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Home My WebLink About07 July Affidavit of Publication STATE OF WASHINGTON) SS COUNTY OF JEFFERSON) NOTICE HEAL THBOARD MEETING CHANGE The Jefferson County Board 'Of Health has changed their regular monthly meeting schedule. Board of Health meetings will now be held on the third Thurs- day of each month from 1 :30 p.m. to 3:30 p.m. at t~ Hea,lth and Hu- man Services Department, Castle Hill Center, 614 Sheridan Ave- nue, Port Townsend, WA 98368. Next meeting: April 20, 2000. Roberta, Frissell, Chairman Jefferson County Board of Health 1175m 4/19 SCOTT WILSON, being sworn, says he is the publisher of the Port Townsend Jefferson County Leader, a weekly newspaper which has been established, published in the English language and circulated continuously as a weekly newspaper in the town of Port Townsend in said County and State, and for general circulation in said county for more than six (6) months prior to the date of the first publication of the Notice hereto attached and that the said Port Townsend Jefferson County Leader was on the 27th day of June 1941 approved as a legal newspaper by the Superior Court of said Jefferson County and that annexed is a true copy of the Health Board Meeting Notice as it appeared in the regular and entire issue of said paper itself not in a supplement thereof for a period of two consecutive weeks, beginning on the 12th day of April & ending on the 19thday of April ,2á)~, ,2á)~, and that said newspaper was regularly distributed to its subscribers during all of this period. That the full amount of $ 45 . 00 has been paid in full, at the rate of $9.50 ($9.00 for legal notices re- ceived electr tion. Publisher Subscribed and sworn to before me this~day of April 2O~1'~ JdL ;p.ÆnÆ:/ Notary Public In and for the State of Washington residing at Port Hadlock ~ -¡¡~~ & Human Erin Lundgren BOCC Office PO Box 1220 Port Townsend, WA 98368 Services --_._-- July 13, 2000 To: Jefferson County Board of Health From: Tom Locke, MD, MPH, Jefferson County Health Officer ~~~~Pff~\Q) JUL 14 2000 JEFFERSON COUNTY BOARD OF COMMISSIONERS Subject: Board of Health Retreat - Thursday, July 20, 2000 The next meeting of the Board of Health will be held on: Thursday, July 20, 2000 12:30 -1:30 Lunch 1 :30 - 5:30 Retreat Roberta Frissell's Home (see enclosed directions) Enclosed are a tentative agenda for this month's meeting, agenda material, and the department's monthly media report. Minutes for the June meeting are omitted and will be adopted at the August meeting. · Follow-up Reports: Letter to School Board Members re: Immunization Exemptions Retreat Agenda Item - · Presentation: Developing Performance Measures: Perfonnance-based management systems are increasingly popular with elected officials and policy makers. At their best, they present clearly defined goals and measurable outcomes that allow policy makers to evaluate the effectiveness of programs and make well-infonned decisions. At their worst, they create additional administrative burdens for programs, divert scarce resources into complex measurement schemes, and produce results that are confusing and unhelpful. Public health practitioners in Washington State have welcomed perfonnance measures both as a way of demonstrating the critical (but often invisible) services public health provides and as a way of improving the effectiveness of these services. This commitment to perfonnance-based accountability is prominently featured in the Public Health Improvement Plan and the Proposed Standards for Public Health in Washington State (agenda item #4). Jefferson County is also in the process of developing perfonnance measures for all its departments. The challenge for the JCHHS management team is to develop a perfonnance measures systems that satisfies multiple objectives: Jefferson County departmental standards, State public health standards, departmental management needs, and perfonnance criteria contained in many of JCHHS contracts with funding agencies. Enclosed is a "Managing for Results" model that Jean has acquired from the Seattle-King County Health Department. The first packet of infonnation describes the different categories used in this model and includes a few completed program assessments from King County. · JCHHS Mission: The starting point for a perfonnance measures system is deciding what your mission is. Enclosed are copies of the current County and JCHHS mission statements. · JCHHS Program Reviews: Preliminary program descriptions that incorporate perfonnance measures have been developed for JCHHS programs. Descriptions that were completed by the mailing deadline for this packet are enclosed. Additional program descriptions will be distributed at the retreat. Staff are working on two different reporting strategies. One involves consolidating - HEALTH DEPARTMENT 360/385-9400 ENVIRONMENTAL HEALTH 360/385-9444 DEVELOPMENTAL DISABILITIES 360/385-9400 ALCOHOL/DRUG ABUSE 360/385-9400 FAX 360/385-9401 - - - programs under general headings, another looks at individual programs. We would like the Board to consider which of these strategies is most appropriate for the types of programs being considered. · Proposed Standards for Public Health in Washington State: Copies of these standards are included for the Board. In addition to meeting County management standards, public and environmental health programs should also meet state standards. In August a state-wide survey will be conducted to detennine how well the public health system meets these proposed standards. At the retreat we will discuss the most challenging of these standards and ways we might couple them to the perfonnance-based system that is being developed. · Presentations: Performance Partnerships and Risk Communications Strategies: No retreat would be complete without some bold new ideas to inspire and enlighten. This is the best we could do. The idea of "perfonnance partnerships" is gaining popularity as a strategy for dealing with an increasingly interconnected world. The basic premise of the "interconnected world" model is that public problems typically cross organizational and jurisdictional boundaries. No single public or private entity has the authority, resources, or expertise to effectively deal with such problems. This model proposes a new strategy based on "catalytic leadership and perfonnance partnerships". This approach may have special relevance to the Board's work on health care access, a decidedly complex and cross-jurisdictional public problem. Risk communication strategies are especially relevant for public health officials and leaders. Dr. Vince Covello, the leading expert in this field, gave a workshop on Risk Communication to public health officials in late April. Jean will discuss lessons learned from this workshop with the Board. · Board of Health 2000-2001 Workplan: A number of issues have been discussed as possible workplan items for the next year. The Board Retreat will provide an opportunity to discuss these issues and set priorities for the next year. · 2001 Legislative Agenda: In the year 2001, the Washington State Legislature will face a number of key public health issues: vaccination funding, health care access, funding for public health emergencies, and maintenance of existing public health efforts. Although the next session will not start until January, Autumn is an excellent time for direct contact with legislators. They will be campaigning in their districts and, hopefully, discussing the issues they will face in Olympia. Proposed legislative agenda items are enclosed. · September Meeting of the State Board of Health: The 9/13/00 meeting of the State Board of Health is scheduled to be held at Fort Worden. The morning session will focus on reports from Clallam and Jefferson Counties about priority community issues and public health response to them. The afternoon session will be structured as a public forum with reports from community groups, informational booths, workshops, and public comment. I will brief the Board on the planning process for this meeting and possible roles the Board may choose to play in scheduled activities. If you have any questions regarding the enclosed agenda, or anv additions to the a!!enda. please call me at 385-9448. JEFFERSON COUNTY BOARD OF HEALTH Thursday, July 20, 2000 12:30 -1:30 PM: Lunch 1:30 - 5:30 PM: Board of Health Retreat Location: Roberta Frissell's Home (See Enclosed Directions) AGENDA I. Approval of Agenda II. Old Business 1. Follow-up Items A. Letter to School Board Members re: Immunization Exemptions III. New Business - 1. Presentation: Developing Performance Measures: "Managing for Results" Performance Model 2. Jefferson County Health and Human Services (JCHHS) Mission 3. Jefferson County Health and Human Services Program Reviews: Draft Performance Measures 4. Proposed Standards for Public Health in Washington State 5. Presentations: Performance Partnerships Risk Communication Strategies 6. 2000-2001 Jefferson County Board of Health Workplan 7. Legislative AgendaJIssues - 2001 Session 8. State Board of Health Meeting - Fort Worden, Wednesday, September 13, 2000: Public Forum Planning and Local Board of Health Role Next Meetine: August 17,2000 - Directions to: Roberta Frissell's 931 N. Jacob Miller Road Port Townsend W A 98368 385-4394 From town: Go down Hastings and turn RIGHT onto Jacob Miller Road-- From Cape George: Go down Hastings and turn LEFT onto Jacob Miller Road-- From Highway 20: Follow Jacob Miller Road to the end-- - Follow Jacob Miller Road to the end of the County road. Turn RIGHT onto the gravel road. At the second driveway turn LEFT. Take the RIGHT fork in the road. - County Health & Human Services June 23, 2000 Sharon Merrick Quilcene School Board PO Box 842 Quilcene, WA 98376 Dear Ms. Merrick: As administrative officer for the Jefferson County Board of Health, I am writing to you on behalf of the Board about the important issue of childhood immunizations. At their June 15,2000 meeting, the Board reviewed the enclosed Report on School Exemptions. This report has been sent to all of the schools that were part of this study along with specific recommendations to improve levels of immunization among school-aged children. In addition, the Board directed me to write to each school board to convey their high level of concern about this issue. The development and widespread use of vaccinations is regarded by most health experts as one of the top public health achievements of the 20th Century. Infectious diseases that caused high rates of childhood mortality 50 years ago are now extremely rare in the United States. Unfortunately, this achievement has not been accomplished worldwide. Although smallpox has been eliminated and polio is on the verge of eradication, other vaccine-preventable diseases are relatively common in other countries. In this age of jet travel and mass migration, these diseases can be reintroduced into communities with little warning. Maintaining high levels of immunization among school aged children plays a crucial role in protecting individual children and the community at large against renewed outbreaks of these deadly diseases. It is for this reason that vaccination has long been mandatory for school aged children in all U.S. states. Washington State law allows exemption from this mandatory requirement for personal, medical, and religious reasons. As detailed in the enclosed report, Jefferson County currently has the second highest level of immunization exemptions in the state, over three times the statewide average. The overwhelming majority of these exemptions are for personal, not religious or medical reasons. There are many potential explanations for this high exemption rate that are detailed in the enclosed report and we are committed to working with school administrators to address all of the problem areas that have been identified. In addition to high exemption rates, our study found significant numbers of student immunization records that were out of compliance with state reporting requirements, i.e. vaccination status of the child was unknown. In the event of a disease outbreak (such as measles) all unvaccinated children would be excluded from school. Lack of accurate infonnation about immunization histories makes this process very difficult and can result in the exclusion of large numbers of students. .