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