Strategic Planning & Community Strategy Mapping for Public Health Systems & Agencies

1. Strategic Planning & Community Strategy Mapping for Public Health Systems & Agencies Jack Moran, Public Health Foundation Paul Epstein, Results That Matter Team

2. Introduction Public Health Foundation www.phf.org National, non-profit organization dedicated to achieving healthy communities through research, training, and technical assistance for over 35 years A key partner in The National Public Health Performance Standard Program (NPHPSP) Lead NPHPSP organization providing tools and technical assistance on performance improvement and quality improvement Epstein & Fass Associates Results That Matter Team www.RTMteam.net Measuring & improving public and nonprofit performance since 1985 Worked with large PH departments, now broadening PH efforts as part of Public Health Foundation QI Consulting Team and a pilot project on Community Balanced Scorecards in PH working with 5 community health partnerships in 3 states. Effective Community Governance and Community Balanced Scorecard methods featured in ThePublic Health QI Handbook (ASQ, April 2009) 2

3. Strategic Planning Overview • Preparation for Strategic Planning • Developing the Strategy • Deploying the Strategy • Reviewing Implementation versus the Plan 3

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5. Business Considerations • Budgets/Finance • Economy Vision, Mission, and Values • Growth Potential • Internal • Partnerships • Customer Consideration • Internal • External • Partnerships • Outputs • What you do 5

6. Strategic Planning • Preparation for Strategic Planning • Developing the Strategy • Deploying the Strategy • Reviewing Implementation versus the Plan 6

7. Preparation for Strategic Planning Data Gathering • Community health status data • Community and partnership relations • Economic trends • Financial analysis • Consumer research • Employee research • Legislative trends • Current measures – Capacity, Process, and Outcome • Current strategy and goal completion rates • Self assessment data • Demographic changes • SWOT Analysis • Accreditation data 7

8. Value of the Data Source Document And Date of Issue Substantiation Relevance Fact Based Opinion Based Assessment Data Low Medium High • Health status data • Community/Partner • relations • Economic trends • Financial analysis • Consumer research • Employee research • Legislative trends • Current measures • Capacity • Process • Outcome • Current strategy • Goal completion rates • Self assessment data • Demographic changes • SWOT Analysis • Accreditation data 8

9. Peter Drucker The leaders’ job is to set a clear direction of what their organizations mean by “results.” 9

10. Focusing on the Future Define the Current Horizon – where are we now? How To Begin: 10

11. Preserve Achieve Avoid Mistakes Pitfalls Core Competencies Success Factors Current Plan • What do we carry over? • What do we leave behind? • What lessons did we learn? • What new approaches should we try? • Should we try for incremental or • transformational change? Next Year’s Plan 11

12. Challenges?? • What are the critical challenges State and Local Health Agencies will face next year? • Any differences between State and Local Challenges? • Next 3 years? • How will it impact your organization’s: • People • Processes • Performance • Culture • Morale • Customersand Partners 12

13. Strategic Planning • Preparation for Strategic Planning • Developing the Strategy • Deploying the Strategy • Reviewing Implementation versus the Plan 13

14. Planning Quiz Question: Rating Scale SD DASA • We develop our strategy based on data. • We identify critical success factors - the • ways the organization must operate and • people must behave to achieve our • vision and mission. • We have both short and long term strategic • goals. • We clearly communicate our strategic goals • to everyone in the organization. • We measure progress toward our strategic • goals on a regular basis and communicate • the results to the organization. 14

15. Focus on Strategy Separately from Operations Improvement If you try to review operations and strategy in the same meeting, operations will always drive out strategy. -- Robert Kaplan, Harvard Business School But strategy and operations improvement still should be linked in a strategic performance management system. 15

16. Strategic Plans Can Be Important Parts of Performance Management Systems The Plan-Do-Check-Act(PDCA) model of QI can also be the basis for an organization’s performance management system, as in the City of Austin’s approach to “Managing for Results” 16

17. Strategy Management and Operations Improvement (QI) Strategy Management: Planning and managing to achieve a future vision or desired outcome. The Balanced Scorecard is one way to achieve this: It is a strategy management system. Strategy mapping is a Balanced Score tool that is valuable for strategic planning even if you do not do a BSC Operations Improvement: Improving processes to make current services better, often striving for efficiency, quality, & consistency, e.g.: Benchmarking Quality Improvement Techniques 17

18. Power of Strategic Alignment from Balanced Scorecards, Primarily from Strategy Maps Strategy Maps and BSC to improve the Alignment and Execution of Strategies No Strategic Alignment Execution Gap High Level Goals Other Public Agencies Health Dept Hospitals Nonprofits Public Health Outcomes Community Groups Families & Individuals Faith Communities Schools 18

19. Strategy and Quality Improvement (QI) A balanced scorecard strategy is a telescope. QI is a microscope. We use the telescope to tell us where to focus the microscope. -- Chief Medical Director, Duke Children’s Hospital 19

20. How do you know if a strategic plan is “strategic”? Does it include or justify everything the organization is already doing? Do the goals, objectives, and actions read like a “laundry list,” with little relationship to each other? Is it based on a credible “theory of change” or “cause & effect model” that clarifies how plans will lead to a desired future? Is there focus? Do different parts of the plan build upon each other? Is there synergy? Is there alignment? 20

