No interventions without risks
Interventions in health promotion and prevention are challenging projects that go beyond the routine activities of organizations and often develop differently than originally planned. The inherent uncertainty and unpredictability of interventions has different causes (based on Wanner 2015):
- Complexity: Health promotion intervenes in complex socio-spatial settings where stakeholders with different interests interact in a variety of ways. Schools, enterprises and neighborhoods are intrinsically unique. Interventions rapidly develop their own and often difficult to predict dynamic.
- Innovation: Health promotion is still a relatively young field with few established interventions. The preferred form for it is programs or projects. The development process is usually innovative and creative and offers many opportunities, but also harbors uncertainties and risks.
- Collaboration: Programs and projects usually have their own organizational structure, which sometimes contravenes the line structure of the host organization. In addition, larger interventions are often staffed by professionals who have been assigned to a program or project by different organizations. These new team structures and the interactions between teams, target groups, stakeholders and other partners often result in unplanned and difficult to predict developments.
- Individuality: People come to interventions with their own individual needs, attitudes, experiences and sensibilities, which may change over time. Wherever people work together, surprisingly high performances are possible, although it is just as likely that errors will occur.
- Context: Some elements in the context of an intervention can change at any time and help or hinder the development. The population’s support for a neighborhood project, the political framework for a school project, and the economic situation of an enterprise are factors that are highly volatile and difficult to predict.
- Participation: Interventions in health promotion should be planned and executed with the participation of stakeholders and target groups. If the participatory principle is fully applied (Wright 2010), target groups will continuously co-decide on the intervention’s development, Therefore, it can become difficult to predict and to plan.
Opportunities and risks are closely related. Seeing risks only as a danger to a project is too narrow a point of view (Wanner 2015). In our own development we are continually taking risks and seizing opportunities. A child who is learning to ride a bike hopes to expand his boundaries and to keep up with older children. He or she also has a chance to have more fun. In order to achieve these goals, several hurdles must be overcome. However, few children will do so without experiencing some falls and scrapes. In other areas of life (profession, travel, etc.) we similarly are confronted by risk, at least if we wish to progress. Life without any risk is hardly imaginable and not really desirable. The goal cannot be to avoid all risk, but to know how to assess and limit it. This is true for both daily life and project work.
Dealing with uncertainty
Finding an adequate approach to questions of transparency and uncertainty is one of the great challenges in health promotion and prevention. Managers must:
- accept that settings and target groups, and even the intervention itself, could develop differently than was originally intended,
- be open to take advantage of windows of opportunities and be aware of potential risks
- to envisage different scenarios for development,
- reflect regularly and systematically on the actual development of a project so as
- to be able to react flexibly and creatively to unforeseen changes.
Caught between predictability and uncertainty, managers need to be clear about the goals that are pursued and also that these same goals need to be regularly reviewed, sharpened and adjusted if necessary. Scheduling by milestones and detailed planning by stages help to reflect continuously on progress, to respond to arising opportunities and to develop the project step by step. Milestones that appear at regular intervals throughout a program or a project are breaks where discussions and detailed planning can take place. They provide good opportunities for a retrospective analysis of actual strengths and weaknesses and for a prospective analysis of possible opportunities and risks (SWOT-analysis).
Wright, Michael, T. (2010). Pratizipative Qualitätsentwicklung in der Gesundheitsförderung und Prävention. Bern: Huber
Wanner, Roland (2015). Risikomanagement für Projekte: Die wichtigsten Methoden und Werkzeuge für erfolgreiche Projekte. Kompakt-Wissen. 2. Auflage. CreateSpace Independent Publishing Platform.
- You assume that you have planned your program or project so well that contingencies are improbable.
- You fear that dealing with risks could lead to a negative atmosphere with the stakeholders.
- You are fully occupied with what is foreseeable and have no time to plan for contingencies.
- You do not know what you could do to see risks in advance and to avoid them.
- You do not waste opportunities that arise for your program or project. The potential impact is thus improved.
- If you deal with potential risks, you can reduce or even avoid them.
- If you have a contingency plan for unavoidable risks, you are prepared and can respond calmly if they actually occur.
- Schedule regular break points (milestones) in your project or program to regularly reflect on the strengths, weaknesses, opportunities and risks.
- Use the tool for risk analysis that is provided by quint-essenz. It allows you to prepare thoroughly for potential threats and to take preventive measures.
- Do you regularly discuss with your team opportunities and risks for your intervention?
- Have you taken preventive measures in order to adequately respond to risks?
- Do you have a "Plan B" should one of the identified risks occur?
- Do you have a reserve for contingencies in your budget?