STRATEGIC PLAN WILLIAMSON COUNTY AND CITIES HEALTH DISTRICT SYSTEMS CAPACITY BUILDING. A Healthy Community CLINICAL AND INDIVIDUAL SERVICES

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1 STRATEGIC PLAN WILLIAMSON COUNTY AND CITIES HEALTH DISTRICT COMMUNITY CAPACITY BUILDING SYSTEMS CAPACITY BUILDING A Healthy COMMUNITY PREVENTIVE SERVICES CLINICAL AND INDIVIDUAL SERVICES -

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3 TABLE OF CONTENTS Executive Summary 3 Acknowledgements by Chair, Strategic Plan Workgroup 4 Section 1: Mission, Vision, Core Values and Operational Framework 5 Section 2: Purpose 6 Section 3: Background 6 Section 4: Organizational Structure 7 Section 5: Strategic Planning Process Timeline 8 Section 6: Quality Improvement Process 9 Section 7: Summary of Focus Areas and Priorities 11 Section 8: Goals and Objectives 16 Section 9: Letter from the Chair 24 Section 10: Record of Changes 25 Appendix A: Healthy Communities Model 26 Appendix B: Functional Organizational Chart 28 Appendix C: Links 29 Appendix D: Glossary of Acronyms 30 Williamson County and Cities Health District Strategic Plan 2

4 EXECUTIVE SUMMARY Because of the great progress of the Health District and community support, it was possible to retire our last WCCHD Strategic Plan early and begin work on this Strategic Plan. Several major accomplishments made the early revision possible. Initially, the Health District completed most of its goals ahead of schedule. I m proud of the progress that staff has made to incorporate the essential services of public health across all programs and activities. Organizing for success included adopting a matrix organizational structure that balanced our programmatic expertise W. S. Chip Riggins Jr. MD, MPH with newly energized workgroup structures. Through re-alignment, prioritization, and other efficiencies, the Executive Leadership Team has freed resources that could be invested in epidemiology, health education, coalition support services, and administrative support functions such as information technology, communications, and marketing. In addition, the Board of Health s steady commitment to Continuous Quality Improvement throughout the Health District has been extremely helpful. While the WCCHD staff evaluated themselves using the National Public Health Performance Standards (NPHPS) Local Tool, our Board evaluated itself using the NPHPS Governance Tool, and in doing so, informed our strategic plan very effectively. The maturation of the WilCo Wellness Alliance has occurred at a staggering rate and the participation in Groups as well as Working Groups features many recognized best practices. The Steering Committee oversaw completion of the Health Assessment and the development of our first Health Improvement Plan. Lastly, the formation of the WilCo branch of the Regional Integrated Care Collaborative could not have come at a better time. It positioned us to respond to the opportunity afforded by the Texas Medicaid 1115 Waiver in truly transformative ways. It focuses on projects between health care entities to improve effectiveness of and access to the health care system. As Executive Director, I am honored to lead this organization and so very appreciative of the support of our Board of Health and Member Governments. Your Public Health Department is positioned to fulfill its vision of healthy people thriving in healthy communities in Williamson County in the most effective and efficient way possible. W. S. Chip Riggins Jr. MD, MPH 3 Williamson County and Cities Health District Strategic Plan

5 Acknowledgements by Chair, Strategic Plan Workgroup It was my pleasure to chair the Strategic Plan Workgroup and to work with staff and stakeholders in its development. Approved by the Board of Health at its Special Called Meeting on February 6, 2014, it has been vetted with the member governments of the District. Deliberately coordinated with the Health Assessment and complimenting the Health Improvement Plan, these three documents should be considered together to realize the full picture of Public Health Strategies in the county. References and vertical alignment of our strategies with state and national objectives will ensure that our community benefits from and contributes to the many Wayne Cavalier current health initiatives. I d like to thank the many people who provided input to the Health Assessment and the Health Improvement Plan. The Forces of Change that were identified and the priorities you have set were invaluable to the Board of Health in this process. I would like to acknowledge the assistance, professional expertise of those who supported the strategic planning process, some of whom are listed below. Board of Health, Chair of Strategic Plan Workgroup Participants: Kerry Russell, Williamson County, Chair, Board of Health Kathy M. Galloway, Cedar Park, Secretary, Board of Health Pamela Sanford, Taylor, Board of Health Rob T. Hardy, Georgetown, Board of Health Florence Winkler, Hutto and Liberty Hill, Board of Health Selicia Sanchez-Adame, Round Rock, Board of Health W. S. Chip Riggins, Jr., MD, MPH, Executive Director and Health Authority Anita Martinez, Deputy Director Cynthia Guerrero, M.Ed., Deputy Director of Health Services David Bastis, Assistant Deputy Director, Special Operations Deborah Marlow, Assistant Deputy Director, Environmental Health Services Katie Arnold, Research Specialist Mary Faith Sterk, Director of Data, Reporting and Information Management Melissa Cammack, Director of Healthy Communities Bride Roberts, Accreditation/CQI Coordinator Mike Caudle, Emergency Preparedness and Response Ryan Moeller, Emergency Preparedness and Response Stella Mulhollan, Director of Clinical Preventive Services Marcus Cooper, Communications Director Deb Strahler, Marketing Specialist Tina Horkey, Workforce Committee Chair Ivah Sorber, Relations Committee Chair Dina Cavazos, Information Technology Committee Chair Williamson County and Cities Health District Strategic Plan 4

