Strategic Plan 2016-2018 - Florida Health Duvalduval.floridahealth.gov/programs-and-services/community...October 2016 Florida Department of Health in Duval County Strategic Plan 2016-2018

October 2016

Florida Department of Health in Duval County

Strategic Plan 2016-2018

Rick Scott Governor

Celeste Philip, MD, MPH State Surgeon General and Secretary

Kelli T. Wells, MD Director, Florida Department of Health in Duval County

Florida Department of Health in Duval County

900 University Boulevard North, Jacksonville, FL 32211 Phone: 904-253-1410 Fax: 904-253-2743

http://duval.floridahealth.gov/

Produced by

The Florida Department of Health in Duval County

Office of Performance Improvement

Mission, Vision, and Values ........................................................................................... 1 Executive Summary ...................................................................................................... 2 Background and Overview ............................................................................................ 3

Demographics ...................................................................................................... 3 Budget and Resources ......................................................................................... 5 Programs and Services ........................................................................................ 7 SWOT Analysis .................................................................................................... 8

Strategic Priorities ........................................................................................................ 9 Strategy Map ................................................................................................... …10 Action Plans........................................................................................................ 11

Appendices Appendix A: Strategic Planning Committee Members .........................................24 Appendix B: Planning and Monitoring Summary ................................................26 Appendix C: Stakeholder Engagement ................................................................28 Appendix D: Alignment ........................................................................................29 Appendix E: Glossary ..........................................................................................34

Table of Contents

Mission – Why do we exist?

To protect, promote and improve the health of all people in Florida through integrated state, county and community efforts.

Vision – What do we want to achieve?

To be the Healthiest State in the Nation.

Values – What do we use to achieve our mission and vision?

I nnovation: We search for creative solutions and manage resources wisely. C ollaboration: We use teamwork to achieve common goals & solve problems. A ccountability: We perform with integrity & respect. R esponsiveness: We achieve our mission by serving our customers & engaging our

partners. E xcellence: We promote quality outcomes through learning & continuous performance

improvement.

Mission, Vision and Values

1

The Florida Department of Health in Duval County (DOH-Duval) initiated a new strategic planning process in September 2015. The process was championed by DOH-Duval’s Strategy and Performance Improvement Leadership (SPIL) Team, and involved numerous internal stakeholders including executive leadership, program managers, and program staff.

DOH-Duval approached the strategic planning process with a number of objectives in mind, including re-focusing efforts on core public health functions and ensuring the provision of essential public health services.

DOH-Duval also sought to articulate what we plan to achieve as an organization, how we will achieve it, and how we will know if we have achieved it. Quarterly monitoring will take place (see appendix B). The DOH-Duval Strategic Plan was developed to clarify the course and direction of the agency for consumers, employees, administrators, and legislators seeking to understand the work of Duval County public health. Our Strategic Plan is intended to position DOH-Duval to operate as a sustainable local health office within Florida’s integrated public health system, under current the economic environment, and to give our customers high quality public health services.

Our strategic planning process resulted in focusing on four critical priorities that are aligned with the Florida Department of Health Agency Strategic Plan 2016-2018. These strategic priorities represent the synthesis and integration of information, data, opinions, perceptions, and issues examined by the DOH-Duval leadership team. DOH-Duval’s strategic priorities are:

1. Healthy Moms and Babies2. Long, Healthy Life3. Readiness for Emerging Threats4. Effective Agency Processes

These priorities guided the development of goals, strategies, and objectives and will help to shape decisions about resources and actions.

The result of the strategic planning process is a well-crafted roadmap that we will review and revise annually to meet emerging challenges and opportunities.

Executive Summary

2

Public health touches every aspect of our daily lives. By definition, public health aims to provide the maximum benefit for the largest number of people. It is what we do collectively to assure conditions in which people can be healthy. Public health is a well-established science that has been in practice for hundreds of years. It is based upon the social, behavioral, environmental, biological, and socioeconomic factors that impact population-wide health.

The over-arching goal of public health is to protect and improve the health of communities through education, promotion of healthy lifestyles, and research for disease and injury prevention. Through research, surveillance, and data analysis, we develop programs and policies that protect the health of the entire community.

Demographics

The DOH-Duval serves a population of 901,215. Duval County is different demographically from most of Florida’s larger counties. It has a relatively low Hispanic population (9.0%), but the county is 29.6% African American, the highest proportionate African American population of Florida’s larger counties. In Duval County, 13.3% of families live below the poverty level, 11.2% of residents above the age of 25 have less than a high school diploma, and 11.1% of the civilian labor force is unemployed.

Population by AgeDuval County and Florida

County – 2015 State – 2015

Age Group Total Number Total Percentage Total Percentage

< 5 60,759 6.7% 5.1% 5 - 14 116,706 12.9% 11.6% 15 - 24 121,040 13.6% 12.7% 25 - 44 250,021 27.7% 24.4% Subtotal 548,526 60.9% 53.8% 45 - 64 232,464 25.7% 26.7% 65 - 74 70,452 7.8% 10.3% > 74 49, 773 5.5% 8.8%

Subtotal 352,689 39.0% 45.8% Source: Florida Charts, 2015.

Background and Overview

3

Where we live influences our health. Demographic, socioeconomic, and environmental factors create unique community health service needs. Duval County is comprised of urban, suburban, and pockets of rural areas. The county is divided into six health zones (HZ) which differ demographically and economically, and that consistently demonstrate large disparities in health outcomes.

HZ1 has long been the focus of resources and targeted efforts to increase the health of residents of this area. HZ1 has higher levels of poverty, lower level of educational attainment, and higher rates of many health conditions (e.g., cancer, diabetes, heart disease). Population demographics and health indicators are analyzed across the HZs in order to make strategic decisions regarding the allocation of community health resources and services.

4

Budget and Revenue

The DOH-Duval’s financial resources are provided through multiple sources. These include fees, grants, and budget allocations from the county, state and federal governments.

