Strategy Planning Tool

SPLAT incorporates two methodologies, including:

• Results-Based Accountability (RBA): Developed by Mark Friedman (author of "Trying Hard is Not Good Enough"), RBA focuses on measurable outcomes by answering three key questions: "How much did we do?", "How well did we do it?", and "Is anyone better off?" The Strategy Planning Tool uses this framework to move from simple counting activities to measuring meaningful impact. Learn more about RBA on our Evidence Framework page and Results-Based Planning resources.
• Root-Cause Analysis (RCA): Using the Fishbone/Ishikawa Diagram (created by Kaoru Ishikawa), users can systematically examine underlying factors affecting health outcomes across six key domains. This approach ensures strategies address fundamental issues rather than just symptoms, leading to more sustainable improvements. Read more about RCA and the fishbone diagram on our Practice-Focused Tools page.

The MCH Evidence Framework operates across three core domains:

Domain 1: Evidence-Linked Strategies - Ensuring programs are meaningful and based on science, experience, and policy

Domain 2: Results-Based Planning - Ensuring programs are measurable and can demonstrate impact

Domain 3: Practice-Focused Tools - Ensuring programs are movable within Title V and adaptable to different contexts

The Strategy Planning Tool (SPLAT) specifically supports Domain 2: Results-Based Planning by helping agencies translate evidence into practice and develop measurable strategies that address MCH priority needs. The tool takes into account each state's unique goals, data trends, root causes, partner resources, and available funding to create strategies that can effectively "turn the curve" on key MCH issues.

Learn more about how this tool fits within our broader MCH Evidence Framework.

Your first step is establishing a clear goal that will guide your entire strategy. Following the RBA framework, this often begins with a broad quality of life condition you want to achieve for a population.

Key Components:

• Your Goal: Articulate the condition of well-being you aim to achieve (e.g., "All women are healthy after they give birth" or "Reducing maternal mortality")
• What It Looks Like: Identify how you'll recognize success through indicators (e.g., "Women attend postpartum visits" or "Increase access to postpartum visits")

This section ensures that everyone knows what the strategy is aiming to accomplish and what change is desired as a result of the strategies developed. The question regarding 'What it looks like' may connect back to the National Performance Measures or Standard Measures to track how this goal will impact those indicators, but can also be used for other planning efforts.

Tips for Effective Goal Setting:

• Start with the desired condition of well-being for a population
• Frame goals in plain, positive language that communicates a shared vision
• Consider both population-level results and program performance
• Allow for goals that express quality of life aspirations, not just numeric targets
• Think about who should be involved in setting the goal

Practical Guidance:

• Review your state's needs assessment data when developing goals
• Consider current performance measures that might serve as indicators for your goal
• Consult with partners to ensure the goal reflects community priorities
• Remember that measurability comes at the indicator level, not necessarily in the goal itself
• Don't confuse strategies with goals - strategies are how you achieve the goal

Examples of Strong Goals:

• "All women are healthy after they give birth"
• "All children, ages 0-11, have a safe and healthy place to live"

In the RBA framework, broad quality of life goals are appropriate starting points. The indicators and measures that follow will provide the specificity and measurability needed to track progress.

This step helps you visualize and understand your data over time. By examining past performance, current status, and desired future outcomes, you can identify patterns that inform your strategy development.

Key Components:

• Past Performance (A): Where were you five years ago?
• Current Status (B): Where are you now?
• Future Goal (C): Where do you want to be in five years?
• Projected Path (D): Where might you end up without intervention?

This visualization helps you understand your starting point and sets the stage for identifying root causes in Step 3. Even simple trend lines provide valuable context for your strategy development process.

Tips for Data Analysis:

• No specific data is needed to start – use your best estimate of general trends (e.g., increasing, decreasing, stable, variable).
• Compare your data to national benchmarks when available
• Look for seasonal patterns or cycles that might affect outcomes
• Consider external factors that influenced past trends
• Document any changes in data collection methods that might affect comparisons
• Identify differences in outcomes among population groups (this might be where you focus your efforts for the remainder of the tool, especially if certain population groups are driving the current trend).

Basic Trend Patterns:

• Increasing: Numbers are going up over time (positive for desirable outcomes, concerning for negative outcomes)
• Decreasing: Numbers are going down over time (concerning for desirable outcomes, positive for negative outcomes)
• Stable: Little change over time (may indicate need for new approaches if improvement is desired)
• Variable: Fluctuating up and down with no clear direction (may indicate inconsistent implementation or external factors)

Discussion Questions:

• What patterns do you notice in the data?
• Are there differences among specific population groups?
• What factors might explain these trends?
• What's working well that we can build upon?
• What barriers might be preventing improvement?

