A Tool for Sharing Internal Best Practices > Case Studies

Case Study #1: Identifying Best Practices at the UNDP Regional Bureau for Asia and the Pacific

Case Study #2: Documenting and Disseminating Best Practices at the Delivery of Improved Services for Health (DISH)

Case Study #3: Disseminating Lessons Learned at Britain's National Health Service

Case Study #1: Identifying Best Practices at the UNDP Regional Bureau for Asia and the Pacific

The United Nations Development Programme (UNDP) Regional Bureau for Asia and the Pacific has begun to systematically identify and document best practices for development projectsin the region. In preparation for a meeting in 2003, each UNDP country office in the region was asked to identify examples of good practices and to document them as case studies. To guide country offices in identifying best practices, UNDP defined good practices and projects as those that:

Induce strategic policy changes, accomplish a goal or produce significant results in an area, and are catalytic in nature;
Are innovative and creative, introducing new approaches and methodologies that have not been used before in that country;
Have significant impact on broad outcomes, such as a country's development goals;
Are sustainable, demand-driven, country-led and owned, and build on existing capacities and cultural context;
Can be replicated in different countries and adapted in response to changing circumstances and the accumulation of experience;
Encourage dialogue, participation, and collaboration among stakeholders at the local, national, regional, and international levels;
Pay special attention to underserved groups, such as ethnic minorities, and seek to involve the community;
Take a rights-based approach to development; and
Demonstrate successful partnerships that respect national ownership and build capacity among national stakeholders.

In order to emphasize lessons learned, country offices were asked to: think of the challenges faced in designing and successfully implementing the project; consider what worked, what didn't, and why; and present the key lessons from their experiences to help others replicate success. A UNDP selection panel evaluated the practices submitted and decided which ones merited inclusion in a booklet distributed at the meeting and an online database (http://www.undp.org/rbap/BestPrac/Bestpractices.htm).

Sources: UNDP, 2002a; UNDP, 2002b; UNDP, 2003

Case Study #2: Documenting and Disseminating Best Practices at the Delivery of Improved Services for Health (DISH) Project, Uganda

DISH was an eight-year (1994-2002) reproductive, maternal, and child health project in Uganda supported by USAID. The project succeeded in improving the quality, availability, and use of reproductive, maternal, and child health services in the twelve districts it served. As the end of the project drew near, DISH managers wanted to document its best practices to facilitate their adoption by other districts in Uganda and by organizations regionally and internationally.

They began by identifying the stakeholders they felt should be involved in compiling best practices. These included representatives from the government, partner organizations, other NGOs, and donors as well as project staff. The next step was to ask staff and stakeholders to nominate potential best practices for review. DISH then hired an outside facilitator to plan and conduct a full-day meeting of staff and stakeholders to define best practices for DISH, select which practices to document, and develop a dissemination plan.

Defining best practices. Participants at the meeting defined a best practice as a model project activity or policy aimed at improving the quality of life of individuals or groups. To qualify as a best practice, they agreed that the activity or policy must:

Be innovative and/or an improvement and/or set a precedent,
Make a difference—and there must be evidence of positive impact,
Have a sustainable effect on the intended audience, and
Have potential for replication.

Participants then divided into small groups to review each practice nominated. They selected seven best practices to disseminate: (1) a marketing strategy for long term and permanent family planning methods; (2) a promotional strategy for adolescent reproductive health services; (3) a management information system that encourages analysis and use of data at the facility and district levels; (4) a certification system for health facilities; (5) a radio game show on health topics; (6) a training program on contraceptive implants for rural midwives, nurses and clinical officers; and (7) a pre-testing methodology that involves intended audiences in materials development.

Documentation and dissemination. DISH hired a Communication Manager to oversee the documentation and dissemination process. She worked with DISH experts to produce:

Information sheets that describe each practice, discuss results and challenges, illustrate project materials and activities, and name a contact person for more information;
Best practice binders containing all of the support materials needed to implement a practice, including strategy documents, training and implementation tools, counseling and communication tools, and sample project materials;
Presentations on each practice; and a
A Web site and CD-ROMcontaining all of the resources in the binders.

The print materials were sent to an extensive mailing list of government and civil society representatives in Uganda, distributed in bulk to governmental and nongovernmental agencies, handed out at workshops, and added to library collections. Regional workshops on four of the best practices addressed health officials from districts not served by the project, NGOs working in related areas, health care providers, and Ministry of Health officials. Many of the workshops included study tours to sites that were actually implementing the practices.

Caption: DISH best practice information sheet

Lessons learned. Most of DISH’s best practices have been adopted elsewhere in Uganda and/or other African countries. For example, the Yellow Star certification system for public health facilities has been expanded to include almost all districts in Uganda and also is being adapted for use with private sector clinics.

However, documenting the best practices proved difficult and time-consuming. DISH had no central location for information, studies, reports, and training manuals. Much of the information needed to share best practices was in people's heads; very little was recorded or documented; and even less was available electronically. It was challenging to get needed information from project staff because they had heavy workloads and did not view sharing best practices as a priority. Also, staff did not always agree on exactly what a best practice was and how it was achieved. In some cases there was little quantitative data to prove that the activity was actually a best practice; it was just thought to be so by staff and stakeholders.

Based on this experience, DISH managers recommend that any organization wishing to collect best practices:

Create an atmosphere that encourages documentation and establish a central location where information can reside from the start of the program;
Encourage people to keep electronic records of their work as well as print copies;
Direct managers and staff to keep a written record of all activities and challenges from the start of the program, so that staff do not have to rely on people's memories to document practices.

Sources: DISH, 2002; Rigby, 2001

Case Study #3: Disseminating Lessons Learned at Britain’s National Health Service

In 1998 the National Health Service (NHS) introduced clinical governance as a systematic approach to improving the quality of health care in England. Clinical governance works to improve quality in a variety of ways, including transforming organizational culture, strengthening leadership, creating multi-disciplinary development teams to analyze and address problem areas—and recognizing and replicating good practices.

The NHS Clinical Governance Support Team (CGST) systematically captures learning from local development teams and shares it throughout the country in print materials, online, at conferences, in slide presentations, and in an email bulletin. Most of these resources use storytelling to convey lessons learned. They also link interested people directly with the local team that devised a specific practice and collect tips for success from NHS managers, providers, and patients.

Three series of print materials are especially notable:

Eureka! flyers briefly describe practical approaches that health professionals, in a moment of discovery, have devised to overcome barriers to change.
Case Studies offer a fuller account of a team’s experiences and achievements, including difficulties faced in carrying the work forward, benefits for providers, patients, and the organization, and lessons learned that could benefit others.
Lesson Cards distill this knowledge base into discrete, practical lessons. Each card retells a story in a single paragraph and draws three specific lessons from the experience; online versions also link to a Eureka! or Case Study. The three collections of Lesson Cards currently available address five broad areas: patient involvement, improving communication, risk reduction, staff development, and ensuring project effectiveness.

Sources: NHS CGST, 2005; Scally and Donaldson, 1998

Johns Hopkins Bloomberg School of Public Health: The INFO Project

A Tool for Sharing Internal Best Practices > Case Studies