From the Management Academy Director

Recently I read an interesting blog written by Dr. Louis Rowitz. Dr. Rowitz, has built a unique career in academia via public health practice issues and initiatives. He currently serves as the director of the University of Illinois Center for Public Health Practice. He has published two public health leadership books entitled Public Health Leadership: Putting Principles into Practice and Public Health for the 21st Century: The Prepared Leader.
The most recent blog focused on the Need to Learn.
Here is a short segment of the article:
Every time we read a book, take a course, attend a conference, work collaboratively with others, use our creativity skills, solve a problem, resolve a conflict, improve the quality of our organizations, or communicate with others, we increase the return on investment in our personal growth and on the organizations for which we work. Knowledge management is cost effective and increases cost efficiency.

The blog is thought provoking and he goes on to cover other subjects related to leadership. He offers a segment of Leadership Is An Art by Max DePree and lists the ideals of helping a leader to define reality. Here are just a few:

• No matter how good a job you do, you can still lose your job.
• Not all team members do the work.
• It is your good managers that make you like your job.
• Most leaders don’t change. The weaknesses remain. Play to the person’s strengths.
• Don’t expect politicians to value what you do. Their priorities are not your priorities.
• Resilience is the secret weapon of leadership.
• People don’t want change and they use budget considerations to justify their resistance.

For more on Rowitz, see
http://rowitzonleadership.wordpress.com/

Dr. Frieden on the implementation gap

The new director of CDC Tom Frieden spoke in Chapel Hill recently and said something I thought was interesting and provocative about managing in public health. (You can hear part of the talk on YouTube). Here's what he said:

We have an implementation gap. The gap between what we know and what we wish to know is huge. But the gap between what we know and what we do is even larger.

In other words, we need to pay more attention to execution. We know what's important, and for the most part we know what things would need to happen to make a difference in those important areas. So what would it take to change the "what we do" side of the equation? Effective plans that are doable.

--Steve Orton

From the Management Academy Director

NACCHO (the National Association of County and City Health Officials) offers a Model Practices Program that "recognizes initiatives that demonstrate exemplary and replicable qualities in response to identified public health needs."
This year, there were 23 local health departments that received Model Practices Awards. Their projects focused on a a variety of topics, including the following that may be of interest to you:

• Vaccination on Wheels - Take It To The Streets
• Accreditation Preparedness
• Ensuring a Competent Public Health Workforce
• A Communicable Disease Prevention and Response Tool for Schools

And, in the past, a couple of North Carolina teams have also had winning entries:

• Henderson County Health Department - Influenza Vaccination Program
• Cabarrus County Health Alliance - Transitioning from a Public Health Department to a Public Health Authority

Have you and your staff submitted any Model Practices? Have you visited the website and searched for Model Practices within the Database? Would you be interested in contributing to a Model Practices Database reserved just for your state and their public health initiatives?

Civic Entrepreneurship: Union Independent School

Wanted to share a "civic entrepreneurship" news story -- Jim Johnson is the founding co-director of the Management Academy for Public Health and has taught in the program every year since 1999.

http://gazette.unc.edu/archives/09aug26/file.4.html

From the Management Academy Director

This year, the Management Academy for Public Health begins its 11th year. The 54 participants represent North Carolina, Nebraska and Virginia. Upon graduation, this group will join over 1050 public health professionals who have completed the Academy, gained valuable management skills and in some cases, went on to fully implement their business plans.

This year's cohort is focused on a variety of important health issues for their communities. Through their Community Health Assessments and the MAPP process (Mobilizing Action through Planning and Partnerships), they are aware of the problems in their communities. Even though most teams are in the preliminary stages of determining their specific business plans, they have already started preparing their general ideas to develop a sustainable business plan.

The current list of topics include: Increasing vaccination rates, establishing a community health center and developing plans to address mental health services, health data analysis, occupational health, diabetes, teen pregnancy, access to primary care, substance abuse and the need for more school health nurses.

In order to develop a viable business, participants learn valuable business skills. During the on-site retreat August 3-6, the faculty spent a lot of time imparting tips related to businesses outside of public health. Frequently, Management Academy participants say "We are not a business; we are public health".

What do you think are some of the best and worst characteristics of a business organization and why do you think some participants are unwilling to accept attributes of businesses outside of public health?

A little off-topic

Over the past month, I’ve had a few experiences that don’t have much to do with public health business planning, but something to do with public health. I traveled to Greece for two weeks, spending time in the Cyclades islands of Folegandros and Santorini, and in the capital, Athens. Greece is an interesting mixture when it comes to public health:

1. They have a very good health care safety net system, paid for by the state. A couple of cab drivers told us how proud they were of their public health program. One was less enthusiastic because, although he himself, who has significant health issues, has never had a problem getting care, he “had heard that some people have some bureaucratic hassles.” He doesn’t realize the “bureaucratic hassles” we have in the states – even if you have health insurance, but especially if you do not!

2. Everyone smokes. Greece is Europe’s biggest-smoking nation: more than 40% of adults smoke. I don’t think we realize what a job we’ve done in this country to curb smoking, until you go to a nation where everywhere you turn – restaurants, stores, taxi-cabs – people are smoking. Greece is attempting to impose anti-smoking laws now – as of July 1, new laws banning smoking from hospitals, schools, and public places are going into effect. But restaurants can avoid the ban if they create smoking sections and they will also be allowed to ban non-smokers if they don’t want to have a smoking section! This is the third attempt in 10 years to curb smoking in Greece: it will be a hard habit to break.

3. Greek highways and roads are not for the timid. Greece ranks among the highest European countries in terms of road traffic accidents per kilometer traveled. Athens has done a great job of making itself more pedestrian friendly in recent years, although the narrow streets, lack of attention to speed limits, and lack of attention to parking regulations makes it difficult in places to get around on foot and it would be impossible in a wheel chair.

