Epiphanami -- further thoughts

I'm really stuck on the idea of an epiphanami--

Perhaps the main difference between an epiphany and an epiphanami is that an epiphany happens to one person, and an epiphanami happens to a whole group. A really good public health business plan idea often looks to me like an epiphanami:

• It makes a whole team of people go "wow" and motivates them toward a big goal
  
• It changes the way they think: a shared epiphany
  
• It changes the way they work going forward
  
• The plan builds its own momentum; it seems to gather strength
• It doesn't hit the beach and meekly return to the depths, it changes the landscape
  

Where does the power come from? I have some thoughts about that. One is that it comes from unleashing human potential in a new way. That's John Gardner, from On Leadership. People want to be inspired. Work gets fun when you are committed to an important, challenging goal.

Business planning provides that important, challenging goal to many of the public health teams we work with. Instead of responding to an RFP designed to meet the goals of others, a business planning perspective encourages you to focus on an issue you think is really important, and then commit to really learning and understanding what's happening. Learning fuels teams as they work their idea into a solid plan. Getting from vision to practical, sustainable plan is the challenge side of the equation. Sustainability is a serious challenge. Starting programs is easy compared to sustaining them. The energy to do that comes from commitment to the goal and belief in a new way of reaching that goal, a way that works now and works into the future.

--Steve Orton

"Accountability" Take 2

I have been getting another manuscript out the door this week and last, so have been absent from this page for awhile. Look for the new book next summer: Managing the Public Health Enterprise: A Practical Guide, ed. Baker, Menkens, and Porter, from Jones & Bartlett. It’s a collection of short essays from the “Management Moment” column of the Journal of Public Health Management and Practice, and some new contributions from our colleagues here at the NC Institute for Public Health and at the Dana-Farber Cancer Institute, all with the goal of giving short, practical advice for common management challenges. Steve Orton is in there multiple times – if nothing else, you’ll want to hear his inimitable voice again!

But I’m thinking now about his word “accountable.” Steve points out the root “count,” but there’s another meaning in there: “account” as in “story,” as in “narrative” – the “teller” at a bank counts your money, but a “teller” of a story describes something. When you are accountable, you give an account of, or answer for, your responsibilities – by telling about them.

So think of planning as telling a story. You gather data, put it together in a clear, open, way: and tell your story to the people that matter. Planners use facts about the past and an understanding of current trends, circumstances, and priorities to tell the story of what the future should be in both broad and deep detail. Evaluators are also story tellers: they use the information about how things worked to tell the story of process and outcome: what worked, what didn’t, and what were we able to accomplish. Yes, it's about counting, but how you report the numbers and to whom you report them matter as well. Your stakeholders, funders, and potential partners in the community cannot know unless you tell them.

Planners are often given less priority in some government settings: good planning takes a lot of time, and story tellers (both those who look to the future to plan new programs and those who look to the past to evaluate current ones) are often the first to get cut in budget crunches. We’re seeing it in our executive education programs: slightly fewer are enrolling this year because of budgetary insecurity around the country. But our students are the ones who go back to their organizations and tell the stories that get new partners excited in new programs. They’re the ones who try to resist the time pressure to demonstrate success: they know you can’t tell the story until you know what happened!

All this is to say: we understand the pressures that public health managers (and others) are under to demonstrate accountability while at the same time they’re not often given the time or tools to truly plan and evaluate their programs. We are thankful to the many public health departments from across the country that are investing in their employees by sending them to the Management Academy, and to the many community partners who are part of those teams. In challenging economic times, it is more important than ever to get the story out about the critical work being done in public health.

-- Anne Menkens

Accountability: Economics 101 for public health

An interesting article came across the desk this week-- on "Business Basics for Nonprofits." The article is a Harvard Business Review piece from February 2004 describing a talk by Jeff Bradach, a strategy consultant to non-profit groups. Here's the lead:

To transform aspirations into quantifiable impact, nonprofits [and public health agencies] need to become more familiar with traditional business tools such as business plans...

Why? Because

Today's... climate demands accountability.

Now, let me make a personal admission (blogging seems to encourage personal sharing). I've always been intimidated-- ok, scared-- of that term accountability. It sounds so judgmental and harsh! Somehow the term is connected in my brain with the notion of being punished for falling short in some area. Accounts will be settled! You will pay for your shortcomings!

Recently though I've started thinking about the word differently. When I hear it now I think:

COUNT-ability.

The ability to count something.

It's nothing personal: just a data inquiry. What are the facts? What is actually happening?

The article lists four areas where non-profits (and I think public health agencies as well) sometimes have difficulty with their counting: the first three are impact, process, and cost. And like the folks in the article, I think that business planning is an approach that can help you count better.

Impact: The difficulty here is in being specific about goals: exactly WHO we are trying to help and exactly HOW they are going to benefit. Among the key questions is "how do we define success?"

