Implementation Of Planning Strategies Research Articles

An Entrepreneurial Lens on Backshoring Implementation by SMEs

AbstractUsing the lenses of internationalization process theory and of effectuation theory, this study investigates how small and medium enterprises (SMEs) implement backshoring initiatives. A qualitative multiple case study is developed involving six SMEs that have relocated from China back to their respective home countries. The analysis illuminates SMEs’ perspectives on the uncertainty perceived when returning to the home country and on how SMEs dynamically manage their domestic commitment and network of relations. The study also sheds light on the different alternative approaches they employ during different phases of the backshoring process and on the outcomes of these initiatives. Notably, the study demonstrates that the conceptual frameworks commonly employed in the literature to explain internationalization can effectively be extended to the domain of backshoring. Successful backshoring for SMEs hinges on their accurate perception of domestic uncertainty and their dynamic utilization of both planning and effectuation implementation strategies. Conversely, the failure of backshoring initiatives can be traced back to SMEs’ misperception of their position within the domestic business network, a cognitive bias that can lead to suboptimal decisions and outcomes.

Deciphering Disparities: The NHLBI Program on Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Risk (DECIPHeR)

Despite several ambitious national health initiatives to eliminate health disparities, spanning more than 4 decades, health disparities remain pervasive in the United States. In an attempt to bend the curve in disparities elimination, the National Heart, Lung, and Blood Institute (NHLBI) issued a funding opportunity on Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Risk (DECIPHeR) in March 2019. Seven implementation research centers and 1 research coordinating center were funded in September 2020 to plan, develop, and test effective implementation strategies for eliminating disparities in heart and lung disease risk. In the 16 articles presented in this issue of Ethnicity & Disease, the DECIPHeR Alliance investigators and their NHLBI program staff address the work accomplished in the first phase of this biphasic research endeavor. Included in the collection are an article on important lessons learned during technical assistance sessions designed to ensure scientific rigor in clinical study designs, and 2 examples of clinical study process articles. Several articles show the diversity of clinical and public health settings addressed including schools, faith-based settings, federally qualified health centers, and other safety net clinics. All strategies for eliminating disparities tackle a cardiovascular or pulmonary disease and related risk factors. In an additional article, NHLBI program staff address expectations in phase 2 of the DECIPHeR program, strategies to ensure feasibility of scaling and spreading promising strategies identified, and opportunities for translating the DECIPHeR research model to other chronic diseases for the elimination of related health disparities.

Islamic Religious Education Learning Outcomes Evaluation: Implementation of Steps, Concepts and Solutions in Public Elementary School

Evaluation activities can be employed as a means to optimise the attainment of learning objectives and learning outcomes. Understanding student performance as a foundation for fostering student potential. This study focuses on the implementation of the evaluation of Islamic Education (PAI) learning outcomes, encompassing the planning process, objectives, types, and implementation strategies. It also examines the challenges faced by educators during the implementation and proposes potential solutions. This qualitative study acquired data through interviews and literature review. Data collection is the initial and essential stage in a study. The researchers employ various data collection approaches. Researchers performed a question-and-answer session with the PAI Teacher at a public elementary school in Kuaro. In field research, narratives or accounts of heard and felt occurrences are analysed in detail to remain natural and accurately depict field phenomena. Planning for PAI learning outcome evaluation, including setting clear goals, identifying components, selecting procedures, collecting data, confirming data, and constructing assessment measuring instruments. Evaluation types: formative and summative. Evaluation methods—tests and non-tests. Evaluation limitations, short study hours, and poor infrastructure. According to the research above, PAI learning outcome evaluations are implemented using prior evaluation planning to maximise efficiency and effectiveness. PAI learning outcomes are evaluated utilising cognitive, emotional, and psychomotor assessments.

Application of implementation mapping to develop strategies for integrating the National Diabetes Prevention Program into primary care clinics.