- A fmal issue that deserves special attention is the growing tide of misinfonnation about the potential dangers of immunization. Sensationalistic media reports, an explosion of anti-vaccination web sites hosted by alleged health experts, and hostile congressional inquiries have all combined to give the impression that the risk of vaccinations exceed their benefit. An objective review of the facts will tell you just the opposite-the health benefits of immunization are enonnous and the risks are exceedingly small. Research involving millions of children throughout the world has conclusively disproved links between HEALTH DEPARTMENT 360/385-9400 ENVIRONMENTAL HEALTH 360/385-9444 DEVELOPMENTAL DISABILITIES 360/385-9400 ALCOHOL/DRUG ABUSE 360/385-9400 FAX 360/385-9401 vaccination and autism, multiple sclerosis, sudden infant death syndrome, attention deficit disorder, and other diseases of unknown cause. Fortunately, reliable science-based information on the benefits and risks of vaccination is available from a wide range of sources. I would especially recommend the Centers for Disease Control's National ImÎnunization Program website (htto://www.cdc.l!ov/nip) and The Immunization Gateway (http://www.immunofacts.com). The Jefferson County Board of Health strongly supports immunizations as a high priority public health protection strategy and urges School Boards to take all reasonable efforts to maximize immunization levels in the schools they oversee. Jefferson County Health and Human Services staff is likewise committed to seeing that as many children as possible receive the important benefits of modem vaccinations. Weare happy to provide speakers for public meetings, respond to specific concerns that parents may have about immunizations, and assist school administrative staff in complying with existing mandatory vaccination reporting rules. We also offer regular immunization clinics for all age groups. Please feel free to contact me if I can provide additional information about this very important issue. Sincerely, Thomas Locke, MD, MPH Jefferson County Health Officer - - - - jfiFR:jj~~Ût~S~~i~iáh.~~iii::::~~W¡/tkb.tJijk~;~~sJ.&w#~Vjjl ...................................g....................................... Develop Purpose Statements How to Develop Purpose Statements Departments will use the :\'Ianaging for Results Template, in a participatory process, to develop Purpose Statements throughout the Business Planning process when detìning: · yIission · Lines of Business · Programs · Services in instances where Performance ,\treasures are developed for a Service Managing for Results Template The purpose of the (name of service, program or line of business) is to provide (or produce) (service or product) [what] for (customer) [who] so that (RESUL T / benefit) [ why] - JVAl1-;fE - State the name of the service, program, line of business, or department. Choose a name that has meaning not only to the employees involved in the program or service, but also to the customers and to citywide decision makers. A void technical terms or words that are so specific to a profession or field of work that the general public could not understand the name. The best name gives an intuitive idea of the whole purpose statement. ".,......... SERVICE OR PRODUCT PROVIDED - State the service or product provided in clear language and keep it succinct. Serv'ices are Use nouns and avoid adjectives. Avoid technical jargon - use commonly understood terms. Think in terms of deliverables rather than processes, and be sure that program's benefit or impact is not included in this line. Lastly, at the program level services need to be summarized, not listed - save time by developing summary names for service groups prior to filling out the template. l\IFR Business Planning Workbook - Section VIII Develop Purpose Statements Page 2 of5 :MFR:jJÙ$Û~~$$:~PÜÚ1h{i;~::WJ.fkb.tfjk::Ä:Šµ~;~it.:~~T.~1··: ~. ,', ,', . ... ,', . .. . . . . . . . . . ,',. . ......... ....ð--..... ,", ..... . . ,', ,',. . ......... .'~~:. .', ...~:~.. Develop Purpose Statements How to Develop Purpose Statements (Continued) Customer - Identify the immediate customer. Be as specitic and descriptive as possible, but keep it succinct. You may need to brainstorm a list of customers and then narrow it down the most immediate customer. Who receives the direct benefit of this program or service? Avoid huge generalizations such as "the citizens of Seattle" unless you are working on a mission statement for the entire city or department. Remember that customers may be internal or external to the organization, Result - Articulate the desžred žmpact on the customer. What wiH change, improve, increase or decrease because of this program or service? Be sure to do a reality check on your result: Can this program or service reasonably be expected to int1uence that outcome? Is it too indirect or long tenn? Is it too vague or broad to be measured? How do we know what our customers want? - Practice - ~Vrite lV/ission Statement using Template Department Mission Statement The purpose of the (name of department) is to provide ( or produce) (service or product) [what] for (customer) [who] so that (RESULT / benefit) [why] Tips on ¡}fission Statements :J Why does the Department exist? :J What is the purpose of the Department today? Next 2-5 years? :J Tf7wt are the principal products or services? o Jt710 are the principal customers? o How does the purpose of the Department differ from what it was three or five years ago? o Is it a simple and clear statement of Department purpose? MFR Business Planning Workbook - Section VIII Develop Purpose Statements Page 3 of5 · .. -.. ... . ......... ... ..... ...... ... .................... :ii:~R' . "B' , ··:-:-:-:·:-:-:;~:-:o;-::iii~~·:-:-:·~~-:-:-::äi.:-:-:;i;;b.· :;;.:;.:;:;~:-:-:-::c;::.;;;~~~j;j::-';it.r:i ~~:;.r<. ::'. ..µ~~~~~~'!-:~:~~f.~!~~~~.g.::f.:r;:-q.r..~: ..~~::~:~~~~~::~:~:~: Develop Purpose Statements Practice - Write Lille of Business & Program Purpose Statements Line of Business or Program Purpose Statement The purpose of the (name of line of business or program) is to provide (or produce) (service or product) [ what] for (customer) [ who] so that (RESULT! benefit) [why] Tips on LOB & Program Purpose Statements :::J How has the Program or Line of Business been defined and llamed ill the past? :::J Are the terms used to describe the service the same as the public uses? Should the terms change? :::J rVho has been defined as our customer in the past? Is this correct? - :::J rv7zo are the immediate customers? :::J rVho do we provide our product or service directly to? :::J Are too many customers identified? Are we being practical? :::J íf710 receives the direct benefit of this program or Line of Business? :::J Is the service listed in the Purpose Statement a summary, not a listing, of the services provided? :::J What is the planned benefit the Department seeks to achieve? Can we directly influence the achievement of this result? :::J Is the planned benefit stated in terms of results? ::J Is it a result that can and should be achieved? (Please see the 'five wh:v's to results' below.) :::J Is the benefit aligned with the Department's goals? - MFR Business Planning Workbook - Section VIII Develop Purpose Statements Page 4 of5 j}tFR:BusiÚ~sš.:J~iiÙiÚiÚ':':::#(¡J.tkbMk:;::šáÆJ)t~~:Vjjj .............................,.... . g.. ...................................... Develop Purpose Statements Otlter Tips on Purpose Statements The "Five \Vhys" to Results The' tìve whys' is very usetùl when trying to develop Program Purpose Slatcmems and arrive at the planned benefit. In the development of both Program Purpose Statemems and Line a/Business Purpose Statements, it is easy to stop short of describing the benefit in tenns of results for the customer. One technique is to ask--several times over, if needed-the question "\Vhy?" until the team moves away from describing effort and arrives at the measurable result that is experienced by the immediate customer. Also... The name of a Program or Line of Business important, especially to the staff and the customers. Be careful to write a name that accurately reflects what it is and that does not carry a stigma with the words used. Ensure that the "services" line of the Purpose Statement reflects the 'deliverables' provided to the customer. rather than processes. Use nouns or noun phrases to ensure a focus on the "what" that the customer actually receives. ~o lists please, only a summary will work. There is a tendency to define the customer too broadly. Focusing on the immediate customer, the people or person who directly receives the benefit, is a critical success factor in writing Purpose Statements and developing results oriented Performance Measures. The Results or benefit is defined as what the Program can reasonably be expected to significantly influence. World peace is great, but don't go there! The "Results" line of the template leads directly to development of the Outcome Measure. If the Output measure does not emerge easily from the "result" line of the Program Purpose Statement, then the team should revisit the statement. · Is the result too broad or vague to be measured? · Is the result actually contained in the "services" line, rather than the 'result' line? · Is the result too indirect or long term? · Is the customer identified correctly? Does the result match the benefits the customer receives? .. · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · . : Next Steps : · . · Now that you've developed Purpose Statements, you're . : ready to develop Performance Measures for your : · Programs and Lines of Business. · · . : ... Onward to Section IX - Develop : · Performance iWeasures .', · . ................................. MFR Business Planning Workbook- Section VIII Develop Purpose Statements Page 5 of5 '- :qÅ::vÅlf.i/N~:ljð¡¿::RESiJ/f)TS:::~i!