The Florida Department of Health in Duval County Revenue Percentage by Source

Fiscal Year 2016-2017

27%

30%6%

17%

2% 5%

1%11%

Revenue by Source 2016-2017

State Appropriated Federal AppropriatedMedicaid Clinic FeeVital Statistics Environmental HealthCity of Jacksonville Other Revenue/Private Contracts

Background and Overview

5

$-

$10,000,000.00

$20,000,000.00

$30,000,000.00

$40,000,000.00

$50,000,000.00

$60,000,000.00

$70,000,000.00

FY 09-10 FY 10-11 FY 11-12 FY 12-13 FY 13-14 FY 14-15 FY 15-16

The Florida Department of Health in Duval County Revenue and Expenses 2009-2016

Revenue Expenses

Linear (Revenue) Linear (Expenses)

Some of the changes affecting our services and programs include the advent of Statewide Managed Medicaid, and state and federal cuts to the Florida Department of Health in Duval County. The graph below represents our revenue and expense relationship over the past five years. The corresponding dashed lines represent the moving average of these values, which smooth out fluctuations in data and shows the pattern or trend more clearly.

Programs and Services

Some of the most effective strategies for improving public health include policies and programs that shape the environment and create opportunities for healthier behaviors. This is the basis for DOH-Duval’s commitment to providing the highest standards of public health through the following core functions and services:

Communicable Disease Control

We protect the health of the community through the surveillance, monitoring, and prevention of infectious and communicable diseases. Activities include investigating contagious disease cases and outbreaks, sexually transmitted infections (STI) detection and control, HIV/AIDS treatment and education, immunizations, and tuberculosis (TB) control.

Community Health

We plan and implement programs to promote healthy behaviors and reduce chronic disease through education, community outreach, and collaborative partnerships.

Dental

We provide dental services to children age one through twenty years of age.

Environmental Health

We protect the health of the community by monitoring and regulating environmental activities which may contribute to the occurrence or transmission of disease by ensuring safe drinking water, safe food, proper sewage disposal, clean swimming pools, complaint investigations and enforcement of public health laws.

Family Planning

We offer education and counseling to help women plan their families and improve their reproductive health and birth outcomes.

Maternal and Child Health

We provide services to reduce infant mortality and low birth weight babies.

Public Health Preparedness

We partner with the local healthcare system, emergency management, government and the community on preparedness and response to natural and man-made disasters. The preparedness effort focuses on developing critical capabilities necessary for an effective disaster response to keep the community safe and minimize loss.

School Health

We collaborate with the local school boards to improve student health by offering immunizations, vision and hearing screenings, and tracking of physical development in all children.

Vital Statistics

We maintain Florida birth and death records locally and are able to assist with birth, death, marriage and divorce records for all fifty states. Using data collected by our office, we are able to assist the state with tracking causes of morbidity and mortality— two main indicators of health status.

Women, Infants and Children (WIC)

We provide nutrition education and counseling, breastfeeding support, and healthy foods to eligible pregnant, breastfeeding and new moms, infants, and children up to age five.

Background and OverviewBackground and Overview

7

Strengths, Weakness, Opportunities and Threats (SWOT) Analysis

Strengths• Scope of services

• Strong partnerships andcommunity involvement

• Engaged employees

• Strong leadership

• Integrated statewide systemof public health

Weaknesses• Lack of communication

• Low wages impactrecruitment and retention

• Inadequate program funding

• Staff feel underappreciated

• Lack of leadershipdevelopment

Opportunites• Build new partnerships to fill

service gaps

• Positive image of healthdepartment

• Demographic changes

• Insurance changes

• Policy and political changes

Threats• Employee dissatisfaction

with workload and pay

• State restrictions ontechnology

• Community disengagement

• Reduction in funding

• Silos in funding streams

SWOT Analysis

See Appendix B for a description of the SWOT process.

8

Goal: Reduce Infant Mortality

Strategic Priority 1: Healthy Moms & Babies

• Strategies:•Reduce racial disparity in infant mortality

•Improve maternal and child health outcomes

Goal: Increase healthy life expectancy

Strategic Issue 2: Long Healthy Life

• Strategies:•Increase the number of DOH-Duval clients at a healthy weight through increased education andimproved linkage to community services

•Meet the identified needs of Duval County residents through improved linkage to community services

•Assist companies in implementing worksite wellness programs

Goal: Demonstrate readiness for emerging health threats

Strategic Issue 3: Readiness for Emerging

Threats

• Strategies:•Increase vaccination rates for children and adults

•Improve capacity to respond to public health emergencies

Goal: Develop and maintain a sustainable performance management and culture of quality framework

Strategic Issue 4: Effective Agency

Processes

• Strategies:•Develop a workforce development plan to attract, recruit, and retain a competent workforce

•Improve employee wellness

•Ensure balanced operational budgets

•Promote a performance management and quality improvement framework

•Improve local communication/marketing of DOH-Duval services and identified public health priorities

Strategic Priorities

OBJECTIVES

3.1 Increase vaccination rates for children and adults

3.2 I

HEALTHY MOMS AND BABIES

GOAL: Reduce infant mortality

READIN ESS FOR EMERGING HEALTH THREATS

GOAL: Demo nstrate readiness for emerging health threats

EFFECTIVE AGENCY PROCESSES

GOAL: Develop and maintain a sustainable performance management and culture of quality framework

educe the

3.1a I

3.1b I

3.2a Ensure 100% of DOH-Duval employees have received basic Emergency Preparedness and Response Training

4.1a A

STRATEGY MAP

LONG, HEALTHY LIFE GOAL: Increase healthy life expectancy

2.1 I c 2.1a I

2.2a D

2.2b R

2.2c Ryear olds

2.3a I

STRATEGIES

1.1 Reduce racial disparity

1.2 I 1.2a In

1.2b I

2.3 A

STRATEGI

4.1D

4.2 I

4.3 E

4.4 P

4.5 I of public health

4.1b A

4.2a I

4.3a M the

4.3b

4.4a

4.4b C r

4.5a P

4.5b

2.2 M

improvement project using the Plan-Do-Check-Act cycle

2 to 5

residents through improved linkage to community services

10

Strategic Issue Area: Healthy Moms and BabiesGoal: Reduce Infant Mortality

Strategy 1.1: Reduce racial disparity in infant mortality

Objective 1.1a Action Steps Anticipated Completion Date Person Responsible

Reduce the black‐white infant mortality gap by 26%

1.1a.1 Complete a data assessment on infant mortality and summarize findings April 29, 2016 Dr. Kristina Wilson

1.1a.2 Conduct a community meeting about disparities in infant deaths and the role of social determinants of health July 1, 2016 Karen Tozzi; Dr. Kristina Wilson

1.1a.3 Develop an action plan to address disparities that incorporates findings from the community meeting September 30, 2016 Karen Tozzi; Dr. Kristina Wilson

1.1a.4 Update data assessment on infant mortality with 2015 data December 31, 2016 Dr. Kristina Wilson

