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

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

Paul Epstein, Results That Matter Team

Jack Moran, Public Health Foundation

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 yearsA 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 AssociatesResults That Matter Team www.RTMteam.net

Measuring & improving public and nonprofit performance since 1985Worked 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 The Public Health QI Handbook (ASQ, April 2009)

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http://www.phf.org/

http://www.rtmteam.net/

Strategic Planning Overview

Preparation for Strategic Planning

Developing the Strategy

Deploying the Strategy

Reviewing Implementation versus the Plan

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Vision, Mission,Vision, Mission, and Valuesand Values

Business ConsiderationsBusiness Considerations

• Budgets/FinanceBudgets/Finance• EconomyEconomy

Customer ConsiderationCustomer Consideration

• InternalInternal• ExternalExternal• PartnershipsPartnerships

OutputsOutputs

• What you doWhat you do

Growth PotentialGrowth Potential

• Internal• Partnerships

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Strategic Planning





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Preparation for Strategic PlanningData Gathering

Community health status dataCommunity and partnership relationsEconomic trendsFinancial analysisConsumer researchEmployee researchLegislative trendsCurrent measures – Capacity, Process, and OutcomeCurrent strategy and goal completion ratesSelf assessment dataDemographic changesSWOT AnalysisAccreditation data

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Assessment Data

Substantiation RelevanceSourceDocumentAnd Date of IssueLow Medium High

OpinionBased

Fact Based

• Health status data• Community/Partner

relations• Economic trends• Financial analysis• Consumer research• Employee research• Legislative trends• Current measures

CapacityProcessOutcome

• Current strategy • Goal completion rates• Self assessment data• Demographic changes• SWOT Analysis• Accreditation data

Value of the Data

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Peter Drucker

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

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Focusing on the Future

Define the Current Horizon – where are we now?

How To Begin:

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Preserve Achieve Avoid

CurrentPlan

Next Year’sPlan

CoreCompetencies

SuccessFactors

MistakesPitfalls

• 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?

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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

Customers and Partners

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Strategic Planning





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Planning Quiz

Question: Rating Scale

SD D A SA

1. We develop our strategy based on data.

2. We identify critical success factors - the ways the organization must operate and people must behave to achieve our vision and mission.

3. We have both short and long term strategicgoals.

4. We clearly communicate our strategic goalsto everyone in the organization.

5. We measure progress toward our strategic goals on a regular basis and communicatethe results to the organization.

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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.

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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”

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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.:

BenchmarkingQuality Improvement Techniques

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Execution

Gap

Strategy Maps and BSC to improve the Alignment and Execution of Strategies

No Strategic Alignment

High Level Goals

Power of Strategic Alignment from Balanced Scorecards, Primarily from Strategy Maps

Public Health

Outcomes

Other PublicAgencies

Hospitals

Schools CommunityGroups

FaithCommunities

NonprofitsHealth Dept

Families & Individuals

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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

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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?

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The Balanced Scorecard (BSC) …

Is an integrated strategic planning and management system traditionally focused on one organizationCommunicates 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)

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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 sectorsAligns 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.

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Community Balanced Scorecard Components

Performance Measures, Targets, & Initiatives

Performance Measures, Targets, & Initiatives

PerspectivesPerspectives

Community Vision, Overall or by Issue or

“Theme”

Community Vision, Overall or by Issue or

“Theme”Community

PrioritiesCommunity

Priorities

Strategy MapStrategy MapStrategic ObjectivesStrategic Objectives

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CBSC, QI, Collaborations, & Information (e.g., from Accreditation)

QualityImprovement:Plan, Implement

& MonitorImprovements

CommunityBalancedScorecards:Plan & ManageStrategy

Stra

tegi

cIm

prov

emen

t

Information & Collaborative Relationships

Improved Public Health Outcomes

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Suggested Perspectives for Public Health Community Balanced Scorecards

