Public Health Management Final

Managerial Structure

-bureaucracy is most common model -most organizations are hierarchical with several individuals reporting to one supervisor -provides clear lines of authority but is slow in responding to changes -the optimum span of control is from three to seven individuals -for some companies, span of control is 20

Governance & Leadership

-governance and leadership are key components in effective and efficient enterprises

John Stacy Adams

-if inputs are rewarded by outputs, people will feel happy in their work -if people feel that inputs are not rewarded by outputs, they will become unmotivated -people will try to re-establish balance and equity by reducing their level of effort, becoming inwardly disgruntled or outwardly rebellious -equity can often be achieved by greater pay or a new position

Collaboration

• Boards may and should collaborate with multiple entities • Boards are tasked with improving collaborative relationships • Board meetings are a source of collaboration in that the general public can participate in the democratic process • Board members are community citizens that are viewed as legitimate spokespersons • Board members are often community leaders with ties to key stakeholders

Generating Cash

• Borrowing cash and lines of credit • Repaying loans • Minor sources include grants, donations or fund raisers

Making Informed Budgeting Decisions

• Budget is a working document • Budgets from previous years are examined • Designating available funds • Operating plans become reality as budget is spent • Begin budget preparations early • Category by category plans are compared with actual spending • Evaluations are only useful with accurate information

Explanation of Behaviors

• Causality: Forces acting on people are responsible for human behavior • Directedness: Behavior is not only caused, but it points toward something • Motivation: A push, want, need, drive, feeling or personal goal that can explain actions

Operations

• Daily operations in a public health agency have been described as organized chaos • The organizational structure of many agencies are the norms for other departments • These are not synonymous with daily operations

Territoriality

• For years, public health agencies have not worked optimally with each other • Not working together stems from individuals seeking to protect their own organization's territory • Territory results from leaders of public health agencies feeling that they know what is best, having finite resources, and working in jurisdictions with boundaries • Health problems usually ignore geographic boundaries and do not respect political boundaries • Building relationships with stakeholders is both time consuming and difficult • For a team approach to succeed, they must be built

Theory Regarding Rewards- Fredrick Taylor

• Fredrick Taylor developed scientific management • He broke down complex tasks into a series of individual components • By understanding the components of each task, management can plan every move and thus create an efficient flow of work • As tasks became more complex, the limits of scientific management became apparent

Informal Group Dynamics

• Informal groups often develop during and after discussions • Reduce the ease of communication for all • Informal communications flow more easily than formal communications • Smaller departments tend to have closer interpersonal relationships than larger departments • Cultures require that individuals obey laws and persons of authority • Small groups develop customs and norms and designate leaders • Leadership can be related to charisma, wisdom or judgment • Subordinates obey leaders due to position, office or perceived power

Theory Regarding Rewards- Kurt Lewin

• Kurt Lewin postulated that employment affects empowerment and productively • Eric Trist and Fred Emery built upon Lewin's ideas and studied employee social systems and the technical aspect of jobs • All said that productive, rewarding work occurs when an organization's social system and technical system are in harmony

Duties of a Board of Health

• Local Boards of Health are responsible for ensuring legal authority, establishing a policy base, providing adequate resources, fostering collaboration and maintaining accountability for public health at a local level

Applications

• Most common form of organization is a bureaucracy (pyramidal hierarchy) • Authority flows downward • Lines of communication are clear • Matrix is another form of organization • Specific skills are brought together to complete a task • Hierarchical structures require support for maintenance • Controls consist of organizational rules and policies • Elimination of ambiguity and discrimination results from controls • Change versus stability • Stability is desired • Stability allows for cooperative human relationships • Succession planning is important for stability • Names for vacant positions should be kept on file

Paperwork

• Most employees dislike paperwork but it is an important requirement • Paperwork documents daily activities reimbursement, cost center allocations, and time spent on projects • Documentation is also important for legal defense

Fixed Asset Management

• Most fixed assets have a useful life of one year • Hospitals are labor and property intensive • Fixed assets incur ongoing costs • Upgrades to equipment • Inventory reviews, condition of equipment and cost centers

Know the Consumers

• Successful marketing strategies focus on consumers from the beginning to end • Surveys and research are used to find out exactly who the customers are • To be considered as a market, individuals must want or need a product or service and be willing to acquire it • A decision must be made to market a product or service to all or part of an audience • Local public health agencies have the responsibility to serve all members of the community • Not everyone in the community needs or wants the services of public health • Demographics must be known to properly create a marketing program

McGregor - Theories X and Y

• Theory X assumes that people are lazy and require constant and close supervision • Theory Y assumes that people seek responsibility and control over their work or production and will reward management with increased productivity

Putting It All Together

• There is no single or best way to improve board of health governance • Making governance issues a priority for both the health officer and the board is a first step • The health officer can use a standardized system for providing information and involving board members in strategic and policy issues • Reporting to the board on how the agency is accomplishing goals will improve knowledge among board members

Types of Boards

• Three types of boards oversee operations • Advisory-report to their county, city or township commissions on public health and also are voices for their communities • Governing-have the authority to establish local ordinances or regulations and hire/supervise/fire the chief executive officer • Policy-making-guide the management of public health activities by setting goals and priorities through the use of statistics and evidence-based data

Accounting Methods

• Two ways to record transactions • Cash basis - when money changes hand • Accrual - when revenue is earned

Personal Freedom

• High-quality staff members are normally expected to make professional judgments • There is no single or best formula for personal freedom • Each organization must make decisions on the extent of personal freedom that will be allowed • Personnel polices should be used to answer questions regarding work time, vacations, and chain of command • Employee morale and performance typically improve when employees are given greater control over their own jobs • Maintaining a clear focus on an organization's mission requires clear and open communications • By increasing openness in communications, a more effective style of management can be developed • Slackers will be shunned when: • Organizational standards exist • Equitable management styles are used • A capable and close-knit staff has been developed

Middle Management

• Individuals with true programmatic expertise normally occupy middle management positions • When budgets become tight, some agencies try to flatten the organization and eliminate middle managers • Ultimately, this eliminates the expertise that makes programs and personnel successful

Legal authority

Local boards may be authorized by state law to adopt public health polices, issue rules and ordinances, enforce regulations, hire-reward-fire employees, and adjudicate appeals

Management

-Provides framework for controls -Controls are circular and plans are made and elaborated -These must be consistent with goals and the mission statement -Plans are made to translate goals into reality -Plans should be periodically reviewed and audited -Were objectives, budgets, and other resources sufficient? -Did members implement plans or were they not productive?

Homans - Exchange Theory

• Behavior is an exchange • People interact to receive rewards • Each person communicates in a group • Contributions must be consistent with group norms • Rewards or sanctions (punishments) help to shape appropriate behaviors

Groups

• Behaviors of individuals that are combined into a group become summed • When summed, individual behaviors, group behavior and group dynamics are not always similar or consistent • Understand individual behaviors before attempting to explain or change group behavior or dynamics

Local Health Departments Day-To-Day Responsibility

-Summarized within six basic service areas: 1. Collecting and analyzing vital statistics 2. Sanitation 3. Communicable disease control 4. Maternal and child health 5. Health education 6. Laboratory services

Leadership

-defined as the skills necessary to integrate local rules. regulations and policies to enable an organization to exist, thrive, and flourish -Important aspect of public health leadership is monitoring the activities of practitioners

Henry L. Gantt

-developed an early pictorial system for planning and task allocation -overall goals are considered as a series of interrelated steps -manager gains a clear understanding of timing and interrelationships of the components or events of a project -does not show dependent relationships between different project steps

Governance activities

must be tied to the core functions of assessment, policy development, and assurance, as well as essential services of public health

Bottom-Up versus Top-Down Budgeting

• Array levels from lowest to highest • Lover levels comprise most budgets • Provide cost control enforcement • Top-down budgets are controlled by management • Mixture of the two is optimal • Budget meetings provide feedback

NPHPSP Instruments

• Assessing state public health systems, local public health systems, and local governing bodies • Aid users in answering questions • How well are essential services being provided? • Information obtained may then be used to improve and better coordinate public health activities

Accounting Concepts

• Assets are economic resources • Liabilities are debts owed • Equity capital, net worth, net assets • Revenue earning of an agency • Expenses are outflows of assets • Profit in a non-profit organization is excess of revenues after expenses

Inventory

• Assets available for direct sale or use in normal operations • Costs of inventory • Point of sale registers also record reductions in inventory • Can set call for order points at predetermined levels

Fixed versus Flexible Budgeting

• Assigns specific dollar amounts • Appropriate to have some mix of fixed and flexible components • Revenue increases as service volume increases • A fixed revenue budget cannot increase its level of service

Mental Health Problems

• At some point in time, most employees behave in a way that inconveniences others • When such episodes are rare or brief in duration, they are likely to be related to situational stressors • Serious mental health problems such as personality disorders are psychological in nature • Most managers may not recognize them

Theory Regarding Rewards- Skinner

• B.F. Skinner coined the term operant conditioning when he constructed the Skinner Box and studied the behavior of lower animals • Skinner showed that the sooner rewards occurred after a task was completed, they become more reinforcing and valued • Based on Skinner's work, managers should remember to be timely when attempting to reward employees • Extrinsic or external rewards are obvious and tangible; examples include pay, promotion, and benefits • Extrinsic rewards are easy to identify but often difficult to provide

Four basic financial statements:

• Balance sheet summarizes the financial position at any given point in time • Income statement delineates profit or loss • Statement of changes in net assets provides reasons for fluctuations in net assets • Statement of cash flow provides information regarding cash received cash paid out

Deontology

• Based on absolutes • Many religions teach that the will of God is absolute • God provides instructions for living • These instructions give sufficient guidance for all situations and are not debatable • Appropriate actions are expected • Imposed rules are not subject to discussion, interpretation or violation • Personal satisfaction is not considered

Getting Down to Business

• Board evolved a regular and predictable pattern for conducting its business • In accordance with statute, announcements of meetings are published locally and sessions are open to the public • Minutes are kept and officially adopted at each subsequent meeting

Borderline Personality Disorder

• Borderline disorders are the most common personality disorders and the most difficult to treat • Employees with borderline disorders are very intense, have frequent outbursts of temper, exhibit constant rage and can become physically abusive • Relationships with other people tend to be very dramatic and turbulent

Organizing and Operating Clinics Marketing

• CHCs must be marketed so that members of the target population can understand the message • Marketing to potential contributors and supporters is important • Community marketing can include local high school and college students

Health Center Governing Boards

• CHCs must have a board of directors that is totally composed of volunteers • A minimum of 51% of directors must be must be users of the services • CHCs must conform to complex regulations that do not apply to traditional health care provider organizations

Type of Measure

• Capacity - something that is in place • Process - a task or something else that must be done • Outcome - a change or lack of change resulting from an action or intervention • Process outcome - denotes situations in which the results of a process are tracked. • Health outcome - indicates that results may include health status information

Cycles of Interaction

• Change is an element of both politics and public health and responsibilities evolve as duties for individuals change over time • The interactions process is necessary for the survival of public health • The interaction process is not just talking but is a planned approach to communicating so not to have lapses of communication

Common Good

• Common good states that living in a community is inherently good • Common good presents the concept that members of the community pursue values and goals that they have in common • Ethical actions advance the common good • Some individuals find that the idea of common good is inconsistent with contemporary pluralistic societies

Organizing and Operating Clinics History

• Community health centers often are referred to as federally qualified health centers (FQHCs) • Today more than 1000 of FQHCs are in operation • Most started as a grass roots efforts to improve overall health • CHCs became unrecognizable because they have had to be very autonomous with their activities

Community and Environmental Health Summary

• Community health is concerned about the total well-being of people • Environmental health is heavily based in epidemiology and science • Police powers are available but should be used wisely • Community and environmental health administer multiple programs