1.1a.5 Examine internal policies for factors that create barriers to enrollment and retention in Healthy Start; Update policies, as needed June 30, 2017 Carolyn Arnister

1.1a.6 Collect qualitative data to increase understanding of factors impacting infant mortality in high risk neighborhoods June 30, 2017 Faye Johnson; Karen Tozzi; Dr. Kristina

Wilson

1.1a.7 Develop guidance to improve pre and interconception health December 31, 2017 Jaci Murphy; Carolyn Arnister; Gloria McNair; Mary Elbell; Rugi Mansaray

1.1a.8 Develop an action plan to increase the number of Healthy Start screenings December 31, 2017

Carolyn Arnister; Funmi Borisade; Spencer Greenwood; Annie Pollard; Jaci Murphy

1.1a.9 Implement 2‐3 initiatives to increase retention of Healthy Start clients December 31, 2017 Carolyn Arnister

1.1a.10 Develop and implement a protocol for mandatory behavioral health screening and referral for Healthy Start and DOH‐Duval maternity clients

December 31, 2017 Bougainvilla Bailey; Carolyn Arnister;

Funmi Borisade; Herb Latney

1.1a.11 Implement and monitor action plan to address disparities in infant mortality December 31, 2018 Karen Tozzi

Action Plans

11


Strategy 1.2: Improve maternal and child health outcomes


Increase the number of baby‐friendly hospitals in Duval County from 2 to 5

1.2a.1 Assess Baby Friendly Status of local hospitals as part of the analysis of the current breastfeeding environment March 31, 2016 Patricia Holder, IBCLC

1.2a.2 Support partnering hospital(s) complete the Baby Steps to Baby Friendly Self‐Assessment Tool March 31, 2016 Patricia Holder, IBCLC

1.2a.3 Assist hospital(s) in registering for a recognition opportunity (either the Baby Friendly Hospital designation through Baby‐Friendly USA or the Florida Quest for Quality Maternity Care Award through the Florida Breastfeeding Coalition)

March 31, 2016 Patricia Holder, IBCLC

1.2a.4 Assist and support hospital(s) to develop a work plan based on the Self‐Assessment results; Ensure that work plan activities are tailored for minority women

July 31, 2016 Patricia Holder, IBCLC

1.2a.5 Work with hospital(s) to identify at least two activities in the work plan that they will complete by September 30, 2016 August 31, 2016 Patricia Holder, IBCLC

1.2a.6 Assist and support hospitals to complete activities in work plan; The following resources are available from the program office: Free staff training resources, My breast feeding plan, and Return to work tools

September 30, 2016 Patricia Holder, IBCLC

1.2a.7 Assist and support hospital(s) to complete the required follow up Baby Steps to Baby Friendly Self‐Assessment September 30, 2016 Patricia Holder, IBCLC

1.2a.8 Receive hospital final work plan, success story, and self‐assessment September 30, 2016 Patricia Holder, IBCLC

1.2a.9 Celebrate the hospital(s) successes through press releases and other media opportunities September 30, 2016 Patricia Holder, IBCLC

1.2a.10 Continue to work with hospitals to complete the 10 steps to successful breastfeeding and monitor progress December 31, 2018 Patricia Holder, IBCLC

12


Strategy 1.2: Improve maternal and child health outcomes

Objective 1.2b Action Steps Anticipated Completion Date Person Responsible

Increase the percent of teen DOH‐Duval Family

Planning clients that adopt an effective or highly

effective method of birth control from 69% to 80%

1.2b.1 Provide programs to increase teens' access to LARCs Ongoing Jameela Afi‐Leigh; Renee Cain; Dr. Pauline Rolle

1.2b.2 Evaluate current process to ensure teen DOH‐Duval Family Planning clients adopt an effective or highly effective method of birth control

December 31, 2016 Jameela Afi‐Leigh; Renee Cain; Dr. PaulineRolle

1.2b.3 Examine best practices from counties that exceed the target for the percent of teen family planning clients that adopt an effective or highly effective method of birth control


1.2b.4 Identify opportunities for improvement; Develop a work plan that increases the percent of teen DOH‐Duval Family Planning clients that adopt an effective or highly effective method of birth control and reduces missed opportunities


1.2b.5 Increase the number of teens screened to assess need for family planning services by School Health, Teen Health Centers, DOH‐Duval, and PACE Center for Girls providers

December 31, 2016 Rugi Mansary; Jameela Afi‐Leigh; Renee Cain; Dr. Pauline Rolle; Dr. Max Wilson

1.2b.6 Implement marketing campaign to increase awareness of and access to LARC June 30, 2017 Jameela Afi‐Leigh; Renee Cain; Dr. Pauline

Rolle

1.2b.7 Provide education to DOH‐Duval staff June 30, 2017 Jameela Afi‐Leigh; Renee Cain; Dr. Pauline Rolle

1.2b.8 Seek funding (internal and external) for additional LARC resources December 31, 2017 Jameela Afi‐Leigh; Renee Cain; Dr. Pauline

Rolle; Carla Jackson

1.2b.9 Implement and monitor work plan to increase the percent of teen DOH‐Duval Family Planning clients that adopt an effective or highly effective method of birth control

December 31, 2018 Rugi Mansary; Jameela Afi‐Leigh; Renee Cain; Dr. Pauline Rolle; Mary Elbell

13

Strategic Issue Area: Long Healthy LifeGoal: Increase Healthy Life Expectancy

Strategy 2.1: Increase the number of DOH‐Duval clients at a healthy weight through increased education and improved linkage to community services


Increase the percent of DOH‐Duval pediatric and

women's health clients who are at a healthy weight by

10%

2.1a.1 Measure BMI at each clinical and WIC visit within a 6 month time period, discuss at wellness check/annual visit December 31, 2016

Annie Pollard; Spencer Greenwood; Dr. Pauline Rolle; Renee Cain;

Jameela Afi‐Leigh

2.1a.2 Update and implement weight management education materials June 30, 2017 Spencer Greenwood; DOH‐Duval provider team (must be created); Nicole Miller

2.1a.3 Market 2 agency wellness activities to DOH‐Duval clients and staff per year December 31, 2018 Gloria McNair; Annie Pollard; Monique

Ellis

2.1a.4 Provide ongoing staff training for use of the Childhood Obesity Prevention Toolkit (weight management, motivational interviewing) December 31, 2018 DOH‐Duval Provider team (must be

created)

