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

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