Strategic Plan. Franklin County Public Health

2015-2018 Strategic Plan Franklin County Public Health

Franklin County Public Health 2015-2018 Strategic Plan Mission 1 Vision Franklin County Public Health leads our communities in achieving optimal health for all. Franklin County Public Health improves the health of our communities by preventing disease, promoting healthy living and protecting against public health threats through education, policies and partnerships. Values We serve our communities, our organization, and each other with: Integrity, Accountability, Excellence, and Respect.

INTRODUCTION The Franklin County Board of Health was established in October 1919 as a result of the Great Influenza, the most devastating pandemic flu on record. The authority of any health department in the State of Ohio is granted by law and is specifically detailed in the Ohio Revised Code. A five-member Board appoints a Health Commissioner who oversees the day-to-day operation of the department. Franklin County Public Health (FCPH) has a staff of approximately 70 people and operates with a budget of about $7.5 million. As defined by Ohio law, FCPH provides service to all of the townships and villages in the county. In addition, 14 suburban cities contract with us to serve as their health department and provide comprehensive public health services to their residents. Today we serve a population of 428,976 in a growing suburban area, through multiple community-oriented programs.

WHAT WE DO 3 As a public health department, we are guided by local, state and federal mandates and collaborate with a wide variety of jurisdictions and organizations to improve the health of our communities. Community-based responsibilities and objectives traditionally provided both our organization s purpose and a framework for accountability. Over the years, these tenets which have become known as The 10 Essential Public Health Services are what every citizen across the United States should expect and receive from their public health department: Monitor health status to identify community health problems. Diagnose and investigate health problems and health hazards in the community. Inform, educate and empower people about health issues. Mobilize community partnerships to identify and solve health problems. Develop policies and plans that support individual and community health efforts. Enforce laws and regulations that protect health and ensure safety. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. Assure a competent public health and personal healthcare workforce. Evaluate effectiveness, accessibility and quality of personal and population-based health services. Research for new insights and innovative solutions to health problems.

OUR STRATEGIC PLANNING PROCESS The strategic planning process began in April 2014 with senior management staff and the Health Commissioner, under the guidance of a facilitator, Jack Moran PhD, a Senior Quality Advisor to the Public Health Foundation. Staff reviewed what was accomplished under the existing strategic plan (2011-2014), and conducted a SWOT analysis for the organization (strengths, weaknesses, opportunities, threats). In June 2014, through a facilitated all-day discussion, staff developed a draft of department strategic goals and objectives. This draft was vetted with managers and supervisors in July 2014. Division specific goals and objectives, based on the department strategic goals, were also developed. In August 2014, senior management staff, managers and supervisors met for an all-day facilitated discussion to prepare a final draft for Board of Health review and approval. In their monthly meeting on September 9, 2014, the Board of Health reviewed the plan and made revisions. The Board officially adopted the 2015-2018 Franklin County Public Health Strategic Plan on November 10, 2014. The 2015-2018 Strategic Plan builds on the Community Health Assessment (CHA) that was completed in January 2013, and the Community Health Improvement Plan (CHIP), completed in May 2014. Our plan also incorporates important internal plans, such as the Workforce Development and the Quality Improvement Plans and is an integral component of our performance management system.

5 SWOT ANALYSIS A SWOT analysis provides organizations with information about internal factors that may help or harm them by listing strengths and weaknesses; and information about external factors that may help or harm, which are opportunities and threats. A SWOT analysis can clearly show an organization where it needs to focus its efforts to assure the best chances for success, given present environmental factors. FCPH conducted a SWOT analysis and the results are described on the next page. Weaknesses and threats focus on unfunded mandates, emerging infectious diseases and the capacity to sustain a trained and competent workforce into the future. Our strengths and opportunities lie in the support we have from our jurisdictions and creating and implementing plans to address critical needs such as workforce development and quality improvement. Franklin County Public Health SWOT Analysis