Strategy 2.2: Meet the identified needs of Duval County clients through improved linkage to community servicesObjective 2.2a Action Steps Anticipated

Completion Date Person Responsible

Develop a reporting system and track referrals to

behavioral health services (both within DOH‐Duval and

to outside agencies)

Herb Latney; Elizabeth Fields



2.2a.1 Develop a reporting system for referrals to community behavioral health services 2.2a.2 Begin tracking referrals to community behavioral health services to assess baseline number of referrals given with current practices in place 2.2a.3 Assess current referral system and its effectiveness; Identify any issues or areas to improve the process of referring clients 2.2a.4 Implement changes needed to improve referral system/process Herb Latney; Elizabeth Fields

2.2a.5 Create a "Community Services" board for each site December 31, 2017 Herb Latney; Elizabeth Fields; DOH‐DuvalSites

2.2a.6 Create behavioral health resource guide to inform providers (DOH‐Duval and community), DOH staff, and clients about community services and who is eligible

December 31, 2017 Herb Latney; Elizabeth Fields; Jocelyn Turner

December 31, 2017 Herb Latney; Elizabeth Fields 2.2a.7 Provide training to all DOH‐Duval staff on information about behavioral health and techniques for making mental health referrals 2.2a.8 Reassess number of referrals being given per quarter since implementation of changes to referral system/process Herb Latney; Elizabeth Fields

14

June 30, 2017

June 30, 2017

June 30, 2017

Ongoing/Quarterly

Strategic Issue Area: Long Healthy LifeGoal: Increase healthy life expectancy

Strategy 2.2: Meet the identified needs of Duval County clients through improved linkage to community servicesObjective 2.2b Action Steps Anticipated


Reduce the incidence rate of HIV among 15‐24 year

olds in Duval County by 10%

2.2b.1 Implement plan to increase routine HIV testing in traditional medical settings June 30, 2017

Max Wilson; DOH‐Duval Minority AIDS Coordinator, DOH‐Duval Early Intervention Coordinator

2.2b.2 Increase implementation of targeted, community‐based HIV testing and education projects (such as Teen Health Centers) from 5 to 8 December 31, 2017

DOH‐Duval STD field staff, DOH‐Duval APO Prevention staff, DOH‐Duval Outreach

staff; JASMYN; Job Corps

2.2b.3 Establish and implement PrEP and nPEP services in Duval County December 31, 2017 DOH‐Duval APO Prevention staff, DOH‐Duval Minority AIDS Coordinator, DOH‐Duval Early Intervention Coordinator

2.2b.4 Develop and implement procedures for Direct Observed Therapy (DOT) delivered by DIS to clients in the field December 31, 2017 DOH‐Duval STD field staff, DOH‐Duval STD

Clinic Staff 2.2b.5 Provide technical assistance visits to top 20 medical providers to disseminate information on HIV treatment guidelines and Expedited Partner Therapy (EPT)

December 31, 2017 Dr. Kelli Wells; DOH‐Duval surveillancefield staff, Dr. Pauline Rolle

2.2b.6 Implement Intervention Strategies (TBD) to target 15‐24 year old populations December 31, 2017

DOH‐Duval STD field staff, DOH‐Duval APO Prevention staff, DOH‐Duval Outreach

staff; JASMYN

Objective 2.2c Action Steps Anticipated Completion Date Person Responsible

Reduce the incidence rate of bacterial STDs among 15‐24 year olds in Duval county

by 10%

2.2c.1 Increase routine STD testing in traditional medical settings through formal STD presentations to top 20 provider groups, DOH sites and 4 major hospitals. Presentations should include STD info related to: prevalence, rate increases, ramifications (to both individuals and community), and the ability/benefits of using EPT

June 30, 2017 Lekisha Cohen (Field Operations Program Manager)

2.2c.2 Develop and implement procedures for Direct Observed Therapy (DOT) June 30, 2017 Lekisha Cohen (Field Operations Program

Manager) 2.2c.3 Increase routine STD testing at FDOH by offering an evening clinic one night per week December 31, 2017 Lekisha Cohen (Field Operations Program

Manager) 2.2b.4 Provide technical assistance visits to top 20 medical providers to disseminate information on STD treatment guidelines and Expedited Partner Therapy (EPT)

December 31, 2017 Lekisha Cohen (Field Operations ProgramManager)

2.2b.5 Enhance Intervention Strategies targeting 15‐24 year old populations by changing current Grid (persons who receive intervention services) to ensure all persons testing positive for Bacterial Infections <24 years old receive Partner Notification Services and are followed to ensure treatment

December 31, 2017 Mary Elbell (DOH‐Duval Disease Control Director)

Strategic Issue Area: Long Healthy Life Goal: Increase Healthy Life Expectancy

Strategy 2.3: Assist companies in implementing worksite wellness programs


Improve five companies' score on the CDC Worksite Wellness Scorecard by 10%

2.3a.1 Identify at least 5 companies that are interested in completing the CDC Wellness Scorecard and using the results to make changes to improve worksite wellness

May 2016 Gloria McNair

2.3a.2 Provide the CDC Wellness Worksite Scorecard to identified companies for completion to assess baseline wellness score May 2016 Gloria McNair

2.3a.3 Provide technical assistance to complete the CDC Worksite Wellness Scorecard June 2016 Gloria McNair

2.3a.4 Provide technical assistance to review the CDC Worksite Wellness card results, select an area to improve a worksite wellness policy, and/or practice, and develop an action plan to improve worksite wellness based on the results

October 2016 Gloria McNair

2.3a.5 Provide resources to implement selected area of improvement October 2016 Gloria McNair

2.3a.6 Companies implement selected area of improvement October 2016 Gloria McNair

2.3a.7 Monitor progress of action plan implementation; Continue to provide technical assistance as needed

January 2017; monthly thereafter Gloria McNair

2.3a.8 Provide CDC Worksite Wellness Scorecard to identified companies for completion to reassess wellness score November 2017 Gloria McNair

2.3a.9 Provide technical assistance to complete the CDC Worksite Wellness Scorecard December 2017 Gloria McNair

16

Strategic Issue Area: Readiness for Emerging Threats


Strategy 3.1: Increase vaccination rates for children and adults

Objective 3.1a Action Steps Anticipated


Increase the percent of DOH-Duval adolescent clients who initiate and

complete the HPV vaccination series to 25%

3.1a.1 Implement training that assists providers in Duval County to make strong and consistent HPV vaccine recommendations