4. On the other hand, compared to my suburban American home I was able to walk much, much more in Greece than I am at home. Exercise came naturally and easily, built in to every day just getting from here to there. In one place we went, cars weren’t even allowed within the town limits. There’s something to the idea that “car culture” destroys the chance to live an active life.

5. When they tell you not to drink the water, don’t drink the water. They know what they’re talking about!

And, finally, the first thing I did when I got back to the states was get the flu! "Welcome Home!"

They say traveling is a great way to see your own home in a new light. It helps me to appreciate what we do well in the states, and what we could do better.

From the Management Academy Director

Recently, I attended the UNC-Chapel Hill Minority Health Videoconference. The title for this year's event was Breaking the Cycle: Investigating the Intersection of Education Inequities and Health Disparities. The speakers were

1. Reginald Weaver, Past President, National Education Association;
2. Dina Castro, Scientist, UNC FPG Child Development Institute;
3. Nicholas Freudenberg, Distinquished Professor and DPH Program Director in Urban Health Hunter College of Health Sciences/City University of New York; and
4. Lillian Sparks, Executive Director, National Indian Education Association

Each presenter spoke of the connection between education and the public's health and they made recommendations for each field.

They spoke of the need for more training and the need for programs focused on school-based health clinics, mental health programs and services aimed at teens on sexuality and HIV transmission. What are you doing within your community to provide a stable lifestyle to produce successful and healthy students? Please share with us.

Life Planning... get real!

One of the great benefits of a management development program is that it helps you manage your life. Our Management Academy students regularly report that they see improvements first in their performance as a parent or as a spouse as a result of trying to develop themselves as managers. Planning skills, negotiation skills, dialog skills, measurement skills, teamwork skills-- they all transfer.

For some of us, work performance begins at home. Are you taking care of yourself? Are you asking for what you need? Are you having the good, real discussions with your life partner that insure you are fulfilled and whole, working on the priority issues and both pulling in the same direction? In other words, are you doing life planning?

Life plans put work plans into perspective. Karl Umble likes to say that the goal is less about balance and more about "harmony." And the skills are essentially the same for both: the ability to plan well and then push through to execution, to work the plan into existence.

As the skin horse says to the velveteen rabbit, it takes a lot of love and attention to go from a stuffed toy to being real. In this respect, the velveteen rabbit is in line with a long stretch of work on authentic leadership, the notion that leaders have to let their personality come through the role to be maximally effective. They have to be present and real.

Last word is this: congratulations Anne on your wedding-- great team!

-- Steve Orton

From the Management Academy Director

In addition to the South Carolina Department of Health and Environmental Control, we have recently received other positive updates of plans that are being implemented and teams that are moving ahead to have an impact on their community.

The Gaston County Health Department, Gastonia, North Carolina, is preparing to break ground for their new Highland Health Center. The team participated in the Management Academy 2007-2008 cohort, along with their community partner, Gaston Family Health Services. They recently received $1.3 million thanks to the American Recovery and Reinvestment Act. The team members were Paula Black, Renee Clark, Veronica Feduniec, William (Bill) Gross, and Selenna Moss. The health department director is Colleen Bridger.

Also, we were contacted recently by a team from the Wilkes County Health Department, Wilkesboro, North Carolina. They participated in the Management Academy for Public Health in the 2008-2009 cohort, which just graduated in March, 2009. Their project focused on the issue of childhood obesity prevention for under-served Latino children. The program is a collaboration between the health department, the Wilkes Family YMCA, Wilkes Partnership for Children, and HOLA of Wilkes County. The program is known as "Y on Wheels" and is up and running. The team members were Melissa Black, Rose Marin, Donna Shumate and Judy West. The health director is Beth Lovette.

We look forward to having a new Management Academy for Public Health cohort starting August 2009 and we look forward to the opportunity to share the book, Public Health Business Planning: A Practical Guide with them.

Outcomes Story, South Carolina

I got a nice email from an alum a couple of weeks ago, Marie Horton from the South Carolina Dept of Health and Environmental Control, DHEC.

We were in the 2001-2002 group. Our project concerned training food establishment staff with the help of a video we produced on food safety. The video was based on our SCDHEC health inspector inspection sheet... The project was a success. I ended up pushing the video through to completion and we had it translated into Spanish and Mandarin a few years ago. The Environmental Health Division has it up on our SCDHEC website, if you want to take a look.

Here's a link to the "food protection" links page at DHEC. Note that DHEC staff partnered with the restaurant association to create and fund this video. This is all by way of background for what comes next:

The Environmental Health Division is working on a new product. They received grant money to produce a food defense video to prevent intentional food contamination. The planning meeting is next week and they have asked me to come and represent our Management Academy team. They want input on our experience in preparing our video.

Just wanted to share that with you. The work lives on!!!!!!!!!

I love the fact that this team implemented their plan. And I love the fact that their experience-- the specifics of what they did and the general lessons about business planning-- continue to bear fruit. Onward and upward!

-- Steve Orton

From the Management Academy Director

This is such an exciting part of the year for the Management Academy for Public Health. Not only have we had 7 teams apply from North Carolina, but we have also been fortunate enough to be able to offer team scholarships as a part of a collaborative effort between NACCHO and the NC Institute for Public Health. The scholarships are for teams that are entering the Action Cycle of the MAPP (Mobilizing Action through Planning and Partnerships) process and are interested in strengthening the implementation phase by developing a business plan centered on a sustainable business that addresses a community health issue. Applications have been received from across the country and we are looking forward to an opportunity to work with the selected teams. Please take the time to share with us your thoughts about the MAPP process and other processes that your health departments have been involved in. We think this is a great opportunity and we are so excited to share the book - Public Health Business Planning and the UNC-CH's Management Academy for Public Health program with new participants.