Diabetes is considered one of the most prevalent and preventable chronic health conditions in the United States. Research has shown that evidence-based prevention measures and lifestyle changes can help lower the risk of developing diabetes. The National Diabetes Prevention Program (National DPP) is an evidence-based program recognized by the Centers for Disease Control and Prevention; it is designed to reduce diabetes risk through intensive group counseling in nutrition, physical activity, and behavioral management. Factors known to influence this program's implementation, especially in primary care settings, have included limited awareness of the program, lack of standard clinical processes to facilitate referrals, and limited reimbursement incentives to support program delivery. A framework or approach that can address these and other barriers of practice is needed. We used Implementation Mapping, a systematic planning framework, to plan for the adoption, implementation, and maintenance of the National DPP in primary care clinics in the Greater Houston area. We followed the framework's five iterative tasks to develop strategies that helped to increase awareness and adoption of the National DPP and facilitate program implementation. We conducted a needs assessment survey and interviews with participating clinics. We identified clinic personnel who were responsible for program use, including adopters, implementers, maintainers, and potential facilitators and barriers to program implementation. The performance objectives, or sub-behaviors necessary to achieve each clinic's goals, were identified for each stage of implementation. We used classic behavioral science theory and dissemination and implementation models and frameworks to identify the determinants of program adoption, implementation, and maintenance. Evidence- and theory-based methods were selected and operationalized into tailored strategies that were executed in the four participating clinic sites. Implementation outcomes are being measured by several different approaches. Electronic Health Records (EHR) will measure referral rates to the National DPP. Surveys will be used to assess the level of the clinic providers and staff's acceptability, appropriateness of use, feasibility, and usefulness of the National DPP, and aggregate biometric data will measure the level of the clinic's disease management of prediabetes and diabetes. Participating clinics included a Federally Qualified Health Center, a rural health center, and two private practices. Most personnel, including the leadership at the four clinic sites, were not aware of the National DPP. Steps for planning implementation strategies included the development of performance objectives (implementation actions) and identifying psychosocial and contextual implementation determinants. Implementation strategies included provider-to-provider education, electronic health record optimization, and the development of implementation protocols and materials (e.g., clinic project plan, policies). The National DPP has been shown to help prevent or delay the development of diabetes among at-risk patients. Yet, there remain many challenges to program implementation. The Implementation Mapping framework helped to systematically identify implementation barriers and facilitators and to design strategies to address them. To further advance diabetes prevention, future program, and research efforts should examine and promote other strategies such as increased reimbursement or use of incentives and a better billing infrastructure to assist in the scale and spread of the National DPP across the U.S.

Enterprise Servitization: Practical Guidelines for Culture Transformation Management

We propose a framework based on ADKAR (awareness, desire, knowledge, ability, and reinforcement) with guidelines to manage the organizational culture change required for servitization—the transition of a company towards a product–service system (PSS) business model that provides cohesive delivery of products and services, increasingly supported on digital technologies. We departed from a systematic literature review across five academic databases, covering human and technological aspects, that confirmed corporate culture as one of the pillars of a successful transformation, along with relevant factors to account for. The results of this work have both theoretical and managerial implications. Companies can apply the framework to support planning implementation strategies that require a corporate mind shift. Finally, we identified directions for future servitization research.

Implementing advance care planning in Swedish healthcare settings – a qualitative study of professionals’ experiences