Helpful Resources:

• Healthy People 2030 Targets (U.S. Deparment of Health and Human Services and the Office of Disease Prevention and Health Promotion)
• National Survey of Children's Health (Data Resource Center for Child and Adolescent Health)
• PRAMS Data Portal (Centers for Disease Control and Prevention)
• AECF Kids Count Data Center (The Annie E. Casey Foundation)

This step uses a fishbone diagram to identify factors affecting your progress. This systematic approach helps uncover underlying causes rather than just symptoms.

The goal is to identify the fundamental causes that, if addressed, will have the greatest impact on improving outcomes. This analysis sets the foundation for identifying effective strategies in later steps.

Understanding the Fishbone Diagram

The fishbone diagram helps you examine six key categories of factors that might be influencing your outcomes:

Measurement & Monitoring

• Data quality and completeness
• Collection methods and timing
• Reporting systems and processes
• Analysis capacity and expertise

Health Access & Outcomes

• Access barriers to services
• Factors related to various backgrounds
• Economic influences on health
• Geographic challenges and distance

Behaviors & Beliefs

• Community practices and norms
• Health knowledge and awareness
• Trust in healthcare systems
• Attitudes toward services

Environment & Community

• Physical infrastructure availability
• Transportation access and options
• Community resources and supports
• Environmental conditions and exposures

People & Partnerships

• Workforce capacity and training
• Community involvement and input
• Partner collaboration and alignment
• Leadership support and priorities

Policies & Procedures

• Regulatory requirements and limits
• Operating procedures and protocols
• Administrative processes and barriers
• Resource allocation and funding

How to Complete This Section:

1. Start with your trend data from Step 2 (remember, this trend data might highlight specific population groups)
2. Brainstorm factors in each of the six categories that might contribute to your current situation
3. Mark key factors with stars (*) to identify the most significant influences
4. Use arrows (↑↓) to indicate whether each factor has a positive or negative impact
5. Circle factors that may be creating differences in outcomes among population groups
6. Identify the most actionable root causes to address in your strategy

Tips for Effective Root Cause Analysis:

• Break down general issues into specific, addressable factors
• Identify specific barriers rather than using broad categories
• Consider perspectives from multiple stakeholders, especially those with direct experience
• Use available data to verify causes where possible
• Focus on factors that your program can influence
• Look for connections between factors across different categories
• Consider internal capacity factors (e.g., staffing, training, resources) that may be root causes

Key Considerations When Analyzing Root Causes:

• Which factors affect different population groups differently?
• Which factors have the biggest impact on outcomes?
• Which factors are within your program's control or influence?
• Which factors, if addressed, would create the most significant improvements?

This step focuses on identifying individuals, organizations, and groups who can help address the root causes you identified in Step 3. Effective partnerships leverage various strengths and resources to create more impactful strategies.

This is an opportunity to consider other programs that may be addressing the same or similar goals, which can help reduce duplication of efforts and create more cohesive, collaborative approaches.

Key Components:

• Partner Identification: List potential partners who can contribute to addressing your goal
• Contribution Assessment: Document what each partner can specifically contribute
• Asset Mapping: Check which key assets each partner brings to the collaboration

Partner Asset Map:

Partner Assets to Consider:

• Community Connections: Networks, relationships, and reach within various communities
• Knowledge of Various Backgrounds: Understanding of traditions and different perspectives
• Data Expertise: Skills in collection, analysis, and interpretation of relevant data
• Financial Resources: Funding, in-kind contributions, or shared resource opportunities
• Lived Experience: First-hand knowledge of the challenges faced by the population
• Meeting Spaces: Physical locations for gatherings, trainings, or service delivery
• Support Services: Expertise in well-being and supportive resources
• Language Services: Translation, interpretation, or responsive communication
• Leadership/Management: Strategic direction, decision-making authority, or influence
• Technical Infrastructure: Technology, equipment, or digital platforms
• Outreach Capacity: Ability to reach and engage with various population groups
• Systems Thinking: Understanding of how different parts of systems interact

Tips for Effective Partnership Development:

• Consider a range of partners who might bring different perspectives
• Look for partners already addressing similar goals to reduce duplication of efforts
• Consider both existing partnerships that can be strengthened and new ones to develop
• Assess what your program can offer partners, not just what they can offer you
• Include partners with direct connection to the communities involved
• Identify gaps in assets and seek partners who can help fill those specific needs
• If you need further technical assistance (TA) around partnership development, our team is here to help! Please don't hesitate to reach out!