Business Planning and Flu Epidemics

Like everyone else in the public health community, we have been thinking a lot about swine flu lately. Public health leaders, managers and practitioners are scrambling to plan for what may come.

I recently contact John Dreyzehner, District Director of the Cumberland Plateau Health District in the Virginia Department of Health. Dr. Dreyzehner has sent many teams to the Management Academy over the years. We wrote about some of those in Chapter 7 of the book, “Competitors and Partners,” pages 68 – 69. One of the programs produced by a team from Dr. Dreyzehner’s district was called “Flu’s Clues,” an influenza vaccination program for children ages 3 – 9, based at the local Head Start programs and elementary schools

Steve and I posted back in November (17th and 20th) about “Flu’s Clues.” The program is now in its third year – now called “See you later fluigator” or “Fluigator” for short, with a sick alligator as a mascot, to avoid intellectual property issues. I asked Dr. Drehzehner whether having the program in place was making swine flu preparation any easier. Here are his thoughts:

“[The vaccination program] certainly increases ours and our partners confidence in being able to push out vaccines and treatments. At this point we can do points of distribution/Dispensing (PODs) in our sleep. The challenge at the moment, as is to be expected, is universal agreement on how/if to widely employ the present Tamiflu resource and to do it in a fashion that is consistent with legal equirements and good medical practice.

“There is understanding that we have to target it to the ill for treatment and, some think, their caretakers to begin at the first sign of illness. In one concept of operations I drafted we have accessible PODs open 8-12 hours daily at various location as drive through or walk -up (will spacing to prevent transmission). No ill (but sometimes exposed people) come in and complete and sign a medical attestation form regarding the illness in the person they are responsible for and get a course for that person(s) AND a reserve course for themselves and any other exposed in the household/place exposed to begin with the onset of fever and respiratory symptoms. In this way, the entire population can be assured the treatment is available for use in 12 hours or less to any one at any time. This works as long as this tricky virus remains sensitive. That is the readers digest version of one of my plans. But it is very doable.”

It sounds as if the Cumberland Plateau Health District is ready to do what it needs to do to address this possible epidemic. The challenge is deciding exactly what ought to be done – but it’s good to have the infrastructure in place to do it. They have that infrastructure in place because somebody thought of an idea, they partnered with important community institutions, they wrote a business plan that accounted for funding it, and they implemented it.

Let's hear from some of our readers -- what are you doing about swine flu? What obstacles are you coming up against?

Business Planning and MAPP

Business planning is indicated for public health organizations that are trying to

1. start new initiatives, that will...
   
2. collaborate with external partners, working together to...
   
3. generate revenue, and ultimately...
   
4. be sustainable (i.e., self-supporting) into the future (e.g., after the grant ends).

Maybe this goes without saying-- but the foundation of a strong business plan is a deep awareness of what the community (or market if you prefer) that you plan to serve actually needs and wants. That's the awareness that processes like MAPP are designed to create.

That's why we are so glad to be working with the Mobilizing for Action through Planning and Partnerships (MAPP) program-- a strategic planning process to help communities understand their community health needs, assets and opportunities, and then take meaningful action on them.

The public health business plan fits in at the "action" phase of MAPP, laying out the details of how a new initiative will work with the various partners, and connecting those details all the way back to specific needs, specific customers, and specific attributes of a community.

I mention all this now because the Management Academy for Public Health is offering scholarships to three MAPP communities this spring-- to come to Chapel Hill for training starting in August. Deadline for applying with your MAPP team is coming up fast, May 15, 2009. In addition to some great management training the team will have the opportunity to develop a business plan with the support of business plan coaches, UNC staff... and a room full of great colleagues from North Carolina and across the country!

Public Health and Health Care and the MAPH

I’ve been toying recently with writing another book or putting out a special issue about the conversation between public health and medicine today: how prevention and treatment are interdependent, what programs are currently under way that depend upon partnerships and collaboration between medical and public health researchers and professionals, and what are the policy implications for state and federal policy makers. The differences between the two fields have always been described as those between population-level issues (like STDs) and individual-level issues (like heart attacks). With the rise of chronic disease, and ever more convincing evidence of how prevention has an impact upon individual health outcomes, the lines are getting blurred.

Some of the recent Management Academy plans that Monecia Thomas described in her last post are great examples of how the two fields are coming together: the primary care clinic being set up by New Hanover County on the same campus as the emergency room; and the Making A Successful Teen (MAST) program dedicated to providing maternity care for pregnant teens, as well as ongoing contraceptive services, support and services for the young fathers, and dental care going forward. That team came to their issue through a desire to provide dental care, which has been linked with health outcomes, including the outcomes of pregnancy.

None of this is easy. There’s a reason many public health agencies are reluctant to provide primary care and dental care: it’s expensive in terms of space and personnel. It’s also difficult to draw in the paying customers who can balance the budget in ways that the poor and uninsured – even if they have Medicaid – can’t always do (particularly in the case of dental care). It is sometimes thought of as a stigma to get your health care at the public health department. In both cases described here, planners thought about this issue. In the case of the primary care clinic on the hospital grounds, users, even those who have a primary care doctor, may find it convenient to visit when their doctor is unavailable. In that case, it’s good that it is a separate facility from the public health agency. In the case of pregnancy services for teens, the team placed the clinic in the area of their county with the highest teen pregnancy rate so that transportation would not be an issue, and it is housed with other public health agency offerings, to protect teens’ privacy.

More and more, prevention is key. Also, individual health problems, if not treated early, have huge impacts on cost for all of society. Both of these Management Academy teams’ projects are promising and impressive ways to address these challenges.