6 SECTION 1: MISSION, VISION, CORE VALUES, AND OPERATIONAL FRAMEWORK Our Vision: Healthy people thriving in healthy communities in Williamson County Our Mission: In partnership with communities, Williamson County and Cities Health District will protect and promote the health of the people of Williamson County. Our Core Values: We recruit stakeholder input We make our services accessible to the people of Williamson County We act in the best interest of the health of the community as a whole We value the worth and dignity of each individual We respect cultural and individual differences We encourage individuals to be responsible partners in their own health and environment We are role models of a healthy and effective work force We are committed to open communication in an atmosphere that fosters individual thinking, a creative exchange of ideas, and decision-making We build community capacity We maintain a supportive atmosphere in which professional growth is encouraged Our Operational Framework: The Healthy Communities Model (Appendix A) has been helpful in making sure that as this community s Public Health Agency, we are providing support and coordination internally and externally for both individual and population health services. 5 Williamson County and Cities Health District Strategic Plan

7 SECTION 2: PURPOSE The purpose of WCCHD s Strategic Plan is to define the direction for our agency over the next three years, and through a common understanding of the Board s focus areas and priorities. Our intent is to ensure quality public health services for our member governments: Williamson County and the cities of Round Rock, Georgetown, Cedar Park, Taylor, Hutto, Liberty Hill and Leander. SECTION 3: BACKGROUND WCCHD s last Strategic Plan was launched in It was focused on improving the health of the health department, to help our agency adapt to a changing public health environment. Major themes were: 1) Complete the transition from clinical care to public health centers; 2) Transition from functional to matrix organizational structure; 3) Pursue national accreditation via a process driven approach; 4) Establish administrative and governance goals and priorities; 5) Consummate key partnerships with medical and academic partners; and 6) Exert leadership at state and national public health forums. With these goals now largely accomplished, the priorities in the Strategic Plan are based on outcomes and will be addressed in a collaborative manner, consistent with our mission statement. Williamson County and Cities Health District Strategic Plan 6

8 SECTION 4: ORGANIZATIONAL STRUCTURE WCCHD s organizational framework was improved and strengthened as a consequence of our previous Strategic Plan. Coordination of internal leadership, governance and community partners ensures infrastructure and resources to realize the goals of the Strategic Plan. We are continuously adapting our organization to meet the needs of our rapidly growing community. Key structures within our organization include: The Board of Health is the administrative authority for the Health District. The governmental entities that form the Health District appoint representatives to serve as directors of the Williamson County Board of Health. The Board ensures the implementation of the Strategic Plan and monitors the progress towards the goals and objectives outlined in the plan. The Executive Leadership Team includes the Executive Director, who also serves as the Health Authority, and the Deputy Directors. This team provides administrative oversight and determines resource allocations for the agency. The District Leadership Team includes program managers and supervisors together with the Executive Leadership Team. Responsible for overall agency planning and coordination, this team also serves as the Quality Council overseeing all agency quality improvement activities. Cross-functional internal committees, chaired by program managers and key staff, are part of WCCHD s organizational matrix structure. All branches of WCCHD are represented on the committees and related sub-committees. Represented as Sections in our functional organizational chart (Appendix B), programs or groups of programs represent the scope of services provided by WCCHD. Each section is responsible for supporting continuous quality improvement and participation in state or national quality programs. Key standards addressed by the agency: Project Public Health Ready Culturally and Linguistically Appropriate Services Voluntary National Retail Food Regulatory Program Standards National Public Health Performance Standards - Local Tool National Public Health Performance Standards - Governance Tool Generally Accepted Accounting Principles 7 Williamson County and Cities Health District Strategic Plan

9 SECTION 5: STRATEGIC PLANNING PROCESS TIMELINE Planning for the WCCHD Strategic Plan began with the decision to use the Mobilizing for Action through Planning and Partnership (MAPP) process. The Health Assessment (CHA) incorporated a Local Public Health Services Assessment (external), a Forces of Change Assessment, an Assessment of Assets and Strengths, and a Health Status assessment. June 2012: The Williamson County Health Profiles were developed and published by WCCHD. These profiles served as a basis for the Health Status Assessment component of the CHA. August 2012: The WCCHD District Leadership Team completed the National Public Health Performance Standards Local Public Health System Performance Assessment Instrument. The results were incorporated into the Local Public Health Services Assessment of the CHA. January 2013: The Continuous Quality Improvement Committee completed the Turning Point Performance Management Self-Assessment Tool, which served as a tool for our agency to identify the extent to which we had components of a performance management system. March 2013: Health Assessment was completed. For purposes of this Strategic Plan, the CHA and its four components served as our assessment of our Strengths, Weaknesses, Opportunities and Threats (SWOT). April 2013: The Board of Health and health district leadership reviewed our previous Strategic Plan, reaffirming the mission, vision and core values statements. The Board concurred that the major objectives of that Strategic Plan had been completed. Utilizing the National Public Health Performance Standards Governance Tool, the Board also reviewed their own progress and identified areas for inclusion in the Strategic Plan. July-August 2013: Strategic priorities identified by the CHA were ranked by a community wide survey to guide development of the Health Improvement Plan (CHIP). The top ranked priorities are referenced in this Strategic Plan. September 2013: A draft Strategic Plan was presented to member governments at the joint meeting of Commissioners Court and Board of Health. June-December 2013: Board of Health representatives and the health district leadership team conducted a series of meetings to review the findings of the Health Assessment and the strategic priorities identified in the Health Improvement Plan. Utilizing these tools, assessments and processes the Board identified the seven focus areas for the new Strategic Plan. February 2014: Board of Health approved and adopted the Strategic Plan. Williamson County and Cities Health District Strategic Plan 8

