Lapeer County Health Department

Strategic Plan

2011-2013

The Lapeer County Health Department develops three year strategic plans to establish priorities and guide decision making and quality improvement processes.

This document represents the 4th 3 year strategic planning document/cycle. Plans have been scaled down somewhat from cycle to cycle to create realistic goals given the reduction in resources that have occurred beginning in 2006.

The strategic planning process begins with an evaluation of the previous plan. The 2008-10 plan included three goals which were largely met. One of these goals was related to plans for the recruitment and retention of staff. Due to ongoing layoffs and hiring freezes during the duration of this plan, the goal was not fully met. However, plans to more comprehensively cross-train staff was very effectively implemented, and informed much of the reorganization of department and staff during this downsizing period.

The strategic planning process for 2011-2013 began in September of 2010. Administrative Team was asked to review current progress and issues with front line staff during staff meetings. During the October 13, 2010 Administrative Team Meeting the SWOT analysis was conducted and Mandates and Stakeholders documents were reviewed and updated. A list of possible strategic issues was created. These materials were reviewed and discussed at a Special Board of Health Meeting that was held November 19, 2010. The Board provided feedback on priorities, strategic issues and a draft plan.

The 2011-13 Strategic Plan was finalized at the January 12, 2011 Administrative Team Meeting.

LAPEER COUNTY HEALTH DEPARTMENT

STRATEGIC PLANNING 2011-13

SWOT ANALYSIS

Internal Strengths

Resources or capabilities that help an organization accomplish its mandates or mission (i.e. professional staff, adequate resources, leadership…)

Staff expertise
Experienced leadership
Disciplinary diversity provides broad based support for service provision
Staff commitment to provide services within the limitations of the resources available
Staff willingness to collaborate
Diversity of revenue sources
Adequate facilities for most programs
Progress toward technology and communications
Board of Health committed to core public health services and supportive of health department staff and programs

Internal Weaknesses

Deficiencies in resources and capabilities that hinder an organization’s ability to accomplish its mandate or mission (i.e. lack of effective communications, absence of clear vision or mission, flawed organizational structure, noncompetitive pay structure).

Inadequate animal control facilities
Negative staff perception of working conditions
Overall, staff perceive a lack of support from governing boards
Some staff perceive a lack of internal communication
Lack of opportunity for advancement/career tracks for staff
Sustained demands on staff resulting in burn-out
Loss of Environmental Health Back-up due to 50% staff reductions
Administrators act as back-up, limiting time for administrative, quality assurance and other oversight responsibilities

External Opportunities

Outside factors or situations that can affect your organization in a favorable way (i.e. new funding from a federal program, political support for a potential project, a chance to modify an outdated mandate).

Slow economy:

**Leads to an increased demand for some services and increased

Funding (i.e. WIC)

Local climate encourages and promotes collaborative opportunities
Affordable Care Act may include some funding for public health prevention

External Threats

Outside factors or situations that can affect your organization in a negative way (i.e. loss of state funding, increasing demand for a specific service, union/management conflicts).

Economic changes lead to shifting funding levels/sources and threaten programs/overall departmental financial security

Political climate trends toward smaller government, increased private sector involvement in traditional governmental services

