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HST6522 Public Health Leadership

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HST6522 Public Health Leadership Questions: Part 1 Pawson and Tilley (2004) describe their Realist Evaluation approach as not asking ‘what works’ or ‘does this program work’ but asks instead “What works for whom in what circumstances and in what respects and how?” Critically discuss what the differences and/or similarities are between this approach and Michelle Issas model. Refer to recommended references for Pawson and Tilley (1997) Realistic Evaluation, and Pawson and Tilley Realist Evaluation. Part 2 In this assignment you will critically review an existing evaluation of a public health care program. You should draw upon what you have learned so far in this topic to develop criteria for appraising the evaluation in terms of methods and approaches (i.e. criteria might include participatory evaluation approach, mixed methods, or advantages of internal versus external evaluators, designing effect evaluations, etc.). Use the criteria to assess the evaluation report in terms of how the evaluation was conducted. Find a formal report of an evaluation that has been conducted in your workplace, or that is relevant to your field of work.  Having developed your criteria by drawing on the literature in this topic, and chosen your evaluation, prepare a critical review of its design and implementation. Your review must provide:   • A brief description of the health care program that is the focus of your chosen evaluation report • A brief description of the evaluation report that should include its purpose, design and methods together with any necessary contextual information  Brief excerpts from the report can be included as an appendix if necessary. • An assessment of the evaluation’s relative strengths and weaknesses against the criteria that you have developed from the literature. Answers: Introduction: Evaluation of health care programs is crucial. It should be done to get an insight of the ways that the health programs inculcate to serve the public (Bauman and Nutbeam 2013). The health of the public of any country can be addressed to, in a managed way by evaluating such set ups in a planned manner. Several organizations are generally involved in the evaluator study of the based health care programs that that are generally done for the betterment of the programs (Sonifield, Hasstedt and Gold 2014). A healthy population influence the economy of a country positively, hence the health programs should be evaluated regularly. The work of Pawson and Tilley on realist evaluation has been elaborately summarized in the report. It also points out the differences between the study done by Pawson and Tilley with that of Michelle Iselle, on evaluation of health programs. The discussion in the report also emphasizes on construction of a methodology for evaluating the health care programs called health practitioner review, Australia. The report also focuses on the existing protocols that the project follows. Part 1: Pawson And Tilley’s Realist Study: The work of the two researchers, Pawson and Tilley work on defining the meaning of realistic evaluation. The study was done by the researchers in 1997 and in the year of 2004 (re-evaluation). The process of evaluation, involves the usage of theories that are presently available on the set up which is being evaluated (Pawson 2013). It gives an insight about the different ways in which the health programs work. The researchers while preparing the baseline of the study process, inferred the importance of distinctively separate the health care giving by the set ups for people of different backgrounds. The programs should consider the important attributes of varied castes and cultures available and plan the programs accordingly. The ecological and environmental features of a place should also be considered, as the needs of people can vary geologically. The program according to the researchers should also consider developing plans on a personalized way, that is, every individual should be given importance to and several sub programs can be set up, keeping the individualistic approach in mind. The foundation of the study is based on epistemological critical realism. The techniques involved in such evaluations, recognize and analyse the variable that operate in an interwoven manner unlike the other studies that are traditionally done. It also constructs ideology that considers varied hypothetical situations that the set up can be in. The steps that are involved in the study process, initialize with the incorporation of sources that are available in the journals and books that incorporate the policies of the health care program. The sources can be taken from presently available documentation of the program, library articles and interviews with the personnel associated with the programs. The sources should finally be assessed and the result of the assessment should be interpreted as per the study. Comparison Between The Pawson And Tilley Study With The Study Done By Michelle Iselle: There are several similarities between the studies of Pawson, Tilley and Michelle Iselle, both the studies emphasize on the upgradation of the available policies and plans of the health programs. The importance of interaction among the stakeholders is also discussed in both the research works. The studies interpret the significance of continuous examination of the health programs to