10 SECTION 6: QUALITY IMPROVEMENT PROCESS The organizational framework for performance management establishes systematic ongoing monitoring and evaluation of the quality and appropriateness of client and population services. We commit to achieving our mission and strategic goals by continually improving effectiveness, empowering employees, and streamlining decision making, thereby cultivating a culture of quality improvement. The goals of this plan: Ongoing assessment of health outcomes, benchmarks and trends Maintenance of and compliance with current standards, protocols and procedures Appropriate administrative structure and support Quality improvement Structure Our QI Process utilizes the 4Qs model, (Quality Assessment, Quality Control, Quality Assurance and Quality Improvement) and represents our approach for a sustainable and systematic process for quality management. Overall coordination and oversight of our QI process is provided by our Quality Council. This group approves a comprehensive quality improvement plan based on Quality Assessment findings and reports from all committees and teams. Quality Assessment At the center of our QI model is the engine for evaluation and assessment which will be a series of Public Health Practice Reviews. Topics will align with Key Health Status Indicators in Healthy People 2020, the County Health Rankings Initiative, and any program-specific goals in such a way that all programs and grants are included over the three year period of this plan. We will ensure that our programs and services are aligned with the nine criteria of the Public Health Quality Aims. Those criteria are: population-centered, equitable, proactive, healthpromoting, risk-reducing, vigilant, transparent, effective and efficient. 9 Williamson County and Cities Health District Strategic Plan

11 Quality Assurance and Quality Control At the base of the triangle, the quality assurance and quality control of our QI process are achieved by Quality Assurance and Administrative Committees. These committees represent a cross-section of each level of the matrix model including: administration, section directors, and program staff. Utilizing the Plan-Do-Check-Act method and other QI tools they will determine program and process improvements. Quality Control Committees include: Workforce o Worksite Wellness o Safety Information Technology Preparedness Planning and Operations Marketing and Communications Quality Assurance Committees include: Quality Management o Child Abuse Reporting o Patient Satisfaction Survey o Program Review Nursing Corrective Action Team (Peer Review) Pharmacy Data Oversight Quality Improvement Act Check Plan Do The top of the triangle represents Quality Improvement initiatives. These initiatives, charged by the Quality Council and selected to be as cross programmatic as possible, will improve Quality and Health Outcomes for our community. It is anticipated that two or three major Quality Improvement initiatives will be conducted annually. Examples of recent Quality Improvement initiatives resulting in new programs or service lines are the development of an Integrated Mosquito Management Program and the implementation of an Electronic Health Record. Williamson County and Cities Health District Strategic Plan 10

12 SECTION 7: SUMMARY OF FOCUS AREAS AND PRIORITIES Focus Area 1: Fully Invest in CHA and CHIP Processes Priority: Strengthen collaborative efforts to improve health outcomes and address health disparities through a sustained CHA and CHIP process Justification: The Board of Health supports the ongoing Health Assessment and Health Improvement Plan as developed by the WilCo Wellness Alliance community groups, working groups, and leadership through the Health Improvement Steering Committee. Potential objectives relating to this goal include focus on improvements to the Health Assessment, strengthening of the WilCo Wellness Alliance, and use of the Guide to Preventive Services. Health promotion strategies related to chronic disease, especially obesity, are reflected in this focus area. Key alignments: CHIP priorities Healthcare Availability, Behavioral Health, Active Living Support, Chronic Disease, Employee Health, Healthy Eating, Substance Abuse, and Controlling Contagious Diseases Background: America benefits when everyone has the opportunity to live a long, healthy, and productive life, yet health disparities persist. A health disparity is a difference in health outcomes across subgroups of the population. Health disparities are often linked to social, economic, or environmental disadvantages (e.g., less access to good jobs, unsafe neighborhoods, lack of affordable transportation options). National Prevention Strategy, June 2011, pg. 25 Focus Area 2: Build Resilience in All Hazards Priority: 2.1 Increase collaboration in preparedness planning 2.2 Provide organizational leadership in preparedness Justification: WCCHD will continue to engage with community, regional and state planning efforts to ensure our community s readiness for adverse events. Efforts to leverage the WilCo Wellness Alliance, including the Integrated Care Collaborative (WilCo ICC), should increase visibility, coordination, and inclusion of stakeholders in preparedness efforts. Deliberate efforts are underway to incorporate the Medical Reserve Corps into the Alliance and leverage their training plan for increased resilience as well as readiness. The agency should lead by example through the revision of our All Hazards Response Plan and our Continuity of Operations Plan and improved readiness to sustain Public Health Services in times of emergency. The Board of Health supports inclusion of preparedness goals in the next CHIP. Key alignments: Project Public Health Ready, National Preparedness Index, Healthy People 2020, CHA-LPHSA 11 Williamson County and Cities Health District Strategic Plan

