Development, application, and evaluation of an "action-reaction" planning method.

It is difficult to design and implement new public policies and programs, at least partially owing to the fact that few useful methods are available to help shape the planning, decision-making, and implementation processes required for change. Planning often tends to focus on wishful thinking rather than on a realistic assessment of the probable outcomes. In this article we describe an action-reaction approach to planning that explicitly recognizes the restrictions on program impact arising from the system in which change is being attempted. A hypothetical example shows the application of this method to the design of a health-care delivery program. The article concludes with a discussion of the long-term uses of the data base that may be compiled with this method.