December 2016 Dr. Kristina Wilson; Dr. Pauline Rolle

3.1a.2 Provide communication tools for public health professionals, immunization programs, and immunization providers to improve awareness and knowledge of the HPV vaccine

December 2016 Dr. Kristina Wilson

3.1a.3 Create toolkit to educate parents and caregivers about the importance of HPV vaccination for cancer prevention and encourage parents and caregivers to vaccinate their children

February 2017 Dr. Kristina Wilson

3.1a.4 Make education and training resources available online August 31, 2017 Jocelyn Turner

3.1a.5 Organize screening of documentary "Someone you love: The HPV epidemic"

August 31, 2017 Dr. Kristina Wilson; Jocelyn Turner

3.1a.6 Implement marketing campaign to increase awareness of the HPV vaccine

December 31, 2017 Dr. Kristina Wilson; Andrea Sharpe

3.1a.7 Implement reminder-recall system for HPV vaccine December 31, 2017 Rugi Mansaray

3.1a.8 Raise awareness of the HPV vaccine among preteens and teens Ongoing Samantha Kwiatkowski; Stephanie Reese

3.1a.9 Promote HPV vaccination through DOH Duval's Breast and Cervical Cancer Program

Ongoing Irina Kolomeyer; Juanita Owens

3.1a.10 Assess immunization rates for improvement on a quarterly basis December 2016

quarterly thereafter Margaret Varnadore



Strategy 3.1: Increase vaccination rates for children and adults

Objective 3.1b Action Steps Anticipated


Increase the percent of 2 year olds in Duval County that are fully immunized

from 77% to 95%

3.1b.1 Improve current vaccination process by decreasing wait times December 31, 2016 Margaret Varnadore; Renee Cain; Dr.

Pauline Rolle

3.1b.2 Develop an immunization marketing campaign targeting parents/guardians and pediatric medical providers (DOH-Duval and community providers) and display materials in community

December 31, 2016 Margaret Varnadore; Jocelyn Turner

3.1b.3 Provide education to DOH-Duval medical staff regarding types of vaccines, availability, importance of vaccination, and the immunization schedule

Ongoing Margaret Varnadore; Balinda Welcome

3.1b.4 Provide education to patients/parents regarding types of vaccines, availability, importance of vaccination, and the immunization schedule

Ongoing Margaret Varnadore; Renee Cain

3.1b.5 Assure patient immunization records are up to date December 31, 2016 quarterly thereafter

Margaret Varnadore; Renee Cain

3.1b.6 Monitor vaccine availability on a quarterly basis July 1, 2016

quarterly thereafter Margaret Varnadore (DOH-Duval; Renee

Cain

3.1b.7 Assess immunization rates for improvement on a monthly basis July 1, 2016

quarterly thereafter Margaret Varnadore; Renee Cain; Dr.

Pauline Rolle



Strategy 3.2: Improve the capacity to respond to public health emergencies

Objective 3.2a Action Steps Anticipated


Ensure 100% of DOH-Duval

employees have received

basic Emergency

Preparedness and Response

Training.

3.2a.1 Develop and maintain Multi-Year Training And Exercise Program:

Jan 1st 2016 -Dec 31st 2019. January 1, 2017 Sarah Winn; Ivette Palomo

3.2a.2 Develop and maintain SharePoint training calendar site with

training and exercise opportunities listed on an ongoing basis. January 18, 2017 Sarah Winn; Ivette Palomo

3.2a.3 Offer at least three training opportunities per month for the 2017

calendar year. December 31, 2017 Sarah Winn; Ivette Palomo

3.2a.4 Survey participants to all On-Site trainings. December 31, 2018 Sarah Winn; Ivette Palomo

3.2a.5 Review surveys for feedback to inform planning, training, and

staff coordination. December 31, 2018 Sarah Winn; Scott Tarzwell; Terri Davis;

Ivette Palomo

3.2a.6 Improve trainings based on survey feedback. December 31, 2018 Sarah Winn; Emergency Preparedness

Team

Strategic Issue Area: Effective Agency Processes Goal: Develop and Maintain a Sustainable Performance Management and Culture of Quality Framework Strategy 4.1: Develop a workforce development plan to attract, recruit, and retain a competent workforce


Achieve a 10% increase in employee satisfaction

4.1a.1 Implement training needs assessment to identify leadership development needs March 2016 Dr. Kristina Wilson

4.1a.2 Identify leadership development opportunities based on needs assessment results May 2016 Dr. Kristina Wilson

4.1a.3 Develop and offer “Giving and Receiving 360 Feedback” May 2016 Andrea Sharpe

4.1a.4 Administer 2016 DOH‐Duval Employee Satisfaction Survey to assess impact of initiative implemented and to identify future opportunities for improvement

May 2016 Dr. Kristina Wilson

4.1a.5 Offer “Refresh: Motivating and Rewarding Team Members” May 2016 Andrea Sharpe

4.1a.6 Lay groundwork for implementation of "Grow," a training series for non‐managers to develop their leadership skills December 31, 2016 Andrea Sharpe

4.1a.7 Highlight "Program of the Month" in SMT meeting Monthly Andrea Sharpe 4.1a.8 Provide staff recognition during employee awards recognition ceremony Quarterly Andrea Sharpe

4.1a.9 Create new SharePoint site that will house information, tools, resources, and forms to increase communication and access to tools needed

July 2016 Andrea Sharpe; Bruce Allen

4.1a.10 Highlight "Program of the Month" in ELT meeting Monthly Andrea Sharpe

4.1a.11 Initiate quarterly manager’s meeting to ensure managers across the agency receive information about agency/department changes May 2016 Andrea Sharpe

4.1a.12 Create new SharePoint site that will house information, tools, resources, and forms to increase communication and access to tools needed

July 2016 Andrea Sharpe; Bruce Allen

4.1a.13 Employee Satisfaction QI group meets on a regularly to discuss and monitor progress Ongoing Dr. Kristina Wilson

4.1a.14 Administer 2017 DOH‐Duval Employee Satisfaction Survey to assess impact of initiative implemented and to identify future opportunities for improvement

May 2017 Dr. Kristina Wilson

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Strategic Issue Area: Effective Agency Processes Goal: Develop and Maintain a Sustainable Performance Management and Culture of Quality Framework Strategy 4.1: Develop a workforce development plan to attract, recruit, and retain a competent workforce