Objectives of Compensation Programs

• Compensation programs are meant to attract, retain and motivate employees • Compensation programs must be adequate, equitable and balanced • Compensation programs differ from organization to organization • Several key questions must be asked to help design compensation programs

Activities

• Conduct food, water and sewage inspections • Post inspection certificates • Control vectors through use of poisons, insecticides, structural alterations and vaccinations • Laws, rules and guidelines exist at federal, state, and local levels

Configuration

• Configuring an organization establishes not only structure but also culture • A working environment should promote productivity and motivate staff to advance public health in the community • Customer service and program delivery should increase with optimal organizational configuration

Core and Support Processes

• Core process • Health care provides service to individuals • Support process • Provides services that enable core processes to function

Developing Potential Managers

• Every supervisor has a responsibility to help identify and develop new managers and successors • Many managers fall short when identifying and developing successors • Developing successors is often based in the practice of delegation • Insecure mangers often fear competition and do not develop successors

External Equity

• External equity and internal equity are major factors to consider • External Equity • Rate of pay that is reasonable compared to similar positions in a given area that perform the same or similar duties • Some regions pay less for the same job compared to other regions • When establishing pay rates, it is important to compare similar regions, similar sized departments and similar work settings (rural versus urban)

Fairness or Justice

• Fairness or justice was developed by Aristotle and is concerned with equal treatment for all • Focus is on how fairly or unfairly actions distribute benefits or burdens on a group • Demands that all people receive the same treatment • If morally relevant differences exist then exceptions can be made to fair treatment

Criteria

• Federal funding for a CHC is provided by the Health Resources and Services Administration • A CHC must: - Be located in a medically undeserved area - Provide comprehensive primary health services - Offer a sliding fee scale based on federal poverty income guidelines - Provide services to all people regardless of their ability to pay

Three Goals of CQI

• Feedback about performance and quality improvement • Accountability and credibility • Staff Morale and visibility

Finance

• Financial information addresses the fiscal status of an organization • Includes use of all funds not just money that is available • Money has a cost • Degree of uncertainty of expected profits or benefits

Financial Statements

• Financial statements can be prepared at any time • The period is usually a year • Period does not need to end on December 31st • Lowest inventory level, end of busy period or end of funding are common ending times

Six Sigma Process Improvement Model

• Five steps: 1. Define 2. Measure 3. Analyze 4. Improve 5. Control

Joint Programs for Media relationships

• Focus on the goal of delivering accurate information • Competition for air time or space in the media is intense • Assisting the media to do their jobs improves the timeliness and accuracy of coverage • Be prepared to meet the media's deadline

Utilitarian Approach

• Focuses on the consequences of outcomes of actions or policies • Straight forward method for deciding on a morally correct course of action • Direct application of teleology • Greatest ratio of benefits to harm

Starting a Board of Health in the 21st Century

• Forming a new health board is an uncommon event • Three are known to have been organized in recent years • One in Maine (Sagadahoc County) • A second in New York (St. Lawrence County) • A third, bi-county board, in Pennsylvania (Lehigh and Northampton Counties)

Standards and Measures for Accreditation

• Framework for the accreditation standards was based on the 10 essential public health services • First version of the proposed PHAB standards was tested by two state agencies and six local health departments • Formal vetting process resulted in more than 3,700 comments

Personal Ethics

• Knowing what is right is harder with the current rapidly changing environment • Personal ethics differ from person to person • The English word ethics is derived from Latin meaning virtuous habits • Having the ability to make decisions means assuming responsibly

Required Benefits

• Legally required benefits include: • Social Security - has expended from basic pension coverage for about 50% of the workforce to a full scale social insurance program available to more than 90% of workers • Social Security is a contribution program where the employees contribute 6.2% of their first $102,000; employers match this contribution • Some equate social security with retirement benefits; however it also includes survivor, disability and health insurance benefits

Long-Term Disability Insurance

• Long term disability insurance exists to protect employees from financial devastation as a consequence of a serious illness or accident • Plans provide for a percentage of an employee's wages, around 60-66%, during a period of disability

Quality as a System Property

• Making quality a system property is ensuring the process itself is sound • To achieve higher levels of quality in services and programs, existing public health processes must be redesigned or new ones developed • An axiom of CQI maintains that only 15% of problems can be attributed to people • The rest (85%) are due to flawed processes

NPHPSP Program

• The board is the entity to which the health commissioner reports • The board oversees purchases, approves budgets and salary adjustments, and reviews contracts and other issues • Board oversight has a large impact on the configuration of a public health agency

Organizing and Operating Clinics Concept

• The concept of a CHC began under President Johnson as part of the Great War on Poverty program • Community leaders or organizations must meet to assess needs and demands before applying to DHHS for funding to operate a CHC • Centers must be located in areas that are considered medically underserved and must accept reimbursement from Medicaid

Defined Contribution

•Employers allocate a fixed amount of money for benefits and provide a list of benefits available to employees •Employees are able to spend their allocated benefit money to address their particular situations such as purchasing extra vacation days, electing coverage for legal services or purchasing day care coverage

Leadership Roles and Responsibilities

-A truly effective board: has fiduciary responsibilities, serves as a strategic partner with a health commissioner, is a major component of the leadership team -Board members must understand their board roles as trustees rather than volunteers

Organizational Requirements

-Ability to stretch budgets -The organization must be configured properly -Separate sections and staff

Management Theories

-Classic bureaucracy or hierarchy -Regular duties are known to all -Hierarchy of jobs, authority, responsibility -Written documents govern the conduct of an organization and its employees -Jobs are distributed to individuals having specialized competence to handle them

Board Governance

-Configuration of public health agencies usually mirrors the statutes under which they operate • Most governing bodies are either board authority or city-council formats • Board members are usually either elected officials or appointed volunteers -The board is the entity to which the health commissioner reports • The board oversees purchases, approves budgets and salary adjustments, and reviews contracts and other issues • Board oversight has a large impact on the configuration of a public health agency

Theory Y

-Integrates individuals and organizational goals -The expenditure of physical and mental effort in work is as natural as play or rest -External controls and threats of punishment are not the only means for eliciting efforts toward achieving organizational objectives -Individuals will exercise self-direction and self-control in the service of objectives to which they are committed

Governance Roles and Responsibilities

-Local health departments have the day-to-day responsibility for public health matters -members of boards of health are appointed or elected to oversee, guide, and establish policy -board of health provides governance leadership -roles of boards of health vary by state -state statues define the legal powers and duties of local boards of health -governing boards are responsible for guiding organizations and addressing the needs of constituents -most board of health members serve without compensation -the work of governing and advisory boards usually goes unnoticed until a problem arises -some public health problems are caused by uncontrollable events

Theory Z

-Management makes longer-term commitments to its employees -Receives a high degree of loyalty from employees -Resembles the paternalism in some US companies in the 1800s -Employers provide day-care, health clubs, and other off the job activities

Theory X

-Provides direction and control -Human beings have an inherent dislike of work and will avoid it if at all possible -Because of this characteristic of disliking work, most people must be coerced, controlled, directed, or threatened with punishment to get them to put forth effort towards achieving organizational objectives

Frederick Taylor

-Scientific management focuses on the most productive use of time -measuring the length of tasks with a stopwatch and organizing them -establishing the pace of an assembly line -theory's appeal is largely intellectual -few executive or professional jobs lend themselves to this organizational principle

Applied Management Theory

-distinguish between motivation and satisfaction -effective managers know what motivates each staff member -tasks should be structured to best utilize the skills and talents of individuals -positions should be structured for tasks, not employees -decision making is a key component of effective management -implications of decisions must be weighed -these include economics, resources, and opportunity costs, mechanisms of implementation, overcoming obstacles, political fallout and future consequences at all levels -alternative decisions must be subjected to the same scrutiny -many decisions must include compromise -a health agency is usually headed by a board -it has final say over the direction of a health agency's plans and activities -responsibilities include hiring, evaluating, and discharging the health officer or health commissioner

History of Governance & Leadership

-infectious disease epidemics prompted the formation of may additional health departments and boards of health in the 1800s -in 1848, the first national board of health was established through the Public Health act -infectious disease epidemics prompted the formation of may additional health departments and boards of health in the 1800s

The 21st Century

-public health encompasses a broad spectrum of practices and disciplines -the majority (74%) of health departments have a local board of health -boards of health are elected or appointed individuals -currently, there are over 3.200 boards of health across the U.S. -A majority of American health districts are governed by a board of health having policy making authority -boards of health are no unique or limited to the united states -boards of health have both a moral and legal obligation to carry out their duties in a responsible manner

Effective and Efficient Governance and Leadership

-the quality, continuity and assurance of public health in the United States depends on the effectiveness of boards of health -public health consists of organized efforts at the community level with the goal of reducing disease and improving the health of the populations being served -effective organizations tend to have boards that are active

Maslow - Hierarchy of needs

1. Basic needs are physiologic such as air, water and food 2. Safety needs include shelter and feeling protected 3. Love and affection needs encompass wanting to belong or interact with others 4. Esteem needs seek approval and respect from others 5. Self-actualization needs allow people to achieve their full potential

Plan-Do-Check-Act

Check-Act (PDCA) cycle • Plan • Do • Check • Act • PDCA cycle is a simple yet powerful technique for organizational improvement

Governing Body

is an individual, board, council, commission, or other entity with legal authority over public health functions of a jurisdiction

Resources

• A board must ensure that its health agency has the resources needed to provide essential public health services • The board should be involved in approving grant applications, contracts, budgets, setting fees and issuing tax levies

Levy Campaign Committee

• A levy committee is essential for success • In addition to the health department, involvement of community stakeholders is vital for a levy campaign to succeed • Board of health members should form the nucleus around which a levy committee is formed • Health department staff are often asked to volunteer to be on the committee • It is important to remember that health department staff cannot participate in tax levy campaign activities as part of their job duties; this is illegal • Key levy campaign personnel: • Chairperson • The chair should be a community leader who has experience with tax levies and coordinator of campaign activities • Key levy campaign personnel: • Treasurer • This person is responsible for money, is usually required to register with the local board of elections and works closely with legal counsel • Secretary • The secretary takes notes at all committee meetings, archive notes and maintains a permanent chronology of all campaign activates

Policy base

• A local board of health is responsible for adopting public health polices, setting directions and establishing priorities • Boards are most effective when they promote a common vision • "What services do we provide to what people, at what quality and at what cost" are the questions a board should ask to determine if an issue should be addressed • A board must have access to community health information • Once a board resolution is approved, every member of the board must agree to support the decision

The Public Health Renaissance in the First Half of the Decade

• A robust public health infrastructure was underscored by the events of September and October 2001 • September 11th demonstrated that terrorists could strike at the heart of the American homeland • In October, the reality of bioterrorism emerged after the subsequent Anthrax attacks • Several documents provided guidance • Institute of Medicine (1988) • National Public Health Systems Performance Standards Program (1994) • The Turning Point projects (1997) began examining the relationship between an official public health agency and the broader network of community partners • A solid consensus emerged that the group should work together to be more organized in its approach to the public health system problem • Effective January 1, 2005, public health became an official demonstration program of the county • Community-based emergency preparedness should include health preparedness • People with desired skills existed but were not always readily available • The concept of a virtual health department was born

Management Reports

• Accounting data provides information to different levels of management • Improves fiscal control and profitability • Reports include budget, cash flow projections, profitability by product line, and ration analyses • Cash flow reporting estimates cash payments and receipts

Accounting

• Accounting is recording and summarizing • Original cost or historical cost? • Financial statements • Reports needed by the government • Standards-FASB, GAAP, SEC • Public health departments and GAAP

Arbitration

• Arbitrators that specialize in human resources have emerged over the last decade • Arbitration is often governed by a collective bargaining agreement • Collective bargaining agreements dictate how interactions and most matters are handled between management and labor • Terminations must follow specific procedures and due process