Background Advance care planning (ACP) is a process involving conversations about values and preferences regarding future care at the end-of-life. ACP has led to positive outcomes, both in relation to quality of life and with increased use of palliative care, less life-sustaining treatment and fewer hospital admissions. Sweden has yet to embrace the practice systematically, but scattered initiatives exist. Aim To study implementation of a routine for ACP in NH settings in Sweden by exploring healthcare professionals’ experiences of engaging in ACP following this implementation. Methods The study followed a qualitative inductive design with convenience and snowball sampling. Semi-structured group and individual interviews with registered healthcare professionals were analysed using qualitative content analysis. Findings Organisational support for sustainable ACP implementation was found to be essential. This included sufficient training, facilitation, collaboration and uniform work routines across providers and professionals. Engaging in ACP conversations following the implemented routine was found to be a process of preparing, being, talking, deciding and sharing. Conclusions Successful implementation of ACP in NHs requires a carefully planned implementation strategy. ACP in NHs tend to be medically focused at the expense of residents’ psychosocial care-planning needs. Widespread uptake of ACP in Sweden could be useful in the national effort to adopt more person-centred care in Swedish healthcare. KEY POINTS While advance care planning has been implemented in many other countries, Sweden lacks a national strategy on advance care planning and Swedish healthcare settings have yet to systematically implement this practice. • This study is the first to report on professionals’ experiences of engaging in sustainable advance care planning, following top-down implementation of the practice in one Swedish region. • Successful implementation of advance care planning in nursing homes requires a system-level approach, and shortcomings of the implementation process are highlighted.

Using Implementation Mapping to Build Organizational Readiness.

Organizational readiness is essential for high-quality implementation of innovations (programs, policies, practices, or processes). The R = MC2 heuristic describes three readiness components necessary for implementation—the general functioning of the organization (general capacities), the ability to deliver a particular innovation (innovation-specific capacities), and the motivation to implement the innovation. In this article, we describe how we used the Readiness Building System (RBS) for assessing, prioritizing, and improving readiness and Implementation Mapping (IM), a systematic process for planning implementation strategies, to build organizational readiness for implementation of sexual assault prevention evidence-based interventions (EBIs). While RBS provides an overarching approach for assessing and prioritizing readiness constructs (according to the R = MC2 heuristic; Readiness = Motivation x general Capacity × innovation specific Capacity), it does not provide specific guidance on the development and/or selection and tailoring of strategies to improve readiness. We used the five IM tasks to identify and prioritize specific readiness goals and develop readiness-building strategies to improve subcomponents described in the R = MC2 heuristic. This article illustrates how IM can be used synergistically with the RBS in applied contexts to plan implementation strategies that will improve organizational readiness and implementation outcomes. Specifically, we provide an example of using these two frameworks as part of the process of building organizational readiness for implementation of sexual assault prevention EBIs.

Using an Implementation Research Framework to Identify Facilitators and Barriers to Physical Activity and Weight Loss in Appalachia.

West Virginia (WV) is the only state entirely located in Appalachia, a large, mostly rural area in the eastern United States. WV has the highest adult obesity rate in the United States, as well as one of the highest physical inactivity rates. Obesity has been found to be significantly higher in rural counties than in urban counties, and many rural communities do not have the resources to address this growing health concern. It is well documented that healthy eating and becoming more physically active can be successful in reducing weight and managing obesity-related illness. Despite this overwhelming evidence, obesity rates in WV continue to climb. The purpose of this study was to understand the factors associated with obesity in WV and identify what influences the behavior of people in regard to weight loss and exercise. Four focus groups were conducted across the state of WV, transcribed, and thematically analyzed to examine the facilitators and barriers associated with healthy behaviors. The Consolidated Framework for Implementation Research (CFIR) was used as an approach to classify characteristics and plan implementation strategies integrating five domains. The CFIR has been used to identify potential barriers and facilitators to interventions and can be used before or during an intervention. In addition, the CFIR has been used as a framework to guide analysis and provide a means to organize intervention stakeholders' perceptions of barriers and facilitators to successful interventions. Participants identified barriers and facilitators across all 5 major domains of the CFIR-intervention characteristics, outer setting (eg, cultural norms, infrastructure), inner setting (eg, access to knowledge), characteristics of individuals, and the implementation process-and 16 subdomains. Participants discussed how socioeconomic, cultural, and environmental factors influenced diet and exercise. Cost, family culture, and limited access to resources (eg, healthy foods, community-based fitness programs, health care) were common themes expressed by participants. The results of this study identify how individuals living in rural Appalachian view lifestyle changes and what influences their ability to pursue physical activity and healthy eating. Future programs to encourage healthy lifestyles in Appalachia need to consider the characteristics of the given community to achieve the goal of a tailored lifestyle intervention program that is feasible and effective. In addition, the findings suggest that the CFIR can be used to implement and refine intervention strategies that can be used in the real world.

