Last night we had our “book launch” for Public Health Business Planning here in Chapel Hill. It was a wonderful event, attended by the current cohort of Management Academy, some former students, the Dean of the UNC School of Public Health, faculty, friends, family, and colleagues from across the country. Thank you all for coming!
One conversation out of many sticks with me this morning. I was talking with one of my colleagues here at the NC Institute for Public Health who runs our Leadership Novant program, and we got talking about rising health care costs. It seems that so much attention has been paid to gas costs recently, but rising health care costs are affecting families, businesses, and communities at least as much as rising gas prices. According to a recent info sheet from the National Coalition on Health Care, national health expenditures on health care costs were $2.3 trillion in 2007. If that number is too vast to mean anything, think of this: the annual premium that a health insurer charges an employer for a health plan covering a family of four averaged $12,100 in 2007. Workers contributed nearly $3,300 toward that premium, or 10 percent more than they did in 2006. You can see that would be devastaing to a full-time minimum wage worker making $10,712, but even people making an average income are feeling the hit, for insurance that often covers less and less. An article in the Washington Post pointed out that even when costs are not directly passed on to employees, the increased prices are effectively lowering pay because employers cannot afford to give regular raises under these conditions.
It's not that the media are ignoring this problem, but it is not front and center the way gas prices are this summer. We mused, one of the reasons we think about gas prices so much is that we look at them all the time: at every corner gas station, there’s a huge sign showing today’s price per gallon. Every nightly news segment starts with a story about the price of gas and its effect on a family’s budget, tourism, the trucking industry, food prices… you name it. What if every corner had a sign saying what today’s price for a colonoscopy was, with flip-numbers ready to go up that next dime per procedure? “Get your colonoscopy today because tomorrow it might be doubled in price!” What if every news day started with a run down of the many things families are giving up because they have to pay such high health insurance premiums? Or, worse yet, how many more families are going without health insurance because they need to eat, pay rent and, yes, buy gas? What if the cost of not preventing flu, tooth decay, heart attacks, cancer were broken down into a per-person or per-illness figure and flashed before our eyes every time we went to the drug store? If every time we had to fill a prescription it was like filling a gas tank, putting one pill in at a time and watching a meter go up, we'd pay more attention!
Food for thought.
Anne Menkens
Wednesday, July 30, 2008
Monday, July 28, 2008
Seeing through the fog
Big day in Chapel Hill today: the twenty-second cohort of the Management Academy started their program at the Rizzo Center.
Jim Johnson talked about civic entrepreneurship this evening. A couple of points hit me as especially relevant right now. First is the notion that most organizations, and most managers and leaders, are in a fog bank right now. It is difficult for most people to clearly see beyond what is right in front them.
Organizations that can find some clarity, that can see ahead instead of focusing right in front of them, will be at a great advantage. Some organizations will be stopping on the side of the road (try not to rear-end them as you go by).
Second is that even in the fog, some things are predictable. To deal with the unexpected, you have to be flexible and lucky. But some things are completely expected. There's no excuse for ignoring the obvious.
Demographics provides a great example. Your workforce is aging. The first baby boomer, Jim said, turned 62 on January 1st this year. That leading edge of the boom generation hits retirement age in three short years, 2011. Are you prepared? Are new leaders and managers being identified and prepared in your organization? Are systems and incentives being put in place to recruit the new workers you will need? Are systems and incentives being developed to retain the baby boomers that you want to stick around a while longer, even though they might be more expensive and less able to read small print and zip around the internet? Or is the organization focused on more immediate concerns?
One team tonight said they wanted to design a business plan to sustain an effort that is currently being maintained by grant funding. They know that grant funding, like an aging cohort of workers, eventually goes away.
The entrepreneur does two things that might seem at odds: one, see clearly what is really happening now , and two, see what could happen, even if it is completely different.
Jim Johnson talked about civic entrepreneurship this evening. A couple of points hit me as especially relevant right now. First is the notion that most organizations, and most managers and leaders, are in a fog bank right now. It is difficult for most people to clearly see beyond what is right in front them.
Organizations that can find some clarity, that can see ahead instead of focusing right in front of them, will be at a great advantage. Some organizations will be stopping on the side of the road (try not to rear-end them as you go by).
Second is that even in the fog, some things are predictable. To deal with the unexpected, you have to be flexible and lucky. But some things are completely expected. There's no excuse for ignoring the obvious.
