Process in Action: Examples from the Field
Below are examples of how the nation and states
have made connections with leadership to develop health objectives and establish planning
structures.
From the National Initiative
Secretary’s Council
The Secretary’s Council on National Health
Promotion and Disease Prevention Objectives for 2010 is the advisory structure for Healthy
People 2010. The membership of the Council promotes leadership commitment and involvement
in the development process. The Council, which meets annually, is composed of former
Assistant Secretaries for Health and the current heads of operating divisions in HHS. The
Secretary of HHS serves as the chair, and the current Assistant Secretary for Health and
Surgeon General is the vice chair.
The Council is charged to do the following,
according to the Healthy People 2010 Charter:
- Provide to the Secretary advice and consultation
to facilitate the process of developing national health promotion and disease prevention
goals and objectives;
- Provide links with the private sector to ensure
their involvement in the process of developing national health promotion and disease
prevention objectives;
- Through those links with the private sector,
enhance the prospects of tying together similar health promotion and disease prevention
efforts throughout the private and voluntary sectors.
Healthy People Steering Committee and Work Groups
The Steering Committee is composed of
representatives of all operating divisions of HHS. The members are joined in these
discussions by work group coordinators from the lead agencies in the Public Health
Service, which have been designated to be responsible for the achievement of the Healthy
People targets. A list of the Healthy People Work Group Coordinators can be found at the
following web site: http://www.healthypeople.gov/HPScripts/focusarea.asp.
The report, Stakeholders Revisit Healthy
People 2000 to Maximize the Impact of 2010, describes the Steering Committee retreat
proceedings which began the 2010 development process. The report includes summaries of the
five Consortium member breakout groups and is available at: http://www.health.gov/hpcomments/stakeholder/default.htm.
From State Initiatives
Governor’s office leads planning process
By Executive Order, North
Carolina’s governor established the Task Force on Health Objectives for the year
2000. The governor's Task Force engaged 25 North Carolina leaders representing health care
providers, consumer organizations, and public representatives. This broad coalition helped
to foster public and private sector ownership of the state's health objectives. A
state-level Office of Healthy North Carolinians offered assistance to local community
leaders and involved the majority of counties in Healthy Carolinians activities. In April
of 1999, the governor signed a second executive order, establishing and expanding a
successor Task Force for year 2010 health objectives. The goal is to review the national
objectives for year 2010 and involve North Carolina counties in establishing the
state’s 2010 objectives. North Carolina believes that the state’s
"decentralized" public health system will lead to success with this approach.
The Louisiana legislature passed a bill to
create the Louisiana Healthy People 2010 Planning Council in the Department of Health and
Hospitals. The task of the Council will be to design a process for developing a state
plan. The bill states that the Council shall be composed of a variety of public, private,
professional, educational, trade, volunteer and advocacy organizations to ensure that all
citizens are represented. It also requires that a paid staff person assist the activities
of the Council.
In 1996 South Dakota’s governor
signed an Executive Order establishing the Governor’s Health Advisory Committee to
provide recommendations and advise the Secretary of Health on health priorities. The
Health Advisory Committee serves as a think tank on emerging and priority health issues
and helps to foster partnerships to improve geographic and financial access to health
care. The Committee uses the Healthy People objectives when applicable. Included in the
advisory committee are key members of the healthcare community including providers,
administrators, educators, and consumers.
In 1993 the Utah Legislature enacted
legislation to create a statewide strategic plan with performance measurements. State
legislators, local government representatives, state agency heads, other
governor-appointed members, and a state coordinator participated in the Utah Tomorrow
strategic planning committee. By centralizing planning through the governor's office, Utah
achieved among various state agencies a common planning language for performance measures
and objectives. The governor's Office of Planning and Budget provided technical assistance
and hands-on skills training to state agencies, which were asked to participate
voluntarily in planning and performance measurement efforts.
Incorporating health objectives into other strategic planning
and evaluation efforts, such as performance-based budgeting
Florida’s year 2000
planning occurred in the context of the state’s 1992 Health Care Reform Act. This Act
requires the state to develop biennial health plans that include population health status
data, specific health status objectives, and outcome measures. These responsibilities were
transferred to the Department of Health when the Department was created in 1997 and
resulted in the development of the Florida State Health Plan. In addition, since Florida
statutes mandated implementation of performance-based program budgeting, the Florida
Department of Health integrated performance-based budgeting into the planning process for
its Agency Strategic Plan, which is updated annually with five-year forecasts.
