Business Planning for the Long Haul

You all have stepped up to the plate these last couple of weeks! Thanks to Monecia for getting the conversation started, and for all of you who are writing in. Keep it coming!

A lot of you mentioned Negotiation as a session of the MAPH that taught you a lot. Dee Dee Downey wrote about an interesting concept about negotiation: “Leave something on the table.” That is, when you’re negotiating, don’t try for the winner-take-all mentality. We're in this for the long haul: relationships are more important than winning.

Public health business planning is all about the long haul. To be successful and build sustainable programs, we have to be creating on-going relationships with partners, colleagues, local politicians, other organizations, and peers across the country. Not to mention communities of people who use and care about your activities. So besides not humiliating people you are in negotiations with, how can we put “the long haul” into action?

- Make note of those things left on the table. Every time you negotiate for something, write down what you wanted but didn’t get – this time. You might get them next time. Similarly, keep a list of the things your negotiating partner wanted but didn’t get. You just might come across an opportunity where what they want works for you.

- Note what your negotiating partner likes. Say you go to a potential funding partner with an idea for a dental clinic at the health department. They say, “We don’t do dental clinics; we do X.” Don’t waste your time tweaking the dental clinic idea for this partner. But do think about coming back later with an idea for doing X with their help. They’ll be more open to a new idea that fits in with their mission or goals.

- Keep a list of ideas that came up you hadn’t thought of before. They can be part of your next brainstorming session. Remember, long term thinking means there’s always another chance to launch an initiative.

- Always, always, always consider the Exit. We devote a whole chapter in the book to planning for the intentional or unintentional exit (Chapter 11). If you’re planning for the long haul, you know that sometimes over time programs need to change or end. If you plan to spin it off to a partner’s control, you’d better keep that partnership healthy throughout your planning and implementation phases!

We hear about great partnerships among our students and alumni. What examples can you share of partnerships you’re particularly proud of or hopeful about?

Anne Menkens

From the Management Academy Director

As Anne mentioned, the Management Academy for Public Health (MAPH) teams have been working hard on their feasibility plans and the meaning of the word "teamwork" has been made clear through a variety of tasks. Working together efficiently is of utmost importance now because each team has a lot of work to do in order to complete their business plan draft by January. The business plan must include detailed project operations, a marketing strategy, potential risks and a thorough description of a first year and a five year budget. The business plan development is a continuous process that has been building since the first MAPH retreat in July/August.

In the final hours of the first retreat, each group presented their first business plan idea to the other members of the cohort. Then as a follow-up, we had an almost 3-hour session during the second retreat for each group to present their current plan to their fellow colleagues. It was amazing to hear the changes and positive transformation that the plans have gone through. The members of the cohort, the business plan coaches and the local public health experts in the room were impressed by the research done to establish the true community need in a specific area. The topics of teenage pregnancy, the uninsured, childhood obesity, childhood immunizations/vaccinations, tuberculosis testing, community recycling, public health program evaluation and medical billing are all important to the residents of North Carolina, South Carolina and Wisconsin and each team had the statistics to prove it. What makes the Management Academy so unique is that each team has to consider how to address the community need, while at the same time, consider how to develop a self-sustaining program that doesn't merely rely on grant funds.

I would definitely be remiss if I did not mention the other activities that took place during the most recent on-site retreat. One of the goals of the Management Academy is to prepare the participants for new management challenges in public health. The faculty members focus, not only on business plan development, but also on improving the participants' individual managerial skills. The retreat included 360 Assessments, tips on negotiation and communication skills and work towards of a plan aimed at improving managerial competencies. Let's hear from the Management Academy participants about what they found most helpful during the retreat..................

"Fun & Fit"

Last week the current Management Academy teams presented their feasibility plans in a session that includes brief presentations and Q & A. This session brings out the meaning of “teamwork” for the Management Academy – it is clear at times like this that we’re all on the team: everyone in that room was there to understand the plans and help make each a better final product. We were lucky, too, to have two special guests: Dorothy Cilenti, a former North Carolina local public health director who is currently Deputy Director for Operations and Management at the NC Institute for Public Health, and Rosemary Summers, current Orange County Health Director.

One of the teams is proposing a program called “Fun & Fit,” which will be a summer day camp created to address childhood obesity. A structured camp for children between the ages of five and 14, “Fun & Fit” will incorporate play, cooking, field trips, swimming, sports, and gardening to encourage children to be active and make healthy food choices. It will also contain evening classes for parents and children on nutrition and health. The partners include the county school system, a local aquatics center, Smart Start, the local 4-H chapter, and the local campus of the state university, which will provide student interns to work with the children. It will be an eight-week program during the summer, with follow-up during the school year. The program will be subsidized through the Department of Social Services.