ðilitfjððit:Ä::S~dibi.i::IX J . . . .'. ).. . . . .. . . . . l. .·V:-. . .'. . . . . . '.-:' . . '.' '.' .......:-..........:-. ..:-:.......:-........................... ........................... ....................................... "........ ............. ..,..... ..... .... ... Develop Perfor1llance j~leasllres What Why Performance measures define the infonnation management needs to manage. Perfonnance measures are tied directly to the operations of the department, i.e. lines of business, programs, and services. Seattle has chosen a balanced, practical approach to performance measurement by using a family of measures that includes outcomes, outputs, demand, and efficiency measures. These four categories 0 f measures shall be developed for all programs, and for services when that is needed. All measures shall have a data collection plan for how the data will be collected. The bottom line reason the City of Seattle is developing Perfonnance Measures and investing in managing for results is to produce better results for people, and provide the greatest return on investment. Perfonnance Measures generate the infonnation that will tell whether or not that is happening. - Here's How Develop Performance Measures 1. Consider what infonnation you need to manage and tell your story. Review basic requirements for perfonnance measures. 3. Review the definition of each category of performance measures 4. Review the program purpose, with emphasis on the result; 5. Develop outcome, output, demand and efficiency measures for each Program. Check each against key criteria. 6. Determine if the proposed measure aligns with the program purpose; 7. Detennine if the information generated by the performance measure will be useful for decision making. ') MFR Business Planning Workshop - Section IX Develop Performance Measures Page 1 of6 - · · · · - · ............"......................... ........... .... .... ... ...... .................. ·:t;iriri··: n······· '.~'.'.'.'.'.'.'.'. :ri/' .......... ....~..... ...... "i:ii"· "':i,;: ..:r.;....... ·········:ø··········~··········l· ~:V :r:~::;;o;';Q: ·············:vl ............. ',i:~'" '~i' (.i........ 'Ø¡'" C······;r.i I: . . ;'>: : .:::. .J'~n~~~::: ::: //:.!t!!:n~g:: . .·Pt.'. .;r: . pp::::::::.:...~"f;.J!!.1!}. :':.. Develop Performance Measures 1. C ollsider what Ù~formatioll you need to manage and tell your story; .-\sk the tòllowing questions: .J \Aihat infom1ation do I need to manage day-to-day operations? .J What information do the customers and stakeholders need to see? 2. Review basic requirements for performance measures. Ask the following Kev Questions to identifv basic requirements: What kind of measures are required? As part of the development of strategic business plans, City departments shall develop at least one Perfonnance Measure in each of the four categories for every ProgTam. A key outcome measure shall be selected from each program. These key outcome measures shall be the outcomes for that line of business. Who develops performance measures? Because the goal is to develop measures that Department staff use to make day-to-day decisions, developing the measures needs to be a participatory process. That Ís why the development ofPertòrmance Measures occurs during the 3-4 week interim between Workshop days two and three and involves staff in the process. For what period of time are we writing performance measures and targets? Performance measures are set and written prospectivelv for the upcoming fiscal year as part of the development of the department's strategic business plan. As data is collected, information about the performance of lines of business, programs, and services is reported retrospecti velv. Do we need performance measures for services? If management determines that it is important to generate perfonnance information for a service, particularly efficiency or cost information, performance measures may developed for that service. When performance measures are developed for a service, a purpose statement must be written for the service prior to developing the performance measures. Performance ~Ieasurement Tips Don't limit measurements to data that is currently available. Start by determining what information is needed, then determine how to get the data. Make sure all \V orkshop participants are clear about the differences between outcomes and outputs. .'vlake sure the outcome measures align with the result in the Purpose Statement. This is a critical success factor in developing good measures. :\Iake sure you can answer the question: "How will this information be used." If you cannot answer this. then the value of the measure should be questioned. .'vleasures \vill be used to make day-to-day decisions - they should be developed in a participatory manner. MFR Business Planning Workshop - Section IX Develop Performance 2\-Ieasures Page 2 of 6 ~fïitJi.:jjÛS11.fêij:iÛqJt¡H1.t.:·:·~~Jpør.:ksj{ô·:·:~::::::~S~¢ÙWjiik .... ....... .............................g................'P....................... Develop Performance Measures 3. Review the definition of each category o.f performance measurement Outcome l~leasures Defined: The impact that a senJice, program or line of business has on the immediate customer. Stated in terms of percentages whenever possible. By definition, outcome measures are difficult because government and public sector managers do not control outcomes for the immediate customer, but government does influence outcomes. Thus, the appropriate definition is that an outcome measures the impact that a given program can reasonablv be expected to significantlv influence. The method for establishing high quality outcome measures rests in the use of the managing for results template that departments use to develop purpose statements for programs and lines of business. When the managers and staff who deliver a set of services or program are able to be clear about the expected result, it becomes a straightforward task to write the outcome measures. The outcomes reflect the language and substance of the result written in the purpose statement. Program Purpose Statement The purpose of the (name of service, program or line of business) is to provide ( or produce) (service or product delivered) [what] for ( customer) [who] so that (RESULT.. benefit) [why] Key Ouestions for Outcome Measures 1. Does this measure impact, not process? 2. Does the Outcome align with the result in the Purpose Statement? 3. How will this information be used? .... .... .... ............. .... - TiD: The outcome measure should be easily and obviously derived from the Program Result ...... ..... .... .... .......... MFR Business Planning Workshop - Section IX Develop Performance Measures Page 3 of 6 "- · .. ..... ......... ............ .............. NtFJi..:B·:·:·:':·~:·:':':·:·:':·:·pi·:·:·:·:·:·:·~:·:·:':·:·:æ:·:·:·}i/·:¡j.·:·:-:·:·:·:·:·:$.·:·:·:t··:·:·:-:·ix ': . . ;'>: : /. .J'~n~f!.~::: .:: .f!~!!:~."g;:: . .-:f!r. .~. P.P:h:·:·.·~Ç:.J!!."r:. :':.- Develop Performance Measures Output :1tfeasures Defined: The units of service provided, products provided, or number of people served. Stated in terms of numbers or counts. ~Iany output measures may be available, so it is important to prioritize which outputs to measure by detennining 1) which measures are most useful in making management decisisions. and 2) which measures have the most direct impact on achieving the Outcomes for each program. Steps for developing Output measures: - :J Analyze past trends in the generation of Outputs in the Services included in the Program compared with the resources available; :J Assess the resources available in the current budget and the upcoming b~dget to deliver Services; :J Review the Change Dynamics developed through the assessment of the future to detennine if there are any dynamics that may increase or decrease the demand for Services; :J Consider if the Services are being delivered in an efficient manner and project whether process improvements may influence the level of outputs that car¡. be delivered; :J Prospectively set the output measures for the upcoming budget cycle; :J Document the methodology for future reference. Kev Questions for Output Measures 1. Does this measure effort? Does this output make a critical contribution to the Outcome? 3. Does the measure align with the Program Purpose? 4, How will this information be used? ì - "IFR Business Planning Workshop - Section IX Develop Performance Measures Page 4 of 6 - ... -.... ......-........ .... .... ............ .... ............. ........................ :~;.f.:¡;:n:': jj.......'.~................: rit' ..............~........... iii······:;;:·' i ž;;..........,.....::v'.......... ~.'.'.'.'. 'I' ~:V í1tI::..c:::;.o;:·;Q; ···,·········:.v.1 ............. .,.¡..;. . 'lii' Ú······· .,;},¡ ... t-·'··· <-i ': . . ;'.::::: /. .J'~n~~~::: .:: .~!J!!:~."g;:: . .-:f1r..~. ."f.)P:::::t·..ø.~.J!!.¥:I-/. :':: Develop Performance Measures Demand JJeasllres Defined: The total units of services requested by or anticipated from the customers of a program. An advanced measure of demand measures the total anticipated need for services. Developing demand data requires a few straightforward steps: ::J Analyze past trends in the demand for services; ::J Assess the current demand for services; ::J Review the Change Dynamics developed through the assessment of the future to determine if there are any dynamics that may influence future demand for services; ::J Project the expected demand for services; and ::J Document the methodology for future reference. Kev Questions for Demand Measures 1. Is this a baseline or trend? 2. How reliable is the data? 3. Does the measure align with the Program Purpose? 4. How will this information be used? - - MFR Business Planning Workshop - Section IX Develop Performance l\tIeasures Page-5 of 6 - {tïtli:Bídi1.têiS::P¡¡tniiif1~:~:WJr.k$h~::::~:::::::S~¢:1.t~k~ix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ð-. . . . . . . . . . . . . . . . 