Success Story: Highland Health Center

Congratulations to our friends in Gaston County NC on their Highland Health Center Grand Opening and Building Dedication last Tuesday, July 27!

A Gaston County team developed the business plan through the Management Academy to plan out how to co-locate health department and health center services. You can read more about the Grand Opening here.

This is a classic example of a public health business plan:

• Starts from health needs
• Identifies a key target market (in this case a specific section of the city)
• Maps out a mutually beneficial alliance (in this case, the health department and the FQHC in the city)
• Shows how the money will flow

Hats off to the whole team, and thanks to Health Director Colleen Bridger for sending them!

--Steve Orton

Business Planning and Flu Epidemics

Like everyone else in the public health community, we have been thinking a lot about swine flu lately. Public health leaders, managers and practitioners are scrambling to plan for what may come.

I recently contact John Dreyzehner, District Director of the Cumberland Plateau Health District in the Virginia Department of Health. Dr. Dreyzehner has sent many teams to the Management Academy over the years. We wrote about some of those in Chapter 7 of the book, “Competitors and Partners,” pages 68 – 69. One of the programs produced by a team from Dr. Dreyzehner’s district was called “Flu’s Clues,” an influenza vaccination program for children ages 3 – 9, based at the local Head Start programs and elementary schools

Steve and I posted back in November (17th and 20th) about “Flu’s Clues.” The program is now in its third year – now called “See you later fluigator” or “Fluigator” for short, with a sick alligator as a mascot, to avoid intellectual property issues. I asked Dr. Drehzehner whether having the program in place was making swine flu preparation any easier. Here are his thoughts:

“[The vaccination program] certainly increases ours and our partners confidence in being able to push out vaccines and treatments. At this point we can do points of distribution/Dispensing (PODs) in our sleep. The challenge at the moment, as is to be expected, is universal agreement on how/if to widely employ the present Tamiflu resource and to do it in a fashion that is consistent with legal equirements and good medical practice.

“There is understanding that we have to target it to the ill for treatment and, some think, their caretakers to begin at the first sign of illness. In one concept of operations I drafted we have accessible PODs open 8-12 hours daily at various location as drive through or walk -up (will spacing to prevent transmission). No ill (but sometimes exposed people) come in and complete and sign a medical attestation form regarding the illness in the person they are responsible for and get a course for that person(s) AND a reserve course for themselves and any other exposed in the household/place exposed to begin with the onset of fever and respiratory symptoms. In this way, the entire population can be assured the treatment is available for use in 12 hours or less to any one at any time. This works as long as this tricky virus remains sensitive. That is the readers digest version of one of my plans. But it is very doable.”

It sounds as if the Cumberland Plateau Health District is ready to do what it needs to do to address this possible epidemic. The challenge is deciding exactly what ought to be done – but it’s good to have the infrastructure in place to do it. They have that infrastructure in place because somebody thought of an idea, they partnered with important community institutions, they wrote a business plan that accounted for funding it, and they implemented it.

Let's hear from some of our readers -- what are you doing about swine flu? What obstacles are you coming up against?

Book Club Webinar 2

We had a book club webinar yesterday to talk with current MAPH students about their progress in terms of industry analysis, community need, competitors and partners, marketing, and project operations. Some of the following issues, thoughts, and suggestions were raised. Do you have any further advice for our community of practice?

Issue: When your community health assessment identifies a problem, but industry analysis reveals a barrier to meeting that problem in a sustainable way.

Example: We have developed an obesity prevention program that will be a summer camp for children. Industry analysis revealed that one success factor is being able to charge enough to pay for the health care and physical education personnel who will work for the program. Alternatively, a success factor is to have a pool of professionals available for volunteer work. We won’t be able to charge enough, so that becomes a barrier for us. We are in a rural county with low income population. We don’t have a large number of professional volunteers to call upon either.

Some ideas: 1) broaden your area of reach. Look to make it a region-wide program rather than just for your county; 2) start smaller; 3) see if insurance will pay, if children are referred by physicians; 4) partner with another group running a summer camp (YMCA?), and be part of their program; 5) charge a sliding-scale fee; 6) consider things that could be offered in-kind to support the program.