Implementation of advanced practice nursing in Brazilian Primary Health Care: methodological path.

to describe the operationalization of the steps of a model proposed by the Pan American Health Organization for implementing advanced practice nursing in Primary Health Care services. a methodological study, with a qualitative approach, carried out in a local health system located in southern São Paulo. The first six steps of the model were followed: 1) improve health outcomes; 2) identify stakeholders; 3) determine unmet health needs; 4) identify priorities and goals to introduce advanced nursing practices in primary health care; 5) define advanced practice nursing in primary health care; 6) plan implementation strategies. in each step, the objectives, methodological strategies and operationalization were described. the model proved to be effective to support the process of development and implementation of advanced practice nursing in the local system studied.

Co-production of a transdisciplinary assessment by researchers and healthcare professionals: a case study.

One definition of research co-production is a collaboration between researchers and healthcare professionals throughout a research process to facilitate knowledge translation and improve the clinical impact of research findings. In this paper, we present a case study of clinical research co-production and reflect on how the process was facilitated between researchers and healthcare professionals. Type of program or service: Development of a novel transdisciplinary assessment for implementation in an acute stroke unit (ASU). Researchers and healthcare professionals integrated perspectives and co-produced a novel transdisciplinary assessment. Team-based activities were guided by a logic model, including task analysis and simulation testing. A logframe matrix was used to plan implementation strategies to mitigate potential risks. Research co-production was fundamental to integrating multiple perspectives to develop an effective, novel transdisciplinary assessment for patients with stroke. Preliminary data demonstrated that the transdisciplinary approach could save up to 103 minutes per patient in assessment time. As the project evolved, the three most important factors for research co-production were 1) the right people to integrate critical disciplinary and pragmatic perspectives; 2) a project leader who was inclusive of perspectives held by researchers and healthcare professionals, and 3) structured and non-biased team discussions using a theoretical tool. We recommend these three factors be considered in future research co-production in healthcare settings.

Using Implementation Science Strategy Mapping on the Age-Friendly Health System's 4Ms Journey

Background: Implementation science is the study of methods to promote the adoption and integration of evidence-based practices into routine health care to improve the quality of care. The purpose of this study was to use Implementation Mapping to guide the implementation of The John A. Hartford evidence-based Age-Friendly Health Systems (AFHS) 4Ms Framework: What Matters, Medications, Mentation, and Mobility. Methods: Implementation Mapping, a systematic process for planning implementation strategies, guided the 9-month integration of the 4Ms Framework in the 1,100 MinuteClinics across the US. Implementation Mapping includes five tasks: (1) conduct an implementation needs assessment and identify program adopters and implementers; (2) state adoption and implementation outcomes and performance objectives, identify determinants, and create matrices of change objectives; (3) choose theoretical methods (mechanisms of change) and select or design implementation strategies; (4) produce implementation protocols and materials; and (5) evaluate implementation outcomes. Results: The implementation plan, developed by the implementation mapping method, was carried out over 9-months. Seven implementation strategies were identified from the Expert Recommendations for Implementing Change (ERIC) project including the provision of education, electronic health record integration, internal champion facilitation, cues to action, and a dashboard to monitor progress. To date, the implementation mapping has resulted in the adoption of the 4Ms by 1145 providers (37%). Monitoring of the adoption of the 4Ms Framework and consideration of future implementation strategies is ongoing. Conclusions: Implementation Mapping provided a systematic process to develop strategies to improve the adoption, implementation, sustainment, and scale-up of the evidence-based 4Ms Framework.