Franklin County Public Health SWOT Analysis Results Issue Strength Weakness Impact Health Outcomes Strong Community Health Assessment (CHA) process Strong Emergency Preparedness partnerships Credible and knowledgeable employees Strong emphasis on public health law and Environmental Health regulations Community engagement Health education and prevention programs Multiple communities with different needs Lack of a strong Community Health Improvement Plan Staff support for technology No good way to measure health outcomes Limited in internal staff to respond quickly Improve Operations Workforce Development Plan support for employee training Plan for Quality Improvement training/culture Policy and procedure system in place Employee turnover Lack of adequate number of staff Cross-training of staff Office space and facility no longer meets needs Staff support for technology Build Relationships Positive feedback from jurisdictions about quality of our service Better understanding about what they value Emphasis on communication and outreach Participation in professional organizations & community coalitions Spending time individually in each of our jurisdictions Consistent outreach to all stakeholders Staff understanding about the importance of their role in relationship building Having adequate staff time to spend with customers and stakeholders Provide Quality Service Emphasis on culture of customer service Good communication tools Need more customer satisfaction feedback and input Improve response time to complaints, requests or questions Quality Improvement training and understanding for all staff

Opportunity Affordable and available technology to support data needs Affordable Care Act emphasis on population health and prevention Economic recovery The Future of Franklin County Public Health Investment Proposal Threat New and emerging infectious diseases Fewer resources for emergency preparedness Increase in chronic disease Loss of historical knowledge with retirements 7 Accreditation supports improvement Availability of subject matter experts (Ohio State University, human resource consultant, etc.) Lack of individuals choosing a public health career Lack of funding sources Mandated consolidations Adequate space Participate in more planning and coordination with partners Increase use of social media Workforce Development Plan Cross-division communication Working more closely with health care providers Public Health is not visible and not valued Seeing Franklin County Public Health as part of their system, not external Some stakeholders not interested in developing a relationship Accreditation has a strong emphasis on quality improvement and best practices The Future of Franklin County Public Health Investment proposal Adequate resources Unfunded mandates

DRIVING FORCES AND EXTERNAL TRENDS Driving forces and external trends are things we believe we know something about, as well as things we consider uncertain or unknowable. They can be positive or negative on the organization. A good understanding of these forces and trends forms the basis for a realistic strategic plan. Below are the forces and trends FCPH considered in development of the strategic plan. Positive Accreditation provides credibility and will help us improve Shared services can help with efficiency Public health is increasingly recognized as a leader in infectious disease emergencies Affordable Care Act may promote public health with its emphasis on prevention Support of the Board of Health and our Jurisdictions Negative Funding is not sufficient. FCPH is the 6th largest local health department in Ohio, with a 2013 per capita expenditure of $18.60, compared to a median per capita expenditure of $31 for all Ohio health departments and $39 for the US (NACCHO Profile of Local Health Departments) Multiple jurisdictions in Franklin County, each with different public health priorities and economic factors Threat of mandated mergers or consolidations with other local health departments Unfunded mandates Public health is not visible and not valued It takes an outbreak to bring resources and appreciation Technology is affordable and available, but developing & maintaining staff expertise in its use is difficult Lack of individuals choosing a public health career Rapidly changing social media Affordable Care Act may not be complimentary to public health Accreditation will cost staff time and money that is currently limited

WHERE WE ARE GOING: Our Strategic Priorities 9 Since 1919 this public health department has managed both ongoing responsibilities and innovative projects that address specific health concerns and general community health goals. Our duties mandated by local, state and federal law will continue to be our priority. We will also continue to respond to emerging community needs and public health threats. To meet the challenges and opportunities of the future, we have reached a consensus on goals to move all of the components of our organization toward common ends and complementary outcomes. As outlined below, these shared goals and strategies create a framework to take action that advances and strengthen the organization as a whole. Our Department Strategic Goals GOAL 1: Promote Health and Prevent Disease GOAL 3: Emphasize a Culture of Continuous Quality Improvement and Customer Service GOAL 2: Build Relationships GOAL 4: Achieve and Maintain Public Health Accreditation and a Competent Workforce