Social Media Policy

• Achieving a social media presence is more involved than simply registering or enrolling online • A social media policy should begin with a statement of purpose • Responders should consider the reading audience associated with a particular social media site as they compose their postings • Offensive language or inappropriate remarks may seem cute but have a great risk of alienating others reading the post • Comments posted to social marketing sites are made in writing • They are subject to copyright and fair use regulations • Any information that is proprietary or confidential must be protected • Maintaining a social media presence should be viewed as another task for any organization

Operational Guidelines

• Administrators must have in-depth operational guidelines and be familiar with accrediting bodies and their requirements, funding sources, and staffing regulations • A CHC must follow local, state and federal polices • A CHC can seek accreditation through the Joint Commission

The End of the Middle Ages

• Advances in medical knowledge began to emerge • New hospitals were organized • With the limited knowledge and resources of the day, people went to hospitals to die

A Board is Born

• Advisors sought NALBOH's help to consider how they might organize • Support from the county commissioners and Sagadahoc EMA, combined with the evolving programs, encouraged the advisors to propose creating a more formal organization • As its first act, the new board considered a set of bylaws • Document was forwarded to the county commissioners for their approval

After Action Reports

• After Action Reports (AARs) are documents produced after an incident • They describe both good and bad aspects of responses to an event • Standardized forms and formats for AARs should be developed and used

After the Vote

• After the vote the committee should meet and review the outcome • All signs must be removed and all required reports must be been filed and accepted by the board of elections • All programs and activities that are supported with tax dollars must be documented • Township trustees and county commissioners should be kept informed of published agency activities • The health department must be visible to elected officials, stakeholders and, most importantly, the general public to make sure future needs can be meet

Sharing Employees

• Agencies serving small jurisdictions are sparsely staffed in comparison with many other types of organizations with comparable scopes and ranges of activities. • An agency director is usually the most difficult person for a public health agency to recruit • Attracting a full time director is difficult; a parttime director is even harder • Sharing of an agency director is a viable option for smaller health agencies to consider

Documentation Guidance

• All documentation must be current and in use at the time of a PHAB accreditation survey. • Documentation guidelines contain two types of information • Required documentation • Examples of documentation: • Policies and processes • Protocols for reporting activities, data, or decisions • Materials that illustrate the distribution of data

Progressive Discipline

• All organizations must create and implement a policy regarding discipline • A progressive discipline policy allows modest disciplinary actions to be imposed rather than letting minor issues develop into major problems • Progressive discipline is a step by step process • Disciplinary actions become progressively more severe if the problem continues to occur • Two keys to disciplinary action are identification and documentation • Most employees make some minor mistakes that can be documented and resolved by a disciplinary discussion • Such employees learn and infrequently repeat the mistakes

Progressive Discipline in Mental Health Issues

• All organizations should create policies regarding discipline • Progressive discipline addresses problems early rather than letting minor issues develop into major problems • Progressive disciplinary action is a step by step process

Dental Workforce

• America is facing an imminent crisis due to a decline in the number of dentists • CHCs can help provide access to dental services but cannot satisfactorily address the dental workforce issue. • An oral health program can be very expensive to operate. After operations begin, the cost of basic supplies continues to be much greater than similar costs for a medical program.

Overview of US Quality

• Americans should be able to count on receiving care services that meet their needs and are based on the best available scientific knowledge • Growing realization that healthcare service providers often fail to deliver the potential benefits • Public health services have not received the level of attention • Sufficient reasons are not always available to provide the necessary public health programs • The United States spends over $2 trillion annually on health care • Approximately 3% is designated for prevention, including public health • CQI was initially developed in 1929 by the Western Electric Company • Institute for Healthcare Improvement (2010)

Employee Discipline

• An organization's operating rules must be clearly communicated to all • A prepared policy and procedural manual, authorized by the CEO or board directors, should be provided to each employee. • During new employee should be given opportunities for discussion with supervisors • The venues for these discussions should not be threatening to employees.

Components of a Budget

• An organizational budget has four components: statistics budget, expense budget, revenue budget and cash budget • Budget allocations are compared with actual expenditures • Over funded and underfunded categories are identified

Structural Factors

• An organizational structure and established hierarchy are necessary to manage people and coordinate activities • Power and authority are vested in the owner or head of a company or agency • Adam Smith: technology and the division of labor determine how authority will be delegated

Effective Mentoring

• Appointing a mentor for a new employee is often helpful even for an experienced employee • Guidance by the mentor for the first few days on the job for a new employee as well as knowing that the mentor is available has value • Mentoring can be effective if officially sanctioned but does not need to be formal • Informal "linking up" of new and existing employees should be discouraged

Customer Service

• Customer service cannot be sub-standard in government agencies • Health agencies must not forget that they exist to serve the general public • They must respond in a rapid and effective fashion • Politicians must receive the same customer service from public health as do members of the general public • The needs of politicians and members of the general public must be prioritized without regard to status • If a food-borne illness is being conducted, a blowing litter complaint from a politician can most likely wait

Creating Products that Are Wanted or Needed

• Customers do not simply purchase a product or service • They must want or desire the product or service • Their needs or desires must be identified to successfully market a product or service • A product line is a group of similar products or services that comprise a mix • The basic product mix of public health includes the 10 essentials of public health • Market research is conducted to determine which products or services are relevant for a given population • Public health agencies use community health assessments as their market research

Communications

• Daily communications with the general public are important • The public deserves information quickly and accurately, delivered with good customer service • Prompt responses messages are appreciated • Roadblocks to information should not exist • Exceeding expectations when delivering information and services helps when seeking funding and levies • Informational meetings with staff are important • During these meetings philosophies, rules and policies of the organizations should be discussed openly • Meetings will build camaraderie and a sense of team • Meetings should be structured but flexible enough to permit open discussions

Data

• Data for the assessment is usually not obtained from a single source • Health information can be found in both quantitative and qualitative forms that include primary and secondary data • Sources of data include national, state and local data banks: • Center for Disease Control and Prevention • US Health Resources and Services Administration • US Census Bureau and other federal agencies • Regional resources-hospital councils, councils of government, disaster service groups • Local resources-local health departments, hospitals, mental health, human services, alcohol counseling agencies, school systems, police and emergency management agencies • To perform a basic assessment a health agency should select a set of standardized health and social status indicators • Primary data has been obtained directly from surveying, talking, and interacting with residents in a community • Secondary data has already been collected by some entity for another purpose • Good health assessments start with data that has already been collected • Secondary data may be represented by a rate, percent or total count • Several important sources of secondary data • The Future of Public Health and The Future of the Public's Health in the 21st Century • Healthy People and Healthy Communities of the 1990s • CDC's consensus indicators • Input from six public hearings was incorporated to draft target objectives of Healthy People 2010 • Focus areas: physical activity, overweight and obesity, tobacco use, substance abuse, responsible sexual behavior, mental health, injury prevention, environmental quality, immunizations and access to health

Retirement Plans

• Defined benefits use a formula to determine the dollar value of periodic payments • Employees know what their retirement payouts will be in advance • Actual amounts of payouts are not determined until an employee retires • Most retirement plans are vested; after a set time, usually five to ten or more years of service, employees have a right to their contributions

Post Event Activates

• Demobilization is the removal of equipment, personnel and systems when an incident is over • Demobilization planning begins at the start of am incident • Lack of resources, fatigue among responders, and achieving goals are all reasons for demobilization • Formal and informal evaluations must be made after an incident • Workers should be debriefed at the end of their shifts or rotations • Debriefing is used to review and evaluate past objectives and too set new objectives • Critique of the response to an event facilitates adjusting plans, reviewing safety issues, evaluating how commands were given and received, and noting other needed changes

NPHPSP Standards

• Designed around the 10 essential public health services • Focus on the overall public health system rather than a single organization • Describe optimal levels of performance, not minimum expectations • Intended to promote and stimulate quality improvement • Three instruments were developed: 1. State Public Health System Performance Assessment Instrument focuses on the state public health system 2. Local Public Health System Performance Assessment Instrument focuses on the local public health system 3. Local Public Health Governance Performance Assessment Instrument focuses on the governing body • Each of the NPHPSP assessment instruments is composed of 10 sections

Multi-state Learning Collaborative

• Developed simultaneously with the establishment of the Exploring Accreditation study • Promote interest in accreditation and to initiate quality improvement culture in public health • Goal is to improve performance and quality of state, local, tribal, and territorial public health agencies • Initiative active in 16 states as of 2010 • Accreditation status ultimately decided by PHAB board of directors and granted for five-year period

Population Education

• Disaster planning must include processes to educate the public • Educating the public on disaster response must be in place prior to an emergency • Many of the messages for the public have already been created • Pathways to disseminate information are varied for different communities and types of disasters

Divisions

• Divisions are organized along professional or programmatic areas • Divisions ensure that qualified professionals are managed by people with similar backgrounds • Divisions provide career paths for employees • Divisions typically have their own budgets

Documentation

• Documentation of any employee problem is a necessity • The documentation must link the problem with the employee • The documentation must follow organizational policies, procedures and civil law • A valid tracking system must be established and followed • Documentation regarding disciplinary actions must be kept in an active personal file • Documentation of any preliminary discussions regarding discipline should be kept for future informal or formal hearings • Disciplinary records should be kept for the length of time specified in the organization's progressive disciplinary policy

Modern Times

• Draining of swamps led to a decline in the incidence of mosquito-borne disease • In 1919 a worldwide influenza epidemic killed between 30-100 million • For the first time in history, more soldiers died from battle injuries than from infections • Alexander Fleming discovered penicillin • Salk produced a vaccine for polio in 1954 • Sabin created an oral vaccine for polio in 1957 • In the 1960s a gap began to appear between developed and underdeveloped nations • The green revolution came from the Rockefeller Foundation's work on rice production in Mexico • In 1976 Ebola was first reported in Africa • In 1978 the World Health Organization declared smallpox to be eradicated • In 1979 the first report of AIDs was published • In the 1980s poison gas was again used as a weapon of war • The orphan drug program was initiated • In the 1990s polio was eliminated from the Americas • Tropical rainforests are shrinking and the Sahara Desert is increasing • Noteworthy concerns at the beginning of the 21st century include SARS, mad cow disease and terrorism

The Renaissance

• During this time medical knowledge reemerged in Western Europe • In Italy the systematic study of anatomy began • William Harvey discovered that blood circulated through vessels and returned to the heart • The first systematic classification of diseases was compiled • Paracelsus described diseases related to occupations

Reporting Findings

• Each subcommittee should produce a separate report • Staff of the health agency can help organize the information but cannot add to the reports • The committee must prioritize the needs • Each subcommittee should present its information at a meeting of the steering committee or health assessment oversight body • The steering committee can reset or further prioritize needs and recommendations • The purpose of the final report is to identify the community's strengths and needs • Once priorities are established, goals, objectives and action plans for programs should be developed to address the identified priorities • Drafting the final report is usually the facilitator's responsibility in conjunction with staff members • A public meeting to accept the report should be arranged • Everyone who worked on the report should receive a written invitation to the meeting • Printed reports should be given to all individuals who participated in the project • Other venues to disseminate the information of the report should be discussed and used

Recording Business Transactions

• Each transaction that occurs is recorded and summarized • Separate sheet records assets and liabilities • Journals for documentation

Changing Behavior

• Effective leaders must promote good attitudes toward the organization • Discuss new projects or programs • Promoting subordinates' careers and career paths is essential • Successful mangers have successful subordinates • Politics is the essence of compromise • Alterations of existing formal structures can produce organizational changes • Managers must assume the task of absorbing and preventing stress

Employee Assistance Programs

• Employee Assistance Programs (EAPs): • In the 1970s employers noticed that outside-ofwork problems affected employee attention during job hours • Employers set up EAPs to address issues such as use of alcohol, drugs, legal problems, difficulties with children or spouses, responsibilities for caring for elder relatives and other issues

Community Health

• Employees have a variety of backgrounds and different disciplines • Professional goals include educating the public and changing behaviors • Often crosses multiple disciplines • Outcomes measured in economic savings