Changing political priorities for funding of public health programs

2011-2013 Stakeholder Identification

External Stakeholders

Mandate Detail 2011-2013

Mandate (Required) / Source (Charter, Policy,
Rules, Law, Norms, etc.) / Key Requirements / Effects on
Organization / Current / Status
Disease prevention and health promotion. / MCLA* 333.2433
MSA** 14.15(2433j) / “Continually and dliligently” seek to prevent disease, prolong life, and promote public health through organized programs directed at environmental health hazards, specific diseases, and specially vulnerable population groups. / Provides direction for agency mission, goals and activities. / 
/ Still appropriate
Out-of-Date
Public Health Law enforcement / MCLA *333.2433 / Implement and enforce laws for which responsibility is vested in the local health department / Provides direction and authority for legal enforcement. /  / Still appropriate
Out-of-Date
Investigation and control of disease / MCLA*333.2433 / Make investigations and inquiries as to: the causes of disease and especially of epidemics; the causes of morbidity and mortality; and the causes, prevention and control of environmental health hazards, nuisances, and sources of illness / Provides direction for agency mission, goals and activities /  / Still appropriate
Out-of-Date
Health education and nutrition services / MCLA*333.2433 / Plan, implement and evaluate health education and nutrition services / Provides direction for agency mission, goals and activities /  / Still appropriate
Out-of-Date
Immunization / MCLA *333.9201 / A local health department shall offer free immunization treatments to the public for protection in case of an epidemic or threatened epidemic of a disease as ordered by the director. / Provides mandate and authority for immunization program. / 
/ Still appropriate
Out-of-Date
Hearing and Vision Screening / MCLA *333.9301 / A local health department shall conduct periodic hearing and vision testing and screening programs without charge for children residing in its jurisdiction. / Mandates hearing and vision testing by the local health department / 
/ Still appropriate
Out-of-Date
Epidemic Emergency Order
Health Threat to Others
Imminent Danger
Nuisance, unsanitary condition or cause of illness / MCLA *333.2453
MCLA *333.5203
MCLA *333.2451
MCLA *333.2455 / The local health officer may issue an emergency order to prohibit the gathering of people for any purpose and may establish procedures to be followed by persons, including a local governmental entity, during the epidemic to insure continuation of essential public health services and enforcement of health laws.
Issuance of a warning notice to an individual who is a health threat to others
Imminent danger to health or lives; informing individuals affected; order; noncompliance; petition to restrain condition or practice
Building or condition violating health laws or constituting nuisance, unsanitary condition, or cause of illness; order; noncompliance; warrant; assessment and collection of expenses, liability, judicial order / Provides authority for emergency action related to public health emergencies.
Provides authority for local health department to restrict individuals who are determined to be a health threat to others
Provides authority for local health department to correct or remove an imminent danger.
Provide local health department with the authority to issue an order to avoid, correct or remove a building or condition which violates health laws or which is a nuisance, unsanitary condition , or cause of illness. / 
/ Still appropriate
Out-of-Date
CountyMedical Examiner / MCLA *333.2844 / Referral of case to county medical examiner; determining an certifying case of death; investigation; completing and signing medical certification / Provide authority and guidance for medical examiner’s cases / 
/ Still appropriate
Out-of-Date
Mandate (Allowed)
Local authority on water and waste / MCLA*333.243 / Advise other local agencies and persons as to water supply and disposal of solid waste / Provides direction for agency mission, goals and activities /  / Still appropriate
Out-of-Date
Authority to enter into contracts / MCLA*333.243 / Enter into an agreement…to assist the local health department in carrying out its duties and functions unless otherwise prohibited by law / Provides ability to apply for State and grant funding for programs consistent with agency mission, goals and objectives /  / Still appropriate
Out-of-Date
Adopt public health regulations / MCLA*333.243 / Adopt regulations to properly safeguard the public health and to prevent the spread of diseases and sources of contamination. / Provides regulatory authority and affects development and implementation of communicable disease, environmental health and animal control programs. /  / Still appropriate
Out-of-Date
Authority to accept grants and other sources of funding / MCLA*333.243 / Accept gifts, grants…for use in performing the local health department’s functions / Provides ability to apply for grant funding for programs consistent with agency mission, goals and objectives /  / Still appropriate
Out-of-Date
Other authority / MCLA*333.243 / Provide services not inconsistent with this code. / Allows Agency to provide other services needed within the community based on Agency mission, goals & objectives and Public Health Code. /  / Still appropriate
Out-of-Date
Authority for the Board of Commissioners to establish an animal control agency by ordinance / 287.276 Section 29a** / The board of county commissioners by ordinance may establish an animal control agency which shall employ at least 1 animal control officer / Provides authority for local establishment of an animal control agency /  / Still appropriate
Out-of-Date
Local authority to establish and implement a program for the licensing and regulation of dogs and other animals and facilities that house them / LapeerCounty Animal Control Ordinance,
October 1, 2008 / Provides shelter operation, dog licensing, and ordinance violation penalties /  / Still appropriate
Out-of-Date
Local authority to implement program and collect fees for the Soil & Sedimentation Erosion Program / Soil & Sedimentation Ordinance
November, 2009 / Provides authority for local enforcement and fee collection /  / Still appropriate (New program 7/09)

* Michigan Compiled Laws (Michigan Public Health Code Act 369 of the Public Acts of 1978, as last amended by Act No. 196 of 1998).** Medical Services Administration (Michigan Department of Community Health)