13 Background: Resilient communities have robust social networks and health systems that support recovery after adversity. They are prepared to take deliberate, collective action in the face of an incident and have developed material, physical, social and psychological resources that function as buffers to the negative effects of these incidents and help protect people s health. U.S. Dept. of Health and Human Services-Public Health Emergency- Resilience Focus Area 3: Support Prevention and Treatment for Behavioral Health and Substance Abuse Priority: Strengthen alliances with Mental Health and Substance Abuse partners Justification: Because of findings in the CHA, Forces of Change and Assets and Strengths coupled with the recognition that health goes beyond the absence of disease, the Board of Health believes that WCCHD should seek to strengthen and expand collaborative efforts with essential community partners. Participation in the Mental Health Task Force and its subcommittees as well as efforts to increase screening and referrals to behavioral health providers should be targeted. Key alignments: CHIP priorities 2 and 6 - Behavioral Health and Substance Abuse Background: Mental and emotional well-being is essential to overall health. Positive mental health allows people to realize their full potential, cope with the stresses of life, work productively, and make meaningful contributions to their communities. National Prevention Strategy, June 2011, pg. 48 Preventing drug abuse and excessive alcohol use increases people s chances of living long, healthy, and productive lives.. Preventing drug abuse and excessive alcohol use improves quality of life, academic performance, workplace productivity, and military preparedness; reduces crime and criminal justice expenses; reduces motor vehicle crashes and fatalities; and lowers health care costs for acute and chronic conditions. National Prevention Strategy, June 2011, pg. 31 Focus Area 4: Promote Collaboration Related to Environmental Health Priority: Strengthen alliances for preventing disease through improved environmental practices Justification: Since 1943 our local public department has worked to ensure a safe environment for our citizens. The Board of Health seeks to become more effective through improved collaboration with local governments and through increased stakeholder participation in processes such as consolidated rule-making and joint task forces. Objectives relating to state level policy on fee-setting rules and improved consolidated rule making for all member-governments are supported. Objectives include continued pursuit of certification under the Voluntary National Retail Food Regulatory Program Standards and implementation of a Level 2 Integrated Mosquito Management Program. Key alignments: CHIP priorities Active Living Support, Healthy Eating Williamson County and Cities Health District Strategic Plan 12

14 Background: Public health departments provide the cornerstone of our nation s public health capacity and are critical in identifying and responding to the needs of their communities. Strengthening surveillance and laboratory capacity allows health departments to identify communities at greatest risk; measure the impact of policy, systems, and environmental changes; detect, control, and prevent infectious diseases; and respond to outbreaks and emergencies. Coordinating efforts across sectors and governmental jurisdictions to prioritize needs and optimize investments can help foster livable, affordable, and healthy communities. National Prevention Strategy June 2011, pg Focus Area 5: Prevent Communicable Diseases Priority: Strengthen community systems for communicable disease prevention Justification: WCCHD provides preventive services as needed to address gaps in provision of services in the community. Implementation of an electronic health record should be accompanied by improved utilization of information technology, fewer missed opportunities for immunization, prevention of recurrent STIs and coordination of WCCHD services with patient-centered medical homes. Emphasis on utilization of the Health Information Exchange and other electronic means to improve disease reporting and response processes is addressed in this Strategic Plan as is an emphasis on utilizing the WilCo Wellness Alliance s ICC, Public Health and Medical Committee, and School Health Forum for communicable disease efforts. Key alignments: CHIP priorities Healthcare Availability and Controlling Communicable Diseases Background: Evidence-based preventive services are effective in reducing death and disability, and are cost-effective or even cost-saving. Preventive services consist of screening tests, counseling, immunizations or medications used to prevent disease, detect health problems early, or provide people with the information they need to make good decisions about their health. National Prevention Strategy, June 2011, Appendix 1, Pg. 18 Focus Area 6: Improve Information Technology and Management Priority: Increase capacity for health communication strategies and health information technology 6.1 Improve information technology, structure, capacity and security 6.2 Use a process-driven approach to developing information management and program analytics capacity Justification: The Board of Health is committed to ensuring that WCCHD has adequate information systems to ensure quality, cost effective provision of care and accurate, consistent data collection. Replacement of legacy software systems, assurance of data storage capacity and improved intra- and internet information delivery systems will continue from our last Strategic Plan. Implementation of an Electronic Health Record and supporting components for billing, environmental health and population-based services will be undertaken. Participation in the Regional Health Information Exchange is expected. 13 Williamson County and Cities Health District Strategic Plan

