Managing and Sustaining the Process

Managing and
Sustaining the
Process "Even if you're on the right track, you'll get run over if you just sit there."

—Will Rogers

In This Section

u Action Checklist

u Tips

u Process in Action: Examples from the Field

Planning and Development Checklist

Sample Time Line—Overview

Sample Time Line—Detailed View

µ Hot Picks: Resources

The success of a Healthy People initiative (national, state, or local) depends on sustaining the process, particularly as leadership, administrations, and policy makers change. Initial commitment and energy of community partners in identifying needs and setting objectives or targets is only the beginning of the process. Sustainability and institutionalization of Healthy People in day-to-day activities of many people in diverse organizations is necessary in order to achieve objectives. Commitment is not a one-time event, but must grow throughout the next decade.

Action Checklist: cogs graphic
Managing and Sustaining
the Process
(See a complete planning and development checklist.)

Designate staff and organizational unit for coordinating state plan development
Create a work plan and time line to develop and release the plan
Coordinate expertise and staff support
Assign development tasks to teams or individuals
Establish and implement processes for ongoing input

Market development process (see the action area, "Communicate Health Goals and Objectives")
Plan periodic reviews
Integrate state plan into ongoing planning, budgeting, programming, and legislative processes
Develop a ten-year monitoring and implementation plan

A car without a driver can’t go anywhere

Identify a person (single point of contact) to manage the process and ensure that things get done
Consider establishing an office, with an annual budget, dedicated to the Healthy People initiative
Designate a state contact to liaison with the national Healthy People 2010 initiative

Let everyone know the final destination and stops along the way

Develop a time line and designate responsible parties
Distribute the time line and tasks to all partners
Establish a means of continuous communication to report progress among those involved (consider electronic possibilities)
Display the relevant time line tasks at each meeting
Make sure major partners see tasks on the time line for them
Share management responsibilities across agencies and possibly with the private sector

Integrate the state plan initiative into many ongoing activities

Incorporate in strategic and annual plans of agencies, (e.g., objectives, performance measures, data collection plans)
Encourage agencies to use the state's Healthy People logo in their documents that refer to the state plan
Tie to agency policies and legislative initiatives
Link to funding proposals and allocations (e.g., foundations, state grant funds, legislative budgeting)

Schedule internal, interagency, and public reviews of the state plan and progress

Monitor progress toward objectives, legislative actions, and organizational commitments in the plan
Time opportunities to review plan with new leaders and after elections for new terms in office
Use reviews to revitalize or redirect the initiative
Identify successes and areas of focus for public and private audiences
Convene periodic summits or conferences around the state plan to maintain momentum

Remember to celebrate milestones, and recognize groups and individuals for their contributions

Use kick-off events to showcase community, government, and business partners and their commitments
Find time and resources for certificates of recognition, plaques, and personal notes
Invite the governor, respected state leaders, and national leaders to participate in milestone events (kick-off, announcement of priorities, draft objectives, etc.)

Be prepared for "postpartum" blues

Plan activities to follow the "labor and delivery" of the plan
Redefine roles of the steering group, work groups, and others in phases following the release of the plan
Bring in new partners for a boost of energy

Process in Action: Examples from the Field

Below are examples of how the nation and states have managed and sustained the development and implementation process for Healthy People plans.

From the National Initiative

Dedicated staff

The Office of Disease Prevention and Health Promotion (ODPHP) is designated as the coordinator of the Healthy People initiative. A staff office reporting to the Assistant Secretary for Health and Surgeon General, ODPHP supports the Secretary’s Council on National Health Promotion and Disease Prevention Objectives for 2010, Healthy People Steering Committee, and the Healthy People Consortium.

Steering Committee

The Healthy People Steering Committee, which meets quarterly, is composed of representatives from all HHS operating divisions. The group is responsible for overseeing the drafting, revisions, and final modifications of the Healthy People document. A list of the Healthy People 2000 Steering Committee members is available at the following web site: http://www.health.gov/hpcomments/Guide/steering.htm.

Lead agencies

The Assistant Secretary for Health has designated lead agencies in HHS to be accountable for the achievement of Healthy People targets. Each lead agency is responsible for monitoring, tracking, and reporting the nation's progress on the objectives in its focus area. For some areas, two agencies act as co-leads. HHS agency heads in turn have designated work group coordinators to assume day-to-day responsibilities for the objectives.

Broad participation and mobilization

ODPHP staff attribute much of the sustained interest in Healthy People 2010 to the widespread year 2000 participation and buy-in, particularly between public sector partners and private non-profit groups. With virtually all states and 70 percent of local communities participating in the year 2000 initiative, vested communities create a strong demand for continuing the 2010 objectives. A critical mass of participation and positive peer pressure fuel partners' continued desire to be "on board" this popular initiative.