'P. . . . . . , . . . . . . . . . . . . . . . . Develop Performance Measures E.fficiellcy Jleasllres Defi/led: Tlte twit cost of an output or twit of service. iWay also measure time per unit of service. Future efforts may make it possible to calculate tlte cost per result. Programs must be measured by at least one cost per unit of service measure. The information used to calculate the costs must be derived from the City's accounting system. Summit. Efficiency measures that measure cost will be developed for all programs. In cases where either department or corporate managers believe it is important to measure the cost efficiency of a serv·ice. that service shall have a purpose statement and an efficiency measure developed for it. Efficiency measures may also measure the time that it takes to deliver an output, such as the time per processed application. - Essential steps include: 'J Consider the Department's need and corporate managers' need for cost information; 'J Review past efficiency data, formulas used to calculate efficiency and the sources of the data used; 'J Detennine if these are stin the appropriate methods and data to use; 'J Establish efficiency measures prospectively; 'J Ensure that the cost data used will come from SGNfMIT. Kev Ouestions for each E(ficiencv j\;[easure develoved: 1. Does this measure the cost or time per output? 2. Is it possible to begin calculating the cost per result? 3. Does the measure align with the Program Purpose? 4. Is the cost data derived from SlTMMIT? 5. How will this information be used? - Characteristics of HirJh Qualitv Performance Aleasures Relevant - logically and directly related to the organization or activity purpose Understandable - communicated in a clear manner. Consistent - used uniformly in the planning, budgeting, accounting and reporting systems. Comparable - provides a clear frame of reference for assessing performance over time to demonstrate performance trends. Timelv - available to users before the information loses its value in assessing accountability and making decisions. Reliable - derived from systems that produced controlled and verifiable data. MFR Business Planning Workshop - Section IX Develop Performance Measures Page 6 of6 - PUBLIC HEA,L TH KING COUNTY ~IISSION THE :\IISSION OF PUBLIC HEALTH IN KING COUNTY IS TO PROVIDE PUBLIC HEAL TH SERVICES THAT PROMOTE HEALTH AND PREVENT DISEASE TO KI:\G COl":\TY RESIDE:\TS IN ORDER TOACHIEVE AND SUSTAIN HEALTHY PEOPLE AND HEAL THYCOMMUNITIES. VISION ALL KING COUNTY RESIDENTS LEAD HEALTHY LIVES IN A HEALTHY ENVIRONMENT. DEP ARTMENT GOALS Provide needed or mandated health services and prevention programs to address individual and community health concerns Assess and monitor the health status of our communities Prevent disease, injury. disability. and premature death - Control or reduce the exposure of individuals and communities to environmental or personal hazards Employ and retain a skilled workforce that ret1ects the diversity of the community Provide for timely, consistent and clear two-way communication tailored to individual constituent communities to assure that the citizenry is fully informed of what the government is doing. BUSINESS PLAN GOALS (SHORT TERM) By 2005, increase the Public Health System's ability to respond effectively to emerging environmental health issues and communicable disease outbreaks, without disruption of ongoing critical public health services. By 2004, the public health workforce will be well trained and have the resources they need to achieve results that exceed recognized standards for quality and cost. By 2005, residents of Jefferson County will understand and support public health priorities and actions. By 2003, Public Health will have a sustaining and flexible funding base sufficient to maintain critical public health servIces. By 2003, Public Health will increase the number of collaborative partnerships that have a high likelihood of reducing regional disparities in health status. - By 2005, the health impact of diabetes and childhood asthma will be reduced. - ,- ---- - -,-- -......- -, --:-- - - - "--- '--------------------------~~~ ---------------------------, I ,__ , , , Chapter 3 Quick Review (and Jargon Cheat Sheet) I I I I I I I I I I I I , I , I I I I I I , I , I I , I I I I I I , I I I I I I I I I I I I I I I I I I I I I I I I I I I I .Hission: The over-arching goal of an organiza- tion boiled do\vn to a brief 3tatement. Let's use "pro- I I moting \vorld peace" as our t'ederal government : I example and "promoting a healthy. prosperous com- : munity" a.:3 our local government example. : I Coals. outcomes or objectiL"es: Slightly more spe- : ciflc areas of results that flo\v from mission. To follow : I our federaL local examples aoo"\:e: elimination of". : I regional conf1icts,healthy children community-wide. : Outcome indicators: The actual data that feed : I into judging progress on outcomes: Examples: num- : ber of refugees created by regional conflict.s world- i \vide/annual rate of children \vho have contracted a : I pre\-entable disease. : Actil...ities: Specific actions meant to move those : I indicators in the right direction. Examples: sending : a peace-keeping mission to the :YIiddle East; send- i ing a van community-wide to vaccinate children. : I Outputs: Specific products meant to move those : indicators in the right direction. Examples: number : I of peace-keeping missions deployed in a year/num- : ber of children vaccinated in a year. ¡ Inputs: The resources mustered to create out- : I puts. Examples: the cost of soldiers' salaries and : benefits. along with the cost of equipment, trans-' portation, bullets, guns, etc./the cost of the roving community van offering free vaccinations, nurses' salaries, the cost of vaccines, etc. Efficiency: A look at the cost of the inputs that go into creating a set unit of output. ----------------------------------------------------------~ - - PROGRAM NAME: WOMEN, INFANTS AND CHILDREN PROGRAM (WIC) Program Purpose Statement The purpose of the Supplemental Nutrition Program for Women, Infants and Children (WIC) is to provide nutrition assessment, education and supplemental food to low income women and young children so that they have adequate nutrition to Çrow and develop to reach full capacity. Program Performance Measures Outcome: · % of WIC participants breastfeeding at 6 weeks and 6 months postpartum Output: . Number of women, infants and children enrolled Demand: . Number of potentially eligible clients Efficiency: · % of case load that receive WIC checks each month Services Included in Program Nutrition assessment, education, referrals, checks to purchase healthy food, contract management for community clinic sites. Line of Business (LOB) Targeted Community Health Services . Key Result from Program for LOB · % of WIC participants breastfeeding at 6 weeks and 6 months postpartum Applicable Change Dynamics · Environmental, demographic, social, epidemiological, and medical trends · Electronic and mass media will increasingly influence individual health behaviors · Clear, understandable communication needed to inform public about increasingly complex public health issues · Public Health will need to increase it's partnerships · Increased difficulty in developing long term, stable funding and political consensus · Unstable health system puts pressure on "safety net" providers to serve low income and uninsured · More "marginalized" populations mean less population-based, comprehensive services · Infrastructure improvements essential to provide cost-effective, customer-focused services · Employees need significant training and support in order to retain a skilled workforce Applicable Goals King County: Promote the health and well being of youth, families, communities and the disadvantaged. Increase public confidence through cost-effective and customer-focused essential services. Public Health: · Provide needed or mandated health services and prevention programs to address individual and community health concerns · Prevent disease, injury, disability, and premature death · By 2003, Public Health will increase the number of collaborative partnerships that have a high likelihood of reducing regional disparities in health status. ProClram Leadls) Shirley Hutchison Individual Employees Involved in 55.2 FTE Program 67 - PROGRAM NAME: Program Purpose Statement Program Performance Measures Services Included in Program Line of Business (LOB) Key Result from Program for LOB Applicable Change Dynamics Applicable Goals - FAMILY PLANNING The purpose of the Family Planning program is to provide reproductive health, STD, outreach and education services for King County residents in 'I order to promote sexual health and well being and reduce unintended . preqnancies. . Outcome: · % of family planning patients leaving an annual visit with a birth control method Output: · # of CSO visits · # of CSO referrals to family planning programs · # of community health education activities · # of STD cases treated Demand: · Unintended births in King County Efficiency: · Cost per visit · Clinical services · Health education services · Outreach services Tarç¡eted Community Health Services % of family planning patients leaving an annual visit with a birth control method · Environmental, demographic, social, epidemiological, and medical trends · Electronic and mass media will increasingly influence individual health behaviors · Clear, understandable communication needed to inform public about increasingly complex public health issues · Public Health will need to increase it's partnerships · Increased difficulty in developing long term, stable funding and political consensus · Unstable health system puts pressure on "safety net" providers to serve low income and uninsured · More "marginalized" populations mean less population-based, comprehensive services · Infrastructure improvements essential to provide cost-effective, customer-focused services · Employees need significant training and support in order to retain a skilled workforce King County: Promote the health and well being of youth, families, communities and the disadvantaged. Increase public confidence through cost-effective and customer-focused essential services. , Public Health: · Provide needed or mandated health services and prevention programs to address individual and community health concerns · Assess and monitor the health status of our communities · Prevent disease, injury, disability, and premature death · By 2003, Public Health will have a sustaining and flexible funding base sufficient to maintain critical public health services. 