Narcissistic Personality Disorder

• Employees with narcissistic disorders think very highly of themselves • Their achievements and talents are exaggerated • Narcissistic employees think they are special, will steal ideas from others, want to be in the limelight and think they should only associate with people having high status • Other employees usually do not want to work with individuals having narcissistic personalities

Environmental Programs

• Environmental programs vary from state to state but generally include food safety, home sewage, radon, vectors and rabies • Some states monitor trailer parks, marinas, hazardous waste disposal, solid waste, public water, air and surface water pollution, tattoo inspections, brothel inspections, plumbing, building codes and radiation safety • States oversee local health agencies who conduct inspections

Environmental Health

• Epidemiology is a basic building block • Epidemiology is the study of the distribution of disease in humans • Includes factors that influence disease • Once causal factors are identified, can construct programs to mitigate the effects of the disease • Sexually transmitted diseases and food borne illnesses are important in communities • Knowing the initial point of contact is important • Environmental health is grounded in science and scientific methodology • In communities, encompasses landfills and food safety • Public health employs sanitarians and environmental health specialists • Sanitary codes exist to protect the environmental health of communities • Procedures reviewed by the National Science Foundation • Public health agencies have the authority to require change • Have the authority to close establishments that violate statutes

Partnerships

• Essential to success of the NPHPSP has been the partnership between the Centers for Disease Control and Prevention and six national partner organizations 1. American Public Health Association (APHA) 2. Association of State and Territorial Health Officials (ASTHO) 3. National Association of County and City Health Officials (NACCHO) 4. National Association of Local Boards of Health (NALBOH) 5. National Network of Public Health Institutes (NNPHI) 6. Public Health Foundation (PHF)

Ethical Standards

• Ethical decision makers are concerned with respecting and protecting the moral rights of individuals affected by the decision • Individuals have free will • They have the right to be treated well • Individuals should be fully informed of outcomes and freely consent to participate in the decision

Making Ethical Decisions

• Ethical decision making requires a belief in ethics as well as knowing the implications of choices, the ability to evaluate complex and ambiguous and incomplete facts, and the skills to implement ethical decision effectively • To make sound decisions requires time to think through the details before acting • Decision makers must think about needed or missing information

Subcommittees

• Fundraising • The fundraising committee usually includes board members and community members that know individuals who can be approached for contributions • Fundraising has legal requirements • Committee money must be kept separate from any other funds • Advertising • The advertising committee must convince the public to vote yes for the levy • An effective slogan is a useful way to focus the campaign • The committee may usually pays for advertising • Public service announcements may be available • Signs • This committee is responsible for designing signs to be put in yards, on major highway intersections and at other locations • Simplicity is useful for sign messages • Local boards can provide copies of applicable regulations • Signs must be removed by a certain date • Speakers • This committee should include the health board president, the medical director, the health officer and other persons of leadership • Service organizations and other community groups should receive notices that committee members are available to speak • The message from the speakers must be uniform and consistent

Greece, Rome, and the Middle Ages

• Greece and Rome • Greeks developed the Hippocratic Oath • The Romans built engineering systems to bring water into Rome and sewage out of Rome • The Middle Ages • Public health declined to low levels in the Middle Ages • Disease and lack of sanitation were hallmarks of cities • Community and personal hygiene were virtually nonexistent • Learning was all but forgotten in continental Europe except for a few Universities in Spain • In the Middle Ages trade started to link cites throughout the world accompanied by rats and diseases carried by the traders and their cargo • The first major bubonic plague swept through Europe in 1349-1354, killing 30% of the population • People that fled the cities or lived in rural areas survived • Quarantines were developed at the end of the first bubonic plague

Hospital Involvement

• Hospitals are an integral part of the public health system • Information obtained from hospitals can influence decisions during an emergency • Relationships with hospitals must be developed prior to an emergency • Early warning systems should be in place to limit the spread of disease • Early warning systems should be tested prior to an emergency

Human Resources Emerges

• Human Resources (HR) is the common name for the department that handles personnel matters • Human Resources is not universally used • Personnel reflects only a small portion of the activities of a full spectrum HR • The personnel department image is still blemished • Some mangers still view HR as having lesser importance because it does not generate revenue • Employees believe HR departments are for the agency and not them • Personnel became Human Resources for several reasons: • The term more accurately reflects the work load • Improves the image • Elevates the status of work performed • Enhances the professionalism of those accomplishing the work

Human Resources and the Agency Environment

• Human resources is about people • In smaller organizations managers assume human resource duties • Managers must have a basic working knowledge of human resources • Typically organizations must have over 150 employees before hiring a designated human resource person • Human resource departments take care of pay and benefits • HR coordinates retirement and employee assistance programs • Legal mandates for human resources have evolved overtime • Legal mandates involve protection of employees • They have extensive record keeping and reporting requirements

Fostering Quality and Performance Improvement

• Identify gaps and needs in achieving quality and performance improvement • NPHPSP user guide and training curricula provide tips for understanding and prioritizing areas for action • Quality improvement concepts and techniques • Plan-Do-Check-Act cycle • Priority-setting matrix • Fishbone technique • Anecdotes and successes of selected jurisdictions provide some of the most compelling data for using the NPHPSP

Coming of Age: A Major Transition for the Board

• In September 2010, the board faced and passed a difficult test • The boards first chair became the immediate past chair when a new leader and chair-elect began their two-year terms • Governance sequence of chair-elect, chair, and immediate past chair provide stable leadership cadre for the executive committee • Notable historical milestones were briefly reviewed • Activities of the new health board were guided by the essential services of public health • Virtual health department model was adopted • Board is committed to continuing existing partnerships while seeking new opportunities

The Age of Bacteria

• In the late 1800s bacteria and viruses were recognized as causing diseases • The heating process to kill off bacteria in products (pasteurization) was developed and canning of food began • During the second half of the 1800s bacteria were isolated and identified • Among the first to be identified were Escherichia coli and Staphylococcus aureus • Vectors were identified for many diseases • Controlling disease vectors meant stopping the spread of disease • Elements of the immune system were being studied and described • When modern drinking water and sewage plants were installed, mortality from typhoid fever decreased • Children's health increased immensely from improved sanitary conditions

The Sanitary Movement

• Increased awareness developed about the importance of regular bathing, clean water, and controlled disposal of human wastes • As the industrial revolution advanced west so did water and air pollution as well as substandard living conditions for many including the urban poor and new immigrants • New York City built the first municipal water system • The new water systems were not for improved health but fire protection • The water systems in New York did provide for better public health from clean water • By the end of the 1800s most cities had water systems • Clean water availability set the stage for the public health problem of polio • The Federal Government passed the River and Harbor Act in 1899 to protect surface waters • Louis Pasteur and Edward Koch developed the germ theory of disease that provided the linkage between pathogens and disease • The linkage led to rapid advances in public health • Improved sanitation decreased the incidence of disease • In 1854, John Snow used epidemiology to stop a cholera outbreak in London, England

Attributes of Community and Environmental Health Employees

• Individuals are highly trained • Usually have a college education • Often work with minimal supervision due to their high levels of competence • Sanitarians tested and licensed • Possess skills in addition to academic training

Collective Bargaining

• Individuals join a union because they believe that the union will improve their work situations • Workers expect to win some combination of high wages, improved benefits, protection against job loss, safer and more pleasant working conditions, and better chances for advancement The National Labor Relations Board (NLRB) establishes the activities that may lawfully be taken by the organizing group in its preelection campaign to persuade workers to join the union and the activities that may be taken by employers to discourage union membership • Once the NLRB certifies an election, the union becomes the bargaining agent and has the duty to represent all workers in the bargaining unit • Management has the corresponding duty to bargain earnestly and in good faith • The contact agreed upon by the bargaining unit and management applies to all bargaining-unit employees, be they union or non-union members • Grievances are formally presented to resolve complaints and issues • A collective bargaining agreement gives workers the opportunity to have their grievances heard at two or three progressively higher levels • Most contracts specify that either management or the union can ultimately present an issue to a neutral third party or arbitrator • Employee discipline is considered to be the single most important issue in a labor contract • Management must have to prove that a contract violation occurred before disciplining an employee • Due process must be followed • Discipline or any form of discrimination against an employee because of union membership or lawful union activity is forbidden by statute

The Enlightenment

• Individuals sought freedom and governments began to appreciate the economic and political benefits associated with a healthy populace • John Graunt assembled the first modern mortality and morbidly data • Edward Jenner's observation that milkmaids who had cow pox did not develop smallpox led to the smallpox vaccine • The industrial revolution helped to improve public health but created water and air pollution • The development of basic food safety guidelines began

Paranoid Personality Disorder

• Individuals with a paranoid personality disorder are excessively distrustful and suspicious of others • Employees with paranoid personalities are rigid and unable to accept criticism even when they are critical of others • Since they are suspicious, even harmless remarks can cause them to threaten legal action

Informal Groups

• Informal groups exist in most formal organizations • Informal groups consist of individuals with similar status and prestige • Informal groups satisfy complex human needs • Employees with minimal or no opportunity for social contact find jobs unsatisfying • Groups provide guidance for appropriate behavior relative to the group • Group members accept guidance better from peers rather than supervisors • Nonconformity results in extra duty or withholding help • Group membership relates to technology and the pace of work • Groups take on lives of their own • Groups often develop informal organizational structures • External and internal factors influence status within a group • External influences are imported from the outside into the workplace • Internal influences are created from within the workplace

Documentation -Event

• Information gathering and record keeping are extremely important • Individuals should be assigned to gather information and keep records • Collecting data after an incident may result in cloudy or incorrect information • Inadequate or inaccurate information may cause problems with reimbursement, legal issues and plan improvements

Command

• Integrated Emergency Management System (IEMS) is used to optimize the allocation of resources • IEMS minimizes conflicts during a situation • IEMS and NIMS are related but different • NIMS is tactical and IEMS is strategic • Relatively small or brief situations allow for a single incident commander • Larger or longer situations call for a unified command structure • Unified command structure has two or more commanders leading the response

Conflict

• Interdependence of parties relies on positive relationships across boundaries • Defining and redefining terms of interdependence is stressful for all • Communication problems are the leading cause of interpersonal conflicts

Internal Equity

• Internal equity •Most employees think their pay is fair when it is equal to the pay of others having the same job title in the same organization •Periodic surveys by independent human resource consultants of both internal and external pay rates helps to ensure equity

Health Education Promotion

• Is becoming increasing important • Chronic conditions such as heart disease, cancer, and stroke that are attributable to lifestyle choices • Tobacco use, obesity, sedentary lifestyles, unsafe workplaces, malnutrition, risky sexual behaviors • Inadequate parenting skills, undetected illnesses, and a variety of other problems fall into the realm of health education

Oral Health Services

• Issues related to the dental workforce • America is facing an imminent crisis due to a decline in the number of dentists providing care • If the downward trend continues, there will be a shortage of dentists and this will affect CHCs • CHCs can not offer large salaries to bring dentists into their facilities • CHCs often lack the office equipment needed to treat people with dental needs • An oral health program can be very expensive to operate • Costs include plumbing, equipment, start up and personnel

Position Description Elements

• Job descriptions must include job identification information • Position title • Department location • Date the position description was verified • Title of the supervisor • Job summary • Provides the overall concept or the purpose • Nature and extent of the tasks performed • A well crafted description should relate to the mission statement and global mission of the department • Principal duties performed • The section breaks down the five or eight duties or functions describing the position • The job functions should be described in descending order of importance • Tasks requiring the most time to complete should be listed first • The function should discuss how the task is accomplished and why it is necessary

Methods for Collecting Information

• Key informant interviews • Conducted individually using prearranged questions • Focus groups • 5-10 people in a group discussing set topics • The group process • 30-40 individuals divided into groups to brainstorm and identify action items • The Delphi technique • Reaching consensus on statements or assessments • Surveys • Collecting data from a sample audience

Cross Training

• Managers can cross train comparable position in terms of job grades or pay scale • Employees that perform similar tasks but are not cross trained have limited flexibility • Cross training can allow resources to be shifted as workloads dictate • Individual employees can cross train other employees • An agency increases efficiency and employees gain greater interests and challenges through cross training

Budgeting

• Managers prepare budgets • Examining and understanding information is necessary • Fund organizational programs and services to achieve goals • Mangers must focus on cost control • Full understanding of budgets provides a powerful tool

Rewards and Recognition

• Many good rewards have been wasted by bad delivery • To properly reward employees, managers must get to know what motivates each employee • There are numerous ways to reward employees

Paid Time Off

• Many organizations are adopting Paid Time Off (PTO) that allows employees to bank time and an allotted number of days that can be used for any need • PTO allows employees more flexibility and recognizes today's outside demands on employees • Used in place of sick, vacation, etc.