Community Health Status

Community Implementation

Community Process & Learning

Community Assets

Assu

med

cau

se &

effec

t

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# 1Assess, Disse-

minate Population

Health Status & Issues

# 7Promote

Strategies to Improve Access to Services

# 2Investigate, Contain PH Problems &

Hazards

Minimize Risks

# 6Enforce PH

Laws & Regulations

Suggested “Generic” Public Health Community Balanced Scorecard Strategy MapBased on the Draft Public Health Accreditation Standards

Improve Health

Outcomes & Eliminate

Disparities

# 3Inform, Educate About PH Issues

(Promote Health)

# 4Engage the

Community to ID & Solve

Health Problems

# 5Develop PH Policies &

Plans

# 9Evaluate &

Improve Processes,

Programs, & Interventions

# 10Contribute to & Apply

the Evidence Base of PH

# 8Maintain a

Competent PH Workforce

A.Administrative

Capacity & Governance

STRATEGIC OBJECTIVESPerspectives

Community Assets


Community Implemen-

tation


Sample THEMES for Community Balanced Scorecards for Public Health

Specific Mortality or M

orbidity Issues

Comm

unity Health Partners’ Roles

Dem

ographic Populations or Geographic Areas

Healthy Behaviors Encouraged

Social or Physical Environment Issues

Cross-cutting PH

System Issues

STRATEGIC OBJECTIVESPerspective

Community Assets


Community Implemen-

tation


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Themes of Five Community Health Partnerships in Ohio, New Jersey, & Florida

Youth & Young Adult Behavioral H

ealth

STRATEGIC OBJECTIVESPerspective

Community Assets


Community Implemen-

tation


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Access to Primary &

Specialty Care

Preventable Chronic Disease

Obesity, N

utrition, & Physical Activity

Child Obesity &

Family W

ellness

Minimize High Risk Behaviors & Conditions

# 3Maximize Multi-Lingual

Outreach, Health Education & Promotion

Possible Community Balanced Scorecard Strategy Map to Improve Health of Homeless Population

STRATEGIC OBJECTIVES



Community Assets

Perspectives

Minimize Chronic Disease in the

Homeless Population

# 7Help Homeless

Receive Housing & Health Services

CommunityImplementation

# 4Develop Community-based Strategies with PH & Social

Service Partners29

# 1Increase Health Status Monitoring of Homeless

# 5Develop Programs &

Plans to Connect Homeless with Services

& Promotion

# 5Advocate for

Affordable Housing & Homelessness

Prevention

Table Top Exercise

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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

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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?

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Strategic Planning




Reviewing Implementation vs. the Plan

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Deployment Quiz: For Internal Operating Units


SD D A SA

1. We have a defined deployment process forour strategy to the operating units.

2. Operating units develop goals that contributeand are aligned with the organization’s goals.

3. Operating units have measures that are alignedwith the organization’s measures.

4. Operating units identify both breakthrough andincremental process improvement opportunities.

5. Operating unit personnel understand the link between what they do and the organization’sstrategic plans and goals.

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Goal Deployment and Alignment: Organizational Improvement

Environmental AssessmentDrives

StrategyWhich Develops

Operation Plan To AchieveThe Strategy

Focus On

Process Alignment AndRepeatable Process To

Translate Into

Aligned Daily Work

• Catalyst To Develop The Intent• Challenge Opinion

• Critical System Issues• Critical Goals• Aligned Measure

• Process Focus• Achievable/Aligned Goals• Establish Accountability

• Process Improvement• Process Redesign

Deployment

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Professor Cranston

Nightmare of Learning Alignment

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.

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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

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Partner Contributions to ObjectiveObjective: Enhance the environment for access to physical activity & healthy foodInitiative: Safe routes to schoolPartners: City of Akron, City of Stow, ODOT, Safe Kids’ Coalition, Schools in the CountyOwner for this initiative: Safe Kids Coalition

Desired Change (More Safe Walking & Biking to School)

Performance Measures for Partners 2009 Targets

% of blocks of sidewalks cleared in bad weather on identified routes

No. of volunteer “walking school bus” escorts

No. of kids walking & biking to school

No. of identified painted crosswalks added to routes

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

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

Performance Measures for Partners 2009 Targets

No. of families from the Spruce and Birch districts participate at least monthly in co-op purchasing and delivery of healthy foods

100

No. of participating families that improve home nutrition 95

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.