74 · By 2003, Public Health will increase the number of collaborative partnerships that have a high likelihood of reducing regional disparities in health status. Program Lead(s) Dr. Grace WanQ Individual Employees Involved in 73 FTE Program -- 75 - PROGRAM NAME: Program Purpose Statement Program Performance Measures Services Included in Program ,- Line of Business (LOB) Key Result from Program for LOB Applicable Change Dynamics Applicable Goals - IMMUNIZATIONS The purpose of the Immunizations Program is to assure access to, and technical support for, immunization services forKing County residents and health care providers in order to prevent disease in individuals and the spread of disease in the community. Outcome: I. 90% of children at age two in King County are complete for immunizations due. Output: · # of doses of publicly-funded vaccine administered by private health care providers and Public Health clinics supplied and monitored through Public Health's immunization program Demand: · # of doses of publicly-funded vaccine ordered by health care providers in King County · # of immunization visits provided at Public Health clinics Efficiency: . · Average cost per dose to distribute publicly-funded vaccine to providers in King County · Averaqe cost per dose for vaccine administration at Public health clinics · Community education · Provider consultation and education · Vaccine delivery services · Contract management · Clinical services Clinical Health Services I Primary Care Assurance 90% of children at age two in King County are complete for immunizations due · Environmental, demographic, social, epidemiological, and medical trends · Electronic and mass media will increasingly influence individual health behaviors · Clear, understandable communication needed to inform public about increasingly complex public health issues · Public Health will need to increase it's partnerships · Increased difficulty in developing long term, stable funding and political consensus · Unstable health system puts pressure on "safety net" providers to serve low income and uninsured · More "marginalized" populations mean less population-based, comprehensive services · Infrastructure improvements essential to provide cost-effective, customer-focused services · Employees need significant training and support in order to retain a skilled workforce King County: Promote the health and well being of youth, families, communities and the disadvantaged. Increase public confidence through cost-effective and customer-focused essential services. Public Health: · Alllono term ooals applv 87 - · By 2005, increase the Public Health System's ability to respond effectively to emerging environmental health issues and communicable disease outbreaks, without disruption of ongoing critical public health services. · By 2003, Public Health will have a sustaining and flexible funding base sufficient to maintain critical public health services. · By 2003, Public Health will increase the number of collaborative partnerships that have a high likelihood of reducing regional disparities in health status ProQram Lead(s) David Bibus Individual Employees Involved in 35.1 FTE Program 88 - - PROGRAM NAME: VITAL STATISTICS Program Purpose Statement The purpose of the Vital Statistics program is to provide certified birth and death certificates to the community that have accurate and timely information on births and deaths Program Performance Measures Outcome: · 90% of requests will be processed within 10 working days Output: . · # of certificates issues Demand: · Number of births and deaths in King county Efficiency: · Total cost per certificate issued Services Included in Program · Birth certificates · Death certificates Line of Business (LOB) Population and Environmental Health Services Key Result from Program for LOB · 90% of requests will be processed within 10 workinq days Applicable Change Dynamics · Environmental, demographic, social, epidemiological, and medical trends · Infrastructure improvements essential to provide cost-effective, customer-focused services · Employees need significant training and support in order to retain a skilled workforce Applicable Goals · King County: Increase public confidence through cost-effective and customer-focused essential services. Public Health: · Provide needed or mandated health services and prevention programs to address individual and community health concerns · Assess and monitor the health status of our communities Proaram Lead(s) Jon Nakagawara Individual Employees Involved in 9 FTE Program 52 - - (f) . .... ~ >, .I-J ~ ::; o U ~ o (f) t..c ~ ~ ~ ~ ÞJ I j ~ ~ r I q ~ .- ~ o ... Q.. o ~ rJ) .- ,.. ,.... o .- [J) fJ) .- E iI.. =' o = 'L .- -... -'0 ,¡"" c... i , ~ -= ~ íf) ~ o ~ ~ ,,;- ~ . ~ I ~JI 5 U r '\ .- ....... >1 ~ /-0" . I QJ ~ N ,.. .- .... o ~ ... c:: ~ ~¡ ;;;a I ~ :: 0} ~~ I ~ ~ Q ~ OJ ~ o . - , i ;;;r ~ = cj) Cf) -0 ~ é § 0 'oIJ ..., ~ J ~ 0 '~I ....: f- '¡; ;/0 -;: ,S IW .= Q..) ,~ E.' ~ t~ ~ ~ ~ o 0 I~ (j .8, >- r> Q.) . I ::> ~ ~, -0 .- ¡ .. ~'-+- ~~?>' (!.J 0 -0 =' i~ = ~ = 0: = ::: Cl.) Õ ="::r': l ) " "'-"" . - ...... iÞl; .- u .- ~ '- ,.. ') '-" ,. "\ ~ ~ ~ ~ --- u; =' o .. ,.. ...... I \ .... ra ~rC . 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'-- O>Oc cuco .- Q) () u,-co «.- > 0_ ~ o ~ <I> Z ....... >- - ï:: .L: :::¡== E co E~ o ü C) :J e "õ .r::. o u <ï: <:: .Q ~ iñ ~ë >. :¡; 'Ë .!:2 ':; ë} ~ ~ « 'O~ C ._ COro - '- co- .- (f () 'c c ._ co E .!: '0 LL« ro - If) C <I> ~ª Q.:ë o t1 ã) .~ ã;o o o o ~ N M o Memorancbnn July 10,2000 To: Board of Health From: Jean Baldwin, Larry Fay, Tom Locke, Mary Anne Preece Re: Program Performance Measures The new County Administrator, Charles Saddler, has placed a high priority on performance based budgeting. This entails establishing clear county, departmental, and program goals that link together and are consistent with the organization's mission. Program management is directed at accomplishing the established goals. Program effectiveness is assessed by tracking agreed upon performance measures that indicate the degree to which goals are being accomplished and enables the County to benchmark performance and allow comparison with other counties and health districts. Use of performance measures is being promoted not just by the county but other funding agencies as well. The department is challenged with identifying meaningful measures that are a clear indicator of the success in meeting community public health goals. One step in establishing performance measures is to adopt a standardized format for program reviews. Attached are examples of a suggested format. Several programs will look familiar, others will not. Where appropriate, a number of programs have been grouped when their respective goals are similar enough that grouping makes sense. Ideally, the measures identified for each program can be readily tracked, are useful to department managers and policymakers, and where applicable, meet other reporting or contract requirements. Please review and be prepared to discuss at the BOH retreat. Attachments - Jefferson County Health and Human Services Nursing Programs split into 4 major areas, Listed by Bars 07/11/00 DRAFT - Bars Family Support Services Maternal Child Health HTH 220 Maternity Support Services HTH 220 Best Beginnings HTH 225 Maternity Case Management HTH 220 Children with Special Health Care Needs HTH 250 WIC and WIC Breast Feeding Promotion HTH 280 HTH 281 ARS, EIP, Passport (CPS Public Health HTH 222 Nursing Contracts) HTH 223 . HTH 224 Targeted Community Health Services Family Planning HTH 260 HTH 270 Breast and Cervical Health Program HTH 430 Adult Health HTH 292 Foot Care HTH 291 Population Health Services and Prevention Tobacco School Health HTH 290 Health Care Access Child Care Health and Safety Child Death Review HTH 221 SHARE/ Peer-in HTH 261 Vital Statistics HHS 710 Communicable Disease HTH 390 Immunization HTH 320 Travelers Immunization HTH 321 Sexually Transmitted Disease HTH 330 TB HTH 340 Syrinqe Exchanç¡e HIV including prevention, education High HTH 351 risk intervention testing and Counseling, HTH 352 Case Management Services, Coordination HTH 353 and Planning HTH 354 HTH 356 - Nursing Programs List for goals 2000 - - - Jefferson County Health and Human Services, Nursing Programs Purpose and Performance Measures 7/10/00 DRAFT PROGRAM NAME: FAMILY SUPPORT SERVICES ! Program Purpose Statement The purpose of the Family Support Service program is to provide assessment, education, skill-building, and support of pregnant women and families with children (including nutrition education, food vouchers for those who qualify for WIC, assistance for Children with Special Health Care Needs, and assistance with health records for foster children) so that babies are born with the best opportunity to grow and thrive, the impact of health problems are minimized, and children receive the care and nurturing they need to become functional adults. Program Performance Measures Outcome: · % Women getting prenatal care in the first trimester : · % Premature birth rate · % Infant morbidity and mortality · % Tobacco use during pregnancy · % Incidence of Child Abuse and Neglect and Domestic Violence · % Unintended repeat pregnancies · % Of WIC participants breastfeeding at 6 wee~s and 6 months Post Partum Output: · Number Home Visits provided · Number Office Visits provided · Number attendees of weekly Breastfeeding Tea · Number attendees of Bi monthly Child Birth Education · Number of women, infants and children enrolled in WIC · Number Children identified with Special Health Care needs · Number Health "Passports" completed for foster children Demand: · Number of newborn referrals · Number of potentially eligible clients for specific programs · Number of women signed up for Maternity Support Services and Maternity Case Management · Number of referrals from Medical community, Department of Social and Health Services and Children's Services · Number of births per year Jefferson County Efficiency: · Number of services per FTE Cost per client getting Family Support services vs. cost of premature birth, or cost to community for incidence of violence, abuse and neglect Services Included in Program Home and office visits, telephone consultations, classes, and groups in which the following services are provided; assessment, education, counseling, referrals, case management, and parenting support. Other services include; WIC nutrition education and food vouchers, review of health records of . children in foster care and development of a health "passport" for each child, and coordination of services between agencies. Family Support Services Jefferson County Health and Human Services, Nursing Programs Purpose and Performance Measures 7/10/00 DRAFT - PROGRAM NAME: TARGETED COMMUNITY HEALTH SERVICES Program Purpose Statement The purpose of the Targeted Community Health Services is to provide outreach, access, health education, support and treatment for specific at risk populations in Jefferson County in order to improve the health of the community. Specific program purposes are: · Family Planning: to