Goal 1: Promote Health and Prevent Disease Objective 1A. Emphasize prevention and protection as our public health role Strategy a. Continually assess community health status and identify emerging health issues b. Prepare the department and the community for public health emergencies c. Prevent the spread of infectious and vaccine preventable diseases 1B. Continue to convene a community health improvement planning process with stakeholders and partners that results in a comprehensive Community Health Improvement Plan (CHIP) a. Utilize Network of Care, Healthy People 2020 and other national databases to establish a community baseline and set targets b. Identify and implement interventions c. Improve the use of evidence-based and best practice interventions to impact priority issues established by the CHIP d. Maintain an established group of stakeholders and partners for our CHIP work 1C. Minimize environmental public health risk and disease a. Ensure education and standardization is woven into Environmental Health programs b. Increase involvement with key partners in planning for sanitary, sewer, and public water to undeserved and unsewered areas in the health district

Continually assess community health status, identify emerging health issues, 11 and together with our communities, work toward improving health Target Date Measure Update the Community Health Assessment January 2016 Updated Community Health Assessment Update the Emergency Response Plan and complete the Mass Prophylaxis Annex Review and update the Infectious Disease Emergency Response Plan Fall 2015 Fall 2015 and then every 2 years Completed plan Completed plan Assure access to identified databases 2015 Baseline and targets established The role of community partners is identified and implementation is underway Practices and interventions are incorporated into the CHIP 2016 Ongoing, regular reporting of progress 2015 Evidence-based and best practice interventions are in use Develop Community Health Action Teams (CHAT) 2015 CHATs are established and meet regularly Establish baseline At least 1 program in 2015 and 1 program annually thereafter Determine relevant data to collect that would identify areas of need. Share findings from data collected with partners responsible for sanitary sewer and public water planning July 2016 Number of programs that have established a formal education component Number of programs with a written, standardized inspection process is completed Data is shared on a regular basis with appropriate partners.

Goal 2: Build Relationships Objective 2A. Engage with our partners and maintain relationships to help accomplish public health goals Strategy a. Prepare and distribute a Return on Investment annual report b. Communicate with stakeholders for input and feedback 2B. Maintain timely and responsive communication with the townships, cities, and villages we serve a. Monitor and track progress of the FCPH elected official, stakeholder and conduit communication plan b. Enhance health service reports through improved data 2C. Maintain and enhance academic partnerships a. Maintain contracts or MOU s with academic institutions to provide public health experiences for students b. Establish academic research partnerships 2D. Improve internal relationships and communication a. Implement Strategic Goal 1 of the Workforce Development Plan: develop and implement a comprehensive new hire training and orientation process b. Establish an Employee Portal c. Provide opportunities for employees to be exposed to other programs and employees in the department

Utilize the unique role and strengths of FCPH in our community to build strong 13 partnerships and collaborations to assure optimal public health service delivery Target Date Measure Summer 2015 and then annually Report completed and distributed Seek feedback from identified and engaged stakeholders Conduct an electronic stakeholder survey (baseline 2013) Meet targets outlined in plan (baseline January 2013) 2016 and then every 3 years January 2015 and then annually Completed survey and report Progress report and updated plan Environmental Health reports baseline; Clinics & Infectious Diseases 2015; Home visiting 2016; community health 2017 Reports completed Schools of Nursing Medical Schools Colleges/Schools of Public Health Environmental Health programs at universities/colleges Public Administration Programs January 2015 and then ongoing Signed MOU s and contracts Reach out to 3 academic institutions Participate in a research project Establish a committee from the Workforce Development Team 2015 and then annually 2015 and review annually Evidence of contact with academic institutions Completed research project Orientation process completed and in use Establish a team to develop Employee Portal 2015 Portal is in on the home page of every employee computer

Goal 3: Emphasize a Culture of Continuous Quality Improvement and Customer Service Objective 3A. Integrate the science and tools of continuous quality improvement (CQI) into our daily work. Strategy a. Monitor the implementation of the FCPH Quality Improvement (QI)plan b. Implement a performance management system to assess performance and manage improvement c. Adapt technology to compile and use data more effectively d. Improve customer access 3B. Continually improve our organizational capacity and structure to assure effective use of resources and alignment with our mission and goals a. Continually update information systems to assure data collection/analysis, program management and communication b. Maximize and diversify existing revenue streams