Fidelity evaluation of the compared procedures for conducting the PVS-PREDIAPS implementation strategy to optimize diabetes prevention in primary care

BackgroundAssessing the fidelity of an implementation strategy is important to understand why and how the strategy influences the uptake of evidence-based interventions. The present study aims to assess the fidelity of the two procedures for engaging primary care (PC) professionals and for the deployment of an implementation strategy for optimizing type 2 diabetes prevention in routine PC within the PREDIAPS randomized cluster implementation trial.MethodWe conducted a mixed-method fidelity evaluation study of the PVS-PREDIAPS implementation strategy. Nine PC centers from the Basque Health Service (Osakidetza) were allocated to two different procedures to engage physicians and nurses and deploy a implementation strategy to model and adapt the clinical intervention and its implementation to their specific contexts: a Global procedure, promoting the cooperation of all healthcare professionals from the beginning; or a Sequential procedure, centered first on nurses who then pursued the pragmatic cooperation of physicians. Process indicators of the delivery and receipt of implementation strategy actions, documented modifications to the planned implementation strategy, and a structured group interview with centers’ leaders were all used to assess the following components of fidelity: adherence, dose, quality of delivery, professionals’ responsiveness and program differentiation.ResultsGenerally, the procedures compared for professionals engagement and deployment of the implementation strategy were carried out with the planned differentiation. Nonetheless, some unexpected between-group differences were observed, the initial rate of collaboration of nurses being higher in the Sequential (93%) than in the Global (67%) groups. Exposure rate to the programed implementation actions (% of hours received out of those delivered) were similar in both groups by professional category, with nurses (86%) having a higher rate of exposure than physicians (75%). Professionals identified half of the planned discrete strategies and their rating of strategies’ perceived usefulness was overwhelmingly positive, with few differences between Sequential and Global centers.ConclusionsThe PVS-PREDIAPS implementation strategy has been implemented with high fidelity and minor unplanned reactive modifications. Professionals’ exposure to the implementation strategy was high in both groups. The centers’ organizational context (i.e., work overload) led to small mismatches between groups in participation and exposure of professionals to implementation actions.Trial registrationClinicaltrials.gov identifier: NCT03254979. Registered 16 August 2017.

Migration and family planning in the state with highest total fertility rate in India

BackgroundThis study examined the relationship between male out-migration and family planning (FP) behaviour of women in rural Bihar.MethodsData was collected from 937 currently married women aged 15–34 years from two districts of Bihar, namely Nawada and Gopalganj. Respondents were selected through a multi-stage systematic sampling and were recruited from both low and high male out-migration blocks. Differences in FP outcomes—use of modern contraceptive methods, intention to use contraceptives in next 12 months and access to FP services—were assessed by volume of migration, husband’s migration status, frequency of return, and duration of husband’s stay at home during visits.ResultsWomen with migrant husbands were about 50% less likely to use modern contraceptive methods. Further, the odds of using modern contraceptives was about half among women with migrant husbands if they resided in high out-migration areas (HMA) than low out-migration areas (LMA) (15% vs 29%, AOR: 0·50, p = 0·017). A higher proportion of women with migrant husbands, specifically from HMA, reported greater intention of using contraceptives in next 12 months than their counterparts (37% vs 23%, AOR: 1·83, p = 0·015). Similarly, access to FP services was negatively associated with the volume of male out-migration, specifically for women with migrant husbands.ConclusionsThe migratory environment as well as the migration of husbands affect contraceptive use and access to FP services among women. Given that a significant proportion of married males leave their home states for work, it is imperative that FP programs in migration affected areas plan and implement migration-centric FP implementation strategies.

Intervention Mapping: Theory- and Evidence-Based Health Promotion Program Planning: Perspective and Examples.

Evidence-informed health intervention planning that incorporates theoretical and empirical evidence and engages key stakeholders and community members or patients in the planning process results in interventions that are more effective. Nevertheless, exactly how and when to use evidence, theory, and community-based participation during planning represents a challenge. In this Perspective, we describe Intervention Mapping (IM), a framework for theory- and evidence-based health promotion program planning that addresses this challenge by providing a systematic and stepwise approach to planning interventions. IM has been used to develop health promotion interventions and implementation strategies in community and clinical settings globally, with over 1000 published articles employing the framework. In this Perspective, we also highlight recent and innovative applications of IM described in the articles of the Frontiers in Public Health Special Topic on IM. We conclude by discussing new directions in the application of IM including novel methods for identifying determinants of behavior and environmental conditions, the application of IM for planning implementation strategies, and IM for adaptation of evidence-based programs in new settings.