15 Business practice improvements such as establishment of an agency hardware replacement plan and document management systems are included. WCCHD commits to continuous assessment and effective communication of health data and information to our working partners and to the community at large. Maintenance of the online community health indicators dashboard, its marketing and community endorsement is imperative. Key Alignments: CMS Meaningful Use Initiative Goals, Healthy People 2020, National Prevention Strategy, CHIP priorities 1) Healthcare Availability, and 10) Controlling Contagious Disease Background: Patients, clinicians, and health care systems can use health information technology to improve delivery of clinical preventive services, improve quality of care, and reduce health care costs National Prevention Strategy, June 2011, pg. 19 Health Care Systems, Insurers, and Clinicians can: Partner with state, tribal, local, and territorial governments, business leaders, and community-based organizations to conduct comprehensive community health needs assessments and develop community health improvement plans. Support integration of prevention and public health skills into health care professional training and cross train health care practitioners to implement prevention strategies. Increase the use of certified electronic health records to identify populations at-risk and develop policies and programs. Recommendation of the National Prevention Strategy, June 2011, pg. 17 Focus Area 7: Ensure a robust and responsive public health agency through continuous quality improvement Priority: Strengthen the public health agency through program evaluation and governance Key Alignments: Key Health Status Indicators in Healthy People 2020, County Health Rankings Initiative, Program specific goals Justification: The Board of Health is committed to ensuring that our public health agency provides the essential services, and that our agency is accountable, sustainable, and engaged in continuous performance management. To ensure an organized and thorough approach to program evaluation, the Board charges WCCHD with implementing a series of Public Health Practice Reviews. These reviews should go beyond compliance audits by funding sources. These will include a review of the health outcomes, benchmarks, and trends toward reaching those goals in our community. Public health agency roles, gaps in capacity or resource shortfalls and targets for process improvement projects will be addressed. All programs with the potential to influence goals should participate as a means for improved coordination and support. Williamson County and Cities Health District Strategic Plan 14

16 Potential topic areas: Access to Health Services Clinical Preventive Services Environmental Quality Food Safety Immunization and Infectious Diseases Injury and Violence Maternal, Infant and Child Health Mental Health and Substance Abuse Nutrition, Physical Activity and Obesity Public Health Preparedness and Response Reproductive and Sexual Health Other areas considered for Board of Health focus in this strategic plan period include: The Board strongly supports the WilCo Wellness Alliance s Employee Wellness Forum, the WCCHD Worksite Wellness Program and the Williamson County Wellness Program and Prevention Plan. The Board is committed to reviewing and revising as necessary the WCCHD policy on Board of Health Selection, Orientation and Responsibilities. Background: Strengthen state, tribal, local, and territorial public health departments to provide essential services. Public health departments provide the cornerstone of our nation s public health capacity and are critical in identifying and responding to the needs of their communities. Strengthening health departments to identify communities at greatest risk; measure the impact of policy, systems, and environmental changes; detect, control, and prevent infectious diseases; and respond to management systems promote accountability and performance improvements. Recommendation of the National Prevention Strategy, June 2011, pg. 15 Monitoring Progress The Board of Health will review progress toward stated objectives in each Focus Area at least annually. The Board will also participate as members in the WilCo Wellness Alliance to monitor progress related to health indicators and oversee plan revisions as necessary. 15 Williamson County and Cities Health District Strategic Plan

17 SECTION 8: GOALS AND OBJECTIVES Focus Area 1: Fully invest in CHA and CHIP Processes Projected Priority Goals Linkages (Alignment) Responsibility Objectives Status completion Strengthen collaborative efforts to improve health outcomes and address health disparities through a sustained CHA and CHIP process Create more efficient and inclusive data collection methods for the 2016 Health Assessment. Strengthen the community health improvement assessment process through successive assessment and planning cycles. National Prevention Strategy June 2011 Healthy People 2020 Map-IT Guide Healthy People 2020 Objective 15.3 CHIP priority: Healthcare Availability CHIP priority: Active Living Support CHIP priority: Chronic Disease CHIP priority: Employee Health CHIP priority: Healthy Eating Health Services Health Services 1. Fully implement the Healthy Williamson County website, using 100% of available indicators. 2. Ensure that 80% of deliverables in the Healthy Williamson County plan of work are met. Q Identify additional data elements over the 2013 CHA for the 2017 CHA process by at least one category in each of the four assessments. Examples: emergency preparedness, school health. 1. Adoption of 80% of the goals of the Health Improvement Plan (CHIP) by the WilCo Wellness Alliance or other stakeholders. 2. Reports on 80% of the adopted goals will be presented to the Health Improvement Steering Committee (CHIC) annually. QI Q Annually Increase active 1. Recruit and sustain 80% of membership across sectors. Annually membership in the WWA. Health Services 2. Expand by 10% the number of sectors represented in community groups. Ensure that 80% of those sectors have representation on the CHIC Annually Completed annual membership and attendance report. Annually Improve accuracy of demographic data Healthy People 2020 goals: Social Determinants of Health 1. Provide REAL Data training to 100% of internal staff. Q collection in all agency systems. CHA: Health of the CLAS: National Standards for Culturally and Linguistically 2. REAL Data training for 11 of 12 external agencies. Q Appropriate Services NACDD Health Equity Council: Recommendations for PHAB Standards & Measures 1.5 Health Services 3.Increase by 10% per year the number of REAL data fields accurately completed. Annually Reduce the negative CHIP Priorities: Healthcare 1. Identify dedicated staff to support the WilCo Wellness impact of chronic Availability, Active Living Support, Alliance's chronic disease prevention activities. Q diseases and conditions, specifically obesity. Chronic Disease, Active Living, Employee Health, Healthy Eating, Healthcare Awareness Health Services 2. Increase the availability of health education opportunities for targeted Williamson County populations identified through GIS mapping assessment tools. Q4 2016

