On The Road in North Platte

A week or two after launching four new groups in North Platte I'm still thinking about the amazing public health system in Nebraska.

The four teams we are working with from north central Nebraska are all rural. Very rural. In fact they would tell you that they don't have enough population to count as rural: most of their counties are "frontier," a few with densities of less than one person per square mile. The health districts themselves have only been around for ten years. The state used tobacco settlement money to establish public health infrastructure.

The teams are working on great public health prevention issues: restaurant inspections (a role not in the public health portfolio in some areas), dental sealants for kids, healthy workplace products, sustainable plans for distributing vaccinations (flu and whatever comes next).

In all four cases they are working hard to find the sustainable revenue stream to support their work over the long haul.

One more thing they all share: great partnerships. Before there were health districts, many of these rural areas had health coalitions of health-conscious partners. As a result, the health leaders in these areas all think very deeply about how to engage and empower their partners. And the partners respond.

To me, the trip it felt like a glimpse at the origins of public health agencies: energy and green shoots and wide-open spaces for the community service mission to express itself.

--Stephen Orton

Wanted to share this email with you from Nancy Cripps, long-time staffer to the Management Academy.

It is with both joy and sadness I send this email. I am retiring on Friday, September 9.

Forty years ago, I embarked on a vocational path looking for a meaningful career. From a telephone operator, to sales representative to administrative assistant. However, I would not know what meaningful was until I joined the public health profession. These last 10 years have been the best time of my life because I was working with the most dedicated of all professions. Certainly, public health workers are dedicated to leaving the world a better place.

I also was able to learn from the best of the best. I will be forever grateful for having the best teachers in the country Janet Porter, Steve Orton and Karl Umble. From them, I learned many skills among them are communication, management and relationship building. Best of all, by observing them in action, I learned leadership skills. With those leadership skills, I was able to do community work and will continue that community work in my retirement.

My greatest joy was helping all you, my students, write your own business plans while fulfilling all your other responsibilities. Whether it was a friendly reminder or a word of encouragement, I felt I was helping your communities through you.

I am excited about this new adventure in my life. I promise you I will take all I learned from you to make my own community happier, safer and most of all healthier.

It was an honor and pleasure working with you.

--Nancy Cripps

On The Road in Raleigh

We launched four new teams in Raleigh this week! Here's a quick look at the projects going forward from that group:

• A phone app/game to help drive school culture change
• A revenue-supported plan for delivering quality improvement training
• On-line weight loss and lifestyle change program... already piloted, and it works
• Diabetes Education at the local level, sustained by revenues

A key theme for me at this session is this: Public Health agencies are ready, willing and motivated to find partners and revenue streams to support their work. Gone are the days when we had to convince some teams that it was OK to think about generating revenue... now revenue-generation is seen as an important part of the public health portfolio. That doesn't mean *every* project or function needs to be revenue-supported, because some can't or shouldn't. It does mean that agencies need to have the tools to create business plans when revenue-generation is appropriate and will make a product or service better, more effective, more integrated, more sustainable.

-- 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

Business Planning On The Road

Yes, we are piloting a program that provides business planning development to communities where they live. We're starting by targeting MAPP communities at the "Action Cycle" end of their process. (MAPP = Mobilizing Action through Planning and Partnership-- check it out at naccho.org/mapp)

Here's how the program works.

• We consult with you in advance to identify the best ideas to develop business plans around, and then form teams around those ideas.
• We come to your community for a one or two-day session; you convene as many members of your MAPP team as is necessary to get one or two or four business plans started.
• At the end of that session, your team or teams will have a good outline of a feasibility plan completed.
• We meet via webinar or conference call with each team as they develop a full feasibility plan.
• If the plan is in fact feasible, we coach them through the full business plan.

I should clarify what I mean by "team" in this context: I mean a cross-community team. For instance, you might have team members from the health department, the hospital, the other hospital, the United Way, the YMCA, the school system, the community health center, the county-- or all of the above.

We're in the middle stages with several teams in Florida right now, and some of the feasibility plans look really good. Two stand-out plans: adding dental services to an existing HIV clinic, and doing ER diversion with at least two and probably three different hospitals across a county.

The lesson for me is this: communities can develop business plans very quickly and efficiently if they already have a good, fresh assessment in hand, and a wide range of partners queued up and ready to go. That defines the MAPP communities we're working with: motivated partners, good data, identified priorities.

-- Stephen Orton

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

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!