Partner Mapping Process:

1. List potential partners in the first column
2. Document their specific potential contributions in the second column
3. Check all applicable assets they bring in the asset mapping section
4. Identify any critical assets that are missing and consider additional partners

Helpful Resources:

• Engaging People with Lived Experience: MCH Navigator PWLE Learning Bundle
• AMCHP Roadmap for Collaboration
• Cottage Health - How to Engage Stakeholders

This step focuses on brainstorming strategies that directly address the root causes identified in Step 3. Developing strategies that target specific root causes increases your potential for meaningful impact.

Key Components:

• Root Cause Connection: Link each potential strategy to a specific root cause
• Public Square Test: Assess whether your strategies meet three key criteria
• Low-Cost Options: Include at least one strategy that requires minimal resources

The Public Square Test:

Your strategies should pass the following criteria.

1. Communication Power: Can this idea be easily explained to a broad, diverse audience?
2. Proxy Power: Does this idea represent a central aspect of the desired result? If measured over time, would it serve as a proxy for overall improvement?
3. Data Power: Can you measure this idea with quality, timely, and reliable data?

Tips for Strategy Development:

• Start with brainstorming multiple potential strategies
• Draw from evidence-based approaches when possible
• Consider strategies used successfully in other states
• Include both short-term wins and longer-term solutions
• Focus on strategies your program has the capacity to implement
• Think creatively about new approaches to persistent challenges

Helpful Resources:

• Evidence Accelerators
• Evidence Toolkits
• MCHbest Database
• AMCHP Innovation Hub

This step helps you evaluate and prioritize your brainstormed strategies using the SILVER Test, a framework that assesses each strategy on six key dimensions.

Understanding the SILVER Test: Rate each potential strategy as High, Medium, or Low on each of these factors:

• Specificity: Is the strategy specific enough to be implemented? Does it have a timeline, deliverables, and budget details?
• Improvement: Is the strategy strong enough to significantly improve the desired outcome?
• Leverage: How much difference will the strategy make? Does it address specific root causes?
• Values: Is the strategy consistent with the values of the community? Will it be adopted?
• Evidence: Is the strategy evidence-based/informed? Can you align it with MCHbest, Innovation Hub, the literature, or effective community-rooted programs?
• Reach: Is it feasible and affordable? Can it actually be implemented within available resources and timeframe?

Tips for Action Planning:

• Start with the evidence base by exploring resources like the MCHbest Database, Innovation Hub, the literature, or effective community-rooted programs.
• Compare multiple strategies to identify the strongest options
• Consider a mix of strategies that address different root causes
• Balance ambitious goals with practical implementation concerns
• Prioritize strategies with the highest overall SILVER ratings
• Document your decision-making process for future reference

Additional Resources:

• For more in-depth program evaluation, explore the Hexagon Tool, which helps assess programs based on need, fit, resources, evidence, readiness, and capacity
• Evidence Accelerators
• Evidence Toolkits
• MCHbest Database
• Innovation Hub

This final step focuses on developing Evidence-based or -informed Strategy Measures (ESMs) required by Title V for each selected strategy. Effective ESMs help demonstrate your impact and guide program improvement.

The RBA Quadrant Framework: Using Results-Based Accountability principles, aim to develop measures in Quadrants 2 or 4:

• Quadrant 1 (Quantity/Effort): How much did we do? (number of activities)
• Quadrant 2 (Quality/Effort): How well did we do it? (percentage measures of quality)
• Quadrant 4 (Quality/Effect): How are people better off? (percentage measures of outcome)

Note: Quadrant 3 measures are typically "weaker" versions of Quadrant 4 measures and should be avoided when possible. Instead, focus on developing stronger measures that demonstrate meaningful change.

Tips for Creating Strong ESMs:

• Focus on quality over quantity measures
• Ensure measures are meaningful, measurable, and moveable
• Link ESMs directly to your selected National Performance Measures
• Consider data availability and collection methods
• Focus on measures that show changes in knowledge/skills, behaviors, or access to care
• When possible, measure how your strategy impacts specific groups experiencing worse outcomes

Key Considerations:

• Meaningful: Is the measure rooted in evidence and directly connected to your strategy?
• Measurable: Can you reliably collect and analyze data for this measure?
• Moveable: Can this measure show improvement over multiple assessment periods?

Helpful Resources:

• MCH DigitalLibrary: Example State ESMs
• Title V Information System: List of Evidence-Based or-Informed Strategy Measures
• RBA Framework Resources