New Modalities for Technical Assistance Consulting

Noam H. Arzt, Ph.D.Technical assistance (TA) is provided by expert consultants to public health systems projects in order to improve their performance against functional standards or to help solve recurring or one-time problems or issues. Unlike other forms of training or support, TA is usually focused or tailored to a specific circumstance or situation. Common examples of TA include assistance to a jurisdiction in migrating from one product to another, consultation related to a specific programmatic initiative such as school immunization health compliance, EHR interoperability implementation, or data quality review.

The table below summarizes some differences between TA and training.

One of the distinguishing characteristics of TA is the bi-directional nature of information exchange. For TA to be effective, a “deep dive” is usually conducted on a project’s particular issues or challenges. A considerable amount of data is collected from the project site through document review and discussion; this forms the basis of the information used to diagnose the situation and recommend strategies for change. But this process can involve the dedication of significant resources to assist a single project. As funding becomes more limited, it becomes less feasible to dedicate substantial resources repeatedly to individual projects. A more leveraged approach to TA would allow multiple projects to share in the benefits and outcomes of a TA intervention.

Technical AssistanceTraining
Targeted as a specific audienceDesigned to appeal to a broader audience
Involves a “deep dive” to understand the specifics of the projectRelies on general trends and understanding across the community
Can offer or support tactical activity to advance specific project goalsIs meant to provide insight or education that a project must apply itself
Is tailored to the political, social, technical, and legal environment of the projectRequires a project to filter the knowledge through its own social, technical, and legal lens

Another characteristic of TA has been providing tactical assistance in advancing a project, often through the provision of project management, business analysis, or sometimes even programming services. This often takes place when the project is not adequately staffed for one or more of these functions, and/or the timeline is particularly aggressive. Experienced consultants can often draw on prior experience and quickly augment project staff with new skills and techniques. While this type of assistance can bring quick and solid results it comes at a cost.

TA projects, while sometimes address similar issues, are never identical. The political, social, technical, and legal challenges and opportunities differ from project to project. TA activities are unique in that they apply general knowledge developed in the public health community to a specific project, adjusting the suggestions and solutions to meet the specific conditions of the project and its environment. This nuanced approach is enabled by the “deep dive” described above and provides more useful, tailored advice to a project.

The challenge, therefore, is to develop new, more cost-effective forms of TA which preserve the essential two-way information flow of the “deep dive” while simultaneously engaging multiple projects with similar issues. In this way, limited funds could provide more “bang for the buck” when it comes to delivering TA projects.

Some TA leverage already takes place. For example, in a recent Immunization Information System (IIS) TA engagement a study was done of system alternatives to support AFIX. While the study was done first and foremost to support that state’s specific requirements, the resulting report was purposefully developed and written with a broader audience in mind as it was clear that other projects would also be faced with this issue. In another instance, planning for a specific migration from one IIS product to another led to the development of a more generic model to support migration projects in other jurisdictions.

But these examples are limited since most TA to date has focused on specific projects and their individual needs. “Shared TA” might have one or more of the following characteristics:

  • A group of projects facing similar issues might meet together (virtually or in person) with a TA team to share experiences and receive guidance on strategies to address the issues. Part of such a meeting might involve small-group activities within a project team to advance project objectives with expert resources available in real time.
  • A group of projects facing similar issue might rely on a TA team to research an issue of common interest and develop a report or white paper for those projects (and likely a wider audience) with insight into the issue.
  • A project facing a challenging issue might agree to serve as a case study by engaging a TA team to address their issues while other projects are allowed to observe and potentially participate in discussions related to the issue and its resolution.
  • A TA team might develop some resources related to a pressing issue in the community and, after engaging a set of projects to collect specific information, prepare a white paper, presentation, or group experience for interested projects around insights into this issue.

There are some risks in these group experiences, particularly when they involve real-time interaction, including:

  • For TA to be effective, projects need to have the right staff in the room to engage in problem-solving and to receive advice.
  • The issues faced by the projects must be similar enough for a group experience to be relevant to addressing them.
  • Projects have to be at the same stage of need for a group experience to be effective. Information too far in advance of need may not allow a project to effectively address an issue when the time comes.
  • The TA team might not have available enough specific information about the affected projects for a TA plan to be developed. TA is not the same as training which provides a standard set of material to an audience – as noted above it is specific to the projects being engaged.