Another reason for the sustainability of the Healthy People Initiative is the many Consortium members from the private and voluntary sectors who have used and promoted the objectives as a framework for their constituents' action. As an example, the American Hospital Association developed Healthy People 2000: America's Hospitals Respond, a resource kit for hospital administrators to help mobilize health promotion initiatives. The American Dietetic Association (ADA) developed Call to Action to inspire its more than 64,000 members to pursue the nutrition objectives. These and other initiatives of Consortium members continue to sustain Healthy People at multiple levels.

From State Initiatives process map

Identify key staff to manage the state plan

All states and territories identify Healthy People state action contacts. Among these, four have appointed staff solely devoted to Healthy People coordination. These four state action contacts have been instrumental in establishing a development plan early and sustaining the effort throughout the decade. A current listing of the state action contacts is included in the Toolkit and available at: http://www.healthypeople.gov/HPScripts/StateContact.asp.

As another example, North Carolina has established an Office of Healthy Carolinians that is responsible for keeping the initiative on track. Staff are available to North Carolina counties for support and training, particularly coalition building. There is also a governor’s task force that certifies counties in the Healthy Carolinians project. The counties do an assessment and then implement an action plan.

The Connecticut Department of Health kept year 2000 planning on track with the help of two staff assigned to the process and an internal advisory committee. The year 2000 process was expanded with the development of Looking Toward 2000—An Assessment of Health Status and Health Services. Connecticut formed the state health planning coordinating committee responsible for analyzing health status data, service data, program plans, and objectives for the Assessment. The committee reconvened to review and coordinate the Department's response to Healthy People 2010—Draft for Public Comment.

Although desirable, an official coordinator is not imperative to success. Because of funding deficiencies, Wyoming lost its Healthy People 2000 coordinator. However, due to individual efforts from key personnel who had "bought into" the process, Wyoming was able to carry on with year 2000 activities.

The Delaware Division of Public Health used a combination of state and grant funds to hire a private consulting group to help manage the development of Healthy Delaware 2010. The Division of Public Health retained responsibilities for convening and leading the steering group, as well as providing technical and administrative support to work groups. The consultants will assist by managing the time line, identifying technical tasks for staff, developing a marketing plan, coordinating community meetings, and preparing the plan for publication.

Maintain communications among partners

The Iowa State Department of Health is working with the Hardin Library for the Health Sciences and College of Medicine at the University of Iowa in establishing listservers by teams, by team leaders and facilitators, and for all chapter team members with e-mail addresses, so they can interact via the Internet. This is a key component in the communication process. (See "Communicating Health Goals and Objectives.")

Since June 1998, Kentucky has been working on their year 2010 plans. The state has assigned 26 team leaders to form committees around each year 2010 chapter, with a key contact appointed to oversee each committee’s progress. Monthly meetings are held with most of the team leaders with regular phone contact in between. A majority of the team leaders hold monthly meetings with their committees as well.

Share management responsibilities across departments

New Jersey’s health department formed an Interdepartmental Steering Committee to oversee development of the year 2010 public health agenda. The committee established a work plan with specific target dates for each step required to complete the document. The committee consists of key staff from within the health department as well as other state departments such as Human Services, Environmental Protection, Education, and Law and Public Safety.

Vermont began with work groups for its identified priority areas. These groups consisted of both Department of Health employees and other agency people. However, these formal groups did not work effectively, and the state discovered that more informal meetings and discussion with these groups worked better.

Integrate Healthy People initiative with other key projects

The Benchmarks Project was a part of Oregon’s strategic plan and is therefore supported by the governor. State Healthy People objectives influenced the selection of Oregon benchmarks. The Oregon Progress Board monitors the benchmarks and reports on progress toward long term performance targets. Oregon Benchmarks are part of the biennial budget process. Agencies must identify benchmark links and report on progress toward achieving the performance targets. Results are reported in a biennial report to the legislature.

By combining the planning processes for the Agency Strategic Plan, mandated performance-based program budgeting, and the State Health Plan, the Florida Department of Health was able to create an ongoing planning process that encompasses both long- and short-range program planning. Through performance based program budgeting, specific outcomes were linked to resource requirements in budgets submitted to the state legislature.

(See also state examples)

tool icon Planning and Development
Checklist

The Planning and Development Checklist is a tool for organizing and tracking the development of a state health plan. The Checklist outlines potential tasks under each of seven critical action areas to develop, manage, and promote a successful state plan. The seven action areas were identified as the common threads found in the national and state Healthy People processes. This list serves as a menu of activities and processes from the beginning of the development process through the final evaluation of the plan in the next decade, as well as a tool for monitoring progress of plan development.

Individual activities listed for each component should be evaluated and adapted for use in a way that best fits the needs of the state. Additional activities may be added in the space at the end of each section's checklist.