18 Focus Area 2: Build community resilience in All Hazards Projected Priority Goals Linkages (Alignment) Responsibility Objectives completion Status Integrate Preparedness Healthy People 2020 goal: 1. Assemble a WilCo Public Health and Medical Q Planning into Preparedness. Preparedness Response Stakeholders group. community forums. EHS 5: Develop policies and Health Services 2. Incorporate 20% of the top 10 jurisdictional risk plans that support individual and assessment priorities in plans, training and exercises. Q4 annually community health efforts. 2.1 Increase collaboration in preparedness planning 2.2 Provide organizational leadership in preparedness Support the Regional Planning cycle (MOC, WEBEOC, Mass Fatality, Responder Protection). Utilize the Williamson County Medical Reserve Corps (WilcoMRC) to enhance Preparedness. Revise the COOP to reflect current operational infrastructure. CHA: LPHSA U.S. HHSC Public Health and Medical Emergency Support for a Nation Well Prepared: Resilience CDC PHEP/HPP Capabilities National Health Security Preparedness Index Project Public Health Ready Health Services Administration Administration 1. Development of a regional public health and medical response SOG. 2. Participate in at least one regional exercise. 3. Implement a comprehensive corrective action plan Q Q4 annually process. Q Form MRC volunteer-led team to oversee 75% of program functions. Q Integrate WilcoMRC representative into WWA and other stakeholder groups. Q Assess the existing COOP to identify policies that need to be revised, updated or created % of the policies related to the COOP will be revised and updated. Q Q Completed COOP presented to the DLT. Q Focus Area 3: Support prevention and treatment for behavioral health and substance abuse Priority Goals Linkages (Alignment) Responsibility Objectives Projected completion Status Support the Mental Health (MH) Task Force and Substance EHS 4: Mobilize community partnerships to identify and solve health problems. 1. Promote the Mental Health Task Force and Substance Abuse Collaborative as evidenced by updates to two Groups annually. Annually Abuse Collaborative CHA: Forces of Change, Assets 2. Schedule presentations by the Mental Health Task Annually integration in the WWA. and Strengths Health Services Force and Substance Abuse Collaborative Chairs for the CHIP priority: Behavioral Health Improvement Steering Committee once Health and Substance Abuse annually. National Prevention Strategy June 2011 Increase operational linkages with Mental 1. Incorporate tobacco, alcohol abuse, and mental health/depression screening in the health risk appraisal of Q Health and Substance Abuse Agencies. Health Services the electronic health record. Strengthen alliances with Mental Health and Substance Abuse Partners Utilize Information Technology tools (HIE) to improve interagency communications. Health Services 1. 80% of clinical professional staff trained on Texas Direct and other I Care tools. Q3 2014

19 Focus 4: Promote community collaboration related to environmental health Priority Goals Linkages (Alignment) Responsibility Strengthen alliances for preventing disease through improved environmental practices Influence state policy on district fee-setting (level playing field for Counties/ Districts). Healthy People 2020 goals: Environmental Health, Food Safety EHS 2: Diagnose and investigate health hazards in the community. CHA: LPHSA CHIP priority: Active Living Support, Healthy Eating National Prevention Strategy June 2011 EHS 6: Enforce Public Health Laws Environmental Health Services Objectives Projected completion 1. Gain support from appropriate organizations and Public Q Health and Funding Committee. Environmental Health Services 2. Promote supportive legislation. Q Status Pursue consolidated rule-making for all member governments via health district orders. EHS 6: Enforce Public Health Laws Environmental Health Services 1. Create a process for Board of Health ordinance/consolidated rule-making. Q Implement the process. Q Explore means for integration of Environmental Health services into public health processes and policies. EHS 5: Develop policies and plans that support individual and community health efforts EHS 6: Enforce Public Health Laws Environmental Health Services 1. Create a process for Board of Health approval of Q Environmental Health policies after vetting through a Task Force or with WCCHD member input. 2. Implement the process. Q Increase retail food stakeholders input to food safety policy and standards. U.S. FDA Voluntary National Retail Food Regulatory Program Standards Environmental Healthy People 2020: FS-5, FS- Health Services 6 1. Establish a Food Safety Task Force. Q Convene the Food Safety Task Force and hold regular Q meetings. Establish a process for ASTHO's Public Health fulfilling member Confronts the Mosquito governments' needs for DSHS West Nile Virus Public environmental health Health Preparedness, services. Surveillance, and Response Guide Environmental Health Services 1. Implementation of a level 2 IMM program. Q Conduct Mosquito Task Force After action review. Q4 2014