The 1993 Oregon legislature directed all
state agencies to develop performance measures with ties to the state’s indicators of
well being, called Oregon Benchmarks. A Progress Board presents biennial progress reports
to the legislature and public. The benchmarks and progress reports help to keep state
agencies focused on results and help leaders evaluate and reset priorities. Many Oregon
local governments have initiated their own benchmark planning systems.
In Ohio, the director of the
Department of Health initiated a strategic planning process designed to strengthen
Ohio’s public health system. It was called Ohio’s Public Health Plan. The plan
targeted five initiatives, one of which was Healthy People Ohio. Ohio Department of Health
senior staff and representatives of public health associations guided the planning process
with a Work Group on Healthy People Ohio.
Using strategic plans and progress reports to evaluate
proposed policies and funding allocations
Utah’s annual budget
cites relevant Utah Tomorrow goals, and state agencies must reference relevant
performance standards for their department proposals. The Utah Legislature’s
Appropriations Subcommittees annually receive reports detailing updated objectives and
performance measures for relevant subject areas. Utah legislators are encouraged, but not
required, to correlate legislation with the state's strategic plan and to use Utah
Tomorrow to evaluate proposed legislation.
Influencing health legislation
Vermont, Delaware, Guam, and
Utah attribute state success in passing clean indoor air legislation to
the state health objectives. In addition to clean indoor air laws, Vermont's legislative
successes have been numerous, including passage of bills related to lead abatement,
immunizations, and seat belt usage.
The Rhode Island Department of
Health was successful in using year 2000 objectives to win legislative approval for new
requirements related to automobile and boat safety and radon control, as well as new
minority health programs funded by a tobacco tax.
Creating a
Structure for Success
1. Preparation
A carefully organized and well-defined planning structure will position the 2010
planning process for success. There are several options for developing steering
committees, advisory committees, and other structures to carry out planning work and
involve people in the process. This tool can be used to structure government leadership or
community involvement. (See the action area, "Identifying and Engaging Community
Partners.")
This tool will give you ideas on how to structure your process, identify participants,
and delineate participant roles and responsibilities. A small group, or 2010 preparation
team, can help make structural decisions before the official steering group is formed. In
just one or two meetings, this team can ensure that invitations are sent to the right
people and their charge is clear from the beginning.
An existing health advisory group or public health management team can serve as a
preparation team.
2. Align the planning structure with state goals
 Know what you want to build
before bringing in the crew.
Consider first what the desired results of the 2010 process are, then build a planning
structure around those goals. For example, if the state's goal is for policy makers to use
the 2010 plan to propose legislation, a planning structure involving the legislative
branch or the governor's office may be desirable. If state goals emphasize local use of
the plan, a planning structure with local involvement would be ideal.
3. Write down what the state wants to achieve,
then consider the structural issues and options that follow by asking, "Which option
will give us these results?"
Issue 1: Authority: Advisory
vs. Steering Responsibilities |
In any planning structure, participants should know:
Who has an advisory role? Persons in an advisory role may provide informed input
on topics such as the 2010 planning process, priority or focal areas, target populations,
scope of objectives, marketing, and other aspects of the 2010 plan.
Who has a steering role? Persons in a steering role navigate the course of the
planning process, establish work groups, determine input processes, and make decisions
about the content of the state plan.
Who makes final decisions, weighing all input?
Who will be held accountable for the plan and see the plan through?
Advisory Structure Options
Single, state-wide advisory group that meets throughout the process
- Two or more advisory groups
to ensure input from specific constituencies (e.g.,
geographic areas, racial and ethnic populations, or local health officers), periodically
convened
- Consortium of various advisory groups
, (e.g., maternal and child health, mental
health, substance abuse)
- No formal advisory group
, but planned events or activities to gain input from key
constituencies (see options in "Public Input and
Involvement")
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How can advisory and
steering structures fit
together?
For a visual
overview of potential relationships among various structures, see four sample
organizational charts. |
Steering Structure Options
-
Steering group with full authority to develop and adopt the 2010 plan
-
Steering group with significant authority to develop the 2010 plan, subject to
the final approval of the governor, state health officer, or others
-
Steering group with specific authority over certain tasks (such as the
development of objectives), with other tasks (such as marketing and publication of the
plan) under the authority of the state health agency or governor's office
Leadership Options
-
Chaired by the governor or his/her designee
-
Chaired by an official or appointed by the legislature
-
Chair elected by the group
-
Chaired or co-chaired by state public health, mental health, substance abuse, or
environmental health director(s)
-
Co-chaired by the state health officer and a community representative (appointed or
elected)
-
Rotating chair
-
No chair—group received direction and guidance from staff
Membership Options
-
State agency staff only
-
State and local public agencies staff
-
Members of the private, public, and voluntary sectors—e.g., academia (schools of
public health, social work, nursing, medicine), community health and social organizations,
business, legislatures, etc.
