1. health and fitness

Strategic Planning & Community Strategy Mapping
for Public Health Systems & Agencies
Jack Moran, Public Health Foundation
Paul Epstein, Results That Matter Team
Introduction
Public Health Foundation
www.phf.org
National, non-profit organization dedicated to achieving healthy communities through
research, training, and technical assistance for over 35 years
A key partner in The National Public Health Performance Standard Program (NPHPSP)
Lead NPHPSP organization providing tools and technical assistance on performance
improvement and quality improvement
Epstein & Fass Associates
Results That Matter Team
www.RTMteam.net
Measuring & improving public and nonprofit performance since 1985
Worked with large PH departments, now broadening PH efforts as part of Public Health
Foundation QI Consulting Team and a pilot project on Community Balanced Scorecards
in PH working with 5 community health partnerships in 3 states.
Effective Community Governance and Community Balanced Scorecard methods
featured in The Public Health QI Handbook (ASQ, April 2009)
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Strategic Planning Overview
Preparation for Strategic Planning
Developing the Strategy
Deploying the Strategy
Reviewing Implementation versus the Plan
3
4
Business Considerations
• Budgets/Finance
• Economy
Growth Potential
• Internal
• Partnerships
Customer Consideration
Vision, Mission,
and Values
• Internal
• External
• Partnerships
Outputs
• What you do
5
Strategic Planning
Preparation for Strategic Planning
Developing the Strategy
Deploying the Strategy
Reviewing Implementation versus the Plan
6
Preparation for Strategic Planning
Data Gathering
Community health status data
Community and partnership relations
Economic trends
Financial analysis
Consumer research
Employee research
Legislative trends
Current measures – Capacity, Process, and Outcome
Current strategy and goal completion rates
Self assessment data
Demographic changes
SWOT Analysis
Accreditation data
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Value of the Data
Assessment Data
Substantiation
Fact
Opinion
Based Based
Relevance
Low
Medium
High
Source
Document
And Date
of Issue
• Health status data
• Community/Partner
relations
• Economic trends
• Financial analysis
• Consumer research
• Employee research
• Legislative trends
• Current measures
Capacity
Process
Outcome
• Current strategy
• Goal completion rates
• Self assessment data
• Demographic changes
• SWOT Analysis
• Accreditation data
8
The leaders’ job is to set a clear direction of
what their organizations mean by “results.”
Peter Drucker
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How To Begin:
Focusing on the
Future
Define the Current Horizon – where
are we now?
10
Current
Plan
Next
Year’s
Plan
Preserve
Achieve
Avoid
Core
Competencies
Success
Factors
Mistakes
Pitfalls
• What do we carry over?
• What do we leave behind?
• What lessons did we learn?
• What new approaches should we try?
• Should we try for incremental or
transformational change?
11
Challenges??
What are the critical challenges State and Local
Health Agencies will face next year?
Any differences between State and Local Challenges?
Next 3 years?
How will it impact your organization’s:
People
Processes
Performance
Culture
Morale
Customers and Partners
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Strategic Planning
Preparation for Strategic Planning
Developing the Strategy
Deploying the Strategy
Reviewing Implementation versus the Plan
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Planning Quiz
Question:
Rating Scale
SD
D
A
SA
1. We develop our strategy based on data.
2. We identify critical success factors - the
ways the organization must operate and
people must behave to achieve our
vision and mission.
3. We have both short and long term strategic
goals.
4. We clearly communicate our strategic goals
to everyone in the organization.
5. We measure progress toward our strategic
goals on a regular basis and communicate
the results to the organization.
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Focus on Strategy Separately from Operations Improvement
If you try to review operations and strategy
in the same meeting, operations will always
drive out strategy.
-- Robert Kaplan, Harvard Business School
But strategy and operations improvement still should be
linked in a strategic performance management system.
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Strategic Plans Can Be Important Parts of Performance
Management Systems
The Plan-Do-Check-Act
(PDCA) model of QI can
also be the basis for an
organization’s performance
management system, as in
the City of Austin’s
approach to “Managing for
Results”
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Strategy Management and
Operations Improvement (QI)
Strategy Management: Planning and managing to achieve a future
vision or desired outcome.