Process: The difficulty here is being specific about the steps necessary to get to the goal. Face it: you are working in a very complicated system. Sometimes people create interventions that don't have the results they expected. How do we know? Bradach wants you to figure out

what comes between the grand, inspirational mission and the activities and programs of the organization. By letting this in-between area remain grey, organizations have no way to measure whether programs are working, or even know if they are on the right track.

Cost: In public health, it isn't uncommon for cost and budget information to flow exclusively to one "business manager" type person, bypassing program staff entirely, and reaching leadership only in summary form. Does this sound familiar? Does your organization count costs effectively?

Bradach's clients typically don't. When he helps them do it they "often see that their spending doesn't align with what they had identified as key points in their mission."

Note that public health business planning requires that you look at all three of these areas.

That brings us to the fourth area, which the article calls "difficulty making hard choices." Across a whole organization, this sort of "counting" of goals, processes and costs might very well lead to some discomfort. Why? Because some people (people like me) will initially get itchy and warm and start jouncing their feet in a classic "fight or flight" response to perceived danger. Someone might get hurt!

Clearly it would be better, in a potentially difficult and emotionally charged situation, to have some data to base a decision on. Without data, these decisions will get hijacked by our individual or organizational lizard brains.

With data-- we might find out that some of our programs... aren't helping very much. Or aren't helping the right people. Or aren't exactly what our customers and stakeholders really need. In other words, we might find out that some of our programs are actually preventing us from moving towards our mission-- because they are tying down people and space and time who could be doing more important work.

Final word: business plans can help in your quest to "transform aspirations into quantifiable impact."

Am I right? Drop a comment and say what you think...

--Steve O

Epiphanami

I spent the end of last week at a leadership training program that I help run-- and as usual I learned more than I imparted.

The theme of the two days was innovation. The group spent half a day working on improv techniques with an expert from Chapel Hill who has his own improv company, and an adjunct appointment at the Kenan-Flagler Business School. The session is all about learning to take risks, listening to the clues that your teammates are giving you and running with them.

The take-away for me was that most people are ready to be much more creative, much more risk-taking, much more committed-- much more entrepreneurial-- than they show on a typical day at work. John Gardner in On Leadership says that this is the most basic function of leadership in organizations: unlock human potential. He argues that organizations get only a tiny fraction of the potential out of their workers.

The other take-away was to not use the term "take-away" any more. Far better is the term "epiphanami." I love this word! A participant came up with it as a way to describe the feeling of learning something, realizing something, really important for a whole group within an organization. I imagine getting a series of epiphanies at a leadership session-- or being in a group of people that all get related, reinforcing epiphanies-- such that the whole group is picked up on the wave and flung at the shore with astounding force.

An epiphanami (epiphunami?), I think, is an epiphany with the power and the breadth of a tsunami, an epiphany with the potential to bring real change. That's the link back to innovation: the point of being an entrepreneur within a government or non-profit organization is to chase your BHAG, your big hairy audacious goal, in a new way, instead of responding to another RFP (and chase somebody else's goal).

--Steve Orton

Business Planning at the State Level

I had a conversation yesterday with a member of a current Management Academy team that happens to be from the state health department. In North Carolina we have an essentially decentralized public health system. Most of our 100 counties have their own health department (some counties double up); and they are individual entities whose employees do not work for the state. This structure gives them more flexibility than is enjoyed by county-level health departments in states with more centralized systems, such as South Carolina, and, it gives them more flexibility than those who work at the State Department of Health and Human Services. So much of what we talk about in this book and at the Management Academy assumes a certain level of flexibility: to create new positions or change old ones, to influence hiring, to affect priorities, and, most important, to incorporate revenue generation into programs. For the most part, our examples in the book and our examples and case studies in the program all assume a level of flexibility unrealistic in some government settings.

So, the challenge is to come up with ways to apply entrepreneurial thinking within less than flexible settings. This team from the state is submitting a feasibility plan for a program to build capacity in the public health workforce. Their analysis of need turned up the need for better evaluation, and the fact that public health entities now often must hire outside consultants to undertake evaluation of implemented programs required by funders. Their industry analysis turned up many great courses and on-line trainings, as well as well-vetted standards and paradigms, so they decided not to create a curriculum. They decided instead to focus on creating a program that offers web resources, links to courses, study guides, etc., as well as developing an exam that would serve as a certification tool for public health professionals who wish to improve their evaluation skills. State funders, representatives of the national associations for public health (NACCHO and ASTHO), local health directors in NC, and individuals involved with accreditation are all excited about the possibilities for such a program.

The team’s business plan advisor has not weighed in, and I’m not sure of all the financial details, but to me it sounds interesting and exciting. In terms of lessons for others at the state level, it might be good to think “big picture” about needs in public health. Perhaps the types of programs you should be thinking about are those that serve others in public health, dealing with training programs for public health or health care professionals, working with state-wide partners, or thinking about priorities that transcend the state, such as the accreditation movement or preparedness activities.