Demographics provides a great example. Your workforce is aging. The first baby boomer, Jim said, turned 62 on January 1st this year. That leading edge of the boom generation hits retirement age in three short years, 2011. Are you prepared? Are new leaders and managers being identified and prepared in your organization? Are systems and incentives being put in place to recruit the new workers you will need? Are systems and incentives being developed to retain the baby boomers that you want to stick around a while longer, even though they might be more expensive and less able to read small print and zip around the internet? Or is the organization focused on more immediate concerns?
One team tonight said they wanted to design a business plan to sustain an effort that is currently being maintained by grant funding. They know that grant funding, like an aging cohort of workers, eventually goes away.
The entrepreneur does two things that might seem at odds: one, see clearly what is really happening now , and two, see what could happen, even if it is completely different.
--Steve Orton
Thursday, July 24, 2008
Adult Learning
Adult learners, I salute you...
The Dean of the School of Public Health, Barbara Rimer, recently blogged about adult learners. She was responding to a recent New York Times article about why some people continue to develop and others seem to stop.
Dean Rimer writes, "I’ve had to work really hard to develop my quantitative skills, but the more I’ve used these skills, the easier it becomes. Many of us, particularly those of a certain age (read: well over 50), grew up thinking that if we weren’t a natural at something, we just couldn’t or shouldn’t do that thing."
Many public health leaders and managers I've met feel that they don't have business skills, that they aren't good with money and budgets. They aren't "naturals" at it. Many of them started in public health because they cared about people, not money or math.
I'm in that category myself-- I never figured to be in public health, and I never figured to have "director" in my title. I've come to believe that, in order to accomplish the things I want to accomplish, I need to keep learning new skills.
Those who decide to work on it, learn it. Sustained effort trumps talent. I remember a study about success in music: the predictive factor wasn't talent, it was the amount of time spent practicing (duh).
The vast majority of the roughly 1,000 people who have enrolled in the Management Academy for Public Health have never written a business plan before-- but all of the graduates wind up writing one. And our graduation rate is 94%! Adults can learn. You may learn by reading, or studying a mentor, or taking a class. Many adults learn by setting themselves a challenge to try something new (especially if it is something that is really important and relevant to their job).
Writing a business plan can be that challenge for you. If so I hope the book, and this blog, help you stay on track!
The Dean of the School of Public Health, Barbara Rimer, recently blogged about adult learners. She was responding to a recent New York Times article about why some people continue to develop and others seem to stop.
Dean Rimer writes, "I’ve had to work really hard to develop my quantitative skills, but the more I’ve used these skills, the easier it becomes. Many of us, particularly those of a certain age (read: well over 50), grew up thinking that if we weren’t a natural at something, we just couldn’t or shouldn’t do that thing."
Many public health leaders and managers I've met feel that they don't have business skills, that they aren't good with money and budgets. They aren't "naturals" at it. Many of them started in public health because they cared about people, not money or math.
I'm in that category myself-- I never figured to be in public health, and I never figured to have "director" in my title. I've come to believe that, in order to accomplish the things I want to accomplish, I need to keep learning new skills.
Those who decide to work on it, learn it. Sustained effort trumps talent. I remember a study about success in music: the predictive factor wasn't talent, it was the amount of time spent practicing (duh).
The vast majority of the roughly 1,000 people who have enrolled in the Management Academy for Public Health have never written a business plan before-- but all of the graduates wind up writing one. And our graduation rate is 94%! Adults can learn. You may learn by reading, or studying a mentor, or taking a class. Many adults learn by setting themselves a challenge to try something new (especially if it is something that is really important and relevant to their job).
Writing a business plan can be that challenge for you. If so I hope the book, and this blog, help you stay on track!
--Steve Orton
The Size of the Pie
Thanks for the input on public health challenges-- tell us more!
By the way-- these challenges will likely have to be met by using existing resources more efficiently, or by creating new alliances and generating new revenue. Why? Because it looks like the size of the pie for governmental public health is not going to grow soon.
Jonathan Oberlander, who gave the Foard Lecture at UNC this spring (you can watch the webcast), warned the audience against "irrational exuberance" about the possibility that a new president might make dramatic changes in health care and population health. I heard similar forecasts from several healthcare executives this week. Folks in state and federal public health are expecting cutbacks, not big new expenditures. In many areas, the mortgage crisis is going to slowly deflate tax revenues.
So financial help is not on the way. If you want pie, it is time to start rolling out your own dough!
By the way-- these challenges will likely have to be met by using existing resources more efficiently, or by creating new alliances and generating new revenue. Why? Because it looks like the size of the pie for governmental public health is not going to grow soon.