The Balanced Scorecard is one way to achieve this: It is a strategy
management system.
Strategy mapping is a Balanced Score tool that is valuable for
strategic planning even if you do not do a BSC
Operations Improvement: Improving processes to make current
services better, often striving for efficiency, quality, & consistency, e.g.:
Benchmarking
Quality Improvement Techniques
17
Power of Strategic Alignment from Balanced
Scorecards, Primarily from Strategy Maps
Strategy Maps and BSC to improve the Alignment and Execution
of Strategies
No Strategic Alignment
Execution
Gap
Health Dept
Other Public
Agencies
Hospitals
High
Level
Goals
Nonprofits
Public
Health
Outcomes
Schools
Community Faith
Groups
Communities
Families
& Individuals
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Strategy and Quality Improvement (QI)
A balanced scorecard strategy is a
telescope.
QI is a microscope.
We use the telescope to tell us
where to focus the microscope.
-- Chief Medical Director, Duke Children’s Hospital
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How do you know if a strategic plan is “strategic”?
Does it include or justify
everything the
organization is already
doing?
Do the goals, objectives,
and actions read like a
“laundry list,” with little
relationship to each
other?
Is it based on a credible
“theory of change” or
“cause & effect model” that
clarifies how plans will lead
to a desired future?
Is there focus?
Do different parts of the
plan build upon each other?
Is there synergy?
Is there alignment?
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The Balanced Scorecard (BSC) …
Is an integrated strategic planning and management system
traditionally focused on one organization
Communicates vision, mission, and strategy to stakeholders and
employees. (Focus)
Aligns day-to-day work to the strategy.
Maps strategies based on cause & effect assumptions across
different perspectives or “views.” (Focus & synergy)
Provides a disciplined framework for measuring strategic
performance as viewed from those different perspectives.
(Strategic Performance Management)
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Community Balanced Scorecard (CBSC)
Combines the community building power of effective
collaborations with the strategy alignment of balanced
scorecards
Pulls the community together around common outcomes
Leverages assets from all sectors
Aligns key community collaborators behind a common
strategy for faster, measurable results
Creates mutual accountability for results
Intended for the many important issues in communities and
regions that cannot be resolved by one organization or
sector.
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Community Balanced Scorecard Components
Community
Priorities
Community Vision,
Overall or by Issue or
“Theme”
Perspectives
Strategic Objectives
Strategy Map
Performance
Measures, Targets,
& Initiatives
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CBSC, QI, Collaborations, & Information (e.g., from
Accreditation)
Community
Balanced
Scorecards:
Plan & Manage
Strategy
Strategic
Improvement
Improved Public Health Outcomes
Quality
Improvement:
Plan, Implement
& Monitor
Improvements
Information & Collaborative Relationships
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Suggested Perspectives
for Public Health
Community Balanced
Scorecards
Community Health Status
Community Implementation
Community Process & Learning
Community Assets
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Suggested “Generic” Public Health Community Balanced Scorecard Strategy Map
Based on the Draft Public Health Accreditation Standards
STRATEGIC OBJECTIVES
Perspectives
Improve
Health
Outcomes &
Eliminate
Disparities
Community
Health
Status
Community
Implementation
#2
Investigate,
Contain PH
Problems &
Hazards
#6
Enforce PH
Laws &
Regulations
Community
Process &
Learning
#5
Develop PH
Policies &
Plans
#1
Assess, Disseminate Population
Health Status &
Issues
Community
Assets
#4
Engage the
Community to ID
& Solve Health
Problems
Minimize
Risks
#3
Inform, Educate
About PH Issues
(Promote Health)
#7
Promote
Strategies to
Improve Access
to Services
#9
Evaluate &
Improve Processes,
Programs, &
Interventions
# 10
Contribute to
& Apply the
Evidence Base
of PH
#8
Maintain a
Competent PH
Workforce
A.