21. The Balanced Scorecard (BSC) … Is an integrated strategic planning and management system traditionally focused on one organization Communicates vision, mission, and strategy to stakeholders and employees. (Focus) Aligns day-to-day work to the strategy. Maps strategies based on cause & effect assumptions across different perspectives or “views.” (Focus & synergy) Provides a disciplined framework for measuring strategic performance as viewed from those different perspectives. (Strategic Performance Management) 21

22. Community Balanced Scorecard (CBSC) Combines the community building power of effective collaborations with the strategy alignment of balanced scorecards Pulls the community together around common outcomes Leverages assets from all sectors Aligns key community collaborators behind a common strategy for faster, measurable results Creates mutual accountability for results Intended for the many important issues in communities and regions that cannot be resolved by one organization or sector. 22

23. Community Balanced Scorecard Components Community Priorities CommunityVision, Overall or by Issue or “Theme” Perspectives Strategic Objectives Strategy Map Performance Measures, Targets, & Initiatives 23

24. CBSC, QI, Collaborations, & Information (e.g., from Accreditation) Improved Public Health Outcomes Quality Improvement: Plan, Implement & Monitor Improvements Community Balanced Scorecards: Plan & Manage Strategy Strategic Improvement Information & Collaborative Relationships 24

25. Suggested Perspectives for Public Health Community Balanced Scorecards CommunityHealth Status Community Implementation Assumed cause & effect Community Process & Learning Community Assets 25

26. Suggested “Generic” Public Health Community Balanced Scorecard Strategy MapBased on the Draft Public Health Accreditation Standards STRATEGIC OBJECTIVES Perspectives Community Health Status Improve Health Outcomes & Eliminate Disparities Minimize Risks Community Implemen-tation # 7 Promote Strategies to Improve Access to Services # 3 Inform, Educate About PH Issues (Promote Health) # 2 Investigate, Contain PH Problems & Hazards # 6 Enforce PH Laws & Regulations Community Process & Learning # 9 Evaluate & Improve Processes, Programs, & Interventions # 1 Assess, Disse-minate Population Health Status & Issues # 10 Contribute to & Apply the Evidence Base of PH # 5 Develop PH Policies & Plans Community Assets # 4 Engage the Community to ID & Solve Health Problems A. Administrative Capacity & Governance # 8 Maintain a Competent PH Workforce

27. Sample THEMES for Community Balanced Scorecards for Public Health STRATEGIC OBJECTIVES Perspective Community Health Status Community Health Partners’ Roles Cross-cutting PH System Issues Demographic Populations or Geographic Areas Social or Physical Environment Issues Healthy Behaviors Encouraged Specific Mortality or Morbidity Issues Community Implemen-tation Community Process & Learning Community Assets 27

28. Themes of Five Community Health Partnerships in Ohio, New Jersey, & Florida STRATEGIC OBJECTIVES Perspective Community Health Status Child Obesity & Family Wellness Obesity, Nutrition, & Physical Activity Preventable Chronic Disease Youth & Young Adult Behavioral Health Access to Primary & Specialty Care Community Implemen-tation Community Process & Learning Community Assets 28

29. Possible Community Balanced Scorecard Strategy Map to Improve Health of Homeless Population STRATEGIC OBJECTIVES Perspectives Minimize Chronic Disease in the Homeless Population Community Health Status Minimize High Risk Behaviors & Conditions # 7 Help Homeless Receive Housing & Health Services # 3 Maximize Multi-Lingual Outreach, Health Education & Promotion Community Implementation # 5 Develop Programs & Plans to Connect Homeless with Services & Promotion # 5 Advocate for Affordable Housing & Homelessness Prevention Community Process & Learning # 1 Increase Health Status Monitoring of Homeless # 4 Develop Community-based Strategies with PH & Social Service Partners Community Assets 29

30. Table Top Exercise 30

31. For a Strategy to Address Preventable Chronic Disease: Objectives Developed After Brainstorming & Affinity Grouping Develop & support wellness programs, policies, and legislation Mobilize community partners in coordinated wellness initiatives Improve access & use of wellness services for all, including the uninsured Eliminate disparities in incidence & outcomes of chronic disease Promote health and learning by engaging community stakeholders Eliminate preventable chronic disease Enhance the environment for access to physical activity & healthy food Monitor & publicize community environments Organize into a Strategy Map 31

32. This Community’s Accreditation Assessment Results Lowest composite scores in: 1. Conduct and disseminate assessments focused on population health status and public health issues facing the community 10. Contribute to and apply the evidence base of public health What do these findings suggest for the preventable chronic disease reduction strategy? 32 32

33. Strategic Planning • Preparation for Strategic Planning • Developing the Strategy • Deploying the Strategy • Reviewing Implementation vs. the Plan 33