Achieve a 10% increase in employee retention

4.1b.1 Confirm DOH‐Duval critical need positions that will be vacant in the next three years December 2016 Yvette Andrews; ELT

4.1b.2 Identify competencies for selected critical need positions April 2016 Yvette Andrews; ELT 4.1b.3 Develop or revise competency‐based position descriptions for identified critical need positions May 2017 Yvette Andrews; ELT

4.1b.4 Develop and implement a workforce development plan based on identified critical need position competencies May 2017 Andrea Sharpe

4.1b.5 Develop and implement a workforce development plan based on the agency's training needs assessment December 2018 Andrea Sharpe

Strategy 4.2: Improve employee wellness


Improve DOH‐Duval's score on the CDC Worksite

Wellness Scorecard by 10%

4.2a.1 DOH‐Duval will complete the CDC Worksite Wellness Scorecard August 2016 Gloria McNair

4.2a.2 Provide technical assistance to review the CDC Worksite Wellness Scorecard results, select area to improve worksite wellness policy and/or practice, and develop an action plan to improve worksite wellness based on the results

October 2016 Gloria McNair

4.2a.3 Provide resources to assist DOH‐Duval sites implement selected area of improvement October 2016 Gloria McNair

4.2a.4 Build capacity for worksite wellness by providing training to DOH‐Duval Worksite Wellness Champions November 2016 Gloria McNair

4.2a.4 Implement selected area of improvement based on CDC Worksite Wellness Scorecard results November 2016 Gloria McNair

4.2a.5 Monitor progress of action plan implementation; Continue to provide technical assistance, as needed

January 2017, monthly thereafter Gloria McNair

4.2a.6 Provide CDC Worksite Wellness Scorecard to identified DOH‐Duval staff for completion to reassess wellness score November 2018 Gloria McNair

4.2a.7 Provide technical assistance to complete the CDC Worksite Wellness Scorecard

November‐December 2018 Gloria McNair

4.2a.8 Ensure DOH‐Duval completes the CDC Worksite Wellness Scorecard by December 2017 December 2018 Gloria McNair

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Strategic Issue Area: Effective Agency Processes Goal: Develop and Maintain a Sustainable Performance Management and Culture of Quality Framework Strategy

4.3: Ensure balanced operational budgets

Objective 4.3a Action Steps Anticipated Completion Date

Maintain the cash reserve balance between 6.5‐10% of the annual operating

budget

4.3a.1 Ensure all DOH‐Duval Managers and Supervisors are properly trained on how to effectively manage and monitor their budgets December 31, 2017

Person Responsible DOH‐Duval managers and supervisors;

4.3a.2 Implement monthly monitoring and managing of all program financial operations December 31, 2017 Carla Jackson; L4 Managers

4.3a.3 Ensure monthly corrective action has taken place once issues are identified December 31, 2017 Carla Jackson; L4 Managers

4.3a.4 Implement quarterly presentation of current budget status of all programs to ELT December 31, 2017 All Departments


Decrease uncollected revenue to <8.0% of Accounts Receivable

4.3b.1 Ensure all current staff are properly trained and are equipped to perform duties December 31, 2017 Sharon Thomas

4.3b.2 Ensure current AR actively reflects accounts due the state that remains unpaid by client, Medicaid, Medicare, or third‐party insurance after services were rendered

December 31, 2017 Sharon Thomas; Carla Jackson; DOH‐Duval Fiscal Assistant lls

4.3b.3 Implement monthly monitoring of AR Control Account to ensure AR is being kept at optimal level, which is lower or equivalent of the statewide recommendation

December 31, 2017 Sharon Thomas; Carla Jackson

4.3b.4 Ensure proper action is taking place monthly regarding all AR accounts in accordance with FDOH rules and guidelines December 31, 2017 Sharon Thomas; Carla Jackson

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Carla Jackson

Strategic Issue Area: Effective Agency Processes Goal: Develop and Maintain a Sustainable Performance Management and Culture of Quality Framework

Strategy 4.4: Promote a performance managment and quality improvement framework


All DOH‐Duval divisions will identify and implement a quality improvement

project using the Plan‐Do‐Check‐Act cycle

4.4a.1 Divisions will identify potential performance improvement opportunities that align with the Duval County CHIP, DOH‐Duval Strategic Plan, or other agency/program goal

August 1, 2016 annually thereafter

DOH‐Duval Division Directors; DOH‐Duval ELT

4.4a.2 Divisions will prepare and submit a QI project proposal form to ELT for approval

September 1, 2016 annually thereafter

DOH‐Duval Division Directors, or identified staff

4.4a.3 QI Team Members and Team Leader selected September 30, 2016 annually thereafter DOH‐Duval Division Directors

4.4a.4 QI Team Members complete the PDCA training October 31, 2016 annually thereafter DOH‐Duval QI Team Leaders

4.4a.5 Design and implement QI projects using the PDCA cycle Ongoing ‐ project

completed by end of each fiscal year

DOH‐Duval QI Team Leaders

4.4a.6 Document all the steps of the PDCA cycle using DOH templates Ongoing DOH‐Duval QI Team Leaders 4.4a.7 Provide QI project status updates to ELT on a quarterly basis Quarterly DOH‐Duval QI Team Leaders 4.4a.8 Share QI project results (presentation at ELT, executive summary, Inside DOH‐Duval)

June 30, 2016 annually thereafter DOH‐Duval QI Team Leaders


Complete documentation for the Florida's Governor's

Sterling Award

4.4b.1 Review Governor's Sterling Award criteria and application process September 2016 Dr. Kristina Wilson

4.4b.2 Identify Governor's Sterling Award Team September 2016 Dr. Kristina Wilson; ELT

4.4b.3 Complete an organizational profile October 2016 Dr. Kristina Wilson; DOH‐Duval Sterling Team (must be created); ELT

4.4b.4 Conduct Sterling criteria self‐assessment November 2016 Dr. Kristina Wilson; DOH‐Duval Sterling Team (must be created); ELT

4.4b.5 Identify priority areas, develop timeline, and action plan December 2016 Dr. Kristina Wilson; DOH‐Duval Sterling Team (must be created); ELT

4.4b.6 Draft application and locate supporting evidence for each Sterling criteria Ongoing Dr. Kristina Wilson; DOH‐Duval Sterling

Team (must be created); ELT

4.4b.7 Finalize Sterling application December 2018 Dr. Kristina Wilson; DOH‐Duval Sterling Team (must be created); ELT