Administrative
Capacity &
Governance
Sample THEMES for Community Balanced Scorecards for Public Health
Healthy Behaviors Encouraged
Social or Physical Environment Issues
Demographic Populations or Geographic Areas
Specific Mortality or Morbidity Issues
Cross-cutting PH System Issues
Community
Process &
Learning
Community Health Partners’ Roles
Community
Implementation
STRATEGIC OBJECTIVES
Perspective
Community
Health
Status
Community
Assets
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Themes of Five Community Health Partnerships in Ohio, New Jersey, & Florida
STRATEGIC OBJECTIVES
Perspective
Community
Health
Status
Access to Primary & Specialty Care
Youth & Young Adult Behavioral Health
Preventable Chronic Disease
Community
Assets
Obesity, Nutrition, & Physical Activity
Community
Process &
Learning
Child Obesity & Family Wellness
Community
Implementation
28
Possible Community Balanced Scorecard Strategy Map to Improve Health of Homeless Population
STRATEGIC OBJECTIVES
Perspectives
Minimize Chronic
Disease in the Homeless
Population
Community
Health Status
Minimize High Risk
Behaviors &
Conditions
Community
Implementation
Community
Process &
Learning
Community
Assets
#7
Help Homeless Receive
Housing & Health
Services
#3
Maximize Multi-Lingual
Outreach, Health Education
& Promotion
#5
Develop Programs & Plans
to Connect Homeless with
Services & Promotion
#5
Advocate for Affordable
Housing & Homelessness
Prevention
#1
Increase Health Status
Monitoring of Homeless
#4
Develop Community-based
Strategies with PH & Social
Service Partners
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Table Top Exercise
30
For a Strategy to Address Preventable Chronic Disease:
Objectives Developed After Brainstorming & Affinity
Grouping
Organize into a Strategy Map
Develop & support wellness
programs, policies, and legislation
Promote health and learning by
engaging community stakeholders
Mobilize community partners in
coordinated wellness initiatives
Eliminate preventable chronic
disease
Improve access & use of wellness
services for all, including the
uninsured
Enhance the environment for
access to physical activity &
healthy food
Eliminate disparities in incidence &
outcomes of chronic disease
Monitor & publicize community
environments
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This Community’s Accreditation
Assessment Results
Lowest composite scores in:
1. Conduct and disseminate assessments focused on
population health status and public health issues
facing the community
10. Contribute to and apply the evidence base of public
health
What do these findings suggest for the preventable
chronic disease reduction strategy?
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Strategic Planning
Preparation for Strategic Planning
Developing the Strategy
Deploying the Strategy
Reviewing Implementation vs. the Plan
33
Deployment Quiz: For Internal Operating Units
Question:
Rating Scale
SD
D
A
SA
1. We have a defined deployment process for
our strategy to the operating units.
2. Operating units develop goals that contribute
and are aligned with the organization’s goals.
3. Operating units have measures that are aligned
with the organization’s measures.
4. Operating units identify both breakthrough and
incremental process improvement opportunities.
5. Operating unit personnel understand the link
between what they do and the organization’s
strategic plans and goals.
34
Goal Deployment and Alignment: Organizational Improvement
Deployment
Environmental Assessment
Drives
• Catalyst To Develop The Intent
• Challenge Opinion
Strategy
Which Develops
• Critical System Issues
• Critical Goals
• Aligned Measure
Operation Plan To Achieve
The Strategy
Focus On
• Process Focus
Process Alignment And
Repeatable Process To
Translate Into
• Achievable/Aligned Goals
• Establish Accountability
• Process Improvement
• Process Redesign
Aligned Daily Work
35
Professor Cranston
Nightmare of Learning Alignment
Deployment in the organization & the community
Use the strategy map as a communication tool to help
people find their roles in the strategy, both for:
Internal operating units
Partner organizations in the community
Each operating unit and partner can have different
approaches for contributing to the same community
goals and objectives.
Define measures and implementation initiatives each
internal unit and external partner will be accountable for.
Set implementation priorities for strategic initiatives.
