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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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what the ranking matrix is

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
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
why to preserve core ph
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
preparatory footwork
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)
prep work cont
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.
other matrices
Other Matrices
  • St. Johns CHD
  • Volusia CHD
  • Walton CHD
the echd matrix
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
ranking criteria
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
the ranking sessions
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
the process
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
the process cont
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.
the process cont13
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.
ranking criteria weighting
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
communication
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
what hasn t been done yet
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
uses of matrix
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
uses of matrix cont
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
lessons learned
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)
lessons learned cont
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