Measure, assure and improve quality and effectiveness in all of our services 15 Target Date Measure QI training for all staff At least 1 formal CQI Project for each division annually 2015 and ongoing Training documented in the Workforce Development Learning Management System Completed CQI projects Employees have been trained on the system and it is operational Develop a formalized method to collect customer satisfaction data agency-wide Summer 2015 Summer 2015 Regular progress reports Method established Implement customer satisfaction data collection 2016 Data is being collected Track and monitor programmatic changes based on customer feedback 2017 Evidence of changes made based on customer feedback Investigate, evaluate and make recommendations to improve customer access at Memorial Hall and outreach locations (e.g. clinics; visitors, employee workspace needs); review capital project needs Investigate, evaluate and make recommendations to improve virtual access to services (e.g. online bill pay; online complaint system). January 2015 October 2015 Recommendations completed Recommendations completed Conduct an assessment of IT and data collection systems and evaluate the use of technology department wide 2015 Completed assessment with recommendations for improvement Establish baseline and set targets 2015 Baseline and targets set

Goal 4: Achieve and Maintain Public Health Accreditation and a Competent Workforce Objective Strategy 4A. Achieve Public Health Accreditation a. Prepare documents and submit to PHAB 4B. Establish internal support for re-accreditation b. Form a re-accreditation committe 4C. Maintain minimum requirements for re-accreditation a. Update plans required for the accreditation process 4D. Provide support, training and continuing education for workforce development a. Implement the Workforce Development Plan b. Monitor and track required licensures and certification. c. Monitor participation in professional conferences by discipline

Being an accredited health department is our commitment to accountability, efficiency and excellence. 17 Target Date Measure Site visit is scheduled 2015 Process is completed FCPH is accredited 2016 Committee is formed Strategic Plan Community Health Assessment Community Health Improvement Plan Workforce Development Plan Quality Improvement Plan 2015 and then annually Plans are updated according to requirements Staff attend required training and submit information to the learning management system Fall 2015 and then annually Workforce Development Plan is current and training is tracked through the learning management system Establish baseline and set targets Establish baseline and set targets Baseline 2015; targets 2016-2018 Baseline 2015; targets 2016-2018 All required licensures and certifications are current Baseline and targets established; targets are met

Our Division Strategic Goals 19 Franklin County Public Health (FCPH) is organized into 3 divisions: Environmental Health Prevention and Wellness Administration Administration is further divided into cross-sector programs and operations. Each division provides a unique contribution to public health in our communities. Guided by department strategic goals, following are each division s strategic priorities.

Environmental Health Division Strategic Goals Environmental Health (EH) addresses all the physical, chemical, and biological factors external to a person, and all the related factors impacting behaviors. It encompasses the assessment and control of those environmental factors that can potentially affect health. It is targeted towards preventing disease and creating health-supportive environments. (World Health Organization WHO) Environmental Health Goal 1: Integrate Continuous Quality Improvement into Daily Operations (FCPH Goal 3A) Objective Strategy Target Date Measure 1A. Use best available technology to improve data management (e.g., collection, utilization, accessibility, retention) 1B. Implement standardization process into EH programs a. HealthSpace feature utilization b. Archiving systems Training and education of staff on standardization process, using FDA as example. 4 Programs: Food Community EH Nuisance Water Quality Solid & Infectious Waste Plumbing 3 Programs: Food Nuisance Water Quality End of 2015 End of 2015 Retention schedule updated A written, standardized inspection process is completed.

Environmental Health Goal 2: Promote a Culture of Workforce Development (FCPH Goal 4D) 21 Objective Strategy Target Date Measure 2A. Division leadership attends at least one supervisory or leadership training per year. 2B. Program staff attends program area core competency trainings each year. 2C. Program staff receives cross-training in at least one program area function each year. MAPS OSU John Glenn Institute Franklin County Human Resources Classes Core competencies GreenLight LMS Core competencies GreenLight LMS Provide support, training and continuing education for cross-training of staff. 100% of division directors, division managers, supervisors and program managers 100% of program staff 100% of program staff End of 2015 End of 2015 End of 2015 Staff implements or suggests at least one change relevant to training received. Staff identifies two take-aways from each training, shares information with program staff, and evaluates for implementation. Environmental Health Goal 3: Minimize Environmental Public Health Risk and Disease (FCPH Goal 1C) Objective Strategy Target Date Measure 3A. Weave education into EH programs. Community engagement and outreach 2 Programs: Solid Waste Healthy Homes End of 2015 Staff educate public at least 85% of encounters