20 Focus Area 5: Prevent communicable diseases Projected Strategy Goals Linkages (Alignment) Responsibility Objectives Status completion Strengthen community systems for communicable disease prevention CHA: Forces of Change Assessment National Prevention Strategy June 2011 CHIP priority: Healthcare Availability, Controlling Communicable Diseases Expand community capacity for prevention. Healthy People 2020 goals: HIV, STD, Maternal, infant and child health Health Services 1. 80% of relevant website content organized in a "Provider Toolbox". 2. Promote expansion through WilCo ICC and School Health Forum as evidenced by presentations on HIV, STD or TB at least twice annually. Q Biannually Ensure accessible services that are culturally and linguistically appropriate. Healthy People 2020 goal: Immunization and Infectious Diseases CLAS Standards Health Services 1. Expand service hours to increase availability of services. 2.Adopt Culturally and Linguistically Appropriate Services (CLAS) based standards for services. Q Q Expand comanagement and coordination of TB and STI services. Healthy People 2020 goal: Improve Access to Health Services 1. Provide program navigation and care coordination to 20% of clients seeking TB and STI services, for improved co-management and coordination of services. Q Develop and implement a marketing plan to promote Health Services referrals for expedited partner therapy from primary care providers. Q Include related metrics in all electronic health records development. Q2 2015

21 Focus Area 6: Improve information technology and management Priority Increase capacity for health communication strategies and health information technology 6.1 Improve Information Technology, Structure, Capacity and Security Goals Linkages (Alignment) Healthy People 2020 goal: Health communication and Health Information Technology; National Prevention Strategy June 2011 Increase Data Storage Carryover from prior Strategic capacity and security. Plan Replace outdated legacy software systems. Responsibility Administration Administration Projected Objectives completion 1. Identify and obtain funding to install virtual server farm Migrate current District data to new system within days of installation. 1. Research and identify requirements for new Q Environmental Health Services software 2. Replace time management system (HATS) Q Status 3. Operationalize selected Electronic Health Record Q technology. Improve internal and 1. Redesign public website to increase utilization by 10%. Q external information delivery systems. Administration 2. Redesign the Intranet (District Heartbeat) to support internal committee and workgroup functions, increase Q internal use by 10%. Develop computer 1. Develop a computer hardware replacement plan. Q hardware replacement plan. Administration 2. Present plan to DLT for adoption. Q Use a process-driven approach to developing Information Management and Program Analytics Capacity Define processes to Improve systematic "routine" data collection and service delivery. Utilize the regional Health Information Exchange (HIE) to inform public health practice as a submitter and a receiver. CHIP Priorities: Controlling contagious disease, Health Care Availability Health Services Health Services 1. Develop the capacity to facilitate process mapping, Q including electronic tools. 2. Use process mapping to establish key internal data Q collection standards and workflow requirements. 3. Fully implement Electronic Health Record. Q % of service delivery staff will enter appropriate Q diagnostic codes in client data systems % of clients receiving clinical services will have 2016 consented to HIE participation. 3. Establish routine HIE/Icare reports to gather population 2016 health data relevant to WCCHD objectives. 4. Utilize HIE to automate disease reporting for 50% of 2016 submitted notifiable conditions. Utilize web-based % of agency policies and procedures imported to Q document PolicyTech. management system to address policy, training, document storage and retrieval needs. Administration % of WCCHD staff receive training in Policy Tech utilization. 3. Fully transition document management to Policy Tech web-based system. Q Q1 2015

22 Focus Area 7: Ensure a robust and responsive public health agency through continuous quality improvement Priority Strengthen the public health agency through program evaluation and governance Goals Healthy People 2020 goals: Health-related Quality of Life and Well-Being CHA: Health of the, LPHSA National Prevention Strategy June 2011 Implement Public EHS 9: Evaluate effectiveness, Health Practice Review accessibility and quality of (PHPR) process. personal and population-based health services. Linkages (Alignment) Responsibility Objectives Administration Projected completion 1. Fill the position of the dedicated PHPR coordinator. Q Conduct 3-4 PHPRs each year Status Implement Board of Health process for monitoring the CHA/CHIP process. EHS 4: Mobilize Partnerships, and EHS 9: Evaluate effectiveness, accessibility and quality of personal and population-based health services. Health Services 1. At least one Board of Health representative serves on the Health Improvement Steering Committee (CHIC). 2. Board of Health presentations to 80% of member governments on WWA coalition activities including CHA/CHIP process. Q Annually Implement a Workforce EHS 8: Assure a competent Development plan to Public and Personal Health strengthen the Public Care Workforce Health workforce. Administration 1. Conduct PH Competency skill-set assessment in 90% of employees. 2. Develop and implement the Workforce Development Plan, based on public health workforce competencies. Q Support the WWA Employee Wellness Forum to improve employee health and morale, reduce absenteeism, reduce utilization of healthcare services and reduce healthcare expenditures. EHS 3: Inform, educate and empower people about health issues, and EHS 8: Assure a competent Public and Personal Health Care Workforce CHIP Priorities: Employee Health, Chronic Disease Administration 1. Utilize annual Worksite Wellness Interest Survey and other available reports to develop an Action Plan to help guide WCCHD wellness policies and initiatives. 2. Present the results of an employee Worksite Wellness Interest Survey and Action Plan to the Board of Health. Annually Annually Expand WCCHD Business Plans. EHS 5: Develop policies and plans that support individual and community health efforts. Healthy People 2020 goal: Public Health Infrastructure Administration 1. Develop a business plan for asset management, to include a vehicle replacement policy. 2. Increase number of vehicles compliant with vehicle replacement policy by 10% per year. 3. Maximize total reimbursements by 50% by developing and implementing a billing system. Q Q Q Develop collections policy for clinical services to maximize reimbursements. Q Reconfigure fees for environmental health services to sustain operating costs. Q Revise policy on Board of Health selection, orientation and responsibilities. EHS 8: Assure a competent Public and Personal Health Care Workforce Administration 1. Establish and convene a Board sub-committee to update policy on Board selection, orientation and responsibilities. 2. Incorporate goals for BOH orientation and responsibilities into the Workforce Development Plan. Q

