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LIBRARY

OF THE

MASSACHUSETTS INSTITUTE
OF TECHNOLOGY



J'RED P. SLOAN SCHOOL OF MANAGEMEN'



USING A MODEL AS A PRACTICAL MANAGEMENT
TOOL FOR FAMILY PLANNING PROGRAMS

562-71

September 28, 1971

Ronald W. O'Connor, M.D.

Glen L. Urban, Ph.D.



MASSACHUSETTS

INSTITUTE OF TECHNOLOGY

50 MEMORIAL DRIVE

lMBRIDGE. MASSACHUSETTS 021?



MASS. INST. TECH.
OCT 27 1971

DEWEY LIBRARY



USING A M3DEL AS A PRACTICAL MANAGEMENT
TOOL FOR FAMILY PLANNING PROGRAMS

562-71

September 28, 1971

Ronald W. O'Connor, M.D.

Zee.
Glen L. Urban, Ph.D.






RECEIVED
OCT 29 1971

M, I. T. LIbKAHlES




Massachusetts Institute of Technology

Alfred P. Sloan School of Management

50 Memorial Drive

Cambridge, Massachusetts, 02139



USING A MODEL AS A PRACTICAL MANAGEMENT TOOL FOR FAMILY
PLANNING PROGRAMS



September 28, 1971



Ronald W. O'Connor, M.D., Senior Research Associate
Glen L. Urban, Ph.D., Associate Professor of Management



Family Planning Management Research Project



.sr^^n*;.,*



USING A MODEL AS A PRACTICAL MANAGEMENT TOOL FOR FAMILY
PLANNING PROGRAMS



I. Introduction

Managing a family planning system is a difficult and complex task.
Managers attempt to answer questions such as:

What have been the past sources of success and failure in our programs'

Where is the system going?

What resources will be needed to support system growth? What budget
should be sought and how should funds be allotted?

How can a diverse group of clinic service agencies be coordinated?

A great deal of data exists to help answer such questions. Even a
single agency or clinic program is confronted by a variety of data sources
including client visit records, outreach worker reports, budget figures,
target population estimates, opinions and survey findings. These inputs
are compounded when there are several programs or agencies involved in
the political realities of one area. In fact, the complexity of the
information presents a problem to the manager who must make sense out of
the data before he can vise it to help in his decision making.

This paper describes an application of management science through the
use of a model as a tool for program managers and areawide planners to
grapple with the inundation of potentially important data. The goals
of this model are to improve tmderstanding of how a particular family
planning system operates and to support improved program management
through the organized use of data in problem diagnosis, forecasting, and
examination of strategy alternatives.



This tool has been developed at M.I.T. in cooperation with the
agencies providing family planning in Atlanta, Georgia, through their
Atlanta Area Family Planning Council (AAFPC) . The Council was formed
when the major providers of service recognized that continued independent
program development was likely to be an inadequate response to the
community's need. One of the Council's interests has been focused on
understanding the sources of clients needing services, where and how
services are in fact obtained, what services are needed and how often
are they needed. The model attempts to provide an explicit structure
of how the managers of the major service agencies perceive their system.

II. Perception of the Family Planning Services System

People concerned with family planning programs in Atlanta visualize
service facilities spreading through the area, serving a Target Group of
clients defined as the rep reductive- age , medically indigent population.
Atlanta managers saw a common denominator between individual clinic programs
emerge in terms of a concern for patient flow: In what ways do potential
users flow into and drop out of clinic programs? How do they move between
various agencies? How do they flow into and out of the eligible service
population? As a means for communicating effectively with each agency
potentially involved, the model was designed around a simulation of this
area of common concern, the patient flow process.

The Atlanta area had several basic settings or channels for serving
the target group: post partum hospital programs, separate or free standing
health care centers (e.g., local health department clinics. Planned Parenthood
Centers, as well as activities through private medical care and commercially



1. Work to date has been supported by M.I.T. , the Carolina Population
Center and since July 1, 1971 by the Health Services and Mental
Health Administration, DHEW, under contract HSM 110-71-127.



3.

distributed over-the-counter methods. The formal public channels use
a common program measure - the number of individual patients actively

receiving family planning services through all publicly supported channels-

2
as a primary evaluation yardstick. Figure 1 diagrams the target population

as composed of three major segments: Pregnant, Active in Program, and

Neither Active nor Pregnant. Although gosls such as improvinp maternal

and child health, introducing the indigent into the health care system and

assuring that every child is a planned and wanted child are stated for

family planning, the most frequent objective mentioned to

reach these goals is increasing the percentage of active family planning

patients in the target population.

To understand how patients obtain services, each service agency

described how they perceived their own program as working. The model

structure was built to reflect the operational program environment in

the user's terms; hence, from the beginning, the program directors who

use it understand and control a planning process which evolves according

to their own needs. Examples of the post partum program and the planned

parenthood channels are structured in Figures 2 and 3. The general flow

sequence is clearly related to events that are part of the clinic program

activities, or to decisions which each patient makes regarding their

use of clinic services.



2. O'Connor, R. W. , Allen, D. T. , and Smith, J.C, "Information Flow
and Service Oriented Feedback in Family Planning Programs," Studies
In Family Planning, No. 46, October 1969, The Population Council,
New York.



Figure 1



TARGET POPULATION



Pregnant



Not Pregnant

and

Not Active in

Program



Active

Family Planning

Patients in

Program



Figure 2



POST PARTUM PATIENT FLOW
FROM THE PREGNANT GROUP IN THE TARGET POPULATION



Target Population



Pregnant



Non Pregnant
Non Active



pregnant
patients
deliver



lost and
return to ■ o -











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events rather than directly on the life table techniques widely employed
by researchers in evaluating contraceptive effectiveness because few
operating managers think in terms of life tables directly. '^ The patient
visit is the concrete event at the heart of all clinic programs, and
is the service unit which managers must plan for.