Indirect Cash (non-cash) Compensation

• Many organizations provide indirect compensation in the form of fringe benefits • It is estimated that for every dollar that is spent on direct compensation another 35 to 40 cents is spent on benefits

Marketing and Local Health Agencies

• Marketing public health programs and services results in social exposure • Social exposure is a state of awareness in which community residents can readily identify and describe benefits • Public health should start small and slow with marketing campaigns • Public health agencies should have a well designed logo • Public service announcements can be used to promote social causes or address social concerns • Local newspapers, TV and radio stations can help to market information • Effective web sites are important but must be current, accurate and visually engaging • Health promotions have been emphasized with decreases in funding

Tax Levies

• Mechanisms and sources of funding for public health programs and initiatives differ from state to state • Statutory authority for public health can be found in state law • In many states the primary role of a local board of health is identifying and providing funding • Local districts can receive funds from a variety of sources such as general tax revenues, fees for services, fees for inspections and licenses, state subsidies, grants and tax levies • Board members must be well informed about fiscal aspects and must ensure that sufficient funds are available to operate programs and activities • Some health departments must obtain operational funding directly from residents through a tax levy • Board members must be involved in strategic planning for a tax levy campaign to be successful • Levies can be placed on the ballot for any purpose, for example: • Funding operations • Constructing a building • The language of the levy must be specific • Attorneys must be involved in the process • The taxing authority is typically a county • County commissioners usually must certify that the revenues are needed • Once certified, a special taxing authority is established • Timing is essential for any levy campaign • Legal requirements must be meet for levies to be placed on the ballot, including filing deadlines, and the legality of a levy • Once all deadlines and issues are meet the county commissioners usually pass a resolution declaring it necessary to place, replace, or renew a levy • The commissioners also pass a parallel resolution to declare that the amount of taxes raised is within the existing legal taxing limit and will be sufficient to meet needs • The board of elections must publish a legal notice of the levy being on the ballot

Governance: Aligning Internal and External Order and Accountability

• Members of the board quickly learned about responsibilities and privileges of being a board member • On the privilege side, the board was encouraged to work independently • Nominations for board officers and new members are solicited from the commissioners and exiting board members • New members and officers are sworn in by the county administrator • Work of the board and the SHIP is performed by volunteers or by virtual members • Modest support is provided by the county through the EMA • Funds are used for the board office, secretarial and administrative support

Assembling Project Team Personnel

• Members of the project team may come from public health, other health programs, or be community volunteers • A steering committee should represent the various stakeholders • The committee should also reflect the demographic composition of the community

Mental Health for Responders

• Mental health concerns exist for responders and the public during disasters and emergencies • Managing stress for both the public and responders is important during and after a crisis • Public and private mental health resources are available in most communities • Mental health messages must be adjusted as a crisis changes • Mental health services may be needed for the public and responders long after a crisis is over

Indicators of Employees with Personality Disorders

• Mental health professionals recognize at least 10 different specific personality disorders • Managers should not attempt to diagnose mental health problems in their employees • The four common personality disorders that a manager may encounter include narcissism, borderline, histrionic and paranoia • Characteristics that are exhibited by employees with the four common disorders include difficulties with interpersonal relationships and a lack of empathy for others

MAPP

• Mobilizing for Action through Planning and Partnerships • Data self-reported and collected by nonstandardized methodology • Data should not be used for accountability purposes • Data best used to understand the general strengths and weaknesses of public health systems

Employee Motivation

• Monetary compensation has been shown to be ranked in the middle of most surveys • Opportunity and security rank ahead of monetary compensation • Monetary compensation can not be ignored • In a theoretical structure, compensation is not capable of enhancing job satisfaction • However, a lack of compensation or inadequate compensation are significant sources of job dissatisfaction

Programs and Services

• State laws often mandate public health agencies • Core Public Health Functions Committee developed the 10 essentials services • Other services are developed after local needs are established • Activities can be grouped into four categories

Vision Services

• More than 158 million Americans use corrective lenses • Fewer than 36 million Americans have vision insurance • CHCs are beginning to offer vision services • Charges for vision screenings are made using a sliding fee scale • The costs of a CHC vision program are minuscule compared to the potential losses in lifetime earnings due to lost education by a child with vision problems

Process Map

• Most basic method used to analyze a process • Four symbols are widely used in process maps • Oval indicates beginning and end of process • A diamond is used when a decision must be made • A rectangle is used to indicate an activity • An arrow indicates process flow -Identifies major action steps and decisions in a process • Orient applicants to application and assessment process • Develop and maintain strategic and relevant partnerships

Shelters

• Most disasters require some form of shelter • Shelters can be needed for long term or temporary housing • Shelters must provide basic needs: food, water and clothing • Staffing for shelters depends on the time frame of operation and services provided • Responsibility for managing and staffing of most shelters is delegated to the Red Cross • Disease surveillance is imperative in shelter settings • Dispensing sites for vaccines and antibiotics require specific preparations • Dispensing sites must have adequate staffing, space and capabilities to dispense pharmaceuticals • Dispensing sites should be recognizable locations such as churches, schools, or other notable places • Dispensing medication is extremely complex when an entire population is to be considered

Differences Between Problem Employees and Those with Personality Disorders

• Most employees are assets to their organizations • Employees who show up late for work, surf the Internet for personal reasons during job time, or take too many personal phone calls are not assets but problem employees • Problem employees can be handled through the progressive disciplinary process • Some employees are exposed to situational stressors such as family or marital difficulties, health problems, substance abuse or financial difficulties • These personal problems can affect workplace effectiveness and productivity • These problems are best addressed by referral to an Employee Assistance Program (EAP)

Major Applicable Laws and Regulations

• Most employers are subject to federal laws on how recruitment is conducted • Title VII of the Civil Rights Act • Prevents discrimination on the basis of race, color, religion, sex, or national origin • Employers with 15 or more employees are covered under this law • Employment agencies are prohibited from discriminating against referred applicants

Funding

• Most states and the federal government have grant funds set aside for CHCs • To offset shortfalls, private entities are sought to donate funds • Corporations may be willing to donate funds in exchange for advertising • Local governments may choose to supplement funding for CHCs • Much governmental funding for CHCs is earmarked for children and young mothers • To provide services to adults, CHCs may have to secure funding from additional sources • Additional sources for funding include Medicaid and Medicare

Environmental Health Concerns

• Must understand applicable laws and regulations • Conducting food safety inspections is essential • Punitive measures are available but should be used judiciously • Public health agencies work closely with the Environmental Protection Agency

The National Incident Management System (NIMS)

• NIMS is a system that provides coordination and control during a disaster • Incident Command System was the predecessor developed from fires in Southern California • NIMS starts at the onset of an emergency and is discontinued when all resources are returned to their starting positions • Incident Commander is the individual that is first on the scene • The scope of NIMS can be expanded or contracted depending on the emergency • Resources are provided at the proper time and place by utilizing NIMS • NIMS can be widely used from a situations such as planning meetings to responding to pandemic influenza • NIMS provides common terminology and management protocols • Using NIMS, command can be easily transferred to new persons during a disaster • NIMS allows for an organized delegation of tasks and lines of authority • Ultimate authority in NIMS is the Incident Commander (IC) • The IC assigns leaders to one of four sections • Operations Section leader uses resources to resolve the situation • Logistics Section Leader obtains resources • Planning Section Leader uses experts to guide the operations to resolve the situation • Finance Section Leader tracks costs and purchases of resources needed or used in a situation

History of Program & Development of Instruments

• NPHPSP initially began from Institute of Medicine report (1988) • Representatives from national organizations and US public health agencies came together to define and issue a "Public Health in America" statement • Consensus statement defined the vision, mission and key responsibilities for public health

Use in State and Local Public Health Practice

• NPHPSP instruments are available for use on a voluntary basis • Assessments are typically conducted through a process of group discussions and ratings • The NPHPSP User Guide and other resources provide tips and guidance for optimal use in any setting • Version 2 tools are still in active use • Data provide much-needed information about state and local public health systems and governing entities

NALBOH

• National Association of Local Boards of Health • NALBOH was formed in 1992 to provide a national voice for concerns of local boards of health • NALBOH's mission is to provide a single voice for boards of health and education and training materials for their members • NALBOH has offices in Bowling Green, Ohio and Washington, DC with a professional staff of 13 • Few new board members know the complexity or responsibility of their position

National Public Health Accreditation Governance

• New and independent entity created to oversee accreditation process. • Recommendations from the study implemented when PHAB was created: • Create a recognized legal entity • Create a volunteer accreditation board • Provide relevant accreditation services • Orient applicants to application and assessment process • More recommendations from the study implemented when PHAB was created: • Develop and maintain strategic and relevant partnerships • Assess conformance of health departments with standards and measures • Train site visitors to assure consistent and fair reviews • Work with partners to ensure availability of training and technical assistance

From Virtual to Virtuous: Striking a Formal Strategic Alliance

• New board became increasingly familiar with the co-located services and activities in the county • More formal agreement, transforming an ad hoc group of collaborators in a virtual health department into formal strategic allies • The agreement would define a relationship between ACCESS Health and the SHIP

Defining Quality

• Nine aims of the public health delivery system 1. Population-centered 2. Equitable 3. Proactive 4. Health Promoting 5. Risk reducing 6. Vigilant 7. Transparent 8. Effective 9. Efficient

Accreditation

• Not a new concept to many community governmental entities. • Public Health profession developed and implemented various approaches to assess performance of public health systems through National Public Health Performance Standards Program

Using the National Incident Management System

• Objectives and tactics are evaluated when NIMS is activated • The IC must focus on saving and preserving life, stabilizing the scene of the event and protecting property • The IC is responsible for response objectives and action plans • Decisions made during an incident may have to be justified to the general public after the incident • Actions taken during an incident should follow existing plans • Decisions made during an incident often must be made with limited information • The DECIDE system can be used to offset possible unintended consequences • Detect the presence of a hazard • Estimate likely harm without intervention • Choose the response objectives • Identify action options • Do the best option • Evaluate progress

Emergency Preparedness and Response

• Officials responsible for responding during an emergency should review material associated with disaster planning • Planners should design plans that meet needs and vulnerabilities • Plans should be tested and critiqued • The federal government should not be counted on for immediate help during a disaster

On-the-Job Training

• On-the-job training may be the best way to train and is best accomplished under a manager's direct supervision • Employees that are receiving on-the-job training are taught step by step • Oversight decreases over time until employees are able to work alone

Balance

• Once a team has been put together they must identify policies and clearly articulate the mission and goals of the group • Group leaders must foster creativity while maintaining a focus on the reason the group exists • The leader must keep the group from wandering while facilitating free thinking

Implementing the Health Assessment Process

• Once the decision and the commitment to conduct a Community Assessment are made, a leader must be chosen to carry out key responsibilities of the process • The commitment by the leader will be about two years • The leader must have skills in community organization, group dynamics, and communications