Jonathan Oberlander, who gave the Foard Lecture at UNC this spring (you can watch the webcast), warned the audience against "irrational exuberance" about the possibility that a new president might make dramatic changes in health care and population health. I heard similar forecasts from several healthcare executives this week. Folks in state and federal public health are expecting cutbacks, not big new expenditures. In many areas, the mortgage crisis is going to slowly deflate tax revenues.
So financial help is not on the way. If you want pie, it is time to start rolling out your own dough!
Tuesday, July 22, 2008
Advice from the Community
The two new cohorts of the Management Academy for Public Health are coming to town over the next two weeks. This is the on-site at which teams get their marching orders—they meet with their business plan advisors for the first time and vet their ideas together; they sit for the first lectures, on business planning, social marketing, civic entrepreneurship, managing people, and finance; and they do the first exercises that will make their working groups into true teams over the next nine months of hard work.
Before they come this year, we are soliciting advice and thoughts for them from our Community of Practice: what do you think are the most important challenges facing public health these days? How are different public health departments addressing these challenges? What have you seen in your own community, or through your public health colleagues? More generally, what does it take to make a successful public health manager these days?
We’d appreciate your thoughts on any or all of these questions – or another we haven’t even thought of – to welcome our new students to town.
Before they come this year, we are soliciting advice and thoughts for them from our Community of Practice: what do you think are the most important challenges facing public health these days? How are different public health departments addressing these challenges? What have you seen in your own community, or through your public health colleagues? More generally, what does it take to make a successful public health manager these days?
We’d appreciate your thoughts on any or all of these questions – or another we haven’t even thought of – to welcome our new students to town.
Friday, July 18, 2008
View from the states
I spent part of two days last week with a group of state health department leaders at their national meeting. These senior deputies meet annually to connect and learn from each other. The central theme of the meeting during my time there was to learn to improve business practices in public health agencies.
By saying "business practices," I think they meant the following: how can we manage our resources more efficiently, so we get the most health out of the dollars and effort that we have available?
For example: they talked about how to use GIS tools to turn data into usable information (for instance: which way is the wildfire smoke going to drift in California, and what communities will be at risk for respiratory impact?); how to use web tools to collaborate more efficiently; how to efficiently track and integrate the huge portfolio of federal money that moves into a state every year, on the way to hundreds of government and non-government public health organizations; how to develop the public health workforce in general and build key management skills in state agencies in particular.
The effort is to become smarter: to know what's happening now, know what's needed, know where the money is being spent, know how to measure change to see whether the resources need to be shifted. These are efforts, on a broad state-level scale, that mirror what you try to do in creating a business plan.
Senior deputies are essentially the top management layer for the state public health agencies, with responsibility for executing strategy more than setting it. They manage lots of data about people and communities in their state; they integrate the work of people in their own agency and with huge numbers of partners who own a piece of the health puzzle; they disburse and/or track the money that funds the work that results ultimately in healthy environments and healthy people. They want to be able to say, about the programs of yours that they fund, "this is clearly a well-designed program; the money spent on this program is likely to result in a healthier community long-term."
As a public health business planner this should sound like good news to you. Of course most organizations have areas of discontinuity, where the goals they espouse clash with their actual behaviors-- and individuals are just the same. No organization is perfect. They throw up barriers to achieving their own goals. For now I want to highlight the desire to change the structures that are barriers and move to structures that reward efficiency and effectiveness and strategic partnerships and sustainability. Progress is being made!
By saying "business practices," I think they meant the following: how can we manage our resources more efficiently, so we get the most health out of the dollars and effort that we have available?
For example: they talked about how to use GIS tools to turn data into usable information (for instance: which way is the wildfire smoke going to drift in California, and what communities will be at risk for respiratory impact?); how to use web tools to collaborate more efficiently; how to efficiently track and integrate the huge portfolio of federal money that moves into a state every year, on the way to hundreds of government and non-government public health organizations; how to develop the public health workforce in general and build key management skills in state agencies in particular.
The effort is to become smarter: to know what's happening now, know what's needed, know where the money is being spent, know how to measure change to see whether the resources need to be shifted. These are efforts, on a broad state-level scale, that mirror what you try to do in creating a business plan.
Senior deputies are essentially the top management layer for the state public health agencies, with responsibility for executing strategy more than setting it. They manage lots of data about people and communities in their state; they integrate the work of people in their own agency and with huge numbers of partners who own a piece of the health puzzle; they disburse and/or track the money that funds the work that results ultimately in healthy environments and healthy people. They want to be able to say, about the programs of yours that they fund, "this is clearly a well-designed program; the money spent on this program is likely to result in a healthier community long-term."