Prevention & Wellness Division Strategic Goals Prevention and wellness includes several disciplines from the public health field, including public health nursing, health education and epidemiology. Public health nursing is a specialized form of registered nursing that combines nursing and public health principles. Public health nurses integrate community involvement and knowledge about the entire population with personal, clinical understandings of the health and illness experiences of individuals and families within the population (American Public Health Association APHA). Health education improves the health status of individuals, communities, states and the nation; enhances the quality of life for all people; and reduces costly premature deaths and disability (Society for Public Health Education (SOPHE). Epidemiology is the study of the distribution and determinants of health-related states or events (including disease), and the application of this study to the control of diseases and other health problems (World Health Organization WHO)

23 Prevention & Wellness Goal 1: Establish a baseline of data for Division programs (FCPH Goal 1B, 3A) Objective Strategy Target Date Measure 1A. Utilize community partners to identify strategies and measures; develop and implement an action plan to address priority issues Conduct Gap Analysis Collaborate with OSU Center for Clinical and Translational Sciences for research and strategy identification. Facilitate development and implementation of action plan Track and report on implementation FCPH and community partners Gap analysis & plan - Feb 2015 Monitor progress Dec 2015 and annually thereafter Completion of Gap analysis and action plan Implementation of plan reported in progress report. 1B. Utilize the tools of continuous quality improvement into the evaluation and assessment of current programs Collect & analyze customer satisfaction data from residents who utilize services from a division program Development and implementation of electronic medical record (EMR) software for division programs to standardize and improve data collection and analysis Customers utilizing services at FCPH immunization clinics Children with Medical Handicaps Program; Immunization Program Dec 2014 June 2015 (collect data) July 2015 Analyze data Aug 2015 Implement changes Annual monitoring thereafter Sept 2015 and annually thereafter Establish methodology Collect data Analyze data Monitor program changes Select vendor to develop and implement an electronic medical record (EMR) software Train staff Collect data Analyze data

Prevention & Wellness Goal 2: Promote use of best practice interventions in division programs (FCPH Goal 1C) Objective Strategy Target Date Measure 2A. Use of evidence-based practice interventions in programs Review and update the Infectious Disease Investigation (IDI) Guide on all reportable diseases Infectious disease surveillance, monitoring, reporting & education Dec 2015 and at least annually thereafter Review current content on all reportable diseases Update current content as needed Distribute updated content Prevention & Wellness Goal 3: Prepare division staff for public health emergencies (FCPH Goal 1B, 4c) Objective Strategy Target Date Measure 3A. Provide training and increase awareness of all division staff on emergency preparedness activities as it relates to mass prophylaxis and mass vaccination Create training materials and provide opportunities for staff to practice methods and processes Division staff March 2015 develop materials May 2015 complete training & conduct table top exercise Aug 2015 - complete set up and conduct drill and at least annually thereafter Develop training materials Provide training content and conduct table top and drills Review After Action Report and schedule annual training thereafter

Administration Cross-Sector Division Strategic Goals 25 The Cross-Sector Division includes those programs that impact all functions at FCPH. Public health emergency preparedness (PHEP) is the capability of the public health and health care systems, communities, and individuals to prevent, protect against, quickly respond to, and recover from health emergencies, particularly those whose scale, timing, or unpredictability threatens to overwhelm routine capabilities. Preparedness involves a coordinated and continuous process of planning and implementation that relies on measuring performance and taking corrective action (RAND Panel, April 2007). Risk communication is a complex, multidisciplinary, multidimensional, and evolving process of increasing importance in protecting the public s health. Public health officials use risk communication to give citizens necessary and appropriate information and to involve them in making decisions that affect them (US Public Health Service). Cross-Sector Goal 1: Establish Process to Maintain Accreditation (FCPH Goals 4A&4B) Objective Strategy Target Date Measure 1A. Implement a system to assure accreditation required documentation is updated or maintained a. Create a tracking system b. Establish a re-accreditation committee Senior Staff Accreditation Team Winter 2016 Tracking system Re-Accreditation Committee