37
Partner Contributions to Objective
Objective: Enhance the environment for access to physical activity & healthy food
Initiative: Safe routes to school
Partners: City of Akron, City of Stow, ODOT, Safe Kids’ Coalition, Schools in the County
Owner for this initiative: Safe Kids Coalition
Desired Change (More Safe Walking & Biking to School)
From:
• Minimal level of kids walking to school
• No sidewalks in some areas of the cities
• Sidewalks & streets aren’t plowed in places
• Lack of adult supervision & safety
• Need safer crosswalks
• Dangerous walking environment
To:
• More kids walking & biking to school safely
• More identified safe walking routes
• Plenty of adult supervision
• Safe walking environment
• Cleared sidewalks & streets in winter for
identified safe walking routes
Actions: - Identify and improve safe routes for all elementary & middle schools
- Add safe routes to municipal priority lists plowing, to be cleared in time for kids to use
- Recruit and organize adult supervision volunteers, parents, & kids to participate
Performance Measures for Partners
2009 Targets
No. of volunteer “walking school bus” escorts
No. of kids walking & biking to school
% of blocks of sidewalks cleared in bad weather on identified routes
No. of identified painted crosswalks added to routes
38
Partner Contributions to Objective
Objective: Enhance the environment for access to physical activity & healthy food
Initiative: Co-op healthy foods purchasing and delivery
Partners: Cost Saver Food Co., Piney Woods Community Development Corp.
Owner for this initiative: Sam Treemount, Piney Woods CDC
Desired Change (Eliminate Food Deserts)
From:
Families in the 2 lowest income areas of
the county (Spruce & Birch districts of
Piney Woods) have no local access to
affordable fresh & nutritious foods.
To:
All families in the county use retailers of
affordable nutritious food they can easily
get to (preferably by walking), or use
free or low-cost delivery.
Actions:
– Develop logistics, allowable items, & delivery & payment mechanisms with CSFC
– Organize families in the Spruce &Birch districts to participate in co-op purchasing
Performance Measures for Partners
No. of families from the Spruce and Birch districts participate at
least monthly in co-op purchasing and delivery of healthy foods
No. of participating families that improve home nutrition
2009 Targets
100
95
39
Strategic Plan Alignment and Deployment
Plan execution is then focused on both organizational
improvements and community actions that move the
needle on priority health outcomes.
40
Setting Implementation Priorities
Strategic Importance
High
Medium
Low
Low
Medium
High
Difficulty of Implementing
41
Encourage Others in the Community to “Jump In”
Strategic Importance
High
Programmed
Priorities
Medium
Low
Low
Medium
High
Difficulty of Implementing
42
5 Critical Barriers to Successful Execution
Barrier
Suggestion
1.
The underlying strategy
is not clear.
1.
Invest the time to get clear.
2.
The plan is overly
optimistic.
2.
Define priorities.
3.
No one is accountable
for results.
3.
Raise the stakes.
4.
The plan has not been
actively deployed.
4.
Mobilize the troops.
5.
Create an execution process.
5.
The plan is static.
43
Strategic Planning
General Eisenhower once said, “Planning is great
until the shooting starts.”
44
Strategic Planning
Preparation for Strategic Planning
Developing the Strategy
Deploying the Strategy
Reviewing Implementation vs. the Strategic Plan
45
Is this your organization?
46
Review Quiz
Question:
Rating Scale
SD
D
A
SA
1. We conduct regular reviews with our operating
units to assess progress towards our strategic
goals.
2. Reviews are used for learning and growth for
our management teams.
3. Reviews result in open and honest dialogue
with senior management about goal achievement
4. During reviews we adapt our priorities, culture,
and capabilities to respond to change.
5. During reviews we take action to resolve problems
rather than spending times deciding who to blame.