Screening, Interviewing and Selecting

• Only candidates that meet set threshold criteria should be interviewed • Selection criteria for the initial screening can include education, skill and experience • Reasons for inclusion or exclusion from the pool should be noted • This data may be needed later for compliance checks • Interviews are face to face meetings with applicants • The primary purpose of an interview is to determine suitability and fit of an applicant for the position • Describe the job and organization • Describe the position and organization in an honest manner • Provide newsletters, brochures or other material that discusses the organization for the applicant to review • Ask interviewees if they have any questions • Ask questions • Behavior-based questions ask how an applicant would respond under certain circumstances • Some organizations have used this type of interview process with success in retaining employees and increasing customer satisfaction • Post-interview evaluation • Allow time to reflect on an interview • The strengths and weaknesses of the applicant should be noted • An applicant's fit into the organization should be examined • Formal post-interview evaluation sheets are useful for ensuring that equal treatment is given to all • Selection • Once the selection is made, the rate of pay must be agreed upon • All necessary paperwork must be completed • The start date must be selected • Employment may be contingent on different requirements such as being of legal age to work, having permission to work in the United States, or passing a physical examination

Reasons for Accreditation

• Opportunity for public health departments to have performance measured • Goal is to support efforts to protect and improve the health of the public • Accreditation requires public health departments to demonstrate accountability and improve quality • People throughout the country can expect the same quality in public health programs and services no matter where they live

Sick Leave

• Organizations attempt to protect employees during times of illness or accident • The number of sick leave days varies among organizations ( average is 5 per year) • Organizations provide incentives to employees that don't use sick leave days • Many organizations buy unused sick leave days back from employees

Approaches to Benefits

• Organizations provide benefits using two main philosophical approaches: Defined benefit plans and defined contribution plans • Defined benefits give the same plan to all employees • The benefits may increase as years of service increase

Other State Health Department Programs

• Other programs that states may deliver include Medicaid, environmental protection, services for the aged, mental health services, oral health programs, occupational health protection, violence and suicide prevention, youth-related services, women's health services, migrant or immigrant health programs, prison health, alcohol and drug abuse prevention, child welfare promotion, and ambulatory clinic inspections

Interacting with Local Governement

• Overcoming challenges is through collaboration • Defining the relevant offices and individuals in local government is a process that involves all the members of a public health agency as well as its governing board • Interactions with local government officials and employees must have the full support of a board and become a part of the culture of an organization.

The Vision Thing

• The board agreed to a broad vision based on the National Health Objectives articulated in Healthy People in Healthy Communities • The board clarified and incorporated into its strategic plan • The vision of the virtual health department was reaffirmed • The board received a modest grant from a local foundation to conduct a survey of the health status and needs of the residents of Sagadahoc County

Clinical Services

• Oversight for clinical services by state health agencies includes developing and enforcing immunization protocols, infectious disease surveillance, TB and sexually transmitted disease monitoring (including AIDS), cancer screening, family planning and well childhood visits • Other tasks that may have state oversight include health education and promotion, school health services, home-delivered skilled nursing, migrant health clinics and full-serve primary care clinics • State health agencies often monitor registered dieticians and WIC programs

Miscellaneous Issues

• Overtime policies should be clearly delineated and understood by staff and management • Unexpected overtime can cause budget problems • Union contracts usually specify that senior union members have the first right of refusal for overtime • Compensatory time at overtime rates may be an option for salaried employees • Safety and security are important concerns for daily operations • Locks and security cameras are important • Other issues include insurance, travel policies, use of departmental vehicles, ensuring that employees have proper insurance and a driver's license • Employees must know about sheltering and evacuating working premises • Every employee must have a photo ID and business cards • Proper documentation of professional licenses and continuing education must be ongoing

National Public Health Performance Standards Program

• Partnership effort designed to "improve the practice of public health and the performance of public health systems" • Focused on providing standards for public health practice

Three Assumptions

• People make an effort to evaluate the ethical aspects of decisions • Individuals have knowledge about ethics • Persons apply their knowledge regarding ethics

Histrionic Personality Disorder

• Persons with histrionic personality disorders will often appear as individuals being in a constant state of crisis • People with histrionic personality disorders are overly dramatic • They have an almost irresistible force that pulls anyone willing to listen or be used by them into their world • Persons with histrionic personalities tend to be very engaging and seductive

Emergency Preparedness and Response summary

• Planning and training for disasters are essential • Public health must use the media effectively • NIMS must be used for any event that requires command and control • Resources must be on hand and tracked in any crisis • Communications are the most needed resource in a crisis and often are the weakest • Hospitals are major partners in any disaster • Educating the public prior to an incident is important • Mental health problems may last for many years after a disaster • Shelters require staffing and other resources • Dispensing site planning should take into account both vaccinations and dispensing of antibiotics • Volunteers must be credentialed, trained and engaged • After action reports provide needed information to improve disaster responses • Post-event activates include demobilization and information analysis • Documentation should be completed during or immediately after an incident • Surveillance is imperative before, during and after a disaster

Politics

• Politics are a factor in all social realms including pubic health • Public health should not underestimate the importance of politics • Public health must understand that politicians must respect public health before they can respect it • Public health must find a way to tactfully let politicians know about the limits of the public health realm • Public health cannot be used for purely political gain • Public health should heed requests of political entities but only if they relate to health issues

Six Sigma

• Process improvement technique • Developed in manufacturing environments • Three key tenets: • Program designed to monitor work output • Intended to be applied throughout all departments in an organization • Goal of Six Sigma is a maximum of 3.4 errors per one million operations

Associations for Public Health Professionals

• Professional organizations are groups that people join to connect with others who have similar interests or responsibilities • Professional associations work to promote the best possible practices among the members • One of the missions of most public health associations is to promote high standards of professional practice for their discipline or occupation

Prevention Strategies

• Professional therapeutic treatment is required for employees with personality disorders • Sometimes therapy is unsuccessful because employees do not recognize that they have a problem or the disorder interferes with therapy • A proactive approach involves trying to identify people with personality disorders during the employee interviewing process • Interviewers of potential new employees must be knowledgeable concerning the traits and signs of personality disorders • The probationary period for new employees should be used to determine if a personality disorder is present • After the probationary period is over, progressive disciplinary action may be needed • The use of psychological screening or protocols is legal, however: • Their use must be justified, and • All candidates, without exception, must be screened • Organizations contemplating the use of screening tests should obtain opinions from their legal counsel and a qualified mental health expert

Linking Products and Services with Consumers

• Promotional campaigns inform, persuade or influence a consumer. • Promotional campaigns utilize a mix of personal and non-personal techniques to achieve specific marketing objectives • Personal promotions are conducted between two parties via telephone, videoconferencing or computer links • Consumer's decision to purchase a product or service • Non-personal promotions include advertising, direct marketing, public relations and other techniques • Advertising strategies are paid communications • Electronic ads often appear on video screens • Direct marketing techniques include mail, product and service catalogs or brochures, telemarketing, direct-response ads and use of electronic media

Successful Managers

• Provide guidance to subordinates • Understand their skills and what motivates them • Multiple styles of leadership are used by successful leaders • Understanding theories enhances success • Groups are dynamic: mores, values and goals are constantly changing

Management's Role In Employee Training

• Providing new employee orientation to assisting employees moving up into management • Employee development is one of the most important aspects of a manager's job • Managers usually have greater depth and breath of technical knowledge and experience in their program areas

Continuous Quality Improvement

• Public Health Departments have increased expectations to perform better and to improve health outcomes • Healthcare delivery systems in the US have adopted Continuous Quality Improvement (CQI) principles and practices • Public Health agencies have begun to adopt CQI concepts in the last five years • NPHPSP, Turning Point Program, and the MultiState Learning Collaborative have provided leadership for the CQI movement

Legal Issues

• Public health agencies have focused on preventing communicable diseases and epidemics • Quarantine severely limits the ability of detainees to exercise other rights • Diseases such as HIV/AIDS and influenza have raised concerns about the powers granted to local health departments and boards to place persons or locations under quarantine

Enforcement

• Public health has police power • Ability to enter property without a search warrant • This power is infrequently exercised • Must later justify activities in a court

Role of Politics and Politicians

• Public health is about physical and community well being • To deliver programs, fiscal support is needed • Politicians usually control funding • Politicians must seek consensus and support from the voting public to continue in their positions • For fiscal support, laws governing funding and operations must be clearly understand • Legislation often designates funding for specific programs, goals or objectives • Laws can limit how funds may be used • Concessions may be needed and agreements made to reach consensus for fiscal support • Compromise is frequently required • Compromise is foreign to public health where health and well-being are concerned • Compromise is a skill that must be mastered for success of public health

Preparedness Planning

• Public health is an important component in any disaster response • Assessment, policy development and assurance are important principles to apply in disaster preparation • Identification of stakeholders and building relationships with those individuals is paramount • Establishing a universal plan allows all agencies to know their roles • Identifying resources, both internally and of other agencies, prior to their need is essential • Formal agreements for use of resources should be made between agencies • MOU (Memorandum of Understanding) and MOA (Memorandum of Agreement) are two types of agreements used • Motivated and highly trained staff will be needed during a disaster • Employees must be properly trained on equipment and procedures prior to a disaster • Public health employees will be called to undertake disaster responses as well as their daily duties • To communicate with the media a well trained Public Information Officer (PIO) is needed • The PIO is often the spokesperson but this can vary • Management and organization of information is a responsibility of the PIO

Environmental Health Legislation

• Public health law contains relatively few statues at the federal level • State constitutions provide much of the guidance for legislation related to public health • All states have statutes that provide police power • Police powers are widely used to prevent disease and injuries • Early legislation to address water contamination by US congress (River and Harbor Act of 1899) • The Soil Conservation Act (1935) and Omnibus Flood Control Act (1936) followed • National Environmental Policy Act (1969) established a national framework to protect the environment • Preceded by the Clean Air Act in 1963 • Congress sought to ensure that Americans would be able to work in safe environments by passing the Occupational Safety and Health Act (1970) • Congress addressed problems related to air quality with the Clean Air Act (1970) • Water quality was addressed in 1972 with passage of the Federal Water Pollution Control Act • Established the basic structure for regulating discharges of pollutants into water • In 1976, congress passed the Toxic Substances Control Act • Superfund Act of 1980 created a federal resource to clean up uncontrolled or abandoned hazardous waste sites • Accidents, spills, and other emergency releases of pollutants • Reauthorized in 1986 by the Superfund Amendments and Reauthorization Act • Required local communities to begin planning for emergencies

Community and Environmental Health Overview

• Public health offers programs and services that contribute to improvements • May work to improve infrastructure • Focus on the total well-being of a community and its people • Address structural and systemic problems

Working Relationships

• Public health should expect to take the lead in establishing media relationships • Public health must become a friendly and familiar name with the media • Ground rules must be established when interacting with the media • There are never "off the record" discussions • Be honest: • A health agency must have the public's respect and trust • False or misleading statements will undermine an agency's integrity and standing in its community • Never make up facts or use misleading information • If you do not have the information, admit it

Social Marketing and Public Health

• Public health's most daunting challenge is to persuade and encouraging people to modify behaviors that negatively impact their health • Years of public awareness campaigns and health education have alerted people to the negative consequences of day-to-day choices • Another challenge is that outcomes of successful public health programs are not immediately apparent • Public health wants to modify people's behavior so that they remain healthy and receive the health services they want and need to live independent and full lives • Consumers must be willing and able to give up something of value to achieve better health • The goal of social marketing is to change the norms of a community

Relationship to Quality Improvement

• Quality and good customer service are linked • Accreditation will not dictate what steps must be taken to health departments and their communities. • Accreditation will provide a framework in which evidence-based public health can be expected, documented, and rewarded. • PHAB uses the following definitions to guide activities that relate to quality: • Quality improvement - integrative process links knowledge, structures, processes, and outcomes • Continuous quality improvement - ongoing effort to increase an agency's approach to managing performance, motivating improvement, and capturing lessons learned

