Part 2: Preparing the implementation plan

2.1
In this Part, we discuss ACC’s leadership in preparing the Strategy’s implementation plan.

Our expectations

2.2
We expected ACC to have:

• prepared a comprehensive implementation plan for the Strategy, with clear objectives, realistic priorities, clear expectations, and defined time frames for action; and
• used effective governance and project management to prepare the implementation plan, working in close consultation with the falls prevention sector.

Summary of our findings

2.3
ACC prepared the Strategy’s implementation plan through a consultative and managed process. The plan contains an appropriate mix of specific and more general objectives and actions, with defined responsibilities, a progress reporting regime, the expected results, and defined time frames for achieving those results.

2.4
The plan provides a useful framework for meeting the Strategy’s goals and objectives.

2.5
The plan was completed in December 2006, six months after the original deadline. Limited staffing and changes in staff contributed to this delay.

The implementation plan

2.6
We assessed the implementation plan to see whether it:

• contained clear objectives;
• set realistic priorities, identified specific actions, defined the expected results, and set time frames for achieving those results; and
• identified agencies responsible for the actions.

2.7
The implementation plan focuses on:

• co-ordinating funding, resources, and research; and
• highlighting ways in which agencies and organisations involved with falls prevention can contribute to implementing the Strategy.

2.8
The implementation plan contains five clear objectives (see paragraph 1.15), for each of which the plan defines:

• action areas;
• activities that describe what needs to be done for the actions to take place;
• the expected results;
• the estimated date or time frame for completing the activities;
• the agency primarily responsible for completing the relevant activities; and
• other agencies and organisations that are associated with relevant activities and that may be involved in supporting their implementation.

2.9
The objectives and expected results are varied. Some objectives relate to processes (such as evidence of collaboration) and others to activities (such as preparing standards, plans, or reports). Some expected results are more readily and directly measurable than others. Therefore, meaningful evaluation of the effects of the Strategy will require an approach that takes account of those different types of activities and expected results. The evaluation will need to be carried out to verifiable standards of evidence, and in close collaboration with the falls prevention sector.

2.10
The Strategy and its implementation plan refer to the goals of reducing the incidence, severity and effects of injuries from falls. However, the plan does not set targets for a reduction in falls, or contain measures to assess the achievement of these goals. We consider it reasonable that ACC has yet to set these targets and measures, given that the plan is in its early stages and involves significant work collaborating and co-ordinating with other agencies and organisations. However, we consider it critical that ACC prepare an evaluation framework that includes clear measures for assessing the implementation of the Strategy in the short and long term. We discuss this later in our report (see paragraphs 3.61-3.65).

2.11
In drafting the implementation plan, ACC included examples of current initiatives that illustrate the type of work that would be consistent with the achievement of each of the five objectives.

Preparing and communicating the implementation plan

2.12
Stakeholders must be committed to the Strategy for it to be successful. We expected ACC to have consulted closely with all relevant stakeholders in preparing the plan, and to have managed this planning process to ensure timely publication of the plan.

2.13
To some extent ACC was considering issues that could arise from the implementation of the Strategy as the Strategy itself was being drafted. This approach helped to ensure that the Strategy’s objectives were practical and achievable, and its actions relevant and realistic.

Project management

2.14
The implementation plan was prepared in the 12-month period from December 2005 to December 2006. Figure 3 sets out the significant events in this process.

Figure 3
Significant events in developing the Strategy’s implementation plan

2.15
A small project team was responsible for drawing up the implementation plan. The project team set up advisory groups, reported progress to the NZIPS Secretariat, and consulted with relevant staff and managers within ACC. The project team considered governance frameworks, decision-making, how the plan would be promoted, resource needs, monitoring of progress, and the use of advisory groups. Research on overseas falls prevention policies and practices, on target groups for falls prevention programmes, and on risk factors for specific settings (such as the home or school playgrounds) provided information for the implementation plan. The project was generally well managed, with ACC management monitoring the project team’s progress.

2.16
Originally Cabinet should have approved the implementation plan in June 2006 but this deadline was extended to December 2006. Cabinet finally approved the implementation plan on 13 December 2006.

2.17
ACC acknowledged that a number of factors contributed to the six-month delay in completing the implementation plan. These included:

• limited staffing to manage the project;
• changes in staffing;
• the demands of two concurrent strategy leadership projects (falls and drowning prevention);
• a freeze on recruitment within ACC;
• an extensive consultation process that involved government agencies, non-government organisations, and district health boards; and
• ongoing drafting of the plan.