-- Anne Menkens

From the Management Academy Director

Public Health Business Planning is based on the Management Academy for Public Health curriculum. The book and the program culminate in the development of a business plan focused on a public health issue in a community. This year's Management Academy session included 2 cohorts of 9 teams from North Carolina, South Carolina and Wisconsin.
Each of the teams developed their business plan throughout the nine-month program and then presented them to a team of business plan experts, public health professionals and their colleagues.
Here is a brief summary of the business plans:

North Carolina Teams

• Wilkes County Health Department

The team developed an 8-week "Fun and Fit Family Health and Fitness Center" licensed summer day-camp for a maximum of 110 children. The day-camp will be offered to children entering kindergarten through eight grade, five days a week, with operating hours from 7:00am to 6:00pm. The children who attend camp and their families will then be supported through case management and educational sessions by a "Health Coach" throughout the rest of the year. The goal is to increase awareness of the importance of physical activity, good nutrition and family time in the prevention of childhood obesity.

• New Hanover County Health Department

New Hanover County has several safety net options for medical care for the low-income uninsured, but there are not enough to meet the demand. At the same time, the number of low-income uninsured is rapidly growing, especially in this uncertain economic climate. As a result, too many low-income uninsured patients are using the emergency room as their primary care home. The team proposed a Primary Care Clinic at the New Hanover County Health Department, on the same campus as the emergency room at New Hanover Regional Medical Center. The Clinic will treat enough paying patients to subsidize the care of low-income uninsured patients, many of them likely referred from the ER. The Clinic will provide those patients a medical home, relieving the burden on the rest of the safety net.

• Northwest Partnership for Public Health

The team, made of staff from four local health departments, proposed a project focused on a medical billing consultant who will provide services to local county health departments in northwest North Carolina. The consultant will be available to help with coding issues, billing problems, evaluations, consultations and training in various areas. Additionally, the consultant will be able to assist the health departments with credentialing with insurance companies and with third party billing.

• Gaston County Health Department

The team developed a M.A.S.T. Program (Making a Successful Teen) that will provide specialized maternity and contraceptive services for Gaston County teens - tailored to their unique and complex needs. The services provided will include contraceptive services, comprehensive services, comprehensive prenatal services and education, periodontal screening and referral for dental health care. The program will operate using a model of comprehensive, interdisciplinary adolescent health care. The objectives of the program are to decrease the low birth weight percentage for infants born to teen mothers, increase the number of teens in Gaston County that initiate long-term contraceptives, increase percentage of teens in Gaston County that receive adequate prenatal care, increase the percentage of teens that remain in school during their pregnancy and have all program participants receive dental screening and treatment as indicated.

• Wilkes County Health Department

The second team from Wilkes County Health Department developed a program entitled Wilkes Goes Green. The project is a recycling business. The business will reduce the amount of solid waste in the Wilkes County Landfill and generate revenue through the sale of recyclable materials.

• North Carolina Division of Public Health

State and local public health departments experience an overall lack of formal education in public health, and therefore have deficits in core public health skills, including evaluation, epidemiology and statistics. Despite documented evidence of this problem, many state health departments lack funding and flexibility within the government system to ensure a competent workforce. The team developed a program entitled EpiSmart as a cost-effective, convenient, and targeted approach to training local public health department employees in core public health skills and on deliverables required for local health department accreditation. The goals for EpiSmart focus on increasing epidemiology, evaluation and statistics capacity, improving the quality of outcome and evaluation data, equiping local health departments for accreditation and providing an opportunity for peer-to-peer mentoring and learning in evaluation and statistics.

South Carolina Teams

• South Carolina Department of Health and Environmental Control

One of the South Carolina teams developed a worksite wellness program, "Wellness Works". The program will offer employees an opportunity to live a healthier lifestyle. The program will be offered four times annually at 12-week intervals with weekly follow-up with each employee during each 12-week period. The components of the program include a health assessment, with baseline health information, nutrition education with measurements of body mass index (BMI), walking program and the option of participation in a Weight Watchers program at the site defined locations.
By offering "Wellness Works", employees will receive information on the importance and benefits of physical activity, proper nutrition and weight loss/maintenance. The program will provide tools to empower employees to take responsibility for their health.

• South Carolina Department of Health and Environmental Control

Youth obesity is a growing epidemic in South Carolina. Currently, there are no programs dedicated solely to eradicating obesity among children in Spartanburg. The two hospitals do not offer classes or outpatient services to overweight children. The Spartanburg County Health Department will offer "Stepping Up", a weight management program for overweight and/or obese children in the 10-12 year age group. The program will address physical activity, nutrition, and behaviors needed for a health lifestyle. The program will be motivational, hands on and fun-filled and is designed for improving fitness, nutrition and self-esteem.

Wisconsin Team

• Milwaukee/Waukesha County Consortium for Emergency Public Health Preparedness

The team from the Milwaukee/Waukesha County Consortium for Emergency Public Health Preparedness along with local public health agencies will develop and implement a Quality Rating System (QRS) for licensed child care centers in Milwaukee and Waukesha Counties. The centers will receive a rating score after the completion of an on-site assessment of their written plans or proof of their compliance in the areas of: communicable disease prevention, immunization rates and records management, staff education, emergency plans, and early childhood curriculum. Revenue will be generated by fee for services for trainings, plan development, record audits, onsite immunization clinics and selling home emergency preparedness kits.

For more information about the 2 selected Award-winning business plans, see www.maph.unc.edu

The site has the complete business plans posted for the Northwest Partnership for Public Health and the Milwaukee/Waukesha County Consortium.
Please take a look and let us know what you think.

Congratulations to all of the teams that have successfully completed their business plans and now the real work of implementation begins!

Opportunities...

You know, one of the big challenges to entrepreneurs inside organizations is creating urgency... and that's a problem that the economic crisis has mitigated. People I'm talking with now are well aware of the urgency. Now we just need to manage it, harness it, use it!