Issue: We’ve got a community health assessment telling us exactly what the public should do to be more healthy. How do we communicate with people about the need to change behavior, environment, etc. without insulting or patronizing them?

Thoughts: Public health workforce needs development in social marketing. We need to learn how to talk with people and understand their struggle. We don’t want to send the message – “your neighborhood is run-down and has bad grocery stores and no sidewalks” or, “you are overweight and need to exercise more and eat better” -- because these messages are not going to encourage change. The message of need has to first come from them, and it has to be communicated respectfully. Sometimes public health people are too focused on the big picture and all the problems that need to be solved. We need to step back and give people space, “partner with people,” listen to them and have respect for their understanding of their own community and its strengths and challenges.

Issue: We’ve brainstormed and identified partners who “have what we need,” but they aren’t interested in working with us. It may be the economic times, or it may just be the small relative scale of the project we’re planning, but we can’t make headway getting partners on board.

Suggestions: think of the partnership as more than a one-shot deal, more than just what they can give you: think of it strategically and long-term. If you can, get on their board, or on the board of some other community project they’re involved with. If you are not the appropriate person in your organization to do this, identify the colleague who is appropriate, and try to get him or her involved. This way the potential partner will see the value you bring to the table and may be more apt to consider you a potential partner. Also, try to find out why the potential partner is not interested. Is it a current circumstance, like the economic downturn, or are they truly not interested in the project? If the latter, find out what they are interested in, and come back later with a different plan, closer to their interest. Either way, if you become involved with their organization in some way, they will be able to see the value of working with you.

Issue: We have not really communicated with our superiors about our project since we first were accepted to the Management Academy. Our project has changed a lot since then.

Suggestions: The Management Academy curriculum has begun including very early discussions with business plan advisors, to troubleshoot before teams even begin so that project change may become less of an issue going forward. The risk here is that your project may have changed to the extent that you need some of your colleagues to help you in its operation. If they don’t know what you’re working on, will they be willing to be part of it when the time comes to implement? Another risk is that your boss may not give you the resources or other support you need if he or she feels you have not communicated well. Try to get a standing agenda line at your staff meetings for talking about your Management Academy progress.

Issue: We’re facing budget cuts of 23%, and have been asked to plan for an additional 15% on top of that. All we’re talking about at staff meetings is this reality.

OK, so maybe new programs are not what your staff meetings are about right now. Fair enough. Keep plugging away. Remember we’ve been through rough times before. Remember that broader support for your programs, in the form of partnerships and ample communication with political and other stakeholders, is going to carry you through.

To our readers: Please help our scholars with the issues they have raised! Have you faced similar challenges? What advice do you have? Thanks to all who participated.
-- Anne

best practices

I was in DC right before Christmas with a group of staffers from NACCHO, the National Association of City and County Health Officials. They are all either writing business plans currently (for new NACCHO initiatives) or interested in learning how their association members might use them.

First my NACCHO pitch: if you work for a local-level health department, NACCHO is where your friends are, even if you haven't met them yet. The staffers and members of the organization live and breathe local public health. This is where the committed, innovative, networked leaders and thinkers can be found.

Let me share some quick notes about working with this group. First, they understood very quickly how a business plan process might serve many different purposes and audiences on the way towards creating sustainable revenue sources (e.g., internally to make a good analysis and solid decisions, externally to connect with potential customers and to attract start-up funding).

They were similarly quick to understand potential downsides to a business planning process:

• Revenue generation is not always the right goal!
  
• Business planning can be hard: some initiatives are too small to justify doing it.
• Business plans that chase the wrong strategy are... counterproductive.
  

One of the fun things about the group was the way they talk to each other: everyone was direct and honest (and respectful of course). Honesty has a way of unleashing laughter I believe... in addition to its other benefits. This openness helped the group to quickly unearth important questions underlying their initiative: who should we serve? what would be most equitable? who ought to be managing the program ten years? what would success look like?

A final note on brainstorming. This group was able to generate an impressive list of possible approaches to what at first seemed a fairly straight-forward educational goal. A turning point was the moment when they agreed to stop censoring themselves and start listing their dumb, impossible and potentially illegal ideas. With those ideas on the board, a whole range of interesting possibilities opened up.

--Steve Orton