\u201cThere is nothing so practical as a good theory\u201d: a pragmatic guide for selecting theoretical approaches for implementation projects

BackgroundA multitude of theories, models and frameworks relating to implementing evidence-based practice in health care exist, which can be overwhelming for clinicians and clinical researchers new to the field of implementation science. Clinicians often bear responsibility for implementation, but may be unfamiliar with theoretical approaches designed to inform or understand implementation.Main textIn this article, a multidisciplinary group of clinicians and health service researchers present a pragmatic guide to help clinicians and clinical researchers understand what implementation theories, models and frameworks are; how a theoretical approach to implementation might be used; and some prompts to consider when selecting a theoretical approach for an implementation project. Ten commonly used and highly cited theoretical approaches are presented, none of which have been utilised to their full potential in the literature to date. Specifically, theoretical approaches tend to be applied retrospectively to evaluate or interpret findings from a completed implementation project, rather than being used to plan and design theory-informed implementation strategies which would intuitively have a greater likelihood of success. We emphasise that there is no right or wrong way of selecting a theoretical approach, but encourage clinicians to carefully consider the project’s purpose, scope and available data and resources to allow them to select an approach that is most likely to “value-add” to the implementation project.ConclusionBy assisting clinicians and clinical researchers to become confident in selecting and applying theoretical approaches to implementation, we anticipate an increase in theory-informed implementation projects. This then will contribute to more nuanced advice on how to address evidence-practice gaps and ultimately to contribute to better health outcomes.

Use of GIS to consider spatial aspects in construction planning process

A construction planner mentally visualises two-dimensional (2D) drawings into a three-dimensional (3D) model and links its components with the respective activities to examine the developed network for missing activities, logical errors and space conflicts. This traditional planning practice does not consider locational and spatial aspects of a construction project which forms the basis in developing an executable construction plan and framing correct implementation strategies. Literature suggests the use of 3D visualisation, four-dimensional (4D) modelling, virtual reality (VR), construction simulation and building information modelling (BIM) to consider the spatial aspects of a project. However, these systems represent 3D virtual model of a building to be developed without considering consequences of surroundings on a construction plan. In this study, the impact of site topography and existing facilities in the surroundings on a construction plan has been considered using geographic information systems (GIS). The use of GIS in the construction planning process facilitates location-based analysis, modelling site constraints and spatial and non-spatial analyses on a single platform. The construction site in India has been modelled along with its site topography and all existing facilities, as the case study, to see their impact on the construction plan.

Collaborative modeling of an implementation strategy: a case study to integrate health promotion in primary and community care

BackgroundEvidence-based interventions are more likely to be adopted if practitioners collaborate with researchers to develop an implementation strategy. This paper describes the steps to plan and execute a strategy, including the development of structure and supports needed for implementing proven health promotion interventions in primary and community care.ResultsBetween 10 and 13 discussion and consensus sessions were performed in four highly-motivated primary health care centers involving 80% of the primary care staff and 21 community-based organizations. All four centers chose to address physical activity, diet, and smoking. They selected the 5 A’s evidence-based clinical intervention to be adapted to the context of the health centers. The planned implementation strategy worked at multiple levels: bottom-up primary care organizational change, top-down support from managers, community involvement, and the development of innovative e-health information and communication tools. Shared decision making and practice facilitation were perceived as the most positive aspects of the collaborative modeling process, which took more time than expected, especially the development of the new e-health tools integrated into electronic health records.ConclusionsCollaborative modeling of an implementation strategy for the integration of health promotion in primary and community care was feasible in motivated centers. However, it was difficult, being hindered by the heavy workload in primary care and generating uncertainty inherent to a bottom-up decision making processes. Lessons from this experience could be useful in diverse settings and for other clinical interventions. Two companion papers report the evaluation of its feasibility and assess quantitatively and qualitatively the implementation process.

