BHAG

Spent several hours with the new and graduating scholars of the Southeast Public Health Leadership Institute on Monday-- a group that included many graduates of the Management Academy on both sides of the room!

While I was there I talked to one health director who is preparing his management team to write a business plan on access to care in their county. He's very concerned about the rise in emergency room use.

The issue is complicated by the fact that his county has two mid-size towns in it, separated by 9 miles, and each with their own hospital. The two hospitals are both part of bigger networks of hospitals, and those two networks (Baptist and Novant) are battling with each other for market share in many different counties around the Winston-Salem market.

I got goosebumps hearing what this leader was going to ask his staff to do. They are going to try to build a strategic alliance for their community that would result in a win-win-win-win situation: a plan to create better, more sensible primary and urgent care in two adjacent communities, and reduce emergency visits simultaneously for two competitors!

Would love to hear your comments and suggestions for this team.

My reason for sharing the story was to inspire you. David Altman of the Center for Creative Leadership said at the conference that everybody should have a BHAG: that's certainly the point of a leadership development program. What is your Big Hairy Audacious Goal?

--Steve Orton

Attracting a Younger Workforce

I recently received the following email from a colleague, whom I had asked to write something for me:

i did a ppt for a buncha reporters a week or so ago. gives you some idea of the ground i would cover in the piece. I think the dec deadline is prolly doable but when is the deadline for the NEXT edition, btw?

My first thought on receiving this email was, Will I have to ask him to write “probably” instead of “prolly” in his article? My second thought was, Boy, I’m getting old!

Wouldn’t it be nice if we had the problem of too many young people entering the public health workforce? As you may know – by looking around and by reading the literature – our workforce is aging. Many of us are merely a bit too old to take easily to writing that looks like a phone-text message. Others are actually aging out – retiring – and leaving the workforce depleted. It behooves us all to think about ways to bring more young people into the profession. Positive benefits of this might be a workforce that is

- open to (and full of) new ideas
- more technologically savvy
- energetic and idealistic
- more in touch with the population we serve

So, how do we get people interested? One way might be to reach out to high schools, colleges, and universities to inform students about what public health is and how they might make a difference with a career in this field. A great way to do this might be through a public health business plan!

Some Dare County, NC grads started a great plan that involved middle school students teaching elementary school students about healthy living. Students took their involvement much further than the original plan required, and ended up getting involved in other local programs around addressing teen smoking and drinking. A team from Wilmington partnered with veterinary students and introduced them to population-level pet concerns while training them and tapping into their enthusiasm and budding expertise; a South Carolina team worked with a university partner to plan a women’s health clinic on campus. A team this year is planning a summer program for children that will provide intern possibilities to local college students.

Other teams over the years have planned programs at schools, or for young people, but not necessarily getting young people involved. A small tweak to their plan might add a component that ensures at least some kids say, “Hey, that might be something I want to do” (or, more likely, “i wanna do”) long-term!

AJM

Book Club Webinar

This week we had a couple of “Book Club” webinars for the current Management Academy cohorts. Thank you so much to everyone who participated. One of the things we did was look at the quotations on the chapter pages of the web site and talk about them. The quotation for Chapter 1 is “A goal without a plan is just a wish” – here are some of the things that came up:

“Wishful thinking is like writing a Christmas list. It is definitely a first step, but to actually fill up under the Christmas tree, you’ve got to save some money, figure out where you’re going to get the stuff, plan when you’re going to go shopping, what you’ll do if they don’t have exactly what you want.”

“Our group has gone through three feasibility plans. The first two ideas were just wishes, and when we started to plan we realized they were not feasible. You need a plan, to ask the hard questions, look for barriers, etc.”

“You may know where you want to be in the end, but unless you have made your plan you might not recognize when you’ve begun making steps in that direction.”

“The people who have the big picture in mind are not necessarily the same people who can see the details to do the plan. It’s as if the “big picture” people are wishing, and the “little picture” people are planning, and sometimes there’s conflict. A way to get around this is to make sure you have good community partners on the team because they’re often able to help you get to where you want to go.”

For the Chapter 2 quotation, “A wise man will make more opportunities than he finds,” some comments included:

“This may be true, but you need to have a structure in place to make opportunities happen. Entrepreneurs go out and create opportunities, but they have a system in place to get them going.”

“I am personally risk averse. It’s hard for me to see myself as an entrepreneur because I’d rather just stay back in the office and make things happen.”

“Staying and making things happen is also entrepreneurial – you’re making sure people are served.”

We talked about the quote for Chapter 3, from Abraham Lincoln and decided that "commitment to success" can have many definitions -- and sometimes "success" looks different at different stages of the process. Finally, the last quotation, "Ideas are like rabbits. You get a couple and learn how to handle them and pretty soon, you have a dozen" drew many different takes:

"Too many ideas are like rabbits taking over the house! You get too many things going and you can't do any of them well. Brainstorming makes us aware of multiple options -- but you need to narrow down the big goals. Take one rabbit and put it in a cage (called "The Definition of Plan") and develop that rabbit."

"I see the rabbits as a good thing. You just need to send a message to the rabbit people -- save that idea for the next project. Keep thinking of ideas, but begin nurturing just one at a time. Learn to control the rabbits!"

Thanks to everyone who participated. For those of you who didn't, please share your thoughts about the Chapter Page quotations from the web site when you get a chance. Have a great Turkey Day everyone! Don't worry about rabbits for a few days at least.