maintain proper health care giving by the officials in the programs (Luce and Elixhauser 2012). Surveys of the health care programs is crucial, it eliminates the chances of redundancy and helps in the scenario analysis of the set up. Both the studies unlike the other available traditional approaches, have highlighted the importance of preparing sub programs on the basis of the needs of individuals. The efficiency of officials and social workers, working in the scenario are also considered under both the studies as the effectivity of a health program majorly depends on the personnel associated with it (Street, Gold and Manning 2013). Focus of both the studies is on the various levels of the population as the determinants of health, vary at different levels. According to both the studies, the geological limitations of health programs should be assessed and the programs should also be made available for the people in extreme ecological locations. The availability of the programs in the hard or extreme locations, reduces the health related problems the public of such locations face due to the challenges that come in front of them as a result of the hard situations that are associated with the places (Eldredge et al 2016). There are several differences between the research work of Pawson and Tilley with that of Michelle Iselle. The work of Pawson and Tilley that is the realistic evaluation, as discussed in the previous section, is largely based on the available theories, on the set ups. On the other hand, the evaluator study done by the researcher, Michele Iselle, involves the incorporation of practicality to the evaluation process (Issel and Wells 2017). The person who is evaluating, should be present in the scenario where the program is held. This procedure improves and manages the client outcome in a planned and better way. The analysis process according to the research work of Pawson and Tilley, does not require the presence of the evaluator in the set up. The evaluation if done only on the basis of available theories, creates a number of confusions in front of the evaluator as they do not have the idea of the set up in the present time. The efficiency of evaluation is highly decreased when it only involves application of theories. The Pawson and Tilley realist evaluation does not require hierarchal division of labor among the evaluators. It also does not consider the evaluation of the set up under consideration, this increases the occurrence of misconceptions in the study base (Kim 2014). The research work done by Michelle Iselle infers the steps that can help the students undertaking courses of evaluator studies to evaluate a health program in the right way, whereas the work done by Pawson and Tilley is meant for the public worldwide. From the comparison between the two research work, it can be deduced that the work done by Pawson and Tilley does not cover all the aspects that are required to analyse a health program, the study done by the researcher Michelle Iselle is far more apt and gives a planning that can be incorporated for evaluation of the health programs righteously. Part 2: Health Care Program In Australia: One of the greatest concerns and issues in Australia can be considered the health care concerns that the aboriginals face while attempting to seek out health care services in the health care industry of Australia. The disparities prevalent in the Australian health care industry towards the native aboriginals have raised a number of alarming concerns. A few of the key health care disparities towards the health care that the aboriginals face while attempting to seek out health care services is the discrimination, lack of health literacy, inaccessibility, and many other such barriers which make the process of seeking out health care increasingly difficult for the aboriginals of the Torres strait island community (Kildea et al., 2010). Hence the aboriginal health program has been introduced by the Australian government in an attempt to address the issues prevalent in the scenario of aboriginal health care and attempt to reduce the disparities so that the aboriginals can be provided equal standing while seeking out health care services. The concept of aboriginal health program was introduced in the late 1900s, and the primary outcomes of this health care program had been to reduce the mortality rate and increase the life expectancy among the aboriginals. However, a lot have been changed in the last decade and the primary outcome of the aboriginal health program has also changed. The last recent aboriginal plan had been introduced in the 2010 and the plan scheme for this health care program had been set for 2010 to 2016. This section of the assignment will attempt to evaluate the effectiveness of the health care initiatives taken and the key achievements of this program. According to the evaluation report, the major initiative taken in the said program by the Australian government for the improvement of aboriginal health care scenario had been essentially called the close the gap initiative ( 2017).   