23 SECTION 9: LETTER FROM THE CHAIR It has been my pleasure to serve as the Chair of your Board of Health. It has been a period of rapid change for public health and health care yet our last strategic plan has served to moderate these effects and preserve our status as one of Texas healthiest places to live, work and play. As I step down from the board, there are many things of which I am proud. The transformation from an agency incorrectly perceived as Kerry Russell being a regulatory agency and indigent care provider is complete. The 10 Essential Services are now incorporated into all agency programs and apparent to our customers. The result is that a much more accurate depiction of Public Health has replaced the old image and for the better. I m extremely proud of the partnerships that have been cultivated to the benefit of our communities. The WilCo Wellness Alliance is a coalition our community should be particularly proud of it was recognized with the Champion Award at the 2013 It s Time Texas Summit. Our Integrated Care Collaborative is another successful illustration of the fact that the best way to confront most of today s challenges is through broad and inclusive collaborative efforts at the local level. I m glad to see our community s culture of collaboration and volunteerism continue to expand through these efforts. I m pleased to see the spirit of collaboration across governmental entities for public health services continue. The strength and wisdom of our cooperative agreement is validated as we welcome the City of Leander as a full member of the District. My congratulations and thanks to the Board and staff for their completion of this strategic planning cycle and best wishes for a next cycle that will be equally productive. Kerry Russell Kerry Russell, Williamson County Representative and Chair, WCCHD Board of Health Williamson County and Cities Health District Strategic Plan 24

24 SECTION 10: RECORD OF CHANGES WCCHD Strategic Plan includes elements that are meant to be reviewed and updated. The activities within the plan will be routinely evaluated. Therefore, it is important that records of these changes should be kept in order to monitor the evolution of this plan. All changes to this plan must be approved by the Executive Director or Board Chair. Date Description of Change Page # Made by: Rationale 7/10/14 Adjust projected completion dates for two objectives in Focus Area 6.1 Q to Q Pg. 23 Executive Director, approved by Board of Health Activities for these objectives in process but not yet complete. 25 Williamson County and Cities Health District Strategic Plan

25 Appendix A: Healthy Communities Model The work that Public Health does can be confusing, contradictory, and often difficult to explain. Efforts to standardize the definition of Public Health began with the Essential Functions, which were expanded to include the Ten Essential Services, and which are now evolving to include the Minimum Package of Public Health Services as defined by the National Association of County & City Health Officials (NACCHO). Still, no one model exists that completely or perfectly organizes and ensures the coordination of these services. The Healthy Communities Model has been helpful in making sure that as this community s Public Health Agency, we are providing support and coordination internally and externally for both individual and population health services. Data guides all of our efforts and the Health Assessment (CHA) is the periodic culmination of our continuous efforts to assess the health and needs of our community. The CHA has informed our Health Improvement Plan, which guides our Public Health System efforts, and this Strategic Plan, which guides our Public Health Agency. Two key definitions create the quadrants into which our work falls. The horizontal axis represents the distinction between the internal branches of the Public Health Agency, Williamson County and Cities Health District Strategic Plan 26

26 WCCHD, which are guided by this strategic plan and the Public Health System which is made up of the much larger constellation of agencies and entities which contribute to the health of our communities. The vertical axis represents the distinction between population-based services, focused on the community, and clinical services directed at individual patients, one at a time. Superimposed in this way, these two distinctions create the four quadrants of the Healthy Communities Model. In reality, the quadrants are not fixed or exclusive but represent a spectrum in which programs, services and initiatives are interdependent. Indeed, the greatest advantages and synergy come from the cross-quadrant coordination of activities. A recent example of this was the Exercise is Medicine project which sought to build community capacity in Departments of Parks and Recreation as well as private gyms (all in the upper left Capacity Building Quadrant) to support individual patients at risk for type two diabetes, referred to the program by agencies in the upper right, Systems Capacity Building Quadrant. The model has also been helpful in defining the charters and agendas for our community s health and wellness coalitions, workgroups, and committees. For instance, the WilCo Wellness Alliance through its Steering Committee is the umbrella organizational structure for the Public Health System and as such has broad stakeholder participation beyond traditional health care provider agencies. Participation by WCCHD programs includes those that are population based (i.e. environmental health and community gardening) as well as those that are clinically oriented, (i.e. TB and Immunizations Programs). 27 Williamson County and Cities Health District Strategic Plan

27 Appendix B: Functional Organizational Chart Williamson County and Cities Health District Functional Organizational Chart Williamson County and Cities Health District Strategic Plan 28