As a public health business planner this should sound like good news to you. Of course most organizations have areas of discontinuity, where the goals they espouse clash with their actual behaviors-- and individuals are just the same. No organization is perfect. They throw up barriers to achieving their own goals. For now I want to highlight the desire to change the structures that are barriers and move to structures that reward efficiency and effectiveness and strategic partnerships and sustainability. Progress is being made!
Wednesday, July 16, 2008
News from Oklahoma
Dear Readers,
Some of what we will do in this space will be to share with you more examples of interesting and successful public health business plans from the Management Academy for Public Health. In the book we deal primarily with teams who attended and completed the Management Academy for Public Health several years ago – they’re the ones whose plans have been implemented, whose outcomes we know. Of course there are many more recent teams we didn’t get to write about—so, until we write another edition of Public Health Business Planning (if we’re so lucky as to get to do so) we will use this blog to share new stories.
An Oklahoma team that just graduated from the program in April has designed an exciting employee wellness program. They are working to create a strategic alliance of the Oklahoma State Department of Health, the Oklahoma Department of Career and Technology Education, and Blue Cross/Blue Shield of Oklahoma, to implement training of businesses on health improvement policies. When the businesses implement these policies, which will provide opportunities for employees to improve their nutrition, increase their physical activity, and eliminate tobacco use, then the businesses would receive a health insurance rate reduction from the Blue Cross/Blue Shield. The plan will be sustained in part by educational fees paid by the businesses.
For many reasons, this is a great plan – it involves a variety of partners who all have an interest in its success; its dependence on grant funding will go down over the years; it will not “make or break” the health department – they can implement it and, if necessary, exit without disturbing their core services and other activities.
One member of that team, Julie Cox-Caine, has just been promoted. She’s now a senior deputy reporting to the state health commissioner. We wish good luck to the team, and hope to hear more from them about their success!
-- Anne and Steve
Some of what we will do in this space will be to share with you more examples of interesting and successful public health business plans from the Management Academy for Public Health. In the book we deal primarily with teams who attended and completed the Management Academy for Public Health several years ago – they’re the ones whose plans have been implemented, whose outcomes we know. Of course there are many more recent teams we didn’t get to write about—so, until we write another edition of Public Health Business Planning (if we’re so lucky as to get to do so) we will use this blog to share new stories.
An Oklahoma team that just graduated from the program in April has designed an exciting employee wellness program. They are working to create a strategic alliance of the Oklahoma State Department of Health, the Oklahoma Department of Career and Technology Education, and Blue Cross/Blue Shield of Oklahoma, to implement training of businesses on health improvement policies. When the businesses implement these policies, which will provide opportunities for employees to improve their nutrition, increase their physical activity, and eliminate tobacco use, then the businesses would receive a health insurance rate reduction from the Blue Cross/Blue Shield. The plan will be sustained in part by educational fees paid by the businesses.
For many reasons, this is a great plan – it involves a variety of partners who all have an interest in its success; its dependence on grant funding will go down over the years; it will not “make or break” the health department – they can implement it and, if necessary, exit without disturbing their core services and other activities.
One member of that team, Julie Cox-Caine, has just been promoted. She’s now a senior deputy reporting to the state health commissioner. We wish good luck to the team, and hope to hear more from them about their success!
-- Anne and Steve
Friday, July 11, 2008
Welcome to public health business planning
Hello and welcome to the public health business planning blog!
Anne Menkens, Pam Santos and I have really missed the fun work of writing the book-- most of it was written in the summer and fall of 2007. So this blog will give us a chance to write some more on one of our favorite topics.
We plan to use this blog space to talk about business plan outcomes we've heard about, books and articles we've read, follow-ups on teams we wrote about in the book (and follow-ups on teams that we didn't write about but could have), and points that we should have discussed last fall when we wrote the book but somehow overlooked.
We look forward to hearing your questions and comments about business planning in public health. Write us!
Anne Menkens, Pam Santos and I have really missed the fun work of writing the book-- most of it was written in the summer and fall of 2007. So this blog will give us a chance to write some more on one of our favorite topics.
We plan to use this blog space to talk about business plan outcomes we've heard about, books and articles we've read, follow-ups on teams we wrote about in the book (and follow-ups on teams that we didn't write about but could have), and points that we should have discussed last fall when we wrote the book but somehow overlooked.
We look forward to hearing your questions and comments about business planning in public health. Write us!
Steve Orton
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