Figure 4 includes a series of questions which have been phrased to
express the movement from one point to another implied by the flow
structure. Figure 5 relates a similar flow example for a free standing
clinic such as might be described by health department or planned
parenthood program staff. Patient record data and program service
statistics answer many of the questions which are asked. Moreover, the
user has focused his questions so that distraction by the mass of program
information is minimized.

A summary view of the patient flow process is presented in Figure 6,
where the target group is viewed as a closed system of the three major
segments at any point in time: Pregnant, Active, and Neither Active Nor
Pregnant. Active patients either remain active, become pregnant intentionally
or through contraceptive failure, or discontinue method use and enter
the non -active, non-pregnant group. Pregnant women either remain pregnant,
deliver and perhaps obtain family planning, or they return to the non-
active, non-pregnant state. Those in the non-active, non-pregnant state
either remain so, accept family planning or become pregnant.



4. Tietze, C. , "Intrauterine Contraception: Researcfi Report " Studies
in Family Planning, no. 18, The Population Council, April 1967.

5. Naert, Philippe, Murthy, Srinivasa, "Visit Continuation Rates, Intervisit
times , and their managerial implications for Family Planning
Administrators: A Case study of Atlanta," forthcoming.



Figure 6 Target Group Segments and Interaction



deliver and accept post partum



deliver and
not accept



accept by request



Pregnant



% TV



±-



or outreach



Not Active
Not Pregnant



^ \^



Active



become



discontinue



pregnant



method



contraceptive failure



and become pregnant



switch



!thods



These flows represent the basic model structure, and in a specific
program situation, managers may want to elaborate their model to include
other phenomena. For example, the manager can include segmentation
of the target population into groups reflecting different levels of
experience, attitudes, or needs. He may want to specify different
methods of contraception, use of private protection, inclusion of
sterilization and abortion, advertising, migration and referral of
patients between service agencies. The model is designed to be used
in an evolutionary way, with the manager specifying important factors
for his program and expanding the model only insofar as it is perceived
as useful.

IV. Relating Inputs to Service Outputs

The patient flow process provides the program manager with a means
for relating actual resource inputs, as measured by his service statistics
in terms of patient visits, selection of methods and the probabilities
of continuation, to measures of output such as active patients and
couple years of protection. By adding budget data and capacity information,
the user can also obtain cost and capacity utilization estimates for
planning purposes. Cost effectiveness measures in terms of cost per
visit, per active patient, and per couple year of protection are available
as model outputs. Program costs at each agency can be entered as a
total cost per year figure, or may be broken into fixed cost (i.e. , building
rentals, fixed salary obligations) and variable cost components (i.e. ,
pills, pap smear kits). Other elements such as system overhead, and
communication programs, can be entered as well.



6. See Urban, above, for a full discussion of evolutionary capabilities.



10.

While facilities to provide service are limited, capacity limitation
may mean different things in different programs with the limiting factor
varying as the program evolves. Space, nurse or physician manpower might
individually be constraints on the program at any particular time. The
question of capacity planning can be dealt with by the program manager's
assessment of the aggregate visit capacity at his clinics or by a more
detailed consideration of scarce resource utilization on first, repeat,
or medical visits.

In advanced stages of model evolution, output measures such as
unwanted births prevented can be obtained. The range of output
possibilities reflects the variety of management objectives, but we
would hope the model would help managers cope with higher order goals
such as unwanted births prevented per dollar.

V, How the Model is Used

Use of this methodology begins by outlining with service agency
directors how they perceive their programs operating, and working with
them to convert this outline into an initial model of patient flows.
Though a computer is used to carry out the calcxilations , it is recognized
that few program directors have the time or interest to get involved with
the tecnical details of computers. To insure that the manager remains
in control of the process, an english language, interactive computer system
IS used.

Past data and judgment are used to estimate the parameters that
control movement in the flow process. All interaction in terms of data
entry and output reports is mediated through an english language control



7. For examples of computer input and output, see O'Connor, R. W. , "The
Use of a Simulation Model as a Decision Support Tool in the Management
of Metropolitan Family Planning Programs," Sloan School of Management,
M.I.T., May 1971.



11.

Q

system. Using a typewriter console, the manager enters the relevant

9
data into his planning model, which is stored in a timesharing computer.

The portable typewriter terminal is connected through an ordinary

telephone to the computer and the planner thereby can use it either

in his office, in a field training session in a clinic, or at home

at his convenience.

The user then runs the model using data for a previous time period,
to assess whether the model visualized and the data entered, when
projected over time, do indeed track actual events acceptably. The
process of tracking and fitting historical data is important in
establishing confidence that projections are reasonable for planning
purposes. (see figure 7 for model tracking). When the program manager
reaches this level of confidence, he can exploit his planning tool for
goal setting, exploring policy alternatives and budget planning.

By running his model for a one, two or three year period, the planner
can examine expected program growth under existing conditions. For
example, program growth measures in terms of percentages of target
group being actually served, or numbers of new patients, or couple years
of protection, are normal model outputs. Alternative policy considerations,
such as increased attention to referral systems, outreach, sterilization,
advertising, or abortion services can be examined. The user enters the
new data for a specific alternative and the additional calculations are
run in a few seconds, giving rapid assessment of each alternative in terms
of growth potential. The setting of arbitrary goals for growth is avoided.



8. Management Decision Systems, Inc, 486 Totten Pond Rd. , Waltham, MA 02154

9. At present, IBM 360/67 CP/CMS




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Online LibraryRonald W O'ConnorUsing a model as a practical management tool for family planning programs → online text (page 1 of 1)