.
Methods: We derived 2.26 million COPD deaths from a national death registry database in Chinese mainland between 2013 and 2019. Exposures to fine particulate matter (PM 2.5 ) and coarse particulate matter (PM 2.5-10 ) were assessed by satellite-based models of a 1 × 1 km resolution and assigned to each individual based on residential address. The associations of PM 2.5 and PM 2.5-10 with COPD mortality were examined using a time-stratified case-crossover design and conditional logistic regressions with distributed lag models. We further conducted stratified analyses by age, sex, education level, and season.
Findings: Short-term exposures to both PM 2.5 and PM 2.5-10 were associated with increased risks of COPD mortality. These associations appeared and peaked on the concurrent day, attenuated and became nonsignificant after 5 or 7 days, respectively. The exposure-response curves were approximately linear without discernible thresholds. An interquartile range increase in PM 2.5 and PM 2.5-10 concentrations was associated with 4.23% (95% CI: 3.75%, 4.72%) and 2.67% (95% CI: 2.18%, 3.16%) higher risks of COPD mortality over lag 0-7 d, respectively. The associations of PM 2.5 and PM 2.5-10 attenuated slightly but were still significant in the mutual-adjustment models. A larger association of PM 2.5-10 was observed in the warm season.
Interpretation: This individual-level, nationwide, case-crossover study suggests that short-term exposure to PM 2.5 and PM 2.5-10 might act as one of the environmental risk factors for COPD mortality.
Funding: This study is supported by the National Key Research and Development Program of China (2023YFC3708304 and 2022YFC3702701), the National Natural Science Foundation of China (82304090 and 82030103), the 3-year Action Plan for Strengthening the Construction of the Public Health System in Shanghai (GWVI-11.2-YQ31), and the Science and Technology Commission of Shanghai Municipality (21TQ015).
Keywords: COPD; Case-crossover study; Coarse particulate matter; Fine particulate matter; Mortality.
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If you disagree with a coverage or payment decision by Original Medicare , your Medicare Advantage or other Medicare health plan , or your Medicare drug plan you can file an appeal.
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IMAGES
COMMENTS
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Learn to design effective action plans with our comprehensive guide. Get inspired with examples and ready-to-use templates.
Learn how to write an action plan with steps and tips from Jennifer Bridges, PMP. Watch the video or read the text guide to action plans.
An action plan is a specific list of tasks in order to achieve a particular goal. Learn how to create action plans with templates and examples
Case studies are marketing tools that showcase your customers' success and highlight your brand value. Learn how to write them with examples and templates.
Learn how to write an action plan and improve project management skills. Plus, explore components, action plan examples, formats, and helpful tips.
This guide will show you how to write a case study that engages prospective clients, demonstrates your abilities, and showcases your results.
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The Seven Steps of Action Planning. Define the Problem (s) Collect and Analyze the Data. Clarify and Prioritize the Problem (s) Write a Goal Statement for Each Solution. Implement Solutions: The Action Plan. Monitor and Evaluate. Restart with a New Problem, or Refine the Old Problem. The following is a simple example of the problem solving ...
An action plan describes the way your organization will meet its objectives through detailed action steps that describe how and when these steps will be taken. This section provides a guide for developing and utilizing your group's action plan.
Are you struggling with writing your case study's Alternative Courses of Action (ACA)? Here are the steps on how to write one plus a few examples to guide you.
In this Indeed Career Coach approved article, learn how to write an effective action plan and reach your goals more consistently.
Find out what an effective action plan is and how to create one for your project or business. Design your own quickly using our editable action plan templates.
Generally, organize your essay around 1. A definition or position statement (your conclusion) - answers the question what? 2. An argument (your evidence - quantitative and/or qualitative) - answers why? 3. A chronological action plan (steps to solve a problem, implement a decision, improve performance, etc.) - answers how? Writing ...
TOOL 11: SAMPLE CASE STUDIES & ACTION PLANST. S & ACTION PLANS Case Study 1 - Salem Selam is a 17 years old wom. n living in rented accommodation in Beirut. She lives with her moth. r, father, five sisters and three brothers. Salem is unable to spe. k and needs assistance with her daily care. Her mother, Amani, and her two younger sisters ass.
Abstract Qualitative case study methodology enables researchers to conduct an in-depth exploration of intricate phenomena within some specific context. By keeping in mind research students, this article presents a systematic step-by-step guide to conduct a case study in the business discipline. Research students belonging to said discipline face issues in terms of clarity, selection, and ...
The guidance supporting Conservation Action Planning provides you generic how-to information to guide you through the process of completing and iterating a conservation plan.
The plan is a step-by-step guide to drive application on the job. This article describes how this process is used and presents a case study showing how one organization, a large restaurant chain, built evaluation into the performance improvement process and positioned action planning as an application tool.
2 Decisions & Actions Taken Since 1996, in recognition of the above problems and constraints, the Government of Burkina Faso has received technical and financial assistance from the Danish Ministry of Foreign Affairs (Danida). One of the most significant results of this collaboration has been the formulation of the Action Plan for Integrated Water Resources Management in Burkina Faso (PAGIRE ...
The scoping study which informed the action plan identified that the Philippines faces five key challenges in relation to achieving sustainable consumption and production:
Appendix H of the draft Action Plan is not a comprehensive compilation, but includes a select number of water reuse case study summaries that were provided in response to outreach during draft Action Plan development and from the public docket. Along with the abbreviated summaries located in the main body of the draft Action Plan, these ...
Case Study Step #2: Developing a Plan of Action Verification of Understanding Objective: Given the desire to appropriately understand the needs of each student assigned to their care, candidates will develop an action research plan that, if implemented, would begin the process of unpacking the complexity connected to cognitive development. Overview: The Case Study assignments provides evidence ...
The main difference between action research and case study is their purpose; an action research study aims to solve an immediate problem whereas a case study aims to provide an in-depth analysis of a situation or case over a long period of time. 1. What is Action Research?
Action Items. Continue face-to-face marketing effort as capacity for growth allows. Hire new personnel as required by growth demands. Transfer all day-to-day activity management to new managers. Establish Executive Reporting structure and regular meeting agenda. Critical Success Factors: Management Team Development. Succession Plan.
Study design. This in-depth case study is part of an ongoing larger multiple (collective []) case study approach.An instrumental approach [] was taken allowing an in-depth investigation of an issue, event or phenomenon, in its natural real-life context; referred to as a 'naturalistic' design [].Ethics approval was obtained by Newcastle University's Ethics Committee (ref 13633/2020).
This study is supported by the National Key Research and Development Program of China (2023YFC3708304 and 2022YFC3702701), the National Natural Science Foundation of China (82304090 and 82030103), the 3-year Action Plan for Strengthening the Construction of the Public Health System in Shanghai (GWVI …
The plan must tell you, in writing, how to appeal. Generally, you can find your plan's contact information on your plan membership card. You can file an appeal if Medicare or your plan refuses to: Cover a health care service, supply, item, or drug you think Medicare should cover. Pay for a health care service, supply, item, or drug you already got.