34. Deployment Quiz: For Internal Operating Units Question: Rating Scale SD DASA • We have a defined deployment process for • our strategy to the operating units. • Operating units develop goals that contribute • and are aligned with the organization’s goals. • Operating units have measures that are aligned • with the organization’s measures. • Operating units identify both breakthrough and • incremental process improvement opportunities. • Operating unit personnel understand the link • between what they do and the organization’s • strategic plans and goals. 34

35. Goal Deployment and Alignment: Organizational Improvement Environmental Assessment Drives Deployment • Catalyst To Develop The Intent • Challenge Opinion Strategy Which Develops • Critical System Issues • Critical Goals • Aligned Measure Operation Plan To Achieve The Strategy Focus On • Process Focus • Achievable/Aligned Goals • Establish Accountability Process Alignment And Repeatable Process To Translate Into • Process Improvement • Process Redesign Aligned Daily Work 35

36. Professor Cranston Nightmare of Learning Alignment

37. Deployment in the organization & the community • Use the strategy map as a communication tool to help people find their roles in the strategy, both for: • Internal operating units • Partner organizations in the community • Each operating unit and partner can have different approaches for contributing to the same community goals and objectives. • Define measures and implementation initiatives each internal unit and external partner will be accountable for. • Set implementation priorities for strategic initiatives. 37

38. From: Minimal level of kids walking to school No sidewalks in some areas of the cities Sidewalks & streets aren’t plowed in places Lack of adult supervision & safety Need safer crosswalks Dangerous walking environment Partner Contributions to Objective To: More kids walking & biking to school safely More identified safe walking routes Plenty of adult supervision Safe walking environment Cleared sidewalks & streets in winter for identified safe walking routes Objective: Enhance the environment for access to physical activity & healthy food Initiative: Safe routes to school Partners: City of Akron, City of Stow, ODOT, Safe Kids’ Coalition, Schools in the County Owner for this initiative: Safe Kids Coalition Desired Change (More Safe Walking & Biking to School) Actions: - Identify and improve safe routes for all elementary & middle schools - Add safe routes to municipal priority lists plowing, to be cleared in time for kids to use - Recruit and organize adult supervision volunteers, parents, & kids to participate 38

39. From: Families in the 2 lowest income areas of the county (Spruce & Birch districts of Piney Woods) have no local access to affordable fresh & nutritious foods. Partner Contributions to Objective To: All families in the county use retailers of affordable nutritious food they can easily get to (preferably by walking), or use free or low-cost delivery. Objective: Enhance the environment for access to physical activity & healthy food Initiative: Co-op healthy foods purchasing and delivery Partners:Cost Saver Food Co., Piney Woods Community Development Corp. Owner for this initiative: Sam Treemount, Piney Woods CDC Desired Change (Eliminate Food Deserts) • Actions: • Develop logistics, allowable items, & delivery & payment mechanisms with CSFC • Organize families in the Spruce &Birch districts to participate in co-op purchasing 39

40. Strategic Plan Alignment and Deployment Plan execution is then focused on both organizational improvements and community actions that move the needle on priority health outcomes. 40

41. Setting Implementation Priorities High Strategic Importance Medium Low High Low Medium Difficulty of Implementing

42. Encourage Others in the Community to “Jump In” High Programmed Priorities Encourage partners to implement other initiatives without draining resources from programmed priorities Medium Strategic Importance Low High Low Medium Difficulty of Implementing

43. 5 Critical Barriers to Successful Execution The underlying strategy is not clear. The plan is overly optimistic. No one is accountable for results. The plan has not been actively deployed. The plan is static. Invest the time to get clear. Define priorities. Raise the stakes. Mobilize the troops. Create an execution process. Barrier Suggestion 43

44. Strategic Planning General Eisenhower once said, “Planning is great until the shooting starts.” 44

45. Strategic Planning • Preparation for Strategic Planning • Developing the Strategy • Deploying the Strategy • Reviewing Implementation vs. the Strategic Plan 45

46. Is this your organization? 46

47. Review Quiz Question: Rating Scale SD DASA • We conduct regular reviews with our operating • units to assess progress towards our strategic • goals. • Reviews are used for learning and growth for • our management teams. • Reviews result in open and honest dialogue • with senior management about goal achievement • During reviews we adapt our priorities, culture, • and capabilities to respond to change. • During reviews we take action to resolve problems • rather than spending times deciding who to blame. 47

48. Review • Review is a continuous improvement process of clarity • Review and Re-New • Improvement, Learning, Growth for all involved in a review • Remember, don’t strategy reviews require their own meetings—don’t mix them with operations reviews 48

49. Goal Deployment and Alignment: Organizational Improvement Environmental Assessment Drives Deployment • Catalyst To Develop The Intent • Challenge Opinion Strategic Intent Which Develops • Critical System Issues • Critical Goals • Aligned Measure Operation Plan To Achieve The Strategic Intent Focus On • Process Focus • Achievable/Aligned Goals • Establish Accountability Process Alignment And Repeatable Process To Translate Into Review • Process Improvement • Process Redesign Aligned Daily Work 49

50. Review • Purpose: • Clarity of Objectives • Clarity of Senior Management’s Expectations • Clarity on what has been achieved • Clarity of what is on and off course • Clarity on what has not been done • Clarity on what remains to be done • Clarity on who is responsible to do what and by when 50