I’ll share more of this team’s story in future columns – as their plan moves from “blue sky” to black and white details – as well as stories from other “less flexible” sites. If you have other examples or thoughts to share, please do.

-- Anne Menkens

NACCHO-ASTHO in Sacramento-- what's your take?

Today is a bittersweet day-- the NACCHO-ASTHO conference starts in Sacramento and I won't be attending. This is my favorite conference-- a great experience for anyone who is interested in public health management and leadership. The sessions are usually very good, and the sessions are designed to facilitate networking.

UNC will have a booth at the show, and information about the book will be available there. Stop by and introduce yourself to Monecia Thomas, the new director of the Management Academy (and also the director of the Emerging Leaders in Public Health program).

I would love to hear about how you are using the book, how you are using business planning principles in your public health work, what innovative new ideas you're working on developing and getting funded-- and what sort of interesting stuff you learned in Sacramento!

--Steve Orton

Preparedness and Business Planning

We in the southeastern US are anxiously watching three hurricanes coming our way. Hanna, Ike, Josephine… like unwanted old friends coming to visit, we’ve seen this before. Did you know that the skills of public health business planning are applicable to disaster planning?

This application can be direct: some teams every year tackle a preparedness problem in their plan. We write in the book about a Virginia team that created a plan to train childcare management and workers in disaster preparedness and create a certification program for that. Another team developed a disaster preparation training program for faith-based organizations interested in helping special needs groups, such as the blind, or those who do not speak English. That more recent team included a Spanish-speaking member as their community partner and envisioned working with the State Bioterrorism Department, local emergency centers, and local businesses to develop this program.

The application can also be indirect: in December, 2001, MAPH evaluation staff surveyed MAPH graduates to see whether and how their training had an impact on their ability to do terrorism and disaster-related work post-9/11. Of the 74% of respondents who said they did such work in their jobs, 90% said that MAPH contributed to their ability to respond. Now, MAPH teaches a lot more than writing a business plan, but the list of things respondents gave as having contributed to their ability includes much that goes into writing a business plan. They listed:
- partnerships, networking and negotiations
- communication, including presenting and writing plans
- planning, including strategic and business planning
- managing people, including delegation and team building
- managing projects
- personal confidence, including management, leadership and priority-setting

On a related note, in an article in Public Health Reports (122:1, Jan/Feb 2007), some of our colleagues at the NC Institute for Public Health compared preparation for two hurricanes: Hurricane Floyd in 1999 and Hurricane Isabel in 2003. They looked at the capacity building activities in the intervening years to see whether there was a correlation between having undertaken these activities and doing a better job preparing for the later hurricane. Surprise! There was – and, among other things like infrastructure development, the capacity building activities are the kinds of things we talk about every day. One important example is partnership building. In this case, partnerships among state and local agencies, health care facilities, businesses, and professional associations involved in preparedness and response. These are the kinds of people you are talking with about your own business plans. Whether or not you are talking about disaster planning, you are talking, getting to know each other, building trust and advancing relationships. When you do turn to disaster planning, you'll have a lot in place with which to work.

I can’t link to the article here, but you should read it if you can. It has the somewhat unwieldy (yet informative) title, “Evaluation of Public Health Response to Hurricanes Finds North Carolina Better Prepared for Public Health Emergencies” by Davis, MacDonald, Kline, and Baker.

Enjoy! And wish us luck with our “visitors” over the next few weeks.

-- Anne Menkens

Succession Planning 2

One of the corollaries of Anne's last post on succession planning in government is this: there is lots of talent in your town or your region that would improve your organization. Where are you looking for your next manager hire?

The default thought might be to find a public health graduate program, of course. But the next person hired as a manager in local public health is probably not coming straight out of a school of public health.

I talk to health directors frequently, at trainings and at national meetings. Even if you are lucky enough to be located near a big school of public health (and most aren't) you will find it hard to recruit graduates of those programs to do community-level health work. Most of the MPH grad students I run into in Chapel Hill, for instance, are aiming for jobs in healthcare, or policy jobs in DC, or international work, or research, or teaching.

Luckily, public health has room for talented managers from all kinds of different educational backgrounds. Great, hard-working, public-spirited managers in your town may be waiting for your call. Certainly there are folks out there who could help you do some of the things you need to do: assess the community, assure quality and access, develop policies to create more. Local knowledge is kind of an important selling point, actually.

Our book is based on the idea that government and non-profit organizations are trying to learn best practices around planning and efficiency and quality from other sectors. Recruiting is a powerful way to help your organization learn. So I would argue that recruiting from outside is actually important-- not just something to settle for.

Yes, these new hires will need to be oriented to population health and trained in that perspective. Again, lots of adult education resources and programs are available to help you do that--including some that are entirely on-line.

--Steve Orton