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Strategic Issue Area: Effective Agency Processes Goal: Develop and Maintain a Sustainable Performance Management and Culture of Quality Framework

Strategy 4.5: Improve local communication/marketing of DOH-Duval services and identified public health priorities


Produce five publications related to public health

4.5a.1 Develop process to identify authors, topics, and venues to publish public health reports September 2016 Dr. Kristina Wilson

4.5a.2 Develop schedule for fiscal year including authors, topics, and venues October 2016 Dr. Kristina Wilson

4.5a.3 Review reports and provide feedback to ensure successful submissions Ongoing Dr. Kristina Wilson

4.5a.4 Coordinate submission of at least five publications Ongoing Dr. Kristina Wilson


Develop and implement marketing campaigns to increase awareness and prevention education on infant mortality, STD/HIV,

healthy weight, immunization, and

breast/cervical cancer

4.5b.1 Identify relevant community partners (new or existing) to strategically engage or re‐engage based on agency strategic priorities December 31, 2016 Gloria McNair

4.5b.2 Develop public health messaging materials on the identified public health issue

December 31, 2018 (messaging will be rolling over time through 12/31/18)

Jocelyn Turner

4.5b.3 Collaborate with identified partners to host or coordinate skills‐based training or community events on the identified public health issue

December 31, 2018 (messaging will be rolling over time through 12/31/18)

Gloria McNair

4.5b.4 Coordinate an evidence‐based practice summit for staff and community partners

Annually, beginning 2017 Jocelyn Turner; Gloria McNair

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The Florida Department of Health in Duval County Strategic Planning Committee Members

The Florida Department of Health in Duval County’s Strategic Planning Committee members are comprised of the Strategy and Performance Improvement Leadership (SPIL) Team. Below is a list of the SPIL Team Members who oversaw the development of the DOH-Duval Strategic Plan 2016-2018.

Dr. Kelli T. Wells, Health Officer

Dr. Pauline Rolle, Medical Director

Antonio Nichols, Assistant Director of Administration and Operations

Gale Tucker-Disney, Assistant Director of Programs

Bruce Allen, Director of Information Technology

Renee Cain, Director of Nursing

Mary Elbell, Director of Disease Control

J. Spencer Greenwood, Director of Nutrition and Chronic Disease Prevention

Charles Griggs, Director of External Affairs

Carla Jackson, Budget Director

Amy Meyer, Chief Legal Counsel

Annie Pollard, Lead Clinical Operations Manager

Andrea Sharpe, Director of Organizational Development

Karen Tozzi, Director of Maternal and Child Health

Scott Turner, Director of Environmental Health

Dr. Kristina Wilson, Director of the Office of Performance Improvement

Dr. Max Wilson, HIV/AIDS Program Coordinator

Appendix A

24

SPIL team members invited staff members from a variety of programs to participate and contribute their expertise during the strategic planning process. Below is a list of DOH-Duval staff members that participated in the development of the Strategic Plan 2016-2018.

Tomeka Bright, Healthy Start

Keith Conger, Disease Control

Treva Davis, AIDS Program Office

Marisha Dixon, STD Program

Elizabeth Fields, Behavioral Health

Colleen Hogan, Nutrition and Chronic Disease

Melissa Jenkins, Disease Control

Kiszzie Jones, Disease Control

Herbert Latney, Behavioral Health

Daniyel Macomber, Nutrition and Chronic Disease

Sharmila Perry, Office of Performance Improvement

Nichole Miller, HERAP

Grazyna Pawlowicz, Environmental Health

Annie Pollard , Clinical Operations

Andrea Sharpe, Organizational Development

Torrencia Shiloh, AIDS Program Office

Shawn Sombutmai, Environmental Health

Dr. Kelli T. Wells, Director, DOH-Duval

Dr. Kristina Wilson, Office of Performance Improvement

Dr. Max Wilson, HIV/AIDS Program Coordinator

Sarah Winn, Emergency Preparedness

25

Planning Summary

The DOH-Duval SPIL Team oversaw the strategic planning process. The SPIL team is

comprised of DOH-Duval’s Executive Leadership Team.

Strategic Plan Development and Implementation Process:

Strategic Pan Timeframe

Conduct environmental scan October 2015

Conduct SWOT Analysis October 2015 Identify key stakeholders October 2015 Two-day strategic planning meeting to review environmental scan and SWOT results November 2015

Review mission/vision/values, identify cross cutting themes, emerging issues, and strategic issues November 2015

Develop strategic issue areas and prioritize goals December 2015 – March 2016

Determine key activities and develop action plans April 2016 – September 2016

Finalize strategic plan October 2016

Implement and monitor strategic plan Through December 2018

In preparation for the development of the Strategic Plan 2016-2018, DOH-Duval staff summarized data from the Community Health Needs Assessment, the Community Health Improvement Plan, and the Employee Satisfaction Survey. Customer satisfaction and financial data were also evaluated. Further, DOH-Duval conducted an agency-wide survey to gather stakeholders’ perspectives of the strengths, weaknesses, opportunities, and threats (SWOT analysis) that exist within the agency.

SPIL team members identified and selected several agency staff members to participate in the two-day strategic planning meeting. During the strategic planning meeting, the team reviewed the environmental scan and participated in a facilitated discussion of DOH-Duval’s strengths, weaknesses, opportunities and threats based on these findings. Topics discussed during the strategic planning meeting included information management, communications, programs and services, budget (financial sustainability), and workforce development.

The strategic planning discussion was summarized into cross cutting themes and trends and presented to SPIL Team for review and discussion. SPIL Team members prioritized

Appendix B

26

the goals to align with DOH-Duval's mission, vision and values, and the Community Health Improvement Plan and the State Health Improvement Plan. After several face-to-face meetings, SPIL Team Members arrived at the final strategic issue areas:

Healthy Moms and Healthy Babies Long, Healthy Life Readiness for Emerging Threats Effective Agency Processes

Monitoring Summary

The SPIL Team is responsible for measuring, monitoring, and reporting progress on the goals and objectives of the Strategic Plan. The SPIL Team will monitor the Strategic Plan through weekly Executive Leadership Team meetings, where the Strategic Plan will be a standing agenda item. On a quarterly basis, the SPIL Team will review the quarterly Strategic Plan Tracking Report that monitors progress toward goals. Annually, a Strategic Plan Progress Report will be produced to assess progress toward reaching goals and objectives and achievements for the year. The Strategic Plan will be revised annually, based on an assessment of availability of resources and data, community readiness, the current progress and the alignment of goals.