Bizbox.com has an interesting take on the unemployment rate right now:

"Plenty of laid-off workers across the country, burned out by a merciless job market, are building business plans instead of sending out résumés. For these people, recession has become the mother of invention." Specifically, right now is when the tipping point seems to be happening: the mentality is changing from one of desperation to one of opportunity. From here on out, the little guys are going to be playing a bigger and bigger role in putting the economy on the road to recovery. [link]

You've heard a similar take from this blog, and from the UNC webinar on survival in a down market. Tomorrow's Public Health Grand Rounds will echo the point as well. This environment is creating opportunities at the same time it is causing havoc.

--Steve Orton

From the Management Academy Director

Recently, another Executive Education program at the NC Institute for Public Health completed its final retreat. The 2008-2009 Emerging Leaders in Public Health cohort completed their 9 month program in February 2009. The Emerging Leaders program is designed to prepare the next generation of public health leaders by identifying and training those individuals with the talent to serve in significant leadership capacities in the next decade.

One of the conference presenters was Keith Caver, the President of Caver Consulting in Charlotte, NC.
Caver shared with the participants information about the 9 Roles of Strategic Leadership:

1. Navigator
2. Strategist
3. Entrepreneur
4. Mobilizer
5. Talent Advocate
6. Captivator
7. Global Thinker
8. Change Driver
9. Enterprise Guardian

It is interesting to note that in public health, there are usually few Strategists and Entrepreneurs in the field of public health. The characteristics of these Leaders include

• Continuously looking beyond the current year
• Perceiving what drives the business
• Taking calculated risks to capitalize on emerging trends
• Turning threats into business opportunities
• Using financial data to help achieve successful business outcomes

The Management Academy for Public Health serves a unique mission to bring some of these more business type aspects to public health, so that we (as public health professionals) can strive for more sustainability.
I look forward to the upcoming Management Academy for Public Health graduation in 2 weeks and seeing the completed projects that showcase the Strategic and Entrepreneurial spirit of the public health professionals in North Carolina, South Carolina and Wisconsin.

Marketing...

Great comment from a good friend in North Carolina on the prior "shovel-ready" post:

Locally we rarely do market research. One survey we do perform is the Community Health Assessment, but only every 4 years. I have recently come to view the community health assessments as looking at what health status people have purchased.

Exactly. What purchasing choices are being made by individuals and by the community? That's a different question than the ones that typically get asked for a health assessment.

Could we instead ask WHY they have made that “purchase”/ lifestyle behavior, or even WHAT would make our public health option “sexier” for them to want to purchase it? For example, instead of asking “have you been diagnosed with diabetes?” could we ask “what stops you from testing your blood sugar every day?”? “How would you like to be physically active?” “What prevents you from doing that?” “What would it take to get you to eat 5 fruits and vegetable servings a day?”

Those are great questions-- and leadership is about asking the right questions.

I'm reading a book called Nudge, by Thaler and Sunstein-- it is about "choice architecture," about the way that policy-makers can "nudge" people to make appropriate choices (and still give people the freedom of options). As Shirin says, maybe that means making the healthy option "sexier," or maybe it means doing the research to find out what choices people are likely to make in certain situations and then adjusting the choice architecture to insure that most people are going to make the best choice for their health.

--Steve Orton

Shovel-ready?

I've been inspired by the term "shovel-ready" in the media reports about the stimulus package. I think that's one of the things we want to foster in public health: organizations that have a set of shovel-ready plans that they would be ready to start quickly.

Maybe some of you have more money than you have ideas-- that's a difficult state of affairs but it can be solved. Innovation is a process you can learn. We've written some about it already.

I'm guessing most of you-- especially now-- don't have lots of extra money to spend. Do you have more ideas than money? Should you?

I think it would be a bad plan to quit brainstorming and quit planning at this point. Because what if someone does offer you some money? What if some stimulus money appears, and needs to be spent in a hurry? What if you wound up with some extra time on your hands, as funding for certain projects dries up?

The answer is this: you will want to have a little folder of "shovel-ready" plans. This is exactly what the business planning structure is about-- getting from the back of the envelope to a fleshed-out, researched, vetted plan with real need, a real chance, a real budget, real partners. A business plan is shovel-ready: ready to get funded and get going.

Let's talk more about developing "shovel-ready" public health ideas-- are you developing plans now? Why or why not? What would constitute shovel-readiness in your organization? Drop me an email or respond here!

--Steve Orton

From the Management Academy Director

On Tuesday, February 10, the current Management Academy for Public Health participants had an opportunity to participate in a webinar presented by Dr. Sergey Sotnikov. Dr. Sotnikov is an Economist and Senior Service Fellow in the Division of Partnerships and Strategic Alliances (DPSA), National Center for Health Marketing (NCHM) at the Centers for Disease Control and Prevention (CDC). He currently serves as Acting Team Lead for the Technical Assistance, Training and Evaluation Team. The presentation, Why Partnerships are Important for Generating Financial Review and How Their Effectiveness Can Be Measured, provided participants an opportunity to know more about the CDC's Division of Partnerships and Strategic Alliances and how partnerships can have many benefits for the field of public health. These benefits include

• Exchanging Information
• Better Operational and Strategic Coordination
• Elimination of Redundancies
• Knowledge Transfer
• Client Referrals

Dr. Sotnikov stressed the importance of certain types of partnerships with public health departments. Tune in to find out more information about which partnerships for local health departments (Faith Based Organizations, Non-Profit Organizations, Hospitals, Community Organizations, Universities) tend to be associated with higher revenues.

The next scheduled webinar presented by Dr. Sotnikov is Friday, February 20th at 1:00PM EST. You are welcome to participate. The Call-in Number is 877-298-8255 and the Participant Code is 7249865.
For the internet access information, please contact Monecia Thomas at monecia_thomas@unc.edu
or Nancy Cripps at cripps@email.unc.edu

If you have difficulty with the internet access information, please feel free to call in and listen.