Receivables

• Receivables include items other than cash • Credit terms and sales • Credit sales made on open accounts • An open account is not secured • Most receivables are secured • Implementing policies that stress short collection times • Analyzing factors that determine terms of credit

Communications -NIMS

• Reliable communications during an emergency are critical • Larger emergencies call for greater reliance on communications • Of all communications, 70% are nonverbal • Communication devices require a supporting infrastructure in which to operate • Amateur radio operators (HAM radios) can be used when other communications fail • Runners are people that convey messages • During a full communication breakdown runners may be necessary

Accessibility

• Reporters will seek out information if information from people is not available • Not meeting a reporter's deadline may result in the public health message not getting out • One person should be designated to speak to the media • The media's job is to decide which stories receive priority

Senior Management

• Senior managers are largely responsible for the success or failure of an agency • The executive officer holds the title of health commissioner, health director, or health officer • The executive officer reports directly to the governing board and is the board's only employee • Agency director heads report to the executive officer • There are several functional areas: • Budget and fiscal management • Human Resources • Administration • Legal services • Medical and/or Nursing

New Employee Training

• Senior managers should have a new employee orientation plan for their agency • New employee orientation: • Is often provided by Human Resources • Addresses an organization's structure, leadership, employee benefits, performance appraisal processes, dress code, parking, security, infection control, and universal precautions

Budget Options

• Several aspects should be addressed when a budget is assembled: • Justification • Detailed information • Best sources • Desired process • Operate with fixed expense budget • Flexible expense budget

Peer Pressure

• Shaping employee behavior and controlling potential employee problems requires managers to establish and support strong work ethics and values within an organization • Rewarding the values of individual staff members strengthens group values • Poor performers can not ignore strong values

Sheltering in Place

• Sheltering in place may be the best process during a disaster • Sheltering in place means staying at home • To have a population shelter in place requires pre-education of the public • To shelter in place requires a home to have enough supplies

Underuse, Overuse, and Misuse

• Six Aims model for CQI has the goal of reducing or eliminating defects or deficiencies • Quality deficiencies can be divided into three categories: • Underuse - this outcome indicates that a service or program has not been utilized at an optimal level • Overuse - refers to a service or program in which demand exceeds the ability of an agency to supply the services • Misuse - services or programs are provided in a way that results in undesired outcomes or complications

Social Media Introduction

• Social media venues have become appealing to large and small businesses as well as service and humanitarian organizations. • Sites range from professional sites, such as LinkedIn, to those catering to youth, such as MySpace. • All social media sites bring people, thoughts, and ideas together for sharing information. • In the early 1990s, email was just beginning to emerge as a medium for sharing ideas • Email has limitations • Social Media sites have reduced these limitations to a point where the free flow of concepts and ideas requires only that data be downloaded before being posted. • Any of number of people can receive the information in an instant.

Accountability

• Some government body must assume accountability for public health such as a board of health • The board of health becomes accountable for public health primarily by hiring, evaluating, and discharging its health officer or CEO • The board must to review a CEO's activities and accomplishments • A board should review how well its programs are addressing major issues on a regular basis

Joint Programs

• Some local agencies have formed joint programs to save on administrative costs • Cost savings can be invested into providing more services • Other agencies have found success in a regional approach in grant proposals for new programs • Many grants are requiring a multi jurisdictional or even regional approach to grant submittal • Agencies must begin slowly if they are going to work together for the first time • Mutual trust must be established for more ambitious projects to be undertaken • Constant vigilance is necessary to identify operational problems in a joint endeavor • Agencies that are not contributing can be given specific assignments and monitored for completion of that work

Clinic Staff

• Staffing CHCs is essential for day to day operations • CHCs must look at laws, demographics of the populations they serve, and the services offered • Guidelines usually require physicians to make periodic visits to review charts and clinical procedures • Physicians must be available for consultation during CHC hours of operation • The staff must meet area physicians to know their strengths and weaknesses for consultation purposes • Drug companies often make contributions to the public health system • Staff should get to know their pharmaceutical representatives and learn how to ask for samples for CHC use • Medicines should not prescribed solely on the basis of cost but personal well being must always be considered first • CHCs should establish relationships with local hospitals, which may bring about donated services such as x-ray or laboratory

Applicability to State and Local Agencies

• Standards are applicable to both state and local departments • There are some unique state measures • Variation in state and local structures was acknowledged • Standards are broadly applicable to agencies to differing structures, sizes, and levels of complexity • Standards and measures focus on core public health functions as defined by the 10 essential services • A separate set of documents features language specific for tribal public health departments

Time Frames

• Standards must have been generated during the five years preceding the starting date of a PHAB accreditation survey • Measured retrospectively • Four definitions of time frame - Annual - occurring or being created within the previous 14 months - Current - occurring or being created within the previous 24 months - Biennial - occurring or being created at least every 24 months - Regular - occurring or being created using a pre-established schedule determined by the health department

Legal Basis for Local Boards and Departments of Health

• States have been left fairly free to determine their own approaches to public health • There are few references in them specifically directed at public health issues. • State constitutions empower either the state legislature or the executive branch to address public health issues • Local boards of health in most states are granted powers to abate nuisances and determine the locations, construction, and repair of water closets, privies, cesspools, sinks, drains, and plumbing • Leaders of local health agencies may impose a quarantine • Most local departments have the power to hire people to remove waste and designate hospitals for cases of communicable diseases. • Some local boards have the power to levy taxes • Some states require health agencies to seek the permission of voters to levy taxes

Local and State Agency Similarities and Differences

• States play a vital role in the national public health effort • Funds for programs such as Family Planning and Maternal Child Health are funneled from states to the local level • Local health agencies rely on state contracts for group purchasing of vaccinations • The reason for the variety of state-local relationships is due to differences in state health laws for delivering federal funds and enforcing public health regulations • The federal government has little to say on the powers that states give to local agencies • Some states do not require the head of the state health department to be a physician • A few states have large staffs and oversee operations of healthcare delivery while other render vary few services to local agencies

Suburban Agencies

• Suburban agencies have both urban and rural concerns • Funding sources in suburban agencies are usually adequate • With increased populations, increased services are needed and provided • Most often these agencies have multiple layers of management

Ouchi - Theory Z

• Successful in Japan • Based on paternalism • Not gain acceptance in the United States • Fell from favor in Japan with recent economic difficulties

Clear Messages, Vision, and Missions

• Successful interactions depend on valid information • Information relayed by public health must be concise, clear and repetitive • Because conflicting issues are likely to arise at the statewide level, interactions with state leaders are important to limiting conflicts • Interactions with local and state leaders should facilitate the passage of statutes related to public health and decrease the number of reactive or negative responses

Surveillance

• Surveillance activities do not differ from day to day versus during an incident • Needed information includes the number of affected people, areas of concern, and issues surrounding the incident • After the incident, additional surveillance may be required for structural issues or for biological, chemical or safety concerns • Dependent on the nature of a problem, nonpublic health personnel may be needed to conduct surveillance • Syndromic surveillance involves gathering information from coded medical data • Sentinel site surveillance involves sites reporting on specific health parameters • Pre-determined thresholds of the parameters are used • Once thresholds are reached or exceeded, notification of that excess is made • Hospitals can identify suspected chemical or biological agents • Laboratories are needed to make positive identification of agents • CDC has developed the Laboratory Response Network

Teleology

• Teleology seeks balance and harmony • Moral goodness is subordinate to achieving balance • Jeremy Bentham and John Stuart Mill are most influential in teleological thinking • Moral rules or absolutes are neither required nor useful • Utilitarian thinking seeks the greatest good for the greatest number of people • Utilitarian thinking is accepted by individuals that make decisions relative to population groups • The right or best decision is the outcome with the greatest net value • A real risk is the possibility of overlooking subtle or future factors

CHC Dental Statistics

• The Bush administration has focused on oral health programs due to the links between dental care and other illnesses • At CHCs, the dental program appointments are booked far in advance • Dental specialists at CHCs are difficult to attract and employ

Requesting Federal Resources

• The CDC cannot enter a state or local jurisdiction unless it has been asked to assist or an interstate problem is involved • Federal activities are limited to international issues, interstate issues, or federal funding and assistance • In the case of needed resources for a terrorist event, the federal government is accessed through a state health department

Federal Government and Resources

• The Department of Health and Human Services (DHHS) is the agency that protects the health of all Americans and provides essential human services • Many DHHS programs are provided to local public health through state, county, or tribal agencies • DHHS has eight agencies in the US Public Health Service and three human service agencies • In the event of an emergency, the federal government can provide extensive resources to states and local municipalities but resources must be requested

The Due Process Clause of Labor Relations

• The Fifth Amendment to the US Constitution pertains to due process • A person's job is not a property right and does not fall under due process unless the person is covered by a grievance procedure • Ordinary gripes are not the same as grievances • A third party or arbitrator is called upon when there is an extremely important matter for one or both of the parties

Community Health Assessment: An Essential PH Activity

• The Institute of Medicine stated that every public health agency has the responsibility to assess the health of the community it serves • This duty cannot be delegated • A public health agency typically passes a resolution to conduct an assessment • The resolution should be disseminated widely and include one or more purposes, a definition of priority, assurance that adequate resources will be available, a request for support, and specify a venue for presenting final results • A community health assessment has several purposes: • Analyze a population's current health status • Determine the strengths and weaknesses of the community's health system • Identify a community's health needs • Develop recommendations to meet those needs • Prioritize the needs

High Quality Low Cost

• The National Association of Community Health Centers (NACHC) estimates that 16 million Americans receive regular healthcare services from a community health center (CHC) • CHCs injected $7.3 billion of operating expenditures directly to local economies and employed 90,000 full-time staff

Constitutional and Statutory Provisions

• The founding fathers developed a federal system. • Two distinct layers • National (federal) • State • States adopted and ratified the Constitution • American legal system based on common law • Federal Court System composed of district courts, circuit courts of appeals, and the Supreme Court • Each state has its on court system. • Trial courts are generally referred to as courts of common pleas • Intermediate appellate courts are generally called courts of appeals or circuit courts • States highest court is usually called the supreme court • Under the constitution, states give certain powers to the national government and retained other powers for themselves • Apparent intent of those framing the Constitution was to delegate issues of health to the responsibility of individual states • Founding fathers believed that states were to remain sovereign • Ratification of the Fourteenth Amendment required states to provide certain protections • Protecting the public's health occasionally requires imposition of quarantine and some police power to enforce such actions • Federal legislation has created programs such as the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC)

State Health Department Structure

• The health director and a number of political appointees generally head a state health department • They share power with longtime civil servants and merit system employees • New directors do not have as much power to change the system as they originally thought • The budget of a state health department is set by legislature as many as two years in advance • Making changes in funding may require a legislative act and could take years to complete • States may have a statewide board to minimize quick changes of policy by incoming leaders • Three health related units are common in state government: environmental, health education and promotion, and clinical services

History of Public Health- The Beginning

• The histories of human beings and disease are linked • Human populations grew because agriculture allowed food to be produced in large quantities, which in turn, allowed cities to grow • Domestication of animals followed farming and put readily available protein in diets and promoted population growth • With domestication of animals, humans came into intimate contact with those animals, allowing diseases to be passed easily from animals to humans • Many diseases such as pneumonia, TB, encephalitis and influenza came from animals • Living in communities promoted better quality pregnancies • Infant survival improved and led to increases in populations • Increased populations forced people to live in close proximity • Crowding spread diseases such as smallpox, influenza, measles and chicken pox • Occupational diseases such as those due to lead and mercury exposure emerged • Modern public health practices have reduced the incidence of occupational diseases • Over time, public health has been assisted by religion and religious practices • Religious prohibitions on eating swine protected followers from pig tapeworm and trichinosis • Prohibitions on eating shellfish prevented hepatitis

