Back in Nebraska

Reflections on my latest trip to Nebraska, where five new teams started writing business plans last week.

•  Nebraska public health folks are really well networked in their communities. These five teams include representatives from the YMCA, school systems, a non-profit doing youth development, multiple hospitals, extension service, a board of health, and a rep from the Chamber of Commerce. 
•  Nebraska communities do a good job on their CHA process as a result of their strong networks, and people involved in Community Health Assessment work (especially partners) are ready to get down to action. For the more action-oriented, it is a huge relief to get down to the specifics of *what we're going to do* in response to the data and the priorities. 
• If you have a good CHA, you are ready to write a business plan. These Nebraska teams clearly have the data they need (or they know where to find it). And they have committed partners - even more committed now than they were before!
• If you spend time driving in Nebraska, you may come to believe that your GPS is broken, because it displays a single straight line in the middle of the screen for long stretches of time. It isn't a malfunction, it's just I-80. 
• Nebraska demographical fact: five cows for every person. North Carolina fact: three turkeys for every person.

Next session: next week in Asheville! I'll be watching for turkeys.

-- Stephen Orton

Management Academy On The Road

Here's a quick update on our Management Academy On The Road program. We completed a pilot in Florida with five counties; we launched a new group in Maryland this spring; two more groups launch this summer. The program is two on-site days, supported by webinars and technical assistance before and after (details on the MAPH website).

Here's a short list of business plan ideas in development across these groups.

• An ER Diversion project with hospitals, public health and the Federally Qualified Health Center
• An "Academic Health Department" plan to allow the county to participate in clinical trials, bringing in revenue and expanding treatment options
• A dental clinic add-on to an existing Ryan White organization
• A free clinic to create a bridge for the uninsured until 2014
• A health coaching project
• A project to combine substance abuse/behavioral health in an integrated organization

What ideas are sitting in your community's health improvement plan? What ideas are bubbling up from your community health assessment or your MAPP process? Can we help you push them to implementation?

--Steve Orton

Recovery Act funds for Public Health

It seems that some public health agencies have access to Recovery Act funds to do specific new things.

The challenge is to figure out how to spend that money in a way that makes a difference during the two years you have it, without losing those gains at the end of the time. One way to approach such an opportunity is to think in terms of start-up funding. Spend the money (time, effort) building something that can then go by itself.

Perhaps in two years you can build something that creates more community health and generates sufficient revenue on its own to support itself through user fees. Perhaps you can build something that generates sufficiently impressive results after two years that you can interest some other funder-- one that values the outcomes you are creating. Perhaps at the end of two years, you operationalize your exit plan: your agency steps back and the program is taken over by an external partner who cares about it and can run it sustainably, with the thanks and blessing of your busy staff!

Dr. Frieden on the implementation gap

The new director of CDC Tom Frieden spoke in Chapel Hill recently and said something I thought was interesting and provocative about managing in public health. (You can hear part of the talk on YouTube). Here's what he said:

We have an implementation gap. The gap between what we know and what we wish to know is huge. But the gap between what we know and what we do is even larger.

In other words, we need to pay more attention to execution. We know what's important, and for the most part we know what things would need to happen to make a difference in those important areas. So what would it take to change the "what we do" side of the equation? Effective plans that are doable.

--Steve Orton

A little off-topic

Over the past month, I’ve had a few experiences that don’t have much to do with public health business planning, but something to do with public health. I traveled to Greece for two weeks, spending time in the Cyclades islands of Folegandros and Santorini, and in the capital, Athens. Greece is an interesting mixture when it comes to public health:

1. They have a very good health care safety net system, paid for by the state. A couple of cab drivers told us how proud they were of their public health program. One was less enthusiastic because, although he himself, who has significant health issues, has never had a problem getting care, he “had heard that some people have some bureaucratic hassles.” He doesn’t realize the “bureaucratic hassles” we have in the states – even if you have health insurance, but especially if you do not!

2. Everyone smokes. Greece is Europe’s biggest-smoking nation: more than 40% of adults smoke. I don’t think we realize what a job we’ve done in this country to curb smoking, until you go to a nation where everywhere you turn – restaurants, stores, taxi-cabs – people are smoking. Greece is attempting to impose anti-smoking laws now – as of July 1, new laws banning smoking from hospitals, schools, and public places are going into effect. But restaurants can avoid the ban if they create smoking sections and they will also be allowed to ban non-smokers if they don’t want to have a smoking section! This is the third attempt in 10 years to curb smoking in Greece: it will be a hard habit to break.

3. Greek highways and roads are not for the timid. Greece ranks among the highest European countries in terms of road traffic accidents per kilometer traveled. Athens has done a great job of making itself more pedestrian friendly in recent years, although the narrow streets, lack of attention to speed limits, and lack of attention to parking regulations makes it difficult in places to get around on foot and it would be impossible in a wheel chair.

4. On the other hand, compared to my suburban American home I was able to walk much, much more in Greece than I am at home. Exercise came naturally and easily, built in to every day just getting from here to there. In one place we went, cars weren’t even allowed within the town limits. There’s something to the idea that “car culture” destroys the chance to live an active life.