Social Marketing for Public Health

Some current Management Academy scholars were asking us about social marketing recently. It’s something we cover in the program but not so much in the book—there’s a lot of literature out there on it. Social marketing is basically using marketing strategies to change behavior. Besides just getting someone to buy something, it’s selling the behavior change, keeping in mind that the “costs” are not necessarily just monetary, and the "product" is not only the main behavior change you want to effect. The example we use in the book is that a program to supply clean needles to drug addicts has some costs that those of us who don’t do illegal drugs may not think of, like the “cost” of losing friends because they think you don’t trust them enough to use their needles. And, the "product" is not just new needles but a new way of thinking of yourself as worthy of using clean needles. And in the end, the hope is that friends will bring friends along to the new "product." Most of what our scholars do is not quite at the level of difficultly as a needle exchange program in terms of “selling” the change—we’re generally talking day care center preparedness or business-place health programs. But still, there are issues related to product, place, promotion, and price—the Four Ps—that should be considered.

One team this year has a clear social marketing angle. They are setting up a primary care clinic in their health department, and they’re working with a community group called 100 Black Men to attract early adopters and motivate others in the particular target group to care about their health in ways they may not have thought of before. Maybe as a group they think of going to the doctor as not a "manly" thing to do, but if they see the 100 Black Men group going, they'll think differently about it. As the group members begin to understand and believe in the program, they’ll bring their friends, and a peer social marketing network is formed.

In a meeting recently of Executive Education program directors from the NC Institute for Public Health we thought about our programs in similar terms, too. With the economic downturn, we must think about how to save money, maybe change the programs to fit a new budget reality, put our own preaching about fiscal efficiency into practice. But at the same time, one thing our students always say is that they love the on-site time and when they graduate they miss how “cool” it is to be part of this special group that gets to come to Chapel Hill a couple of times over the course of a year. What is lost if we replace some of the on-site time with distance learning components? The cost of those components is a fiscal reality, but there may be a cost in not doing them (or doing less of them) that we have not considered. A lot can be gained if more public health professionals can attend who would not be able to come if they had to travel, but some sense of being part of a special club might be lost. When we are considering the social marketing angle of our program, we will have to think about what, exactly, we are “selling” besides the nuts and bolts of public health management and leadership education.

Please share any thoughts you have about the "product" we call the Management Academy for Public Health. What did you value? For you, how did its "costs" compare with the "product" you received? How can we do it better?

-- Anne Menkens

Industry Analysis and Competitor/Partner Analysis

During a recent webinar, someone raised the question, “What is the difference between industry analysis and analyzing competitors for potential partnerships?” The answer might be worthwhile to share with our larger audience:

When you analyze the industry, you are asking questions about the work you want to do, where you want to do it, how to do it best, and so on. Who else does it (competitors) is part of the analysis, and interviewing them about their experience with the work is an important step, but the questions are broader than that. What types of organizations succeed at doing this, and what exactly did they do that helped them succeed? This last is called a “key success factor” – and it’s very important. One team this year is planning to operate a primary care clinic at the health department. They know it’s needed in their community, mostly by the uninsured, but they’ve learned through their industry analysis that a key success factor for such programs is to include patients who have insurance (but who may not have a primary care doctor) in the mix of clientele. To ensure that they can include this factor in their program, the team is working on the customer service angle of their organization – making the waiting area more welcoming and time-efficient, and making sure that customer service is considered as their organization builds a new facility in the coming months.

Now, making competitors into strategic partners is the next step. Use your industry analysis to figure out what you bring to the table, what you need from your partners, and how you two can most effectively work together, mutually beneficially, to get the job done in a sustainable way. So, you’ve identified you need clientele from a broad range of “ability to pay,” then think about what partners would help you get there. If you only partner with the local hospital, you’ll get all of their uninsured patients and none that can pay. Is there a health network in your area that works to coordinate care for the under-insured poor? Is there a Community Health Center that has trouble keeping providers, or needs a place to send the overflow of patients? Talk to specialists who will take referrals, and private practitioners who will refer to you or work with you to provide care.

This example may not seem exactly like “public health” work, but unfortunately public health providing primary care is a reflection of the current economic times. And ideally, public health brings prevention to the equation, making the whole community healthier over the long haul, than they would be without your participation in primary care.

More to come.

From the Management Academy Director

Public Health Business Planning: A Practical Guide is based on the highly successful Management Academy for Public Health (MAPH). As the new year kicks off, we are now in the midst of recruiting for the 2009-2010 cohort. We have received a lot of support from the North Carolina Division of Public Health and the local health departments across the state. I recently sent a brief note to several health directors in North Carolina and I wanted to share it.

I want to thank you for your support of the Management Academy for Public Health.
As I attended the North Carolina State Health Director's Conference last week, it was interesting to hear so many speakers reference information presented during the Management Academy.

• As our state health director spoke about becoming the healthiest state, I thought about how carefully each of you considered the needs of your community as you contemplated your MAPH project.
• As Dr. Howard Frumkin, Director, National Center for Environmental Health-CDC, spoke about environmental health risks, his final talking points focused on the fact that Solutions are at hand and Collaborating Creatively and Thinking Broadly are important, I thought about how MAPH encourages each team to collaborate and include a community partner, such as a local physician, social work manager, hospital administrator, or non-profit representative.
• As Dr. Rich Cohn, Director, Health Sciences Research-Global Health Sector at SRA International, spoke about increasing efficiencies, I thought about how your project will focus on increasing efficiencies, while developing community oriented projects.
• As Dr. Gary Cox, President, NACCHO, spoke about what if the price of a dozen of eggs had increased at the same rate as healthcare, the price would now be over $80 for one dozen of eggs, I thought about the importance of being able to provide healthcare services for those that can not afford it.
  

