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Escambia CHD Services Ranking Matrix

Escambia CHD Services Ranking Matrix. November 21, 2007. What the Ranking Matrix is:. A list of all activities we, at Escambia County Health Department (ECHD) do, used to assess each activity’s value to Public Health in Escambia County. Goals for Ranking Matrix.

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Escambia CHD Services Ranking Matrix

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  1. Escambia CHD Services Ranking Matrix November 21, 2007

  2. What the Ranking Matrix is: A list of all activities we, at Escambia County Health Department (ECHD) do, used to assess each activity’s value to Public Health in Escambia County

  3. Goals for Ranking Matrix • Complete list of all services/activities that cost money • Use ranking criteria that help to distinguish activities’ value to public health • Align with Essential Public Health Services (Operational Definition of a Functional Health Department) • Re: accreditation & learning • Included rumored 11th domain (Manage PH Resources) • No activities assumed to be required by law without legal documentation

  4. WHY?!?: to Preserve Core PH • Budget squeeze • Loss of funding--$1.7M in GR over five years; $800K in 2005 alone. • End of trust fund draw-down • 2007-08 $745K cut • Additional $1.2M in cuts anticipated for 2008-09 • Prioritization of General Revenue funds • Disaster expectations • Disaster plan

  5. Preparatory Footwork • Florida Statutes (F.S.) • Florida Administrative Code (FAC) • Code of Federal Regulations (CFR) • Escambia County Ordinances • (not grant/contract requirements) • Operational Definition (www.naccho.org)

  6. Prep Work (cont) • Review other CHDs’ matrices (St. Johns, Volusia, Walton) • Set ranking criteria • Compile list (matrix) of all activities from those provided by EMT members • Group activities by subject area to tickle more thoughts • Utilizing legal references provided by EMT members, create hyperlinks in matrix.

  7. Other Matrices • St. Johns CHD • Volusia CHD • Walton CHD

  8. The ECHD Matrix • F.S. and FAC references • Ranking Criteria Scoring • If “yes” to “Law Requires”, “COOP/COG”, or “PH Disaster Response”, activity was considered mandatory and no further ranking was performed • Functional Definition Reference Number assigned

  9. Ranking Criteria • Ranking criteria were chosen to represent what distinguishing factors make something a critical/viable public health activity. • “Primary Prevention of a Real PH Hazard” (not just perceived) • “ECHD Must Do” (fills a PH gap) • “Saves ECHD Time Later” (not saves overall system time) • “Funded” • “Good, Inexpensive Public Relations” • Rank choices • 0=no • 1=partially true • 2=yes

  10. The Ranking Sessions • Room bright & spacious, with tables • Two display projectors • Computers with access to network and internet • One display showing matrix, horizontally compressed to one screen (but large enough to see) • Second display showing matrix incorporating links to legal references, so actual references could be accessed and reviewed • Both displays with matching and unvarying line numbers

  11. The Process • ECHD Director there every session (to describe his preferences and tie-break) • All Executive Management Team (EMT) members attended every session • learn about other divisions of the ECHD • participate in resulting scores • All bring current version of matrix and Operational Definition for reference

  12. The Process (cont) • Each activity/line of matrix discussed and ranked by consensus • Added “PH Disaster Response” criteria halfway through • Each page completion celebrated with a cheer • one break per half day session; long lunch break during whole day sessions.

  13. The Process (cont) • In between sessions, footwork required to locate more specific F.S., FAC pertaining to discreet activities • The process took three full days and five half days, totaling 38.5 hours, over eight months.

  14. Ranking Criteria Weighting • Mandatory activities were scored “mandated” • For ease of interpretation, non-mandated activities were weighted to achieve an overall score of 100 • “Primary Prevention” assigned 50% of score • “Must Do” assigned 20% of score • “Saves ECHD Time Later” assigned 10% • “Funded” assigned 10% • “Good Inexpensive PR” assigned 10% • Final scores very much in line with common sense

  15. Communication • Matrix felt to be useful tool for communicating relative value of ECHD activities, internally and externally • Concern by EMT about misinterpretation, and clarity • Talking points developed and inserted in front of document • Name changed to “ranking tool” • Matrix sounded “final”, when in fact it is just one tool in the decision-making arsenal • Wanted “softer” name so employees who do low-scoring activities would not feel their fate had been determined

  16. What Hasn’t Been Done Yet • Review of Operational Definition Standards re: what’s missing on the matrix • Distribution of budget based on results • Established process for evaluating new tasks on the matrix

  17. Uses of matrix • Funding/workload limitations in ECHD’s epidemiology program • sorted matrix by “epi” • Identified unfunded activities and discussed changes • Additional statewide CHD funding losses imminent • used matrix to identify unfunded activities • List added to discussion about which activities may be divested • In atmosphere of large additional cuts to CHDs from state and local level, many CHDs re-evaluating activities, and have expressed interest in the tool

  18. Uses of matrix (cont) • Best practice submission for DOH best practices program • NACCHO interested in use of Operational Definition • Plan to submit NACCHO Model Practices application

  19. Lessons Learned • Important for CHD leader and every member of management team to attend every session of ranking process • Tie-breaker must be present every session • Ranking very subjective; difficult to be consistent throughout • Essential to have recorder(s) present for real-time recording of scores, and to provide displays • Important to have current copies ranking tool, with matching line numbers (constant throughout)

  20. Lessons Learned (cont) • One can fit almost anything into the Operational Definition (two exceptions) • May want to add a column representing the activities’ “fit” with the Operational Definition (e.g. 0=no fit; 1=stretch, 2=wording matches closely) • We assigned quite a few CHD support (“administrative”) functions to Operational Definition Standard 11, which doesn’t exist (yet?). May need to re-assign • Many things we thought were required by Florida law actually aren’t

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