-
Community members excluding state agencies and academia
Issue 2: Distributing the Work
The options below may apply to distributing the work of advisory groups, as well as
steering groups, according to the planning structure in your state. (See "Participant
Roles and Responsibilities," for additional ideas on ways to coordinate the work
of developing the state plan.)
Delegation Options
-
The steering group does all the work in steering group meetings
-
The steering group divides its members into work groups or subcommittees
-
The steering group establishes work groups to be chaired by a steering group member,
with work group membership open to non-steering group members who have expertise or
interest
-
The steering group charges the state health agency with forming work groups as needed
Work Group Options
Number
Organization
-
By focal areas (e.g., tobacco, infectious diseases, infrastructure), so that work
groups are responsible for all aspects of developing the plan for their areas of expertise
-
By functions (e.g., objectives, strategies, marketing, public input), so that work
groups oversee one aspect of the process for all focal areas
-
By populations (e.g., grouped by life stage, gender, race/ethnicity, people with
disabilities)
-
By target audience (e.g., business, government, community organizations)
-
Combination of work group types
Communication
-
Work groups operate independently, reporting only to the steering group
-
All work groups are periodically convened with steering and advisory groups, sharing
progress and discussing priorities of common concern
-
Certain, related work groups periodically meet
-
Staff, materials, web site, or electronic newsletters facilitate communication among
groups
Staffing Options
-
Members, or their respective staffs, do all the work
-
Public agencies jointly support the process
-
State health agency shares technical support (e.g., data, program expertise, or
references) and administrative support responsibilities with members.
-
State health agency provides unlimited technical and administrative support, as
delegated by the group
-
State hires contractual staff for administrative or technical support, funded by state
or private grants
Issue 3: Public Input
and Involvement
Options
-
Public meetings with formal testimony
-
Public meetings with informal discussion with steering committee members
-
Public meetings with break out rooms for structured input or activities
-
Dissemination (via e-mail, web site, fax, or mail) of requests for specific input or
comment
-
Surveys
-
Focus groups
-
Internet discussion group
Scheduling public input
-
One location (such as the state capital)
-
Multiple locations (meetings in every region)
-
Single point in the process
-
Multiple points in the process (see options below)
Potential opportunities for public input in the 2010 planning
process
General questions to consider for 2010 planning
groups:
-
How many members do you want, and what type of skills do they need to have?
-
What will be their time commitment? (How many hours per month for how long?)
-
How will member travel arrangements and expenses be handled?
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Where, when, and how often will they meet?
-
Will the meetings be open or closed? (Check state regulations.)
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What rules of order will be followed?
-
Will the members be expected to represent their agencies, community, or constituencies?
-
Which population groups should be represented?
-
Will the group sustain itself once the plan is developed? If so, how? What will the role
of members be after the release of the state plan?
-
How will you evaluate the effectiveness of the groups?
-
How will you reward great efforts?
Sample
State Statutes
State legislation may help to establish planning authority and build policy makers'
support for the development and implementation of a state plan. Under the two sample
statutes below, the Florida Department of Health has been given specific responsibility
for the development of a state health plan. Building Healthy Communities: Florida's
Public Health Plan is the Florida Department of Health's state health plan for
1998-2000.
SECTION 408.601, FLORIDA STATUTES:
"The Department of Health and Rehabilitative Services [now the Department of
Health or DOH] shall develop a biennial Healthy Communities, Healthy People Plan that
shall be submitted to the Governor, the President of the Senate, and the Speaker of the
House of Representatives by December 31 of each even-numbered year.
"The plan must include data on the health status of the state's population, health
status objectives and outcome measures, and public health strategies, including health
promotion strategies. The plan must also provide an overall conceptual framework for the
state's health promotion programs that considers available information on mortality,
morbidity, disability and behavioral risk factors associated with chronic disease and
conditions; proposals for public and private health insurance reforms needed to fully
realize the state's health promotion initiative; the best health promotion practices of
the county health departments and other states; and proposed educational reforms needed to
promote healthy behaviors among the state's school-age children."
SECTION 20.43 (1) (L), FLORIDA STATUTES:
The Department of Health is required to "biennially publish, and annually
update, a state health plan that assesses current health programs, systems, and costs;
makes projections of future problems and opportunities; and recommends changes needed in
the health care system to improve the public health."
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