In addition, thank you for carefully considering your projects and your team composition.
I was so pleased to review the applications and see a diverse group of people (racially and by gender). Also, a few of you mentioned that although your team is limited to 5 or 6 participants, you understand that there can be additional health department staff that can provide assistance for the project, so that all of the work is not placed on the shoulders of the team members alone.

I will contact you over the next few weeks in reference to scheduling a conference call to discuss your team project with the business plan coaches. Meanwhile, if you have any questions, please feel free to contact me.


As you read this and you would like to send a team to the Management Academy, please see www.maph.unc.edu

Book Club Webinar 2

We had a book club webinar yesterday to talk with current MAPH students about their progress in terms of industry analysis, community need, competitors and partners, marketing, and project operations. Some of the following issues, thoughts, and suggestions were raised. Do you have any further advice for our community of practice?

Issue: When your community health assessment identifies a problem, but industry analysis reveals a barrier to meeting that problem in a sustainable way.

Example: We have developed an obesity prevention program that will be a summer camp for children. Industry analysis revealed that one success factor is being able to charge enough to pay for the health care and physical education personnel who will work for the program. Alternatively, a success factor is to have a pool of professionals available for volunteer work. We won’t be able to charge enough, so that becomes a barrier for us. We are in a rural county with low income population. We don’t have a large number of professional volunteers to call upon either.

Some ideas: 1) broaden your area of reach. Look to make it a region-wide program rather than just for your county; 2) start smaller; 3) see if insurance will pay, if children are referred by physicians; 4) partner with another group running a summer camp (YMCA?), and be part of their program; 5) charge a sliding-scale fee; 6) consider things that could be offered in-kind to support the program.

Issue: We’ve got a community health assessment telling us exactly what the public should do to be more healthy. How do we communicate with people about the need to change behavior, environment, etc. without insulting or patronizing them?

Thoughts: Public health workforce needs development in social marketing. We need to learn how to talk with people and understand their struggle. We don’t want to send the message – “your neighborhood is run-down and has bad grocery stores and no sidewalks” or, “you are overweight and need to exercise more and eat better” -- because these messages are not going to encourage change. The message of need has to first come from them, and it has to be communicated respectfully. Sometimes public health people are too focused on the big picture and all the problems that need to be solved. We need to step back and give people space, “partner with people,” listen to them and have respect for their understanding of their own community and its strengths and challenges.

Issue: We’ve brainstormed and identified partners who “have what we need,” but they aren’t interested in working with us. It may be the economic times, or it may just be the small relative scale of the project we’re planning, but we can’t make headway getting partners on board.

Suggestions: think of the partnership as more than a one-shot deal, more than just what they can give you: think of it strategically and long-term. If you can, get on their board, or on the board of some other community project they’re involved with. If you are not the appropriate person in your organization to do this, identify the colleague who is appropriate, and try to get him or her involved. This way the potential partner will see the value you bring to the table and may be more apt to consider you a potential partner. Also, try to find out why the potential partner is not interested. Is it a current circumstance, like the economic downturn, or are they truly not interested in the project? If the latter, find out what they are interested in, and come back later with a different plan, closer to their interest. Either way, if you become involved with their organization in some way, they will be able to see the value of working with you.

Issue: We have not really communicated with our superiors about our project since we first were accepted to the Management Academy. Our project has changed a lot since then.

Suggestions: The Management Academy curriculum has begun including very early discussions with business plan advisors, to troubleshoot before teams even begin so that project change may become less of an issue going forward. The risk here is that your project may have changed to the extent that you need some of your colleagues to help you in its operation. If they don’t know what you’re working on, will they be willing to be part of it when the time comes to implement? Another risk is that your boss may not give you the resources or other support you need if he or she feels you have not communicated well. Try to get a standing agenda line at your staff meetings for talking about your Management Academy progress.

Issue: We’re facing budget cuts of 23%, and have been asked to plan for an additional 15% on top of that. All we’re talking about at staff meetings is this reality.

OK, so maybe new programs are not what your staff meetings are about right now. Fair enough. Keep plugging away. Remember we’ve been through rough times before. Remember that broader support for your programs, in the form of partnerships and ample communication with political and other stakeholders, is going to carry you through.

To our readers: Please help our scholars with the issues they have raised! Have you faced similar challenges? What advice do you have? Thanks to all who participated.
-- Anne

best practices

I was in DC right before Christmas with a group of staffers from NACCHO, the National Association of City and County Health Officials. They are all either writing business plans currently (for new NACCHO initiatives) or interested in learning how their association members might use them.

First my NACCHO pitch: if you work for a local-level health department, NACCHO is where your friends are, even if you haven't met them yet. The staffers and members of the organization live and breathe local public health. This is where the committed, innovative, networked leaders and thinkers can be found.

Let me share some quick notes about working with this group. First, they understood very quickly how a business plan process might serve many different purposes and audiences on the way towards creating sustainable revenue sources (e.g., internally to make a good analysis and solid decisions, externally to connect with potential customers and to attract start-up funding).

They were similarly quick to understand potential downsides to a business planning process:

• Revenue generation is not always the right goal!
  
• Business planning can be hard: some initiatives are too small to justify doing it.
• Business plans that chase the wrong strategy are... counterproductive.
  

One of the fun things about the group was the way they talk to each other: everyone was direct and honest (and respectful of course). Honesty has a way of unleashing laughter I believe... in addition to its other benefits. This openness helped the group to quickly unearth important questions underlying their initiative: who should we serve? what would be most equitable? who ought to be managing the program ten years? what would success look like?

A final note on brainstorming. This group was able to generate an impressive list of possible approaches to what at first seemed a fairly straight-forward educational goal. A turning point was the moment when they agreed to stop censoring themselves and start listing their dumb, impossible and potentially illegal ideas. With those ideas on the board, a whole range of interesting possibilities opened up.

--Steve Orton

The Time is Right...