provide reproductive health, outreach and education for Jefferson County residents in order to promote sexual health and well being and reduce unintended pregnancies. · Breast and Cervical Health Program: provide public education and health screening services to women age 40-94 with low incomes and no or limited health insurance in order to assure early detection and I treatment of breast and cervical cancer. · Foot Care: provide foot care and health outreach to Jefferson County seniors unable to care for their own feet,k due to physical limitations, for the purpose of preventinq health complications. Program Performance Measures Outcome; · % Pregnancy rate under age 18 in Jefferson County i I : % Deaths due to breast and cervical cancer in Jefferson County % Hospitalizations due to complication of diabetes and other vascular conditions r---' Output: · # Unduplicated clients served in Family Planning · # Adolescents < 19 served in Family Planning · # Breast and Cervical screening exams completed · # Foot care contacts · Demand: · Unintended births in Jefferson County · # Of women age 40-64 with low incomes and no or limited health insurance · # Of calls requesting foot care and how long to get foot care appointment Efficiency: · Cost per Family Planning visit · Cost of unintended pregnancy vs. planned and wanted pregnancy · Cost per woman screened in Breast and Cervical Health Program · Cost per foot care contact vs. hospitalization for amputation Services Included in Program · Clinical Services · Health Education · Outreach Services · Contract management · Coalition building I Targeted Community Health Services - Jefferson County Health and Human Services, Nursing Programs Purpose and Performance Measures 7/11/00 DRAFT PROGRAM NAME: POPULATION HEALTH SERVICES AND PREVENTION Program Purpose Statement The purpose of the Population Health Services and Prevention is to provide assessment, health education and public health interventions to county residents in order to prevent disease and unintentional injury, improve the quality of life and reduce disparities in health. Programs included: · Tobacco · School Health · Health Care Access · Child Care Health and Safety · Child Death Review · SHARE/Peer-in · Vital Statistics See s ecific ro ram erformance measures attached Pro ram Performance Measures Services Included in Pro ram - - Population Health Services and Prevention Jefferson County Health and Human Services, Nursing Programs Purpose and Performance Measures 7/11/00 DRAFT -' Population Health Services and Prevention PROGRAM NAME: TOBACCO PREVENTION AND CONTROL Program Purpose Statement The purpose of the Tobacco Prevention and Control Program is to ultimately reduce health care costs and increase both the lifespan and quality of life for all who live in Jefferson County. Program Performance Measures Outcome: · Jefferson County restaurants are smoke-free · Number of youth and adults who consume tobacco. · Number of retailers in compliance with tobacco regulations. Output: . · # of restaurants participating in restaurant campaign. · # of participants attending coalition meetings. Demand: · # of requests for presentations. · # of inquiries requesting information. · # of inquiries requesting cessation referrals. · # of requests for technical assistance. .-" Efficiency: · Cost per presentation · Cost per site visit · Cost per retailer compliance check Services Included in Program · Assessment · Educational sessions · Educational materials · Contract Management · Coalition Building · Guideline Development & promulgation · - Tobacco Prevention and Control Jefferson County Health and Human Services, Nursing Programs Purpose and Performance Measures 7/11/00 DRAFT - Population Health Services and Prevention PROGRAM NAME: Program Purpose Statement Program Performance Measures - Services Included in Program - School Health SCHOOL HEALTH PROGRAM The purpose of the School Health Program is to provide health education, needs assessment, school nursing technical assistance and resources to school districts in Jefferson County so that the physical and mental health of youth is optimized and educational goals not compromised. Outcome: · % Improvement in specific social and health indicators for youth Output: · # Of in-services and trainings provided · # Of mandatory health screenings . · # Of Public Health Nurse staff days spent at each school district · # Of Health education classes given · Assessment of student health needs Demand: · School age population in Jefferson County Efficiency: · Cost for prevention and health education vs. cost of unintended pregnancies, cost HIV infections, cost of hospitalization for preventable illness and injury, and cost of lost education time due to disabilities (i.e. uncorrected vision and hearinq loss). · Training and education · Assessment of student health needs · School Nursing technical assistance and health policy review · Coordinating Health Screening Jefferson County Health and Human Services, Nursing Program Purpose and Performance Measures 7/11/00 DRAFT - Population Health Services and Prevention PROGRAM NAME: Program Purpose Statement Program Performance Measures Services Included in Program Health Care Access HEALTH CARE ACCESS The purpose of the Health Care Access program is to provide outreach, medical application assistance, linkage to community services and resources, coordination of care and targeted interventions to uninsured, underserved and/or high risk individuals and families so that health disparities are minimized. Outcome: · % of individual without health insurance and/or local health care access in Jefferson County Output: · # Of individuals contacted · List of community outreach activities and trainings Demand: · Estimated number of uninsured children in Jefferson County Efficiency: · Cost of providing outreach vs. cost to medical community for providing uncompensated care or emergency room cost for non emergent or preventable medical problems because clients had no insurance or medical provider. · Trainings and information on Medical Assistance and CHIP · Outreach includes: Health fairs, poster and brochures through out community, libraries, community centers, medical clinic, · Individual outreach through out all JCHHS nursing programs · Coordination with local DSHS, Community Service Office . Jefferson County Health and Human Services, Nursing Programs Purpose and Performance Measures 7/11/00 DRAFT - Population Health Services and Prevention PROGRAM NAME: Program Purpose Statement Program Performance Measures Services Included in Program - Child Care Health and Safety CHILD CARE HEALTH AND SAFETY The purpose of the Child Care Health and Safety program is to provide facility assessment, training and support. immunization tracking and consultation about children of concern to child care providers and families so that children achieve optimum growth and development and families are able to maintain em 10 ment. Outcome: · No incident of reportable disease transmitted in child care settings in Jefferson County · %100 Immunizations complete of 2 year olds in child care Output: · # of training and/or consultation contacts provided to child care providers Demand: · # of licensed child care centers and homes in Jefferson County Efficiency: · # of child care roviders served er ublic health nurse · Assessment of childcare facilities, training and classes for child care providers on health and safety issues, support and consultation with providers and families of children in childcare, immunization tracking and environmental health su ort for rivate water s stems. Jefferson County Health and Human Services, Nursing Programs Purpose and Performance Measures 7/11/00 DRAFT - Population Health Services and Prevention PROGRAM NAME: CHILD DEATH REVIEW Program Purpose Statement The purpose of Child Death Review involves a process of data collection using local agencies involved in unexpected child death with the goal of identifying disease and injury prevention interventions to improve overall health and safety for all children. Program Performance Measures Outcome: · Child health and safety interventions implemented Output: · All unexpected child deaths in Jefferson County will be reviewed within 6 months of the death . Demand: · # of unexpected child deaths in Jefferson County Efficiency: · Cost per review vs. cost of unintentional injury and preventable diseases Services Included in Program · Convening Child Death Reviews meetings as needed · Maintaining and updating Child Death Review.team list · Providing training for Child Death Review team · Collecting and transmitting data to Department of Health Child Death Review program ~ Child Death Review Jefferson County Health and Human Services, Nursing Programs Purpose and performance Measures 7/11/00 DRAFT - Population Health Services and Prevention PROGRAM NAME: Program Purpose Statement Program Performance Measures - Services Included in Program - SHARE/Peer-in SHARE/PEER-IN The purpose of SHARE/Peer-in is to provide learning environment for high school students to interact and develop peer education skills, and empower middle school teens to delay the onset of sexual activity and/or prevent unintended pregnancy with the goal of improving health and social well-being amon st teens b reducin re nanc and STD rates. Outcome: · Reduction in rates of pregnancy and STD's amongst teens. Output: · # of training meetings · # of Peer-in and SHARE meetings · # of attendees to all-day retreat · # of classroom presentations and workshops Demand: · The high incidence of pregnancy and STD's amongst teens Efficiency: · Cost of program per student involved · Cost of program vs. cost of unintended pregnancy or cost of treatment for he atitis infection due to dru use · Monthly training meeting with interactive exercises, gust speakers, bonding/trust-building activities · Retreat planned and presented by teens · Present classroom educational worksho s Jefferson County Health and Human Services, Nursing Programs Purpose and Performance Measures 7/11/00 DRAFT - Population Health Services and Prevention PROGRAM NAME: VITAL STATISTICS Program Purpose Statement The purpose of the Vital Statistics program is to provide certified birth and death certificates to the community that have accurate and timely information on births and deaths Program Performance Measures Outcome: · 90% of request will be processed with 5 working days Output: · # of certificates issued . Demand: · Number of births and deaths in Jefferson County Efficiency: · Total cost per certificate issued Services Included in Program · Birth certificates · Death certificates -. --- Vital Statistics - Jefferson County Health and Human Services, Nursing Programs Purpose and Performance Measures 7/12/00 DRAFT Program Purpose