Cross-Sector Goal 2: Increase Promotion of FCPH Programs and Services (FCPH Goals 1A&2B) Objective Strategy Target Date Measure 2A. Create a stronger promotion strategy to increase knowledge of FCPH programs and services (including wellness and prevention) a. Work with programs to determine promotion priorities b. Establish tool to measure success FCPH Programs Fall 2016 Established annual strategy Measurement tool Cross-Sector Goal 3: Continually Prepare for Public Health Emergencies (FCPH Goal 1A) Objective Strategy Target Date Measure 3A. Develop operation standards for implementation of Incident Command System (ICS), utilization of the FCPH Department Operations Center (DOC) and FCPH s role in ESF#8 coordination a. Differentiate the emergency activities that will be conducted by FCPH within ICS and through the FCPH DOC. b. Develop activation protocols for FCPH s ICS and DOC that account for FCPH s role in ESF #8 coordination Update the FCPH Emergency Response Plan End of 2015 Updated Plan

Administration Operations Division Strategic Goals Health departments must have a well-managed human resources system, be competent in financial management and technology, knowledgeable about public health mandates, and the ability to conduct assessments and evaluations for the best public health service delivery. 27 Operations Goal 1: Adapt technology to compile and use data more effectively (FCPH Goal 3A) Objective Strategy Target Date Measure 1A. Increase number of Human Resource (HR) functions that are electronic 1. Identify eligible HR functions 2. Assess potential systems available or develop systems 3. Prioritize functions and implement 1 function per year By December of each year Identified function is electronic and in use 1B. Create a central location for forms, policies and other critical fiscal / HR documents 1. Develop and implement an employee portal Portal is functional and contains critical documents By December 2015 and review annually Portal is on every employee home page Operations Goal 2: Continue to improve our organization capacity and effective use of resources (FCPH Goal 3B) Objective Strategy Target Date Measure 2A. Develop a long-term policy and plan to maximize resources and diversify existing funding streams - include resolution of adequate space for all public health functions and services 2B. Develop a performance management system for financial operations 1. Work with Board of Health to develop the plan and policy 2. Work with Board of Health to develop the performance management system Plan and policies are finalized and shared with jurisdictions System is developed and finalized By December 2015 and review quarterly By December 2016 and review quarterly Plan is implemented and is being tracked System is in place and operational

TRACKING PROGRESS The strategic plan goals and objectives will be part of an electronic database within the performance management system. Staff will enter their updates into the database which can be viewed by all senior management staff, supervisors and managers. The Strategic Planning Committee will conduct quarterly reviews to track progress and make adjustments. Progress reports will be shared with the Board of Health on a semi-annual basis.

OUR STRATEGIC PLANNING TEAM 29 SENIOR MANAGEMENT STAFF Susan Tilgner, Health Commissioner Debbie Wright, Assistant Health Commissioner, Director of Prevention and Wellness Niki Lemin, Assistant Health Commissioner, Director of Environmental Health Mitzi Kline, Director of Communication John Wolf, Director of Finance and Business Operations Peggy Bartow, Human Resources Manager SUPERVISORS AND PROGRAM MANAGERS Charlie Broschart, Environmental Health, Division Manager Jeff Gibbs, Environmental Health, Division Manager Ken Farmwald, Garrett Guillozet, Melissa McArthur, Gary Young, Environmental Health Supervisors Terry Bugg, Radhika Iyer, Stacie Williamson, Public Health Nursing Supervisors Mike Adair, Jeff Grose, Nathan Ralph, Environmental Health Program Managers BOARD OF HEALTH Jack Bope Jerry Lupfer Dana McDaniel Dr. Annemarie Sommer Joe Weaver FACILITATOR Jack Moran, PhD, Public Health Foundation Published January 2015