47
Review
Review is a continuous improvement
process of clarity
Review and Re-New
Improvement, Learning, Growth for all
involved in a review
Remember, don’t strategy reviews require
their own meetings—don’t mix them with
operations reviews
48
Goal Deployment and Alignment: Organizational Improvement
Deployment
Environmental Assessment
Drives
• Catalyst To Develop The Intent
• Challenge Opinion
Strategic Intent
Which Develops
• Critical System Issues
• Critical Goals
• Aligned Measure
Operation Plan To Achieve
The Strategic Intent
Focus On
• Process Focus
Review
Process Alignment And
Repeatable Process To
Translate Into
• Achievable/Aligned Goals
• Establish Accountability
• Process Improvement
• Process Redesign
Aligned Daily Work
49
Review
Purpose:
Clarity of Objectives
Clarity of Senior Management’s
Expectations
Clarity on what has been achieved
Clarity of what is on and off course
Clarity on what has not been done
Clarity on what remains to be done
Clarity on who is responsible to do what
and by when
50
Review
No long presentations – 10 minutes
Use standardized review forms
Questions in advance
Three slides maximum
Fifteen minutes per review
Not defense but proactive
51
Review Slide Layout Per Goal
Goal Detail and Alignment To
Organizational Objectives Summary
Gantt Chart Showing Major
Activities and Timelines
Baseline and Metric Data
Next Quarter Action or Recovery
Activities
Summary of Accomplishments
52
Review Roles and Responsibilities
Reviewer
Reviewee
Come prepared
Come prepared
Understand the topic
Have “Why’s” ready
Confront constructively
Action plans to convert
deltas
Accept bad news with
remedies
Probe for specifics
Look for alignment
Challenge where
appropriate
Show alignment to
organizational
objectives
Tell bad news
Accept challenges
Be accountable
53
Focus of the Review
Project goals and objectives
Time frames
Focus on deltas
Alignment of projects or actions to
organizational goals
Detail critical improvements
Discuss changes to timetable or goals
Discuss impact on customers
Detail risks
54
Senior Management Review Checklist
Before The Review:
Familiarize yourself with the Status
Reports or Plan/Delta Reports submitted
Inform participants about questions to be
asked
Confirm time and place for the Review
Send each participant a completed
Management Review Form
55
Senior Management Review Checklist
Before The Review:
Inform participants about questions to be asked such as:
What are your work unit goals?
Which Organizational objectives are you aligned?
What criteria did you use to choose those goals?
Who is accountable for goals being completed?
Why did you choose these improvements?
How will you measure them?
What % completion are you at this point?
Are you on plan or off plan? Why?
Do you have actions detailed to get back on Plan?
56
Senior Management Review Checklist
Before The Review:
Inform participants about questions to be asked Cont:
What additional resources might
you need?
What are the critical processes?
Can these results be replicated
elsewhere in the organization?
57
Senior Management Review Checklist
During The Review:
Clarify the purpose of the Review
Stick to the agenda and questions
Look for the alignment of goals and
objectives
Ask the agreed upon questions
Create a two-way dialogue and build trust
Probe the goals/objectives/targets - make
sure they are stretch
Document agreed upon modifications and
follow-up items
Give everyone feedback at the end of the
Review
Decide on the time and place of the next
Review
58
Senior Management Review Checklist
After The Review:
Send out formal Feedback Report with
one week
Document agreements and modifications
Follow-up on agreements
Document obstacles that are common
among all teams/participants and start to
address them – Executive Level
Involvement
Prepare notes for next Review
59
CBSC REVIEW
Community Health Status
Use of “Outcome” & “Driver”
Performance Measures Over
Time to Test Assumptions &
Improve the Strategy
Outcomes
Community Implementation
Outcomes & Performance Drivers
Community Process & Learning
Performance Drivers
Community Assets
Performance Drivers
60
Instructions: After each of the pitfalls check the appropriate column as it applies to your
organization: It is always there, sometimes we have the problem, and never in this
organization?
Multiply the always column number of checkmarks by 1, the sometimes number of
check marks by 3, and the never number of check marks by 5. The highest score is 50 which
is a world class strategic planning organization.
Pitfalls:*
Always
Sometimes
Never
1. Mix-up
2. Bermuda Triangle
3. Data Gathering
4. Meeting-Of-No-Purpose
5. Roles and Responsibilities
6. Involvement
7. Wallpaper
8. Lack Of Aligned Measures
9. Key Words
10. OK Corral
Total Number of Check Marks:
Multiply by:
1
3
5
Score: _________
* The “Thirty Pitfalls of Strategic Planning” by Jack Moran is
available at www.phf.org/
61
Contact Information
Jack Moran
Senior Quality Advisor
Public Health Foundation
www.phf.org
E-mail: [email protected]
Paul Epstein
Results That Matter Team
www.RTMteam.net
Epstein & Fass Associates
212-349-1719
E-mail: [email protected]
62