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

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slide1

Strategic Planning & Community Strategy Mapping

for Public Health Systems & Agencies

Jack Moran, Public Health Foundation

Paul Epstein, Results That Matter Team

introduction
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

strategic planning overview
Strategic Planning Overview
  • Preparation for Strategic Planning
  • Developing the Strategy
  • Deploying the Strategy
  • Reviewing Implementation versus the Plan

3

slide5

Business Considerations

  • Budgets/Finance
  • Economy

Vision, Mission,

and Values

  • Growth Potential
  • Internal
  • Partnerships
  • Customer Consideration
  • Internal
  • External
  • Partnerships
  • Outputs
  • What you do

5

strategic planning
Strategic Planning
  • Preparation for Strategic Planning
  • Developing the Strategy
  • Deploying the Strategy
  • Reviewing Implementation versus the Plan

6

preparation for strategic planning
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

slide8

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

peter drucker

Peter Drucker

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

9

focusing on the future

Focusing on the Future

Define the Current Horizon – where are we now?

How To Begin:

10

slide11

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

challenges
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

strategic planning13
Strategic Planning
  • Preparation for Strategic Planning
  • Developing the Strategy
  • Deploying the Strategy
  • Reviewing Implementation versus the Plan

13

planning quiz
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

focus on strategy separately from operations improvement
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

strategic plans can be important parts of performance management systems
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

strategy management and operations improvement qi
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

power of strategic alignment from balanced scorecards primarily from strategy maps
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

strategy and quality improvement qi
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

how do you know if a strategic plan is strategic
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

the balanced scorecard bsc
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

community balanced scorecard cbsc
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

community balanced scorecard components
Community Balanced Scorecard Components

Community

Priorities

CommunityVision, Overall or by Issue or “Theme”

Perspectives

Strategic Objectives

Strategy Map

Performance Measures, Targets, & Initiatives

23

cbsc qi collaborations information e g from accreditation
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

slide25

Suggested Perspectives for Public Health Community Balanced Scorecards

CommunityHealth Status

Community Implementation

Assumed cause & effect

Community Process & Learning

Community Assets

25

slide26
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

sample themes for community balanced scorecards for public health
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

themes of five community health partnerships in ohio new jersey florida
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

possible community balanced scorecard strategy map to improve health of homeless population
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

slide31
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

this community s accreditation assessment results
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

strategic planning33
Strategic Planning
  • Preparation for Strategic Planning
  • Developing the Strategy
  • Deploying the Strategy
  • Reviewing Implementation vs. the Plan

33

deployment quiz for internal operating units
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

slide35

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

professor cranston

Professor Cranston

Nightmare of Learning Alignment

deployment in the organization the community
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

partner contributions to objective
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

partner contributions to objective39
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

strategic plan alignment and deployment
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

setting implementation priorities
Setting Implementation Priorities

High

Strategic Importance

Medium

Low

High

Low

Medium

Difficulty of Implementing

encourage others in the community to jump in
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

5 critical barriers to successful execution
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

strategic planning44
Strategic Planning

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

44

strategic planning45
Strategic Planning
  • Preparation for Strategic Planning
  • Developing the Strategy
  • Deploying the Strategy
  • Reviewing Implementation vs. the Strategic Plan

45

review quiz
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

review
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

slide49

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

review50
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

review51
Review
  • No long presentations – 10 minutes
  • Use standardized review forms
  • Questions in advance
  • Three slides maximum
  • Fifteen minutes per review
  • Not defense but proactive

51

slide52

Review Slide Layout Per Goal

Goal Detail and Alignment To

Organizational Objectives Summary

Baseline and Metric Data

Gantt Chart Showing Major Activities and Timelines

Next Quarter Action or Recovery

Activities

Summary of Accomplishments

52

review roles and responsibilities
Reviewer

Come prepared

Understand the topic

Confront constructively

Accept bad news with remedies

Probe for specifics

Look for alignment

Challenge where appropriate

Reviewee

Come prepared

Have “Why’s” ready

Action plans to convert deltas

Show alignment to organizational objectives

Tell bad news

Accept challenges

Be accountable

Review Roles and Responsibilities

53

focus of the review
Focus of the Review
  • Project goals and objectives
  • Time frames
  • Focus on deltas
  • Alignment of projects or actions to organizational goals
  • Detail critical improvements
  • Discuss changes to timetable or goals
  • Discuss impact on customers
  • Detail risks

54

senior management review checklist
Senior Management Review Checklist
  • Before The Review:
    • Familiarize yourself with the Status Reports or Plan/Delta Reports submitted
    • Inform participants about questions to be asked
    • Confirm time and place for the Review
    • Send each participant a completed Management Review Form

55

senior management review checklist56
Senior Management Review Checklist
  • Before The Review:
  • Inform participants about questions to be asked such as:
    • What are your work unit goals?
    • Which Organizational objectives are you aligned?
    • What criteria did you use to choose those goals?
    • Who is accountable for goals being completed?
    • Why did you choose these improvements?
    • How will you measure them?
    • What % completion are you at this point?
    • Are you on plan or off plan? Why?
    • Do you have actions detailed to get back on Plan?

56

senior management review checklist57
Senior Management Review Checklist
  • Before The Review:

Inform participants about questions to be asked Cont:

    • What additional resources might you need?
    • What are the critical processes?
    • Can these results be replicated elsewhere in the organization?

57

senior management review checklist58
Senior Management Review Checklist
  • During The Review:
    • Clarify the purpose of the Review
    • Stick to the agenda and questions
    • Look for the alignment of goals and objectives
    • Ask the agreed upon questions
    • Create a two-way dialogue and build trust
    • Probe the goals/objectives/targets - make sure they are stretch
    • Document agreed upon modifications and follow-up items
    • Give everyone feedback at the end of the Review
    • Decide on the time and place of the next Review

58

senior management review checklist59
Senior Management Review Checklist
  • After The Review:
    • Send out formal Feedback Report with one week
    • Document agreements and modifications
    • Follow-up on agreements
    • Document obstacles that are common among all teams/participants and start to address them – Executive Level Involvement
    • Prepare notes for next Review

59

slide60
CBSC REVIEWUse of “Outcome” & “Driver” Performance Measures Over Time to Test Assumptions & Improve the Strategy

Community Health Status

Outcomes

Community Implementation

Outcomes & Performance Drivers

Assumed cause & effect

Community Process & Learning

Performance Drivers

Community Assets

Performance Drivers

60

slide61

Instructions:After each of the pitfalls check the appropriate column as it applies to your organization: It is always there, sometimes we have the problem, and never in this organization? Multiply the always column number of checkmarks by 1, the sometimes number of check marks by 3, and the never number of check marks by 5. The highest score is 50 which is a world class strategic planning organization.

Pitfalls:*AlwaysSometimesNever

1. Mix-up

2. Bermuda Triangle

3. Data Gathering

4. Meeting-Of-No-Purpose

5. Roles and Responsibilities

6. Involvement

7. Wallpaper

8. Lack Of Aligned Measures

9. Key Words

10. OK Corral

Total Number of Check Marks:

Multiply by: 1 3 5

Score: _________

* The “Thirty Pitfalls of Strategic Planning” by Jack Moran is

available at www.phf.org/

61

contact information
Contact Information

Jack Moran

Senior Quality Advisor

Public Health Foundation www.phf.org

E-mail: jmoran@phf.org

Paul Epstein

Results That Matter Team www.RTMteam.net

Epstein & Fass Associates

212-349-1719

E-mail: paul@RTMteam.net

62