2.18
ACC’s senior management was informed of the staffing issues at the time. Our analysis of project resources suggests that ACC did not recognise the work involved in preparing the plan and carrying out the associated consultation. ACC did not have a succession plan to address the contingencies of staff leaving or having competing work priorities.

2.19
However, ACC took various steps to ease the effects of limited resources, as described in paragraphs 2.20 and 2.21.

2.20
The initial project manager left ACC in December 2005 and ACC seconded another ACC staff member to provide continuity and maintain momentum with the preparation of the implementation plan.

2.21
A contractor provided strategic policy support to supplement the limited staff time assigned to the project. The contractor was experienced in preparing government strategies and planning their implementation. The contractor had also been heavily involved in helping ACC draw up the Strategy.

Consultation

2.22
Governance and consultation networks worked well. They provided guidance to the project team and ensured that the plan reflected a broad focus on strategic falls prevention issues and took account of differing perspectives.

2.23
Two advisory groups — a Working Group and a Stakeholder Reference Group – helped prepare the implementation plan. The membership of each reflected the falls prevention sector’s wide range of interests and perspectives.

2.24
The Working Group was made up of representatives from government agencies, non-government organisations, and research institutions. This group provided valuable guidance to ACC. The Working Group helped draw up the project plan for the implementation plan and worked on drafts of the implementation plan.

2.25
The Stakeholder Reference Group was a larger and more widely representative group that oversaw the activities of the Working Group and provided advice. It confirmed that the plan was complete, and that time frames were realistic. Together these groups were important governance mechanisms, and helped to ensure that the plan reflected a national perspective on falls prevention and the issues facing the falls prevention sector.

2.26
The project team also maintained contact with other parts of ACC, particularly ACC’s injury prevention teams. As the plan was being prepared, the project manager and project team worked with ACC’s injury prevention operational teams to promote engagement and partnerships in falls prevention, and to discuss progress on activities for which the teams were responsible or to which they were committed under the implementation plan. We discuss these partnerships further in Part 3.

2.27
Extensive external consultation took place between June and October 2006. ACC recognised the extent to which implementing the Strategy effectively relied on a positive response from the health sector. Therefore, ACC consulted closely with district health boards, seeking strong commitment from each. ACC staff met with the Ministry of Health, and ACC’s Chief Executive approached each district health board’s chief executive for their endorsement of the implementation plan. By December 2006, 18 of the 21 district health boards had endorsed the plan. This was a positive outcome for ACC and an important step in setting the foundation for future partnerships in falls prevention activities.

2.28
ACC established a reporting framework and the project team kept senior management, the ACC Board, and the Minister for ACC (the Minister) well informed of progress.

2.29
The stakeholders we interviewed were positive about the roles of the Working Group and Stakeholder Reference Group, how they functioned, and their membership. These stakeholders also identified the links between the Strategy and the NZIPS as a strength. These links were made possible by the close working relationship between the Strategy’s project team and the NZIPS Secretariat.

2.30
In our questionnaire, we asked stakeholders about:

• consultation on the Strategy’s initiatives and injury prevention activities;
• the reasonableness of the plan and timetable for implementing the Strategy;
• and targeting of populations, activities, and settings (where falls might take place).

2.31
Of the stakeholders involved in designing both the Strategy and the implementation plan, most considered consultation was adequate, thought that the plan and timetable were reasonable, and agreed that the plan generally identified the highest risk population groups and settings.

2.32
Comments from interviews referred to the challenge that ACC faced in working with a disparate group of organisations that, at the time, was not functioning as an identifiable and integrated sector. The generally expressed view was that ACC was successful in bringing these groups together and drawing on their differing perspectives. The relationships built in this phase should provide ACC with a useful source of specialist expertise for future work.

Communicating the implementation plan to stakeholders

2.33
A communications strategy for the Phase One of the implementation plan was drawn up in August 2005. In September 2006, a communications plan was put together to provide a framework for the implementation plan from 2006 to 2010. The communications plan promoted the implementation plan to stakeholders nationwide and provided consistent messages. It had clear objectives, and identified communication channels, promotional opportunities, resources, audiences, messages and themes, and networks.

2.34
The implementation plan was launched in March 2007. ACC published the plan on its website to enable users to search for specific activities related to their work environment, and for transparent monitoring and recording of the progress. Throughout 2006 and into 2007, the project team made presentations on the Strategy and the implementation plan to ACC managers and staff, and to a variety of external audiences.