Statement '+(~qmmÛf1íGßÞrªPíse}3$ªi;f;lªJj(th'$ery¡cØs:R(¡' ···rjœs~t6t*:i\1~0: ",'1;:~;t", The purpose of the Communicable Disease Health Services Programs is to provide health education, surveillance, disease investigation and reporting, immunization services, STD and TB screening and treatment, and H IV testing and prevention services to Jefferson County residents in order to prevent disease and promote health. Program Performance Measures Outcome: · Investigation initiated on 100% of immediate report or "Category An diseases within 24 hours of report. · 80% of immediate report and high priority disease investigations completed within 21 days of initial report. · 90% of children at age two in Jefferson County are complete for immunizations due. · Establish immunization registry in Jefferson County, promoting use by all immunization providers. · Prevent increase in incidence of TB in Jefferson County. · 75% of clients who receive HIV testing will be high risk. I. 90% of new H IV clients who seek case management services will have an assessment within 1 week of the date requested. · The Chlamydia rate in Jefferson County will remain below the Washington State rate of 207 cases per 100,000. - Output: · # of reportable communicable disease incidents investigated. · # of communicable disease reports confirmed, interventions applied and processed for reporting to the state. · # of doses of publicly funded vaccine, administered by private health care providers and Public Health clinics, supplied and monitored through Public Health's immunization program. · Local immunization providers provided information and training on Child Profile immunization registry. · # of patients provided with preventive therapy for latent TB. · # of syringes exchanged. · # of persons counseled and tested for HIV infection. · # of client visits to the Family Planning/STD programs. · # of Chlamydia tests provided by the Family Planning/STD programs. - Communicable Disease Health Services Programs Jefferson County Health and Human Services, Nursing Programs Purpose and Performance Measures 7/12/00 DRAFT - Communicable Disease cant. Program Performance Demand: Measures · # of communicable disease case reports that were received. · # of doses of publicly funded vaccine ordered by private health care providers. · # of doses of publicly funded vaccine administered at Public Health clinics. · # of people needing preventive therapy for latent TB. · # of needle exchange clients. · # of new STO infections and new HIV infections acquired annually by Jefferson County residents. · # of Jefferson County residents who acquire Chlamydia infection annually. Efficiency: · Cost per communicable disease investigation. · Average cost per dose to distribute publicly funded vaccine to providers. · Average cost per dose for vaccine administration at Public Health clinics. · Cost of providing treatment and preventive services per individual case managed by the TB program. I · Cost per client per year of needle exchange program compared to cost of medications to treat one HIV or Hepatitis C case for 1 year. · Family Planning/STO clinic clinical services will meet Region X efficiency standards. Services Included in Program · CD, HIV, and STO case investigation and reporting. · CD, HIV, and STO surveillance. · Infection control intervention and recommendations. Consultation and technical support to health care providers : · (CD, immunizations, TB, STO, and HIV). · Community education (CD, immunizations, TB, STO, and HIV). · Vaccine delivery services. · Contracts management. · Clinical services (immunizations, STO, HIV testing). · TB investigation and case management. · TB screening. · HIV and STO partner notification. · H IV case management. · HIV and STO educational sessions. , · HIV and STO educational materials. · Coalition building. · STO clinical services. 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U L 0 .. t: I.. ,,~ ; en 0 J.;~ en E ~~ Q) ......J t- O '+- t- l\) a.. -- r J I I r - ~ L Performance Partnerships ·:·Use data as a tool for motivation and management. ì r~ Performance Partnerships ·:·Circumvent hierarchy and turf. ~ L Performance Partnerships ·:·Focus on measurable results tied to a vision. ì r J L Performance Partnerships ·:·Draw from all sectors and all levels of government using an open door policy. Don't forget to include non-traditional partners. ì r l,-l L Performance Partnerships - ·:·Focus on better use of existing resources. + people + money +time ì ,J L Performance Partnerships ·:·Employ multiple strategies. Allow partners to "agree to disagree" on the strategy as long as they agree on the result. - I r Performance Partnerships ·:·Measure progress frequently. .J L Performance Partnerships - ·:·Agree to flexibility in exchange for accountability. 'ì r .J Performance Partnerships ·:·Generally, use an inductive approach rather than a deductive approach--just get started! ì r - ,s Performance Partnerships ·:·Tolerate~ ~n messiness and asymMetRy. IJ Performance Partnerships - ·:·Encourage self-organizing efforts. ì ~ ,s Performance Partnerships ·:·Reward progress, but remember rewards don't have to be financial. ·:·They can include lots of positive attention, flexibility, increased trust and other non-traditional benefits. - ì L rl L L - - - s Performance Partnerships ·:·Oe-emphasize programs. Emphasize partnerships and cross-sector initiatives. L 1 ,- 1rJ- Catalytic Leadership: "r7¡-rl:""rrrrrr Strategies for An Interconnected World Jeffrey S. Luke, Jossey-Bass, 1998 '-- - It "" :.... r-- :- :- "" r r ,- err How do we provide effective leadership to address interconnected public problems with fewer fiscal resources, a lack of consensus on options, and the involvement of diverse stakeholders? ~ !- o' :.. r r '" r r ~ :-- Ir - ---, J ..... :- !"'" t" :- ,- r- r I~ r r r Emerging challenges, complex and interconnected, require new forms of collective action across traditional agency lines and jurisdictional boundaries. ~ ".' r- r- !... '" r r r-- ~-:- r r'"" [, - - J Public Leadership .:. Non-hierarchical and interorganizational .:. Evokes collaboration and concerted action .:. Provides the needed spark (catalyst) for action - ---, Public Leadership ·:·Convenes stakeholders and facilitates agreements for collective action .:. Is facilitative; asks the right questions ·:·Has a stake in getting the right outcome, but encourages multiple strategies to get- there . 1 - ] The Four Catalytic Tasks of Public Leadership - Il Catalytic Tasks .:.Focus attention by elevating the issue .:.Engage people in the effort by convening a wide array of stakeholders I[ ] . .~ Catalytic Tasks ·:·Stimulate multiple strategies and options for action ·:·Sustain action and maintain momentum by managing the interconnections through rapid information sharing and feed back [ J ] Connie Ravelli, Clark County 2010 Oregon Benchmarking System (Shorthand by) Jean - Performance-based partnerships 1. Demand driven. 2. Partners set them up 3. All of us do something Key elements are measurable results A key ingredient is articulate vision and much redundancy. The redundancy continues to state the vision. · Measures are agreed upon · Driven by demand from the community · Committed energy comes from the partners · Organized without traditional hierarchies Step by step 1. Find specific measurable outcomes with total complete agreement. Set aggressive but realistic numeric targets Separate what from how. How gets to the strategy and often times causes battle. Continue to focus on the what. Look at Healthy People 2010 to define the whats. Many times words will stumble people. Pregnancy prevention implies one thing. Teen births could imply to someone else that folks are encouraging teen abortions. _ 2. Gap analysis. Convene the right partners to analyze the gap between where you currently are and where you want to go. This will expose the perceived and the real barriers. 3. Various partners take ownership of the barriers and go to work on them. Be sure to allow room for multiple strategies or room for multiple hows. Example: Americorps students doing immunization outreach. The important thing on this one is agree to disagree on how but we all agree on what. It's a bit like a jazz combo with conflicting beats. 4. Catalytic leaders. Keep partners moving towards the desired results and provide frequent measurement of progress for motivation and management. Catalytic leaders are truly visionary. 5. Bring in new partners as needed. Recruit people and organizations based on their desire to accomplish the results. They have to care about the results in order to be a partner. 6. Minimize turf and control battles by refocusing partners on the desired results and refocusing on the results. 7. Celebrate successes along the way. Regroup if you are not finding any successes. Transparent accountability is very important. Measure all the time. 8. Select an alternative outcome: Where now? Where are we going? How do we know we are getting there? Each strategy group has measures. Each strategy group and each idea has measures. For example: · · · · - · School attendance 12-18 years old Number of contraceptive visits to family planning clinic, how long of a wait before they are able to be seen? Number of teens participating in after school activities Sex Ed numbers Wait 48 hours for an appointment 9. Each of these things needs to be continually measured and then needs to be continually maintained. The maintenance in this type of community partnership is very difficult. As success is reached people often times slide and the numbers have changed in a number of these successful programs. 10. Tolerate messiness and asymmetry. It is a self-organizing not controlled group. - 11. De-emphasize programs. Emphasize instead partnership and cross-sectional leadership. Catalytic Leadership, by Jefrrey Luke. Herding Cats or a Jazz Combo. Another interesting person to refer to is Clara Prat from OSU, Building Resultsfor Wellness Goals. She does maternal child health and asset modules. 