Because many activities run well concurrently, skillful integration of these components will lead to an efficient and effective process. For example, identification and engagement of partners can help in engaging leaders and securing resources. Refer to the sample time line, which illustrates concurrent activities.

Tasks for which tools are available in the Toolkit are identified by page number and with the tool icon.

	Activity Deemed Relevant	Process Initiated	Process Completed	Comments
Build the Foundation: Leadership and Structure
Secure buy-in and commitment to develop state plan from senior health department staff (including state health official, state epidemiologist, vital statistics director, chronic disease coordinator, and the Healthy People 2010 Coordinator)
Meet internally and form preparation team to identify goals and guide early stages of development
Create a structure for the planning process See Creating a Structure for Success See Sample 2010 Planning Structures
Examine policy/political environment (e.g., current policies, governor’s priorities, legislative agenda, legislative mandates)
Define functions and composition of an advisory group and/or steering committee See Participant Roles & Responsibilities
Identify potential barriers and facilitators to success, including lessons learned from year 2000 activities See SWOT Worksheet
Present state plan development process to political leaders (executive and legislative) and leadership of other agencies for support See Sample State Statutes
Identify related initiatives to integrate or consider coordination with state plan
Engage partners early in process and maintain involvement as appropriate See Potential Partners
Other activities:
Identify and Secure Resources
Identify staff, financial, and technical resources needed to develop state plan
Develop budget to plan, publish, market, and (if desired) support implementation of state plan See Sample Budget Line Items
Plan to integrate the plan into state planning, budgeting, and programming processes
Identify existing resources (e.g., block grants) that could be used to support proposed tasks See Finding Other Resources
Develop staff and technical support plan
Identify potential external funding sources and organizations or businesses that can offer printing, supplies, other donated services, and/or dollars See Finding Other Resources
Secure identified resources, (including staff expertise in other agencies, organizations, foundations, etc.) and develop alternative resources, if necessary (See resource listings in Appendix A.)
Other activities:
Identify and Engage Community Partners
Define target audiences See How to Develop a Marketing Plan
Identify key individuals and organizations that can provide connections to the community or specific expertise See Potential Partners
Design strategies for engaging all partners in development and implementation processes
Identify roles for partners and assign responsibilities
Establish formal partnership agreements where appropriate to sustain activities and involve partners See Forming Partnership Agreements See Consortium Pledge
Develop accountability and evaluation plans, including identification of specific persons or groups of people responsible for each action item with target dates
Develop a communication vehicle to highlight partner activities as they relate to the state plan
Reassess and evaluate partner involvement and satisfaction in plan development
Other activities:
Set Health Priorities and Establish Objectives
Evaluate input received from community partners and expert advisors See Worksheet 1 See Simple "Market Research" Strategies
Collect and review information from previous community/state health needs and assets assessments and determine if new ones are needed
Conduct assessments of health needs and assets, if necessary See Defining Assets
Examine and plan for transitions from year 2000 to year 2010 health objectives (e.g., updates, integration, progress reviews)
From previous activity, decide where changes from year 2000 plans need to be made and what should be retained. Identify specific health priorities, contributing factors, and other issues that have emerged and should be addressed.
Define the scope of the state plan, (e.g., racial disparities, public health infrastructure, mental health, environmental health, substance abuse, and behavioral factors)
Set criteria for establishing potential priority areas or focus areas See Priority Setting Worksheet See Priority Setting in Maryland See Leading Health Indicators
Establish a process for final determination of priorities
Identify and obtain information to evaluate areas according to criteria
Select final priority or focus areas
Determine types of objectives desired [e.g., measurable vs. in need of data (developmental), qualitative vs. quantitative, process vs. outcome] for each area and establish criteria for adopting them See Criteria for Objectives Development
Outline standard information to include with all priority areas and objectives, (e.g., trend data, targets, accountable or committed partners, policy and regulation issues, populations to target, standards or guidelines, intervention strategies, exemplary programs) See Developing Priority Areas
Specify intervention points; identify potential topics and indicators for objectives (what you want to measure, such as health status, behaviors, or interventions) See Potential Health Measures
Develop draft objectives See Defining the Terms See Worksheet 2: Writing Objectives
Other activities:
Obtain Baseline Measures, Set Targets, and Measure Progress
Consult with state vital statistics division, or other appropriate agencies to provide information on census changes, data changes/requirements for age adjustment, ICD-10, and other data changes See Explaining Data Changes
Set criteria for evaluating the quality and appropriateness of existing public and private data sources See Evaluating Data
Inventory relevant public and private data sources to support measurement of objectives See Potential Health Measures See Existing Data Systems
Review progress and successes in achieving state Healthy People 2000 objectives See Measuring Progress
Develop targets with appropriate baselines and measures (i.e., determine the desired amount of change for each objective), and finalize objectives See Setting Targets for Objectives
Develop methods for measuring objectives without existing data sources (e.g., new data sources, estimation techniques, attainable proxies)
Gather and evaluate other data and information to include in state plan
Plan regular intervals to measure and track achievement of targets via identified data sources (e.g., annual progress reviews) See Measuring Progress
Other activities:
Manage and Sustain the Process
Designate staff and organizational unit for coordinating state plan development
Create a work plan and time line to develop and release the plan See Planning and Development Checklist See Sample Time Line —Overview
Coordinate expertise and staff support to carry out identified tasks in work plan See Participant Roles & Responsibilities
Assign development tasks to teams or individuals
Establish and implement meaningful, ongoing processes for input from key staff, partners, stake-holders, and communities See How Do You Define Meaningful Citizen Participation?
Market development process and time line both internally and externally (see Communicate Health Goals and Objectives)
Plan reviews to update baselines and targets, add objectives to meet emerging issues, and report on progress
Plan to integrate state plan into ongoing planning, budgeting, programming, and legislative processes
Develop a ten-year plan and time line to release, implement, and monitor the plan
Other activities:
Communicate Health Goals and Objectives
Establish marketing and communication goals and objectives See How to Develop a Marketing Plan
Conduct target audience research See Simple "Market Research" Strategies
Develop a publication and dissemination plan
Design state-specific Healthy People identity (e.g., logo, color scheme, web site, spokesperson)
Develop and implement marketing and communication plan (e.g., strategies for using the media and other available resources to engage the community and influence actions or beliefs) See How to Develop a Marketing Plan
Prepare state plan for publication and dissemination
Develop supporting companion documents that target specific audiences, focus areas, or strategies
Manage document review process
Publish and release state plan
Collect and disseminate to community partners exemplary practices from local plans throughout state
Continue to promote interest in meeting targets and health improvement (e.g., web sites, press releases, newsletters, TV spots, speeches, etc.)
Periodically report progress to partners, policy makers, and community partners
Evaluate marketing plan See Evaluate Your Marketing Plan
Other activities:

tool icon Sample Time Line—Overview

Percent Time Elapsed (tailor to your project period)

ACTION AREA

25%

50%

75%

100%

Build the Foundation: Leadership and Structure…

Identify and Secure Resources…

Identify and Engage Community Partners…

Set Health Priorities and Establish Objectives…

Obtain Baseline Measures, Set Targets, and Measure Progress…

Manage and Sustain the Process…

Communicate Health Goals and Objectives…

tool icon Sample Time Line—Detailed View

Percent Time Elapsed (tailor to your project period)

ACTION AREA

25%

50%

75%

100%

Build the Foundation: Leadership and Structure

Secure senior staff commitment to develop state plan

Meet internally and form preparation team to identify goals and guide early stages of development

Create a structure for the planning process

Examine policy/political environment

Identify potential barriers to success, including lessons learned from 2000

Determine composition and function of advisory/steering groups

Present process to leaders and agency colleagues for support

Identify initiatives to integrate with state plan

Identify and Secure Resources

Identify staff, financial, and technical resources needed to develop the state plan

Develop budget to plan, publish, market, and (if desired) support implementation of state plan

Develop staff and technical support plan

Identify potential funding sources aligned with goals of planning and implementation

Secure or develop alternative resources

Identify and Engage Community Partners

Define target audiences

Identify key individuals and organizations

Design strategies to engage partners

Establish partnerships and clarify roles

Develop a plan to evaluate partner involvement

Set Health Priorities and Establish Objectives

Evaluate input from partners

Review available needs assessments and data sources. Conduct needs and assets assessment, if needed

Examine and plan for transitions from year 2000 to year 2010 objectives

Describe scope of state plan

Set criteria for determining priority or focus areas

Identify and obtain information to evaluate areas according to criteria

Determine types of objectives desired for each area and objectives for adopting them

Outline standard information to include with all priority areas and objectives, such as trend data, strategies, and model programs

Select priority or focal areas

Develop draft objectives

Draft final text for each priority area

Obtain Baseline Measures, Set Targets, and Measure Progress

Partner with vital statistics or others for technical assistance on data issues

Set criteria to evaluate public and private data sources

Inventory public and private data sources to support measurement of objectives

Review progress in achieving state Healthy People 2000 objectives

Develop final objectives with appropriate baselines, targets, and measures

Develop methods to measure objectives without existing data sources, as needed

Gather and evaluate other information to include with objectives in state plan

Manage and Sustain the Process

Designate staff and organizational unit to coordinate state plan activities

Create a work plan for planning process, release, and monitoring of plan

Assign development tasks to teams or individuals

Establish and implement processes for input from key staff, partners, and community members

Market the development process