What are some of the challenges for a project like this? Some questions raised had to do with medical participation. Dr. Summers asked who would provide on-site medical supervision? And, perhaps it could be a prescription program, with doctors “prescribing” it for overweight or at-risk children. Would that help it be covered by insurance? Would that help the program planners target the children who would most need it? Related to targeting children, another question was raised about the program’s marketing: how would such a program be marketed so as to avoid stigmatizing children who attend? The team answered that it plans to target all children and avoid a stigma, which led one attendee to suggest that then they might only get the concerned parents whose children are not necessarily overweight or at risk, those who are already thinking about healthy behaviors and choices. The group ended by brainstorming ideas for encouraging participation – they could use active video games to “meet the kids where they are” – even offering such games as prizes for meeting healthy eating or activity goals. That team might have to go find another partner – maybe a video game company or store – who would donate things that could be incentives for the children.

Other challenges might be regulatory issues. Studies show that regulatory issues are the second most common reason given by MAPH students for plans not getting off the ground. Also, public health planners often neglect to “think like a business” when it comes to marketing. Marketing for a program like this might target doctors, parents, children themselves, and schools, and the marketing plan would have to comprise more than just public service announcements. There are a lot of competitors for children’s time in the summer.

What do you think? Can you -- our Community of Practice -- think of other ideas that would help this team make "Fun & Fit" the best plan it could be?

-- Anne

Feasibility Plans

The current MAPH scholars are here this week for their second on-site session. This is the session at which (among a lot of other things) they present their feasibility plans to the group and get feedback. Their ideas have come a long way from the first tentative ideas that were batted about in July. Any former scholars in our audience can well remember the feeling of free fall that comes that first week when you realize this is a long, sometimes difficult process of brainstorming, fact-finding, going back to the drawing board, and work, work, work. It’s exciting (like an epiphany) and yet terrifying (like a tsunami) (and I promise not to write any more about that word, this week at least!).

In conversations the last couple of days I’ve been asking these scholars – “what do you want to see more of in the book?” – and to a person, they all said, “We need a good example of a feasibility plan!” I have a few answers to that request:

1. Business plan coaches Pamela Santos and Catherine McClain do not want us giving out sample feasibility plans in the fear that you’ll see one of these imperfect plans and model your own after it. Plus, plans are so different that there is no perfect plan that would work across the board. We say that in the book, and it’s true: no one plan will work for everything, so it’s better to work with the parts and make your own plan. And, like your teachers told you in high school: there is value to figuring it out for yourselves.

2. The feasibility seems HUGE to you right this minute because it’s what you’ve been working on to present here this week. But it is a means to an end. After this session you will not go back and revise your feasibility plan: it’ll be time to write your business plan!

3. If you still insist that you need a model, on the member’s site of the MAPH web site (, under “Business Plan Project” there is a link to “Feasibility Plan Details,” where you can get very detailed descriptions of the parts of a feasibility plan with examples from past plans. Not one big plan from start to finish, but a close description of what the parts would consist of. I hope you were pointed in that direction when you began the program, but if not, there it is, better late than never. For those of you who are not in the Management Academy program, I’ll see about getting that link available to you if I hear back from you that you want it.

4. One of the readers of our book in manuscript said the feasibility chapter should have come first, because it is what you do first. We put it where it is because even though you do it first, you do need to know what the parts of the business plan are before you do it. And, again, it’s a means to an end. When you’ve done your business plan you forget about the feasibility plan. However, we can revise that chapter, move it, bulk it up for the new edition (if we’re lucky enough to get to do one) if we hear enough feedback that indicates that would be what you, our audience, wants. So let us know!

OK. I'll write more soon about the plans that were presented this week. And perhaps Monecia will give us an update "From the Director" --

-- Anne Menkens

Another Look at Tsunami + Epiphany

OK, Steve, I’ll take up your word, “epiphanami.” You’re right about all the positive connotations of a sweeping new way of seeing the world, a “tidal wave” of shared inspiration and motivation.

However, it also behooves us to look at the other side of things, if only because a lot of people in public health are afraid that the “epiphanami” of “thinking like a business person” about public health issues will destroy the field. They may not want to change the way they – or their stakeholders – think about public health because they may worry that the new way of thinking will make them answerable to a new set of private stakeholders. Tsunamis do, after all, bring annihilation to what was stable, staid, predictable, land. So how do we answer these doubters?

One thing to say is that the epiphanami is the effect, not the cause, of the upheaval affecting public health right now. As Professor Johnson points out, the earthquake going on in the middle of the sea is economic pressures, changing demographics, new demands for sustainability from granting organizations, changing political priorities – a host of things beyond the control of local public health. As public health professionals, we can either run for the hills to get out of the way, or we can accept the reality of the situation and work with it.

Better yet, we can embrace the situation! Build a boat and sail in the water brought in by the storm. That’s the epiphany part! The inundation feels like a disaster until we realize that we have some control over the situation. Not every business is going to be a proper partner. But bringing business people with an interest in public health into your circle of influence will make public health stronger and richer. And, “running things like a business” does not mean running things like a bad business! It means learning how to plan what you need and then do a budget, as opposed to fitting what you do into someone else’s budget. It means recognizing that things cost money, that the money has to come from somewhere, and that you can sustain yourself if you plan carefully.