5. When they tell you not to drink the water, don’t drink the water. They know what they’re talking about!

And, finally, the first thing I did when I got back to the states was get the flu! "Welcome Home!"

They say traveling is a great way to see your own home in a new light. It helps me to appreciate what we do well in the states, and what we could do better.

Life Planning... get real!

One of the great benefits of a management development program is that it helps you manage your life. Our Management Academy students regularly report that they see improvements first in their performance as a parent or as a spouse as a result of trying to develop themselves as managers. Planning skills, negotiation skills, dialog skills, measurement skills, teamwork skills-- they all transfer.

For some of us, work performance begins at home. Are you taking care of yourself? Are you asking for what you need? Are you having the good, real discussions with your life partner that insure you are fulfilled and whole, working on the priority issues and both pulling in the same direction? In other words, are you doing life planning?

Life plans put work plans into perspective. Karl Umble likes to say that the goal is less about balance and more about "harmony." And the skills are essentially the same for both: the ability to plan well and then push through to execution, to work the plan into existence.

As the skin horse says to the velveteen rabbit, it takes a lot of love and attention to go from a stuffed toy to being real. In this respect, the velveteen rabbit is in line with a long stretch of work on authentic leadership, the notion that leaders have to let their personality come through the role to be maximally effective. They have to be present and real.

Last word is this: congratulations Anne on your wedding-- great team!

-- Steve Orton

Business Planning and MAPP

Business planning is indicated for public health organizations that are trying to

1. start new initiatives, that will...
   
2. collaborate with external partners, working together to...
   
3. generate revenue, and ultimately...
   
4. be sustainable (i.e., self-supporting) into the future (e.g., after the grant ends).

Maybe this goes without saying-- but the foundation of a strong business plan is a deep awareness of what the community (or market if you prefer) that you plan to serve actually needs and wants. That's the awareness that processes like MAPP are designed to create.

That's why we are so glad to be working with the Mobilizing for Action through Planning and Partnerships (MAPP) program-- a strategic planning process to help communities understand their community health needs, assets and opportunities, and then take meaningful action on them.

The public health business plan fits in at the "action" phase of MAPP, laying out the details of how a new initiative will work with the various partners, and connecting those details all the way back to specific needs, specific customers, and specific attributes of a community.

I mention all this now because the Management Academy for Public Health is offering scholarships to three MAPP communities this spring-- to come to Chapel Hill for training starting in August. Deadline for applying with your MAPP team is coming up fast, May 15, 2009. In addition to some great management training the team will have the opportunity to develop a business plan with the support of business plan coaches, UNC staff... and a room full of great colleagues from North Carolina and across the country!

Marketing...

Great comment from a good friend in North Carolina on the prior "shovel-ready" post:

Locally we rarely do market research. One survey we do perform is the Community Health Assessment, but only every 4 years. I have recently come to view the community health assessments as looking at what health status people have purchased.

Exactly. What purchasing choices are being made by individuals and by the community? That's a different question than the ones that typically get asked for a health assessment.

Could we instead ask WHY they have made that “purchase”/ lifestyle behavior, or even WHAT would make our public health option “sexier” for them to want to purchase it? For example, instead of asking “have you been diagnosed with diabetes?” could we ask “what stops you from testing your blood sugar every day?”? “How would you like to be physically active?” “What prevents you from doing that?” “What would it take to get you to eat 5 fruits and vegetable servings a day?”

Those are great questions-- and leadership is about asking the right questions.

I'm reading a book called Nudge, by Thaler and Sunstein-- it is about "choice architecture," about the way that policy-makers can "nudge" people to make appropriate choices (and still give people the freedom of options). As Shirin says, maybe that means making the healthy option "sexier," or maybe it means doing the research to find out what choices people are likely to make in certain situations and then adjusting the choice architecture to insure that most people are going to make the best choice for their health.

--Steve Orton

Shovel-ready?

I've been inspired by the term "shovel-ready" in the media reports about the stimulus package. I think that's one of the things we want to foster in public health: organizations that have a set of shovel-ready plans that they would be ready to start quickly.

Maybe some of you have more money than you have ideas-- that's a difficult state of affairs but it can be solved. Innovation is a process you can learn. We've written some about it already.

I'm guessing most of you-- especially now-- don't have lots of extra money to spend. Do you have more ideas than money? Should you?

I think it would be a bad plan to quit brainstorming and quit planning at this point. Because what if someone does offer you some money? What if some stimulus money appears, and needs to be spent in a hurry? What if you wound up with some extra time on your hands, as funding for certain projects dries up?

The answer is this: you will want to have a little folder of "shovel-ready" plans. This is exactly what the business planning structure is about-- getting from the back of the envelope to a fleshed-out, researched, vetted plan with real need, a real chance, a real budget, real partners. A business plan is shovel-ready: ready to get funded and get going.

Let's talk more about developing "shovel-ready" public health ideas-- are you developing plans now? Why or why not? What would constitute shovel-readiness in your organization? Drop me an email or respond here!

--Steve Orton