A Qualitative Analysis of Health Education Practice in Applied Work Settings.

Job analysis projects play a critical role in the health education profession by validating what is constant in the profession and identifying emerging patterns of effective practice. In this regard, the Role Delineation Project, Competencies Update Project (CUP), and Health Educator Job Analysis Project (HEJA) have provided frameworks for the accreditation of professional preparation programs, credentialing, and continuing education of health education specialists. To date, projects (CUP, HEJA, and Health Education Specialist Practice Analysis) have revalidated the framework to help describe the contemporary practice of health education specialists. Evidence is lacking regarding exactly how the frameworks have been integrated into applied practice and what guides the practice of health educators. In context of the Areas of Responsibility for health education specialists, the purpose of this qualitative study was to examine the gap between the "state of the art" and the "state of the practice" among health education practitioners in a range of workplace settings. Data were collected through structured interviews and analyzed for emergent themes. Major themes included the use of formal and informal assessment methods, program-specific planning materials and implementation strategies, supplemental materials for planning and conveying information, and the influence and work with organizations. Based on the emergent themes, the gaps between the "state of the art" and the "state of the practice" were described, with suggestions for advancing the profession.

Carbon reductions and health co-benefits from US residential energy efficiency measures

The United States (US) Clean Power Plan established state-specific carbon dioxide (CO2) emissions reduction goals for fossil fuel-fired electricity generating units (EGUs). States may achieve these goals through multiple mechanisms, including measures that can achieve equivalent CO2 reductions such as residential energy efficiency, which will have important co-benefits. Here, we develop state-resolution simulations of the economic, health, and climate benefits of increased residential insulation, considering EGUs and residential combustion. Increasing insulation to International Energy Conservation Code 2012 levels for all single-family homes in the US in 2013 would lead to annual reductions of 80 million tons of CO2 from EGUs, with annual co-benefits including 30 million tons of CO2 from residential combustion and 320 premature deaths associated with criteria pollutant emissions from both EGUs and residential combustion sources. Monetized climate and health co-benefits average $49 per ton of CO2 reduced from EGUs (range across states: $12–$390). State-specific co-benefit estimates can inform development of optimal Clean Power Plan implementation strategies.

Watershed Plan Implementation Challenges for SMS4s in Murrells Inlet

This case study describes the plan development process, implementation strategies and initial and future challenges to implementation for the Murrells Inlet Watershed Plan (WRCOG, 2014). The Plan was crafted by a group of key stakeholders with community support and guidance to address fecal coliform bacteria loading in shellfish harvesting waters in the Murrells Inlet Estuary along the northeastern South Carolina coast. Stakeholders debated the interpretation of the data analysis and ultimately concluded that the primary pollutant sources were non-human, namely wildlife and domestic animals. Stakeholders also concluded that the loads from these sources were being delivered to the estuary via a landscape that includes a network of surface drainage ditches and subsurface pipes so that water retention on the landscape has been largely short-circuited. Armed with this information, plan participants devised management measures that encompass several strategies, including: (1) utilize an end-of-pipe/ditch solution that addresses pollution nearest the discharge point; (2) generally reduce volume and flow and/or increase retention/detention across the landscape to reduce the pollutant load; and (3) use education and outreach to achieve behavior change. During both plan development and the implementation of management measures, the plan steering committee faced significant challenges. Initial challenges include: geographic and space limitations that make the use of large retention or detention devices impractical; lack of state or local requirements to use low impact development techniques to increase retention; and mounting outreach campaigns that cannot guarantee significant pollution reductions. Additional complications include mechanisms to sustain community support and involvement. As implementation progresses, the steering committee must track plan implementation and determine creative ways to evaluate the effectiveness of management measures. Local funding allocations must also be sought to leverage against potential grant funds to enable implementation.