Evaluation Report Of Aboriginal Health Plan: The health care program that has the spotlight for the health practitioner review evaluation program in this assignment is the specific and curated ‘closing the gap’ program developed by the government authorities of Australia for safeguarding the best interests of the huge aboriginal population of the Australia when it comes to the health care needs and requirements. The key understanding on which the health care plan is based on is the fact that aboriginals have a very different idea regarding health and the health care plan designed for them must also cater to those traditional ideas and believes regarding health and health care services. A few primary objectives of the health care plan for the aboriginals include, supporting good health, enhanced primary health care, better identification if the primary health needs of the aboriginals, special emphasis on the health care priorities, and most importantly designing an collaborative and integrative health care plan which addresses all the key needs and requirements of the aboriginal community along with respecting and valuing their own traditional views and cultural understanding of health (Murray et al. 2011). Now in order to evaluate the effectiveness of the health care plan, along with analysing the primary outcome of goals set for the organization, it is equally important to analyse the efficiency of the actions taken in order to determine the effectiveness of the plan.  The key actions taken in this plan to ensure optimal care delivery to the aboriginals include introducing culturally safe care, health care leadership, improving the safety and quality of care provided, evidence based quality care and robust health care information documentation and recording initiatives (Anderson 2010). Over all it can be concluded that the most of the steps taken in the attempt to improve the health care services provide to the aboriginals have undoubtedly successfully addressed a few of the key concerns within aboriginal health care, however there are still a number of bigger concerns that have not been addressed in the health care plan developed. The evaluation report of the ‘close the gap’ initiative of the aboriginal health care program is the most relevant aboriginal health plan till date; where the majority of the gaps or disparities that identified are lack of health literacy, high mortality rate and extremely low life expectancy. According to the evaluation the actions taken address most of the health disparity and gap although the evaluation lacks criticism of the health care plan (Cheng, Cheng and Tang 2010). Strengths And Weaknesses Of The Plan: The purpose of an evaluation report is vital to a health care program; it does not just evaluate the goals and actions taken to achieve those goals, it co- aligns the goals and actions with the prevalent needs of the community to determine the effectiveness of the health care program. Hence an evaluation report must have both positive and negative factors taken into consideration critically while evaluating the efficiency of a health care program ( 2017). Considering the strengths of the evaluation report it has to be stated that the evaluation report has very critically addressed the positive impact made by the closing the gap initiative. It has very effectively evaluated the relevance of the plan by the means of five different parameters, plausibility, implementation, evidentiary conformation, identification of confounding factors and alternate explanations. Each of these factors analyse different relevance areas of the initiative to check how effective it had been in implementing improvements in the aboriginal health program and reduce the gaps that have been identified (Taylor and Thompson 2011). First of all the report analyses the plausibility of the initiative where the need of the aboriginal individuals and the actions taken by the health program. It has to be mentioned in this context that it is very important for the heath care plan funds and resources to be utilized in the actions and programs that will meet the actual needs of the aboriginals, the plausibility of the report analyses these factors. The next section analyses the implementation procedure of the entire program or initiative, here the coordination between the implementation and the original plan is evaluated in critical details. The third strength of this evaluation report is the evidentiary conformation of the closing the gap health program. Now it has to be considered that health care is a highly evidence based practice, hence it is extremely important for the health care plan and initiatives be completely based on authentic evidences (Rigby et al. 2011). The report judges whether the initiates have been established based on authentic evidences in acute detail as well which further increases the reliability of the evaluation report. Lastly the identification of the external confounding factors to the success of the health care program will discover key challenges that need to be evaluated further to be overcome in the future. The evaluation report has taken efforts to discover and analyse those external confounding factors as well which is undoubtedly commendable (Halseth 2013). Now any evaluation report along with highlighting the positive points of the program must also take into consideration the negative factors, the gaps that the health care program failed to address. A key limitation in the evaluation report can be considered the fact that it failed o address one of the main drawbacks of the closing the gap program. Health literacy, or lack thereof in the aboriginal communities has been identified as one of the key gaps in the aboriginal communities. There are a multitude of health care benefits that the aboriginals have access to like free of cost vaccination, maternity care and primary health