12. Continue to go back to the barriers to review the givens. Continue to look for conflicting language from the charts, from the partners. -1v ~¡~ - Highlights from the April 27, 2000 Risk Communications Workshop By Dr. Vince Covello Risk communication is a science-based approach for communicating effectively in high concern, low trust, sensitive, or controversial situations. Risk communication has 3 goals: 1. Increase knowledge and understanding 2. Enhance trust and credibility 3. Resolve conflict Risk communication skills can be grouped into 3 areas: 1. The message (what) 2. The messenger (who) 3. The media (how) ......... Every situation can be characterized by the level of public conc~rn and trust in the responsible organization. Risk communication is essential when there is high concern and low trust, and highly recommended when there is high concern and high trust. I. MESSAGES: Problem - people who are upset (as most people in are high concern and/or low trust situations) have trouble processing and retaining information. This can reduce the ability to process up to 80% of the information you give them. Solution - limit the amount of information you send to 3 key messages · Three tips for effective messages: 1. Make your messages simple, short and relevant to your audience 2. Repeat your 3 key messages often 3. Always use visuals because they increase attention, recall and understanding · Three pitfalls to avoid in developing messages: 1. Avoid risk comparisons; they usually backfire 2. Avoid spontaneity. Invest time in preparing your communications. 3. Avoid complexity. Always group your messages and supporting facts in groups of 3. If you have more than 3 messages, supporting facts or statistics, develop a different tool for communicating them. - · Negative words to avoid: no, not, can't, don't, never, nothing, none. · Message Mapping is a technique for developing and displaying your 3 key messages and supporting points. Message maps are used as talking pOints and as the basis for written materials, exhibits and other communications. Message maps contain information designed for varying levels of comprehension, ranging from 6th grade to post-graduate. They are developed by a group consisting of persons with expertise in four areas: policy, technical, communications and legal. Message maps are combined into briefing books and routed to those who will communicate about the issue. The maps need to have a "champion" who maintains them; this is usually the technical expert. - · 3 reasons to develop a message map: 1. To clarify the agency position 2. To increase consistency in what different people in the agency say about the issue 3. To increase cooperation across programs, with other agencies, and with stakeholders II. MESSENGERS: . Problem - people who are upset are often distrustful. In high concern and/or low trust situations, the acceptability of the message is based on the trust and credibility of the source. - Solution - demonstrate your trust and credibility in your communications · Trust and credibility on health and environmental issues (1998 survey) : 1. Local citizens who are well informed were rated as the most credible information sources by citizens 2. Nurses, physicians and other health professionals ranked in the top third 3. Emergency response, educators, non-profits, and professional societies also ranked in the top third · Three tips for building trust and credibility: 1. Demonstrate empathy and caring in your bOdy language and key messages. 50% of your credibility depends on whether people believe you care about their concerns. 2. Demonstrate commitment to address people's concerns; expertise in the subject area; and an open, honest approach to handling information. Together, these 3 factors account for the remaining 50 percent of your credibility. - 3. Remember that credibility is in the eye of the perceiver. Find out who is highly credible with your target audience and align yourself with them, if possible. . Three ways to work with highly credible sources: 1. Ask them to endorse your messages 2. Partner in developing messages (and actions) 3. Ask them to deliver your messages . Negative dominance theory: (iN = 3P) If you are attacked or accused by a credible source, you need 3 positive messages to neutralize one negative message. You need one additional positive message to reestablish your credibility. III. MEDIA . Town meetings are ineffective in high concern and/or low trust situations. They encourage adversarial behavior, tend to be dominated by people who are opposed to the topic, and do .not Increase knowledge and understanding, enhance trust and credibility, or resolve conflict. - . A better option is an open house, where people can have tyvo-way information exchange and get more or less technical information based on their individual needs. Three important features of an open house are: 1. Information displays based on your 3 key messages 2. Opportunities for people to move around at will 3. Experts available to answer questions and listen to comments This summary can be used in conjunction with tyvo other documents available from the DOH Communications Office: 1) a template for developing message maps, and 2) guidelines for developing message maps. May 10, 2000 Prepared by DOH Communications Office - Guide to Developing Message Maps for Risk Communications Based on a DOH workshop by Dr. Vince Covello - Message mapping is a technique for developing and displaying your 3 key messages and supporting points. Message maps are used as talking points and as the basis for written materials, exhibits and other communications. They are valuable in high concern, controversial situations because many people can use them to ensure consistency and repetition of the 3 key messages. Message maps contain information designed for varying levels of comprehension, ranging from 6th grade to post-graduate. Forming a message mapping group: Maps are developed by a group consisting of persons with expertise in four areas: policy, technical, communications and legal. Choosing a "champion": . One member of the group (usually the technical expert) is designated as the "champion" for the message maps. It is this person's responsibility to update and maintain the maps. In a fast-moving situation, content may change daily. - Time commitment: It takes about 1 hour to develop each map. 20 maps are usually needed to address the most common concerns and questions that will be raised about a public health issue. After a map is developed¡ individual work is needed to develop examples, clarify legal issues, resolve policy questions, obtain citations, quotes¡ etc. Tip for getting your mapping group off to a good start: Early on, discuss the balance the group wants between being technically accurate and communicating effectively. 3 steps to develop "areas of concern¡' for message mapping: 1. Surveys¡ focus groups and other research methods can be used to identify audience concerns. Or, brainstorm tough questions you expect to be asked. 2. Organize similar questions into "areas of concern". Try to capture the most inflammatory way of expressing each concern. 3. Order "areas of concern" from most to least likely to be raised. - - 3 steps to develop a message map: 1. Beginning with concerns that are most likely to be raised, develop 3 key messages in response to each concern (1 message per map). When you're done you will have 3 maps for each "area of concern". 2. Next, working with one map at a time, develop 3 "proof points" for your key message. Proof points may be a fact, statistic, results of a study, statement by a third party, or an anecdote -- whatever your group believes best supports the key message. 3. For each "proof point" develop 3 supporting facts. Again, select whatever information your group believes best supports the key message. 3 tips for effective maps: 1. For each area of concern, restrict your message map to groups of "3" (3 key messages, 3 proof points for each message, 3 supporting facts for each proof point). You can develop more, but think of these as auxiliary - available if you need them. Because people in high concern situations have dJfficulty retaining information, repeating the same information is the best way to increase knowledge and understanding. ,- 2. Use simple, positive language. 7-12 words is ideal. Key messages and proof points should be written at 6th-8th grade reading level. Supporting facts (and additional supporting information) can get increasingly technical and complex. The idea is to make your key message and proof points understandable to the general public, and have more technical information available if it's needed. At the outside of the map, you can write at pH comprehension level. 3. Know the concerns of your target audience (town, group, etc.). Since the maps are based on audience concerns "guessing" people's concerns is the least preferred method. Alternatives to surveys include focus groups, man- on-the-street interviews, a standing citizen advisory committee, opinion leaders, and contacts within the audience group. This guide can be used in conjunction with two other documents available from the DOH Communications Office: 1) a template for developing message maps, and 2) a summary of Dr. Covello's workshop. May 22, 2000 Prepared by DOH Communications Office - :z: w 0::: C> w « u en - :z: (I'J 0 w u ~ a.i a.i ... ... Q) Q) .s:: .s:: Q> Q) Q) 10- e. e. C") Q> .... >- >- l- I- l- I- :z: ::I: z a.i 0 Õ a.i Q; a. Q> a. Q; ~ u.. ~ :::s u.. <D 0 <D a.. U) 0 a.. >. 0 0 >. I- 0::: U) c::: I- a. - a. Q> a. >a f- . . 10- 0 ...... e. n:s :E "",..s:: ~~ Q> l~ C) 3~ n:s j ~ U) f~ U) ~ Q) ~ N M :æ .... N M x - o X <l> 0) C'C 0.. ~ ~r-W WNZ :I:00 W"""::I: I-~c.. « N - Oc:i~ o::~« W _Z I-<DI- ZUU W!:E« ..01- -g",Z 7ã§O "'8.."ffiU ¿ .S¿ 0:: -c<::w <D'='I- '-Ez ~EW <DO-,-, 5..U ~ <D::r:- 7ãO§ OOU - N M ~ N M N I- Z Õ a. u.. o o c::: a. I- Z Õ c.. u. o o 0:: c.. >- 0:: « -I -I X ::Þ « a.i Q; ~ <D a.. >. I- · · - · · · · 6I20/00RM 2001 PRELIMINARY LEGISLATIVE COMMITTEE PRIORITIES Process Goals for 2000-01 . Increasing the number of members making contact with their legislators at home before the session, as well as expanding those that participate during the session. (The great strength of WSALPHO is that we have teams in every legislator's home district. Our increasing dependence on the State makes capitalizing on this strength vitally important. I would like to take this message to each forum in the coming months). . Sharing of our evolving legislative agenda through the forums and soliciting their ideas and issues. Creation of a web page out of our legislative tracking form and committee minutes. (Hopefully, this will make access to legislative information a little easier.) Items that wilIfmay be on our 2001 Legislative Agenda . · 24 months (vs. 18 months) MVET replacement. Restoration of the $IM in LCDF/Partnership dollars excluded from base. Potential funding to move the Standards forward. (This may be coupled with outcomes of the Public Health Financing Committee's work.) Emergency funding (CDfTB). Tobacco Plan funding. Facilities financing. HB 2392 and the various local government finance studies and task forces. · Surface/recreational waters. · HB 3090, civil fining authority for health districts. · Youth access to tobacco. · Fluoridation and other oral health initiatives/issues. · Health care access · Home visiting/early intervention. · Vaccine/immunization policy. · Other items. - Challenge for 2001 . How to manage and prioritize an ever expanding workload.