Tips for Policies and Procedures

1. Tips for Policies and Procedures Lydia Lehnertz, WI AHEC CHIP Intern - Buffalo County & Alyssa Weinrich, WI AHEC CHIP Intern – Pepin County

2. Introduction • Assigned to project from Wisconsin Area Health Education Center (AHEC) Community Health Internship Program (CHIP) within Pepin and Buffalo Counties. • Goal to update policy and procedure manual to a standardized electronic format • Created PowerPoint to help others find an effective way to update, maintain and create policies and procedures in an electronic format

3. Contents • Table of Contents • Guide to Hyperlinking • Standardized Template • Policy Review • Revision Log • Archiving Documents • Tips for Accreditation

4. Standardized Table of Contents Useful components of electronic table of contents: • Subheadings organized in logical way • Columns for dates effective, reviewed, and revised • Policies hyperlinked from title listed in table of contents

5. Example Table of Contents

6. Guide to Hyperlinking 2 different options: 1) You can hyperlink existing text Ex: A hyperlink for policy xyz… 2) You can select location where you want hyperlink after text Ex: A hyperlink for policy xyz can be found here: s://publichealth/policy/xyz

7. How to Hyperlink Existing Text • Highlight words you want to hyperlink • Right click your mouse • From dropdown select hyperlink • On left hand side select “existing file or webpage” • Select location of file • Click “ok”

8. How to Hyperlink Following Text • Place curser where you want to hyperlink • Right click your mouse • From dropdown select hyperlink • On left hand side select “existing file or webpage” • Select location of file • Click “ok”

9. How to Open a Hyperlink • Right click the text you hyperlinked • Select “open hyperlink” from dropdown menu • File should open automatically in new window

10. Standardized Template for Policies and Procedures • Found many different methods for structuring policy and procedure manual • Decided to use format that included purpose statement, policy, procedure, references/legal authority • Could possibly add other components such as: responsible staff, definitions, supplies needed, related policies • Key to keep the policy and procedure as SIMPLE as possible

11. Example Policy Template

12. Policy Review • There is no set guideline as to how often policies need to be reviewed; however, they need to be kept current • Local policies at each health department give the specific details within their policies (ex: create and/or execute a policy on policy revisions)

13. Tips for Keeping Policies Current • Use a table of contents with columns for effective date, date reviewed/revised • Develop a sign-off sheet to be kept in a central location • Create a revision log which allows you to make note of future changes needed to policies • Find an effective method for keeping revisions current (ex: policy review at staff meetings, individual accountability)

14. Example Revision Log

15. Archiving Documents • Health Departments should have their own policy on policy retention • One option for organizing policies is to create “archived policies” folder within electronic policy and procedure manual • Organize based off method that works best for your health department

16. Tips for Accreditation • Policies and procedures cannot be drafts • Must be in electronic format • Must have documentation for each standard and measure within Public Health Accreditation Board Standards and Measures

17. Helpful Resources for Accreditation • National Association of City and County Health Officials (NACCHO) - Contains toolbox with examples of each domain • Public Health Accreditation Board (PHAB) - Contains structure and guidelines for accreditation process • Public Health Accreditation Wisconsin (PHAW) - Private webpage available upon request from regional office

18. PHAB Website • Found to be very helpful throughout this process • Contains standards and measures necessary for becoming accreditation • Each measure requires documentation to prove compliance • Next slide outlines measures that may require a policy and procedure

19. Policies and Procedures Necessary for Accreditation in 2012

20. Policies and Procedures for Accreditation Continued

21. Conclusion • Keeping policies current is easier said than done • Find a method that works best for your health department • Best of luck and remember to keep it simple!