Goal(s) and objectives of practice
The goals and objectives of the practice are as previously stated:
- Improve community participation in the HLC and in the development of the triennial CHA. The objective was to increase regular community participation in the HLC from about 15 participating member organizations to more than 30. Also, the intent was to increase overall community input into the CHA process.
- Improve the process used to develop the CHA to ensure better community buy-in and resolution of community issues. The purpose of this goal is not only to improve community participation but to show the effectiveness of the CHA process, that goals can be achieved and celebrated.
- Increase staff expertise in the Community Health Assessment and Community Health Improvement Planning (CHA/CHIP) process to reduce consultant expenses and facilitate better community buy-in and participation in improvement efforts. The objective is to develop health department staff members to acquire expertise and community credibility in order to facilitate the MAPP process. The goal was to have three staff members with this expertise.
- Improve measurability, set improvement targets, and make measurable improvements in the CHA/CHIP process to show trended improvement of results: In 2005 and 2008 CHA Reports, recommendations were stated in difficult-to-measure terms, for example: Focus efforts on substance abuse prevention and education for alcohol, tobacco and other drugs.” Poor measurability makes it difficult determine success as changes are made. Specific improvement targets should be set to be able to show the community how to measure and celebrate success. The goal was to have each strategic objective of the CHIP having at least one outcome measure, and with improvement targets set for each measure.
- Establish needed community services as identified in the CHIP. It was anticipated that the CHIP would identify critical actions leading to the establishment of new and/or expanding services as a result.
What did you do to achieve the goals and objectives?
These goals were achieved through a long-term improvement effort. DOH-SJC has been a practitioner of the Baldrige/Sterling management model since 2004. This model focuses organizations on long-term continuous improvement through the implementation of leading edge management practice in response to the Baldrige Criteria requirements. For this project, Dr. Allicock took on the role of convener and Chief Health Strategist with joint health department and local hospital leadership of the project. An HLC Charter was created and updated for each MAPP cycle. The MAPP process is project managed with milestones developed and projected completion dates set with various health department staff asked to lead each task and partners assisting as appropriate. Estimated completion dates are established for each major milestone. Each MAPP cycle takes 12 to 18 months to complete in this manner.
Steps taken to implement the program:
The improved MAPP was implemented through the following steps:
- Build the partnership (and rebuild/expand for each MAPP cycle). This was done by the Chief Health Strategist (Dr. Allicock) and her team by reaching out to key partners, asking for recommendations for new partners, inviting members to include Executive-level leaders and Boots-on-the-Ground staff members to participate, and creating a Charter and timeline for each triennial CHA cycle. Prospective new HLC members receive a personal invitation and a one-on-one meeting (if desired) to learn more about the HLC.
- Build internal expertise in MAPP. Initially three health department leaders were chosen to lead this project. They were organizational leaders who had attained expertise in the Sterling/Baldrige management model used by DOH-SJC, had a solid understanding of the strategic direction of the organization, were knowledgeable of the then new PHAB accreditation standards, and had shown a passion for public health. These staff members received advanced training in MAPP and in using a Community Balanced Scorecard concept taken from literature to enhance MAPP. For continued staff development, in the most recent 2017 cycle three newer staff members received similar training and took on important roles in the development of the latest CHA/CHIP.
- Research best practice CHA/CHIP documents and methods. Numerous examples of CHA and CHIP documents from throughout the US were reviewed, many of which were recognized as NACCHO Model Practices. Ideas were taken from many of these and incorporated into each successive version of the SJC CHA/CHIP.
- Work the MAPP process and embed additional tools/methods including Chief Health Strategist, Community Balanced Scorecard, and Health Equity. For the 2017 MAPP cycle several additional enhancements were made. For this cycle Dr. Allicock and the Director of Public Health Practice and Policy, Noreen Nickola-Williams, empowered a small team of health department staff to manage the process. DOH-SJC applied for and received a CDC Public Health Associate who was assigned to the team and provided expertise at no additional cost. The team was given autonomy to develop a project plan, find creative ways to engage partners and staff, and provide in-process review and evaluation as work was completed. This team developed innovative ways to educate, engage, and develop both staff and community through teambuilding, volunteer opportunities, and process suggestions. Sixteen health department staff members were cited in the CHA document for their outstanding contributions and subject matter expertise.
- Engage partners in the various phases of MAPP. Partners have been engaged and taken leadership roles in this process through the HLC. To create even further partner engagement for the 2017 cycle a series of small one-on-one meetings were held and partners were asked to provide input to CHA and CHIP by providing feedback on the content and structure of process and documents.
- Outstanding results were achieved in the team's approach to the MAPP Community Health Status Assessment. In the 2017 cycle 2,700+ responses were collected in a community-wide survey (more than 1% of the population) with far better representation of the various demographic groups than in earlier cycles. This is more than double the response rate achieved previously. Methods used included on-line surveys, DOH-SJC service centers providing surveys to clients as a part of the registration process, county-wide distribution of survey collection boxes at various partner locations, with staff and community partners assisting in delivery/collection of surveys throughout the county. More than 60% of completed surveys were paper-based. Results were reviewed weekly and appropriate process adjustments made.
- Meet with the HLC as a group and individually through the cycle in order to gain buy-in and understanding of findings from community focus groups and surveys and from research findings
- Determine highest priority community issues based on community needs and HLC capability and capacity.
- Build the CHA, build the CHIP, review with staff and partners. The CHIP is displayed using a Community Balanced Scorecard which enables easier review and continuous update through the three-year MAPP Action Cycle.
- Publish the CHA and CHIP. For the past several cycles the, the local community hospital (Flagler Hospital) has provided funding for publishing.
- Work the plan. This is the three-year MAPP action cycle.
- Improve the process for the next cycle
Any criteria for who was selected to receive the practice (if applicable)? N/A
What was the timeframe for the practice? The SJC CHA and CHIP are completed in a 12 to 18-month cycle. The latest cycle began in October 2016 and the CHA/CHIP was published in March 2018. Several months were lost along the way due to recovery from Hurricane Matthew in 2016 and Hurricane Irma in 2017.
Were other stakeholders involved? What was their role in the planning and implementation process? The SJC HLC was very engaged throughout the process. The HLC is comprised of approximately 30 community partner organizations that include DOH-SJC, Flagler Hospital, County Government, and numerous not-for-profit healthcare and non-healthcare agencies. These organizations are involved in the leadership of the HLC for assisting in the development of the CHA/CHIP, and for taking responsibility for working critical actions leading to measured performance improvement on key indicators of community health.
What does the LHD do to foster collaboration with community stakeholders? Describe the relationship(s) and how it furthers the practice goal(s) The LHD and its Health Officer as Chief Health Strategist takes on the role as previously described to convene the HLC and other community partners to take on key roles in Health Improvement Planning and implementation of these plans.
Any start up or in-kind costs and funding services associated with this practice? Please provide actual data, if possible. Otherwise, provide an estimate of start-up costs/ budget breakdown
The primary cost to implement this process is the labor cost for individuals involved in developing and implementing the CHA/CHIP. It is estimated that approximately one person-year of LHD effort was expended for each CHA/CHIP cycle. This included the three staff members mentioned previously and various degrees of leadership oversight of the project. Workforce development cost were minimal as training consisted primarily of on-line training offerings through TRAIN and other means along with on-the-job coaching and mentoring similar to what is done for any staff member.