Health Promotion Switzerland

The challenge of systematics

Hubert Studer, Büro für Qualitätsentwicklung & Cornelia Conrad Zschaber, RADIX

In general, intervention projects in health promotion and prevention are planned and implemented by employees in organizations (implementing organizations). Managers of these organizations can pilot the manner and method in which this is done and share responsibility for the quality of the projects. The key – and also the great challenge – in achieving quality in projects, is the establishment of a systematically applied set of criteria.

In the following, you will find the summary of the results of an empirical study, some thoughts on pragmatism in projects and organizations, and basic tips for starting work with quint-essenz.

Present situation

quint-essenz is a quality management system that has been developed for projects in health promotion and prevention. In recent years, the site has expanded to include an extensive project management tool and then has further developed into a community platform for professionals and organizations active in health promotion and prevention.

In the spring of 2011, we conducted a survey of 24 organizations in German and French Switzerland. We wanted to discover the level of importance that managers of health promotion and prevention organizations attribute to quality development and also set out to determine if and how quint-essenz is used.

The majority of managers who were interviewed judged quality management to be important or very important (20 to 24). However, implementation of quality management often encounters resistance by employees, especially if the effort is large and the purpose and benefits are not obvious.

Seven of the 24 institutions have already implemented a comprehensive quality management system, such as ISO 9001 or EFQM. Another twelve have introduced individual elements, such as process management or controlling. In most cases, these partial quality systems incorporate actual project work. About three-quarters of the organizations in the sample already use standard project management tools and quality assurance criteria, have standardized procedures and systematic project reviews and involve others - at least partially - in their quality work. Commissioning or funding organizations have great influence on the quality of work, particularly if they include quality aspects in their requirements. The demand for quality is already quite high, according to the statements of surveyed managers, but it is not always regarded as binding as some scepticism remains about the benefits of standardization. Tools that offer some flexibility and that provide direct, tangible benefits for practitioners seem most likely to be met with acceptance.

The quality system quint-essenz is well known by the organizations surveyed and is already used by a majority of them (17 of 24). Emphasis is placed on the quality criteria (14 organizations) and on individual instruments (13 organizations). The topical texts, the glossary, the project management tool and the community platform are used by about a third of the surveyed organizations. Quint-essenz is especially valued as a reference framework for a high standard of quality. Eight out of 20 respondents estimate the value of the systematic use of quint-essenz to be high, but just as many rated it as moderate. For some respondents, the complexity of the content and application is a barrier, or they think that standardized guidelines restrict the flexibility of project leaders. Nine of the surveyed organizations hope to receive support in the use of quint-essenz, while others have either attended appropriate training or believe that they do not require such services. Only five of the 24 organizations would be willing to pay for support in quality development.

In conclusion, one might say that quality development is only slowly put into practice, although its importance is acknowledged by funding organizations and managers of implementing organizations alike.

Pragmatism in Projects

Many project managers, especially those from so-called 'small' projects, say that they have no time for comprehensive and systematic quality development. They prefer to use their scarce time resources for the implementation of measures. So, they settle for what is at best a selective use of individual quality tools.

This pragmatic way of thinking and acting by project managers is understandable. It is both the cause and the result of a widespread intervention practice in our field that, given the challenges of complex socio-spatial systems, must be critically analysed. An effective and long-term intervention is a challenging task that cannot be accomplished with a series of 'small' projects. A new school refectory or the reconstruction of the recreation ground does not turn a school into a healthy school. Water dispensers, fruit baskets and a guide to correct sitting do not turn a company into a healthy company. Sustainable behavioural and environmental changes generally require longer-term and coordinated interventions at different levels (see Newsletter 2011-1). Management and evaluation are also marked by this pragmatic attitude towards project management. The mere documentation of one’s own activities and micro-evaluations (e.g., of individual events), which furthermore mostly concern the satisfaction of participants, are an insufficient basis for sustained improvement of personal project experience.

Pragmatism in Organizations

A pragmatic attitude towards quality development is also common in organizations. In many cases, organizations will receive mandates and/or instructions from a higher authority. These requirements can regard content, like thematic focus; or they can regard strategies for specific settings; or budget requirements. They can be about methods, too: the requirement to develop both a multi-year plan and an annual plan is but one example. Additionally, an organization may be obliged to implement a quality management system. However, despite such conditions, there is generally a great deal of leeway in how interventions are planned, implemented and evaluated.

Most organizations in the field of health promotion and prevention have developed guidelines for their projects. Specific forms and instructions for project drafts and designs are common, as well as specific instruments to be used in planning, evaluating and documenting the project. There may also be specific procedures to follow. These provide some consistency in dealing with certain projects, but still do not constitute continuous quality development. That would require a comprehensive, critical, periodically recurring and systematic analysis of project practice that is based on quality criteria.

Systematic Approach with quint-essenz

At the core of quality development are the critical and systematic analysis of projects based on quality criteria, the establishment of quality goals and the stipulation, implementation and evaluation of concrete improvement measures within periodic development cycles.

The quint-essenz quality management system provides a suitable frame of reference. It is comprehensive and based on criteria. All terms, topics, tools and analytical aids are related directly or indirectly to a set of 24 criteria to measure quality. What can you, a manager within an organization, do in regard of the use of quint-essenz? How can you motivate your employees to use it?

Establishing the Status Quo

An initial starting point is a critical analysis of the current quality management in projects within your own organization. The two evaluation grids for organizations in charge of projects and for funding organizations provide an initial overview.

Use of Consulting and Training Services

Health Promotion Switzerland supports organizations in project quality development. An external consultant can help to link your existing system of procedures, guidelines and practices with quint-essenz.

Staff Support

Criteria-guided analysis of projects results in greater transparency in project work. This can cause fear and resistance in employees, but these can be averted by discussing them in staff meetings, by agreeing personal objectives with each collaborator, by introducing appropriate training measures and by developing a “no blame” culture.

Connecting Quality Management and Quality Improvement in Projects

Sooner or later managers in organizations need to know how to combine quality management at the organizational level with project management and quality development at the project level. The execution of a project, from the sketching of a project idea to the valorisation of project results, provides the ideal opportunity for creating an interface that can deal with quality demands from both levels. During this process, decisions must be made continuously. With the quality criteria of quint-essenz, these decisions will be professionally sound and comprehensible (see Studer & Ackermann 2009).

Maintaining Networks and Exchanges

All registered users have an opportunity to form their own interest groups on the quint-essenz platform, and to initiate and maintain an exchange with project leaders of other organizations.


Managers of organizations that plan and implement interventions have an opportunity to design their own way of handling projects, so that, measured against the available resources, the potential for efficiency and sustainability is maximized. This assumes that individual interventions are embedded in a longer-term overall strategy and coordinated with others, and that the planning, implementation and evaluation of projects is systematic at all levels and for all projects. The introduction of quint-essenz constitutes an intervention in a complex system. The transformation of an existing system (for projects within organizations) will work if the stakeholders for whom the new system provides added value can be identified. We believe that project managers in health promotion and prevention are best motivated by tangible support and by the evidence of their projects’ effectiveness.


Studer, H. & Ackermann, G. (2009). quint-essenz – Potenziale in Projekten erkennen und nutzen. SuchtMagazin, 2009-2, 26-30. Download: StuderAckermannSuchtmagazin_2009.pdf

Evaluationsbericht 2006. Download (summary): EvaluationqeSummary_2006.pdf

Last modification: 16 December, 2011 07:24