Local Government and the Community

• The interaction process often begins with a specific need • Working with local government is easier when an entire community is involved • Local government will support public health efforts if they are linked to programs that promote community health • Public health provides excellent opportunities to build bridges between local government and the community

Change and Adaptation

• The life cycle of a product or service moves through several phases • The introduction stage is the first phase when a product is first presented • Growth occurs with acceptance of the product • Maturity occurs when product sales peak • Decline is the final stage

Direct (Cash) Compensation

• The main requirement for a direct compensation program is developing a base salary program or system • Developing a program means utilizing specific techniques • Incentive plans • Pays for output rather than merely for time worked; may be applied to individuals or groups • Merit pay plans • Provides superior increases for superior performance • Benefits • Provided on the basis of membership in an organization or membership in a specific class of employee within an organization • General increases • Provided to all members of an organization; generally used to reflect changes in the cost-of-living, general economic changes, or changing conditions within a defined labor market

Working with the Media

• The media should be included early in any planning process for programs or projects • Members of the media can help identify the best means to reach the desired target audiences • When both politicians and the media understand agency goals they are likely to support the agency's objectives • The media should be given accurate information and kept abreast of a project or program's development • Relationships between public health and the media must be established and nurtured to be sustained

Health Protection Plans (cont'd)

• The need to control health insurance costs has given rise to employees sharing the costs for their coverage • Employees sharing costs have increased from 19% in 1983 to 60% in 2003 • The Consolidated Omnibus Budget Reconciliation (COBRA) mandated that insurance benefits be extended to terminated employees at the some cost to the former workers so that an employer's administrative costs will not increase

A Board is Only as Strong as Its Members

• The new board of health shared a vision of a virtual health department • Embraced the 10 essential public health services • Founding board members included persons with strong linkages to public health

Position Analysis

• The output of job analysis is a job description • Complete and accurate job descriptions are used for selecting, training, evaluating, compensating and sanctioning employees • Job analysis is the basis of employment • Information regarding positions is needed to direct and control activities and operations of agencies

Trust

• The price of cooperation is trust • Trust in not easily or quickly established • One-third of all employees feel their employers are trustworthy • Personal and organizational mistakes occur; both affect employee performance • Mistakes should not be dwelled on • Originations or individuals should not be allowed to chastise the agency that made the mistake

Documentation HR

• Written documentation is essential when addressing employee problems • Organizations should have written procedures governing the content, creation, exchange, and retention of documents • Human resources should have written procedures for retention and disposition of personnel documents • Documents are the property of the employer

The Context for Innovation in Local Public Health

• The public health system in Maine was highly centralized and headquartered in the state capital • Local public health services were provided by hard-working state employees • Maine uses a traditional New England homerule system • When Maine became a state in 1820, it had very little public health infrastructure • The 1918 influenza pandemic swept through Maine • Following the pandemic, Maine legislature transferred all statewide health guidance to the Maine Department of Health • Health officers were placed under the direct supervision of the state department • Most local public health systems are defined by the boundaries of counties, cities, or municipalities

Access to Healthcare Services

• The result of hospitals shifting increased costs to private insurance has resulted in a growing number of consumers who lack access to basic, non-emergency health services • Local health departments have started their own clinics to provide non-emergency treatment for individuals not being served by the traditional health care system • Effectively organizing and operating a healthcare clinic requires community to understand, communicate, and connect with its target population • The location of the clinic is critically important so that it is easily accessible by public and private transportation • Location is a greater concern in smaller communities than larger metro areas • The age of the population served is an important demographic when organizing and operating a clinic • Healthy people are more productive than persons who are ill • Community clinics contribute to worker health social well being • Cultural competence is a must for clinics to operate properly (signage, interpreters, etc.)

Rural Agencies

• The services supplied by public health agencies are essentially similar • Resources available to agencies depend on the population being served • Rural areas are less populated and the main industry is usually agriculture • State subsidies are usually in proportion to the population being served • Rural communities may have to rely on levies • Transporting staff is a concern because of the long distances between stops • Rural communities may have different types of programs than urban communities • Relationships between an agency and the community are often very close in rural communities

Theoretical Models

• There are two different theoretical models for making ethical decisions • Deontology • Teleology

Whyte - Interaction Theory

• Three main dimensions: 1. Interaction is synonymous with personal contact 2. People interact when they engage in activities together 3. Individuals have sentiments • Measurable deviations can be quantified and used as the basis for change

Identify Available Media Outlets

• To identify media outlets, public health must assess them • Assessment includes a through review of written material and observation of the media outlet • Then make decisions about which are reputable, fair and unbiased

Types of Social Media

• Traditional marketing channels are unidirectional • They quickly become dated and lose their usefulness to both marketers and recipients • Social media channels are bidirectional, offering opportunities for exchanges of information • Social media is rapidly evolving • About one out of every nine minutes (11%) spent online involves social media sites • Approximately one in four (24%) of internet pages viewed involved social networking sites • Facebook • One of the fastest growing and most popular online platforms • Has formalized essentially informal networks • Commercial organizations use Facebook because it is so familiar to their customers • MySpace • Serves a large and diverse audience • Allows users to customize their profile and include features such as blogs, discussion groups, bulletins, and a variety of applications

Volunteers

• Trained volunteers are extremely useful in a crisis • Volunteers must be identified, organized, trained, credentialed, engaged, evaluated and recognized • Volunteers should always be utilized • Unutilized volunteers lose interest

Employee Training

• Training of employees is integral to the success of an employee • Human resource provides some of the needed training • Many smaller organizations can not afford a full-time human resource employee • Consultants offer an alternative or supplement for a full-time human resource person

Recruit Outside of an Organization

• Two types of employment agencies • Free; these are usually general, state, or union referral halls • Recruiters • Private employment agencies including search firms charge a fee but can save time and resources • The fee is usually paid by the employer and may be 40% of one year's salary; one month's salary is more common • The Internet has many advantages such as reaching a wide range of applicants, being available 24 hours a day, and is less expensive than print media • Disadvantages of the Internet: • The pool of potential employees may overwhelm an organization • Resumes may be spread out geographically so that interviews are not feasible

Type of Review for Individual Measures

• Two types of review can be applied to each measure: • Sample Review - measures that apply at the program or activity level • Department Review - measures that apply at the department level

Exploring Accreditation Project

• Undertaken in August 2005 • 25-member steering committee • Is it desirable to develop a national voluntary public health accreditation program for the country? • Is it feasible to initiate such a program? • Public Health Accreditation Board (PHAB) incorporated in 2007 - http://www.phaboard.org/

Unemployment

• Unemployment Compensation Insurance • Individual states administer unemployment compensation insurance • Unemployment insurance rates encourage employers not to terminate employees • Employees are taxed according to their record of terminations • Currently the standard tax rate for unemployment compensation is 0.77% of payroll

Workers' Compensation

• Workers' Compensation • Workers' Compensation is intended to provide income maintenance, health care coverage and survivor protection for workers that become disabled or killed due to or by occupational events • Rates for Workers' Compensation Insurance vary widely and are determined by utilization and industry rating • Policies are often issued by states • Organizations may provide benefits that are not mandated such as health protection, payment for child care, tuition assistance, pensions, discounts, recreation programs, recognition awards and other nonmonetary incentives for enhancement of productivity

Union Management Issues History

• Unions became a force in the United States in the middle of the 1800s • Between 1860 and 1865 the number of local crafts unions tripled in the US • In 1886 the American Federation of Labor (AFL) was formed • For years trade unions and collective bargaining were viewed with disfavor • Bitter struggles ensued as management and workers each sought control • Public opinion favored strong unions as a counterbalance to large, powerful and centralized corporations • Significant regulations were passed to regulate interactions between labor and management • Two major pieces of labor legislation: • The National Labor Relations Act (Wagner Act of 1935) • The Labor-Management Relations Act (TaftHartley Act of 1974) • The Congress of Industrial Organizations (CIO) was formed in 1938 • The AFL and CIO merged in December 1955 and became the AFL-CIO • Union membership in the United States has steadily declined since the mid 1950s • Currently only about 12% of American workers belong to a labor union

Urban Agencies

• Urban agencies usually have the greatest number of staff and programs • Increased vectors and infectious diseases are problems for urban communities • Urban agencies face problems related to former industrial areas that have toxic chemical concerns, industrial accidents and areas of environmental contamination

Incremental versus Zero Based Budgeting

• Use the previous period's final plans and budgets • Public health departments use an incremental budgeting process • Zero-based budgeting is an alternate process • Each activity and expenditure must be justified and then prioritized

Depreciation

• Useful life of assets • Fixed assets (long-term assets) relative to a year • Depreciation and the gradual loss of value • Recorded in several different ways

Social Media Users

• Users of Social Media websites form two different groups • First group includes individuals that submit comments • Second group includes people that respond to postings they receive at the home pages of websites • A wide variety of organizations maintain a presence on social media websites • Range in size from cabinet agencies to local health departments

Life Insurance

• Usual for employers to give employees one or two times their annual compensation • The life insurance is usually provided at no cost to employees but does require employees to pay taxes on premiums provided to purchase coverage in excess of $50,000 • Employers may allow employees to purchase limited amounts of life insurance through payroll deduction

Values and Principles

• Values are concepts that individuals cherish • Value systems are inherently individual • Values that rank higher than others comprise the core values of a person • Values are translated into principles to make decisions and motivate ethical conduct • Values become guiding principles expressed as actions that should be taken and actions that should not be taken • Behavior becomes ethical when principles are acted upon • Conduct becomes unethical when prohibited actions are taken • An element of ethical behavior is self restraint • Rights that are available may be legal but not ethical • Persons defer decisions to act on personal desires after considering their impact on the welfare of others • Personal ideas of what is right or wrong are usually based on religion, cultural roots, family teaching, personal experience, laws, organizational values, group norms or political habits

Virtue

• Virtue encompasses the attitudes, disposition, or character traits that contribute to human development to the greatest extent or degree possible • Applying virtue enables individuals to develop their personal character • Behaviors become ethical when they contribute to morality and moral virtues

Establishing Relationships

• When a microphone is put in front of most public health professionals, they forget almost all of what they have learned • Public health should not wait to contact the media when a crisis is imminent • Working with the media is a must • Knowing how to work with members of the media is often omitted in academic classes

Involving the Community

• When committees are set and structure of group is in place, community can become involved • The community should be surveyed to obtain perceptions of health strengths and weaknesses for both their health and the community's health • Responders to supply demographic information • Keeping the public informed and involved in the process is important • Individuals that want to become more involved should be recognized and given the opportunity to take on more responsibility on an advisory committee • The advisory committee should be divisible into four or five subcommittees • The first meeting should include both the steering committee and advisory group to discuss the process including timelines for the project • The second meeting of the advisory committee should be devoted to organizing and beginning the work • At a minimum the subcommittees can expect to meet at least biweekly for 6 months • They should meet as a group because each subcommittee may be addressing different but related aspects of the community's health

Discharge

• When the disciplinary process does not result in employee improvement or when a problem is sufficiently severe, discharge is the next course of action • Organizations cannot discharge someone without just cause • Discharge requires adequate documentation • If problems or actions taken by supervisors are not documented, they do not exist • Lower level supervisors should not use discharge as a threat but they can say that they are recommending dismissal • A dismissed employee has the right to appeal • The right to appeal follows established procedures to ensure that the process is fair • Appeals are extremely expensive and time consuming • Complete documentation is a necessity

Defining Continuous Quality Improvement

• Within public health, CQI is defined as: • Using deliberate improvement techniques • Focusing on activities that improve population health • Making a continuous effort • Achieving measurable improvement in a process • Four key components • Using deliberate improvement techniques • Activities that improve population health • Continuous effort • Achieve measurable improvement in a process

Recruit Within an Organization

• Word of mouth is an informal and unscientific form of recruitment that can be effective • Jobs may be advertised through job postings • Jobs can be posted on a central board for five to seven days before moving to other recruitment techniques