27

Stakeholder Engagement

The DOH-Duval has been working diligently to maintain transparency throughout the strategic planning process. Key activities to engage community stakeholders include: publishing the strategic plan on the DOH-Duval website for community review and comment, and requesting comments and feedback from internal stakeholders. We have also aligned our strategies to the FDOH State Strategic Plan and the DOH-Duval Community Health Improvement Plan (CHIP).

Appendix C

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The following charts display our local strategic plan’s alignment with the Community Health Improvement Plan (CHIP), the Quality Improvement (QI) Plan, and the Agency Strategic Plan.

DOH-Duval Alignment

Strategic Issue Area: Healthy Moms and Babies

ObjectiveCHIP

Alignment QI Plan

Alignment Agency Strategic Plan Alignment

Responsibility

1.1a By 12/31/18, reduce the black-white infant mortality rate gap by 26%

1.1a -- 1.1.1A Karen Tozzi (Maternal and Child Health)

1.2a By 12/31/18, increase the number of baby-friendly hospitals in Duval County from 2 to 5

1.1d -- -- Karen Tozzi (Maternal and Child Health) & Patricia Holder, IBCLC (Nutrition and Chronic Disease)

1.1b By 12/31/18, increase the percent of teen DOH-Duval Family Planning clients that adopt an effective or highly effective method of birth control from 69% to 80%

1.3a -- -- Karen Tozzi (Maternal and Child Health)

Appendix D

29

Strategic Issue Area: Long Healthy Life

ObjectiveCHIP

Alignment QI Plan

Alignment Agency Strategic Plan Alignment

Responsibility

2.1a By 12/31/18, increase the percent of DOH-Duval pediatric and women’s health clients who are at a healthy weight by 10%

2.1a 2.1b

-- 2.2.1B Spencer Greenwood

(Nutrition and Chronic Disease) & Annie Pollard (Lead Clinical

Operations Manager )

2.2a By 12/31/18, develop a reporting system and track referrals to behavioral health services (both within DOH-Duval and to outside agencies)

3.1 3.2 3.3 4.2

-- -- Dr. Pauline Rolle

(Medical Director)

2.2b By 12/31/18, reduce the incidence rate of HIV among 15-24 year olds in Duval County by 10%

-- -- 2.1.5 Dr. Max Wilson (HIV/AIDS Program)

2.2c By 12/31/18, reduce the incidence rate of bacterial STDs among 15-24 year olds in Duval County by 10%

-- -- -- Mary Elbell (Disease Control)

2.3a By 12/31/18, improve five companies’ score on the CDC Worksite Wellness Scorecard by 10%

2.1a 2.3a

Healthiest Weight Project

2.1.1B Andrea Sharpe (Organizational Development)

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Objective CHIP

Alignment QI Plan

Alignment

Agency Strategic Plan

Alignment Responsibility

3.1a By 12/31/18,

increase the percent

of DOH-Duval

adolescent clients

who initiate and

complete the HPV

vaccination series to

25%

-- -- 3.1.1B Kristina Wilson (Office of

Performance Improvement)

3.1b By 12/31/18

increase the percent

of 2 year olds in

Duval County that

are fully immunized

from 77% to 95%

-- -- 3.1.1A Renee Cain (Director of

Nursing)

3.2a By 12/31/18 Ensure 100% of DOH-Duval employees have received basic Emergency Preparedness and Response Training

-- -- 3.1.3A Sarah Winn (Environmental

Health and Preparedness)

Strategic Issue Area: Effective Agency Processes

ObjectiveCHIP

Alignment QI Plan

Alignment

Agency Strategic Plan

AlignmentResponsibility

4.1a By 12/31/18, achieve a 10% increase in employee satisfaction

-- Employee Satisfaction

Project

4.1.2 Kristina Wilson (Office of

Performance Improvement) & Andrea Sharpe (Organizational Development)

4.1b By 12/31/18, achieve a 10% increase in employee retention


Project

4.1.2 Kristina Wilson (Office of

Performance Improvement) & Andrea Sharpe (Organizational Development)

4.2a By 12/31/18, improve DOH-Duval’s score on the CDC Worksite Wellness Scorecard by 10%


Project

Karen Tozzi (Maternal and Child Health)

4.3a By 12/31/18, maintain the cash reserve balance between 6.5-10% of the annual operating budget

-- -- 4.1.3 Carla Jackson (Finanace and

Accounting)

4.3b By 12/31/18, decrease uncollected revenue to <8% of Accounts Receivable

-- -- 4.1.3 Carla Jackson (Finanace and

Accounting)

4.4a During each fiscal year, all DOH-Duval divisions will identify and implement a quality improvement project using the Plan-Do-Check-Act Cycle

-- -- -- Kristina Wilson (Office of


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4.4b By 12/31/18, complete documentation for the Florida’s Governor’s Sterling Award

-- -- -- Kristina Wilson (Office of


4.5a During each fiscal year, produce five publications related to public health

-- -- 4.1.1 4.1.5A

Kristina Wilson (Office of


4.5b By 12/31/18, develop and implement marketing campaigns to increase awareness and prevention education on infant mortality, STD/HIV, healthy weight, immunization, and breast/cervical cancer

1.12.1

-- 4.1.1 Andrea Sharpe (Organizational Development)

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Glossary

Baseline Data Existing data that show current level of the indicator you are seeking to improve. Baseline data are used to determine the quantitative level for success and indicates how much change will occur if the desired outcome is achieved.

Goal Long-range outcome statements that are broad enough to guide the agency’s programs, administrative, financial and governance functions (Allison & Kaye, 2005).

Objective Short to intermediate outcome statements that are specifically tied to the strategy and goal. Objectives are clear and measurable. Measure of change, in what, by whom, by when

Strategy The approach you take to achieve a goal.

SWOT Analysis A structured planning method used to evaluate the strengths, weaknesses, opportunities and threats involved in your agency.

Strengths: characteristics of your agency that give it an advantage. Weaknesses: characteristics that place the agency at a disadvantage. Opportunities: outside elements that the agency could use to its advantage. Threats: elements in the environment that could cause trouble for the agency.

Target Measurable and time-specific aim toward which efforts are directed.

Appendix E

34

Documents

Strategic Plan 2016-2018 - Florida Health Duvalduval.floridahealth.gov/programs-and-services/community...October 2016 Florida Department of Health in Duval County Strategic Plan 2016-2018