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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 foodInitiative: 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

Actions:– Develop logistics, allowable items, & delivery & payment mechanisms with CSFC– Organize families in the Spruce &Birch districts to participate in co-op purchasing

Desired Change (Eliminate Food Deserts)

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.

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Setting Implementation Priorities

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Low Medium High

Low

Medium

High

Stra

tegi

c Im

port

ance

Difficulty of Implementing

Encourage Others in the Community to “Jump In”

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Low Medium High

Low

Medium

High

Stra

tegi

c Im

port

ance

Difficulty of Implementing

Programmed Priorities

Encourage partners to

implement other initiatives

without draining resources

from programmed priorities

5 Critical Barriers to Successful Execution

1. The underlying strategy is not clear.

2. The plan is overly optimistic.

3. No one is accountable for results.

4. The plan has not been actively deployed.

5. The plan is static.

1. Invest the time to get clear.

2. Define priorities.

3. Raise the stakes.

4. Mobilize the troops.

5. Create an execution process.

Barrier Suggestion

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Strategic Planning

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

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Strategic Planning




Reviewing Implementation vs. the Strategic Plan

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Is this your organization?

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Review Quiz


SD D A SA

1. We conduct regular reviews with our operatingunits to assess progress towards our strategicgoals.

2. Reviews are used for learning and growth for our management teams.

3. Reviews result in open and honest dialogue with senior management about goal achievement

4. During reviews we adapt our priorities, culture,and capabilities to respond to change.

5. During reviews we take action to resolve problemsrather than spending times deciding who to blame.

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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

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Goal Deployment and Alignment: Organizational Improvement

Environmental AssessmentDrives

Strategic IntentWhich Develops

Operation Plan To AchieveThe Strategic Intent

Focus On

Process Alignment AndRepeatable Process To

Translate Into

Aligned Daily Work

• Catalyst To Develop The Intent• Challenge Opinion

• Critical System Issues• Critical Goals• Aligned Measure

• Process Focus• Achievable/Aligned Goals• Establish Accountability

• Process Improvement• Process Redesign

Deployment

Review

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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

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Review

No long presentations – 10 minutes

Use standardized review forms

Questions in advance

Three slides maximum

Fifteen minutes per review

Not defense but proactive

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Review Slide Layout Per Goal

Goal Detail and Alignment To Organizational Objectives Summary

Baseline and Metric Data

Gantt Chart Showing Major Activities and Timelines

Summary of Accomplishments

Next Quarter Action or Recovery Activities

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Review Roles and Responsibilities

ReviewerCome prepared

Understand the topic

Confront constructively

Accept bad news with remedies

Probe for specifics

Look for alignment

Challenge where appropriate

RevieweeCome prepared

Have “Why’s” ready

Action plans to convert deltas

Show alignment to organizational objectives

Tell bad news

Accept challenges

Be accountable

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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

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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

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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?

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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?

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During The Review:

Clarify the purpose of the ReviewStick to the agenda and questionsLook for the alignment of goals and objectivesAsk the agreed upon questionsCreate a two-way dialogue and build trustProbe the goals/objectives/targets - make sure they are stretchDocument agreed upon modifications and follow-up itemsGive everyone feedback at the end of the ReviewDecide on the time and place of the next Review

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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

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

Community Health StatusOutcomes

Community Implementation


Community Assets

Assu

med

cau

se &

effec

t

Outcomes & Performance Drivers

Performance Drivers

Performance Drivers

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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:* Always Sometimes Never

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: _________

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* The “Thirty Pitfalls of Strategic Planning” by Jack Moran is available at www.phf.org/

Contact Information

Jack Moran

Senior Quality Advisor

Public Health Foundation www.phf.org

E-mail: [email protected]

Paul Epstein

Results That Matter Team www.RTMteam.net

Epstein & Fass Associates

212-349-1719

E-mail: [email protected]

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http://www.phf.org/

mailto:[email protected]

http://www.rtmteam.net/

mailto:[email protected]

Documents

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