Intervention of the Technical Assistance Center of the Center of Evidence:
Following numerous requests from the field, in particular health establishments in the process of carrying out their territorial media project, a technical assistance system was set up to support the process of knowledge appropriation and implementation Developments. The system is made up of experts (health and medico-social) experts who move to the institutions and then propose a report on the implementation of the report’s proposals (prerequisites, obstacles, adaptation of proposals, impact indicators) .
- Our methodology of intervention is inspired by the theory of change (Da Silva et al., Trials 2014, 15: 267). The implementation of this methodology relies on :
- The definition of ultimate change targeted (taking into account the gap between the report’s proposals and the state of the existing one). It is about identifying the desired change in the long term. It is a positive vision and not a problem to solve. This vision must be plausible.
- Prerequisites (or intermediate changes) to achieve this ultimate target.
- The definition of the strategic areas that will be prioritized to support this change (which will be at the heart of the proposals).
These strategic choices are based on the analysis:
- Of the existent: resources of the establishment, means of establishment, current management of the population of interest targeted by the mission, dysfunctions identified by the actors of the establishment … The participation of the institution’s IMG At this stage of evaluation of the existing is essential. Indeed, the mission may need data not included in the documents provided.
- Of the “drivers” of change (key actors or individuals, adapted representations of the future, theoretical references, calibration of the means necessary for change, evaluation of necessary partnerships …)
Obstacles to change (the blocking factor linked to the absence of acquired knowledge must be removed by the intervention of experts – the mission has an educational dimension)
- The presentation of the acquired knowledge (appropriation of the knowledge by the actors) is used as leverage of influence on the process of change. It conditions the “path of change”. It imposes an evaluation of the degree of appropriation of knowledge by the actors by analyzing the induced behavioral changes. Most of the interventions made by the teams (held for the essential units of change, which must therefore be the targets of the intervention) are in the form of a “focus group in two stages”: a specific question on themes Having been the subject of proposals in the report and taking stock of the positions of the actors / presentation of the proposals contained in the report and their argumentation / evaluation of the position of the actors on this topic, having benefited from knowledge of the acquired knowledge.
- The development of change impact indicators (progress markers for teams) that can be routinely collected is done in collaboration with the institution’s IMG.
The report is based, on the one hand, on the evaluation of the structure, its dynamics, the available resources, the obstacles to change that can be identified, and on the other hand, on co-constructed proposals with stakeholders, Knowledge relevant to their operational representation, accompanied, as far as possible, by indicators of actual implementation.
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