-- Anne

More on Flu's Clues

I'd be interested in hearing more about the project Steve wrote about Monday. It’s called “Flu’s Clues,” and it provides flu vaccine clinics in local public schools. As of mid-October, Tazewell County, VA, nurses had given 596 flu vaccines in 9 school clinics, with two clinics left to go. That’s quite an achievement! This happened in the Cumberland Plateau Health District of Virginia. We write about the CPHD at length in Chapter 7 of the book (Competitors and Partners) as an example of great partnering activity over several years that has resulted in some amazing projects (pp. 67-69).

Some thoughts and questions about this program:

First, this program is a good example of strategic budgeting. You could never just take the annual costs of this project and divide them by 12 to get monthly costs. How does a program like this deal with the large fluctuations in costs over the course of a year? Have any of you come up against this problem in their program planning?

Also, does this team have a plan to expand the program at some point to offer other products or services to school children? Well-child tests or other immunizations, for example? Or is this an example of something well-focused that should stay that way?

Public schools can be problematic when it comes to private sponsorship. Did you come up against that here? What about the rest of you who have experience working with schools – several teams have attempted such programs over the years. One obvious lesson might be to make sure you include a representative from the local schools on your planning team. What are other lessons learned to share from the process of working with public schools?

Anne Menkens

Outcomes Story

Talked on the phone a couple of weeks ago with Kathy Hypes, a public health manager in southwest Virginia. She and a team of colleagues created a business plan back in 2004 to fund flu shots for kids in the school system of Tazewell County, a rural county in the mountains of Virginia.

Talk about unforeseen barriers: for two years the whole country had problems getting the right flu vaccine. Finally last year the group launched their pilot flu shot program in Russell and Tazewell county elementary schools. From that pilot year the team gathered positive stories and used their pilot success to expand the program to the middle schools this year.

If you have worked with the schools before you realize the challenges associated with permissions, space, and timing for a project like this-- not to mention the challenge of making sure that you can generate enough revenue to support the work. Through a combination of Medicaid billing, insurance, state money for uninsured children and a contract with Anthem Healthcare, they have made the finances work-- and made a well-targeted intervention to prevent flu and the spread of flu with one of the larger institutions in the area.

From the Management Academy Director

We are so pleased to hear about the valuable lessons you have learned from the Management Academy for Public Health retreats. Several of the current participants mentioned improved Communication Skills, learning to Negotiate, mastering Finance Skills and the information received from their 360 Assessment.
One aspect that was consistently noted was that this entire 9-month program is a long learning process to reach your goal of creating a business plan that successfully addresses a community need. The Management Academy staff continues to be impressed by how much work is put towards creating the plan and then later working to get it implemented. Most teams are now meeting in person each week or every other week, in addition to conference calls and email exchanges. Earlier today, we received an email from a team that completed the Management Academy several years ago; their plan is being implemented now in its entirety. More information to come!

It is also great to see that you are using the teambuilding skills presented by Triangle Training as you continue to work with individuals who may have a style different from your own. Don't forget some of the valuable lessons about communicating openly and honestly, working together, setting goals and not giving up. As mentioned by our colleague, Carolyn, - "We have many challenges ahead", but I would like to add that the "Best is yet to come". Thinking of the best is yet to come, the current Management Academy participants will participate in several upcoming webinars about the book: Public Health Business Planning..............As you continue to read chapter by chapter, please feel free to share your thoughts here.

Partnering for Economic Sustainability

I heard on the news recently that there’s a silver lining to the economic troubles facing us right now: people actually live healthier during economic downturns! We eat at home more, we exercise more, we’re less apt to smoke and drink, and we don’t drive as much. I hope that’s comforting to all of you as you see your budgets shrink.

The good thing about the partnerships described in the comments to my last post is that they are broadly collaborative. That makes them more resistant to economic downturns. I count 54 members of the The Eat Smart, Move More Leadership Team – groups from academia, the medical industry, and non-profits; groups that are local, statewide, faith based, youth-oriented, and farm or school oriented; groups that focus on nutrition, or activity, or the environment that encourages healthy living. Bringing all these groups and individuals together to gather information and then actually DO something with that information is exciting. Someone will always have a new idea, the right expertise, and "know someone who knows someone" who can get it done.

“Vaccinate and Vote” is a collaboration between the Virginia Department of Health and the Augusta Medical Center and Eastern Virginia Medical School. It’s exciting because it brings together academia, the public health system, and a private health care center – around an issue important to all of them. The breadth of this type of collaboration is always a good thing in turbulent economic times, because it shares the cost AND because it nurtures longer-term collaboration. The next time these partners think of a good idea, they won’t have to re-start the negotiations. They’ll be able to “start where they left off” so to speak.

We’ve seen that phenomenon in our alumni, who often say, “We did that one MAPH project, and other ideas just kept coming up!” One team from a county Animal Control Services Division several years ago worked with local veterinarians (initially seen as competitors) to build and staff a spay/neuter clinic in their community. Since then, they’ve established continuing educational programs for local veterinarians and their staff, created educational programs for local schools, partnered with pharmaceutical company that makes rabies vaccine, and worked with the local college pre-veterinary program whose students act as interns in the spay-neuter clinic, among other projects. In a way, once you start, it never ends!

I look forward to hearing more about interesting and exciting collaborations going on. And what about challenges you’ve found? What did you do about them?