care. However, according to the most of the research, there is an alarming lack of health literacy and basic health care knowledge i9n the aboriginals and they lack any knowledge even regarding the benefits they are allowed. Hence the health outcome and life expectancy of the aboriginals remain at the rock bottom despite the extensive health plans and coverage schemes bestowed for the aboriginal community (Altman 2010). Alone with that it also needs to be mentioned that there has not been any extensive effort to incorporate health promotional and preventative programs catered for the aboriginal communities. Closing the gap program has not taken into consideration the need of health literacy and promotional campaigning for improving the knowledge and understanding of the aboriginal communities regarding health care in general and the benefits they have access to. The evaluation report failed to highlight this key requirement of aboriginal communities which had not been addressed as effectively the need demands.  Hence it can be considered as a conspicuous limitation of the evaluation report and it restricts the general reliability of the report, although the efforts of the evaluation report must be appreciated for the thorough evaluation of the contribution of closing the gap program (Donato and Segal 2013). Conclusion: On a concluding it can be said that the health care programs are initiates that are towards the betterment of the health care services provided in general so that the scope of the health care can be widened and all sectors of the society can avail the health care services overcoming any socioeconomic, racial or gender related discrimination. The closing the gap program had been one such curated program that has aimed at improving health care for the aboriginals. There had been a myriad of achievements for this program and the contribution of this initiative has undoubtedly improved the health are scope of the aboriginal communities. However there are still gaps left behind that has to be overcome in order to change the face of aboriginal health and remove all the existing disparities. References: Altman, J., 2010. What future for remote Indigenous Australia? Economic hybridity and the neoliberal turn. Culture crisis: Anthropology and politics in Aboriginal Australia, pp.259-280. Anderson, W.K., 2010. Closing the gap between actual and potential yield of rainfed wheat. The impacts of environment, management and cultivar. Field Crops Research, 116(1), pp.14-22. Bauman, A. and Nutbeam, D., 2013. Evaluation in a nutshell: a practical guide to the evaluation of health promotion programs. McGraw Hill. Cheng, M.M., Cheng, A.Y. and Tang, S.Y., 2010. Closing the gap between the theory and practice of teaching: Implications for teacher education programmes in Hong Kong. Journal of Education for Teaching, 36(1), pp.91-104. Donato, R. and Segal, L., 2013. Does Australia have the appropriate health reform agenda to close the gap in Indigenous health?. Australian Health Review, 37(2), pp.232-238. Eldredge, L.K.B., Markham, C.M., Ruiter, R.A., Kok, G. and Parcel, G.S., 2016. Planning health promotion programs: an intervention mapping approach. John Wiley & Sons. Halseth, R., 2013. Aboriginal women in Canada: Gender, socio-economic determinants of health, and initiatives to close the wellness gap. Prince George, BC: National Collaborating Centre for Aboriginal Health. (2017). [online] Available at:…/%7BB351C79D-1B96-4FE0-9F06-E621E4B52DD… [Accessed 16 Oct. 2017]. Issel, L.M. and Wells, R., 2017. Health program planning and evaluation. Jones & Bartlett Learning. Kildea, S., Kruske, S., Barclay, L. and Tracy, S., 2010. ‘Closing the Gap’: how maternity services can contribute to reducing poor maternal infant health outcomes for Aboriginal and Torres Strait Islander women. Rural and Remote Health, 10(3). Kim, J., 2014. Impact of indoor environmental quality (IEQ) factors on occupant evaluation of workspaces. Luce, B.R. and Elixhauser, A., 2012. Standards for the socioeconomic evaluation of health care services. Springer Science & Business Media. Marmot, M., 2011. Social determinants and the health of Indigenous Australians. Med J Aust, 194(10), pp.512-3. Murray, K.A., Rosauer, D., McCallum, H. and Skerratt, L.F., 2011. Integrating species traits with extrinsic threats: closing the gap between predicting and preventing species declines. Proceedings of the Royal Society of London B: Biological Sciences, 278(1711), pp.1515-1523. Pawson, R., 2013. The science of evaluation: a realist manifesto. Sage. Rigby, W., Duffy, E., Manners, J., Latham, H., Lyons, L., Crawford, L. and Eldridge, R., 2011. Closing the gap: Cultural safety in Indigenous health education. Contemporary Nurse, 37(1), pp.21-30. Sonfield, A., Hasstedt, K. and Gold, R.B., 2014. Moving forward: Family planning in the era of health reform. Street, R.L., Gold, W.R. and Manning, T.R. eds., 2013. Health promotion and interactive technology: Theoretical applications and future directions. Routledge. Taylor, K.P. and Thompson, S.C., 2011. Closing the (service) gap: exploring partnerships between Aboriginal and mainstream health services. Australian Health Review, 35(3), pp.297-308. West, R., Usher, K. and Foster, K., 2010. Increased numbers of Australian Indigenous nurses would make a significant contribution to ‘closing the gap’in Indigenous health: What is getting in the way?. Contemporary Nurse, 36(1-2), pp.121-130.

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