I was talking with Monecia Thomas, the director of the Management Academy for Public Health, about recruitment for the program. She and the program coordinator, Nancy Cripps, have been working hard contacting teams that have expressed interest and urging them to submit applications. All are due at the end of May, but because it is a competitive process, the earlier the better!

We know that funds are tight right now, but I’m going to lay out a few reasons this is actually the perfect time to come to the Management Academy.

1. The economy may get worse, and the skills you gain at the Management Academy will see you through the rough patches. It will help you manage your people and resources more efficiently and effectively; it will maximize your connection with the larger community of individuals and organizations interested in the public’s health; it will give you the means to bring money in to your organization that is not tied to political or grant makers’ priorities. The external evaluation of our pilot phase indicated that public health agencies had garnered $6 million in revenue from training that had cost $2 million to provide. And that was back in 1999-2002: we’ve had hundreds more students since then, all of whom have written, and many of whom have implemented successful business plans for revenue-generating public health projects. Imagine what the next large evaluation study may show!

2. The political environment is changing. All signs point to a greater willingness of the new administration to put federal monies towards health care and public health priorities in the coming years. Already Congress and President-Elect Obama are preparing to renew the bill that provides health insurance for low-income children. Also, insurance for legal immigrants under 21 may be added back into the bill, after having been cut more than a decade ago. As public health managers, you can be at the forefront of this new era. Expertise in building strategic partnerships, managing data to make the best case for your priorities, and managing money to support shifting emphases will all help you.

3. The workforce is changing. It has to: we must bring in new public health professionals and management to fill the void that will be created as today’s public health workforce retires. How better to groom that promising middle manager for a leadership role than to teach him or her strategies for managing money, people, and information? Do they know how to delegate tasks? Do they know how to read a budget? Do they know how best to communicate in written work or oral presentations?

Public Health Business Planning: A Practical Guide is about one small part of the Management Academy for Public Health. Call Nancy Cripps at (919) 966-2248 or Monecia Thomas at (919)843-8541 to learn more about the rest of the program.

-- Anne Menkens

Big Hairy ATTAINABLE Goals

Making New Years resolutions is not all bad. If you take Steve’s words of advice and make your resolutions positive statements with a clear mission, and break them down into concrete things you can do to reach that mission, a resolution to succeed could be the ticket to success.

In Chapter 1 of the book (pg. 11 to be exact), we list a few examples of initiatives that started out as Management Academy business plans. Here are some of the New Years resolutions that might have been the germs for those plans:

• Deal with mental health issues in our community
• Bring private practice behavioral health providers into the orbit of the public health department
• Increase positive results for low-income, at-risk pregnant women
• Decrease Medicaid costs for treatment of at-risk pregnant women
• Provide training options for public health workforce development in Wisconsin
• Increase physical activity in our community’s children
• Help the family members of HIV-positive patients to get health care services
• Improve waste water treatment in rural Virginia

Notice a few things:

• Each of these resolutions is a positive statement of a concrete (not abstract) goal
• Each resolution is a reasonable goal for a public health organization
• Each resolution is easily broken down into specific objectives, tasks, plans
  

When we talk about BHAGs, the A stands for Audacious, but it could also stand for Attainable. Audacious is better, because it gets your attention, and it forces you to say WHAT should be done and WHY, without worrying too early about the WHO or HOW. But Attainable should be your next thought: WHO’s going to do it? HOW will they do it? And answer positively, as if the sky’s the limit, but stay concrete. WHO will do it? The 10 new people we’re going to hire. HOW will we hire them? By partnering with these potential stakeholders…. WHEN? Maybe not today, but by this particular date, if we do these particular things.

So don’t stop making resolutions. Just keep it real, as they say. And don't wait for January 1.

New Year's Resolutions...

Happy New Year everybody--

I've been thinking about New Year's resolutions over the last few days. A friend asked me what mine were, and I told him I didn't like them. He wanted to know why not.

Partly, my issue with the New Year's resolution is the way it suggests that I am the problem. I'm doing too much of something (smoking, drinking, watching TV, surfing) or not enough of something (working out, helping the kids with homework). Why? Because I'm rotten. If I just had a little more resolve, this issue wouldn't exist.

Many resolutions, it seems to me, are addressed at long-standing issues or behaviors. It isn't that I turned bad last year all of a sudden, it's that I've been this way for a long time. But what's changed, besides the big number at the top of the calendar? Nothing. All the reasons for my bad behavior remain the same. There's a book I like, How the Way We Talk Can Change the Way We Work, that addresses this point. Keegan and Lahey point out that there are almost always competing priorities that have been preventing you from changing whatever it is you now want to change by making a resolution. Underlying those priorities are assumptions. (For example: I can't take time to run because that's not productive work; other people need me. Running is selfish; if I'm selfish I will be shunned, which is much worse than heart disease).

The point is this: in the absence of some careful thought, even our best-intentioned resolutions are unlikely to be successful. The system will prevail. Worse yet, the role of the system will remain invisible to us! We will likely see our failure as a reflection on our own lack of willpower, our insistence on subverting our own good intentions, our own failure in self-management. This is all in the structure of the New Year's resolution: "Do this... or else know yourself to be an irresolute failure."

Better would be to develop some big strategic goals for yourself, and then start devising plans to address those big goals. My wife and I have made "healthy and happy" a strategic focus for the last couple of years. There are hundreds of ways to go after that goal-- and if many of them fail, that's OK. Keep trying! Find some things that work! Reflect regularly on what is and isn't making you happy! Ditch what isn't working! Maybe a conscious program of saying "please" in the family setting would increase happiness! Give it a shot! Try a pilot! And then think of ways to sustain it!

Let me briefly bring it back to the subject of the blog: one, self-management is a key success factor, the foundation of good leadership. Two, don't do "New Year's Resolution"-style planning and then expect good results. Do solid strategic planning, and then do solid business planning on specific action items.

--Steve Orton