Term Paper: Program Evaluation to Health Care

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[. . .] Thus, evaluation is more important when applied to large programs and when it will help managers make important decisions about those programs.

Is program evaluation a choice or a necessity? For many organizations, evaluation is a must. Some type of evaluation is necessary if an organization's long-term success depends on maintaining competitive advantage by offering cost-effective care. The real question is how much managers should invest in program evaluation to avoid mistakes and make the best decisions about future programs.

For this reason, the design of an evaluation is important. Each evaluation project must be carefully designed to provide the best information for the money spent. Broadly defined evaluation projects can serve as a detailed and comprehensive assessment of a program, while limited, focused evaluations address specific questions. Managers must determine research needs and identify the value of addressing each issue. Subsequently, an evaluation project can be designed, addressing the key research questions with an affordable budget.

A well-designed evaluation project should make a positive net contribution to an organization's long-term profitability, perhaps through reduced costs of service utilization, reduced cost of operating the managed care program, or improved marketing (Grannemann, 2002).

How much should be spent on program evaluation? When making a decision about an investment in program evaluation, manager should estimate its rate of return. An estimated calculation of costs and expected benefits can help guide decisions. The key variables in this estimation are: expected ultimate size of the program, the cost of the evaluation, and the expected contribution of the evaluation to improved program efficiency.

In many cases, health care managers discover that the expected rate of return from an investment in program evaluation is very expensive. Even if an organization does not have a budget for program evaluation, determining the costs and potential benefits of a specific evaluation project may be convincing in showing organization leaders that formal evaluation is a good use of an organization's resources.

Designing a Useful Program Evaluation

When designing an evaluation approach, manager should review the following three types of evaluations, which are common in most organizations, in order to maximize the usefulness of their evaluations. Often the manager will act as the evaluator in the evaluation.

Weiss describes academia's view of evaluation's impact, "It would give cause-and-effect theories for policymaking, so that statesmen would know which variables to alter in order to effect desired outcomes" (1977). Ideally, the evaluator would design a hypothesis as close to the policy goals as possible. The error of probability would be no low and the research would be conducted. At the conclusion of the study, if the program's performance reflected the desired policy goals, the program would have a greater chance of continued funding and continuance.

However, if the results where negative or at best questionable, managers could at this point reduce funding or disband the program with scientific assurances of their decision (Nachmias, 174-175). Much is expected of managers and their use of the information presented by researchers. With project evaluation, therefore, it is important to conduct the right evaluation for the organization.

The first type of evaluation is goals-based evaluations, which are helpful in determining whether or not programs are achieving their overall, predetermined objective (McNamara, 1998)s. In many cases, programs are designed to meet one or more specific goals. These goals are often described in the manager's blueprint for program plans and goals.

Goal-based evaluations aim to determine which programs are successfully meeting predetermined goals or objectives. There are a series of questions that manager must address when designing an evaluation, including (McNamara, 1998):

1. How were the program goals established? Was the process effective?

2. What is the status of the program's progress toward achieving the goals?

3. Will the goals be achieved according to the timelines specified in the program implementation or operations plan? If not, then why?

4. Do personnel have adequate resources (money, equipment, facilities, training, etc.) to achieve the goals?

5. How should priorities be changed to put more focus on achieving the goals?

6. How should timelines be changed?

7. How should goals be changed (be careful about making these changes - know why efforts are not achieving the goals before changing the goals)? Should any goals be added or removed? Why?

8. How should goals be established in the future?

Process-based evaluations aim to determine how a program really works, as well as its strengths and weaknesses (McNamara, 1998). Process-based evaluations, when properly designed, help managers to understand how a program works and how it produces the results that it does.

These evaluations are useful if programs were established a long time ago and have changed over the years, if employees, clients or patients report a large number of complaints about the program, if there appear to be significant problems in delivering program services and if they are also useful for portraying to outside parties (such as shareholders) how a program truly operates.

Managers must address several questions in a process evaluation, including (McNamara, 1998):

1. On what basis do employees and/or the customers decide that products or services are needed?

2. What is required of employees in order to deliver the product or services?

3. How are employees trained about how to deliver the product or services?

4. How do customers or clients come into the program?

5. What is required of customers or client?

6. How do employees select which products or services will be provided to the customer or client?

7. What is the general process that customers or clients go through with the product or program?

8. What do patients or clients consider being strengths of the program?

9. What do employees consider to be strengths of the product or program?

10. What typical complaints are heard from employees and/or customers?

11. What do employees and/or customers recommend to improve the product or program?

12. On what basis do employees and/or the customer decide that the product or services are no longer needed?

Outcomes-based evaluations are important in the health care industry, as they are helpful in identifying benefits to clients. An outcomes-based program allows a manager to determine if the company is really using the right program activities to bring about the outcomes needed by clients, rather than just engaging in busy activities that appear to be correct. Outcomes are benefits to clients from participation in the program, and are usually in terms of enhanced learning or conditions, including increased literacy, self-reliance, and more.

The following table demonstrates the major methods used for collecting data during program evaluations, as well as how they can be useful and challenging to managers (McNamara, 1998):


Overall Purpose


Challenges questionnaires, surveys, checklists when need to quickly and/or easily get lots of information from people in a non-threatening way can complete anonymously

-inexpensive to administer

-easy to compare and analyze

-administer to many people

-can get lots of data

-many sample questionnaires already exist might not get careful feedback

-wording can bias client's responses

-are impersonal

-in surveys, may need sampling expert

- doesn't get full story interviews when want to fully understand someone's impressions or experiences, or learn more about their answers to questionnaires get full range and depth of information

-develops relationship with client

-can be flexible with client can take much time

-can be hard to analyze and compare

-can be costly

-interviewer can bias client's responses documentation review when want impression of how program operates without interrupting the program; is from review of applications, finances, memos, minutes, etc.

A get comprehensive and historical information

-doesn't interrupt program or client's routine in program

-information already exists

-few biases about information often takes much time

-info may be incomplete

-need to be quite clear about what looking for -not flexible means to get data; data restricted to what already exists observation to gather accurate information about how a program actually operates, particularly about processes view operations of a program as they are actually occurring

-can adapt to events as they occur can be difficult to interpret seen behaviors

-can be complex to categorize observations

-can influence behaviors of program participants

-can be expensive focus groups explore a topic in depth through group discussion, e.g., about reactions to an experience or suggestion, understanding common complaints, etc.; useful in evaluation and marketing quickly and reliably get common impressions

-can be efficient way to get much range and depth of information in short time

- can convey key information about programs can be hard to analyze responses

-need good facilitator for safety and closure

-difficult to schedule 6-8 people together

Benefits to Health Care

According to the Association of periOperative Registered Nurses (AORN) (2000), program evaluation of patient care can effectively assist health care managers when making decisions about clinical innovations. In health care, many managers implement innovations but never fully evaluate their effect in a consistent manner.

Until recently, no unified program evaluation framework or structure existed in… [END OF PREVIEW]

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