** Michigan Penal Code (Act 328, Public Acts of 1931, as amended)

3/04; 8/07; 10/08; 10/10 SS

LAPEER COUNTY HEALTH DEPARTMENT

PRIORITY NEEDS

2011-13

Priority / Program / Mandate Status
1 / Communicable Disease Surveillance, Investigation and follow-up (Rabies, meningitis, tuberculosis, hepatitis, etc) / Mandated
1 / STD / Mandated
4 / Nutrition Services / Mandated
Health Education / Mandated
1 / Immunization / Mandated
4 / Hearing / Mandated
4 / Vision / Mandated
2 / Public/Private Sewer / Mandated
Public Swimming Pool Inspection / Mandated
1 / Food Protection / Mandated
2, 4 / Public/Private Water Supply / Mandated
3 / Medical Examiner / Mandate to County
Jail Health / Mandate to CountyJail
3 / Emergency Preparedness (Community Health Annex) / Mandated under Emergency Management Act
Animal Control / Basic
General Environmental health Programs: Campgrounds, FIA Inspections / Basic
Children’s Special Health Services (CSHCS) / Basic
Maternal Child Health / Basic
Family Planning / Basic
5 / WIC / Basic
Smoking Enforcement / Basic
Tatoo Parlor Control / Basic
Substance Abuse Treatment / Allowable
Senior Programs / Allowable
5 / Maternal Infant Health Program (Maternal Support Services/Infant Support Services) / Allowable
Population based child-family home visitation (First Steps to Success) / Allowable
Soil Erosion and Sedimentation Control Program / Mandate to County

PRIORITIES

1: Top 3

Immunization

Food

2: TB

Sewage

3: M.E.

Emergency Preparedness

4: Nutrition

Hearing

Vision

Public/Private Water Supply

5: Maternal Child Health

WIC

LAPEER COUNTY HEALTH DEPARTMENT

STRATEGIC PLANNING

KEY STRATEGIC ISSUES

WORKSHEET 2011-2013

What is the issue? Phrase the issue as a question that has more than one answer. The issue should be one the organization can do something about.

Issue #1: How will the health department maintain the ability to provide health department services in light of changingresources?

Why is this an issue?

Providing quality public health services has been shown to be an efficient, cost-effective way of doing business. Preventive services can be difficult to measure in terms of outcomes since it can be difficult to quantify the value of preventing costly health events such as the transmission of disease, food/water contamination, health conditions secondary to poor nutrition or tobacco/alcohol abuse. While quality is measured in some cases in some programs, and quality is addressed on an ad hoc, problem-driven basis in all programs, a more comprehensive quality-driven process could reduce costs through greater emphasis on best practices.

IncomingState of Michigan leadership has indicated an intention to engage in outcome-based funding. The ability of public health as a whole and Lapeer County Health Department to establish and measure health outcomes is likely to have an impact on funding in the future.

How is it related to the agency’s mission, mandates, internal strengths and weaknesses or external opportunities and threats? Public health is preventive by definition. However, in most cases we have not adequately defined or measured outcomes in a way that provides a strong case for outcome-based, value-added funding for the future.

What are the consequences of not addressing this issue? The likely result of not addressing this issue will be a continued erosion of public health preventive dollars.

What should our goals be in addressing this issue?

Maintain an adequate funding base for the highest priority, results-based programs.

Identify desirable health outcomes

Determine method(s) to best measure outcomes

Conduct periodic measurement of outcomes

Evaluate outcomes and revise policies/procedures to improve outcomes

Issue #2: How can Lapeer County Health Department support and encourage staff during times of economic challenges?

Why is this an issue?

The vast majority of outcomes accomplished by the Health Department are done so through front line staff work. Staff burn out can compromise the quality of efforts directed toward health efforts in this county. Lack of employee engagement can lead to sub-standard work and can compromise customer service.

How is it related to the agency’s mission, mandates, internal strengths and

weaknesses or external opportunities and threats?

Increased staff engagement often allows for an enhanced customer experience. The majority of public health prevention work is educational in nature. Having engaged, supported staff serve the public improves the message the client receives and may lead to improved health outcomes.

What are the consequences of not addressing this issue?

Having a large proportion of unengaged staff can affect the morale of the entire workforce and lead to a negative, less productive customer educational experience.

What should our goals be in addressing this issue?

Goal: Improved staff engagement leading to improved work climate and improved customer relations

Identify markers and measurement for staff engagement

Identify current levels of staff engagement.

Determine factors that contribute to staff disengagement

Identify policies, activities, etc. that could improve staff engagement

Implement policies/activities, etc.

Evaluate

LAPEER COUNTY HEALTH DEPARTMENT STRATEGIC PLAN 2011-2013

Strategy / Responsible / Projected / Progress
Person/Entity / Completion Date

Develop an outcomes-based structure for a minimum of one program/division that includes front line staff input

a)Provide staff training if indicated
b)Identify desirable health outcome(s) for program
c)Determine method(s) to best measure outcomes
d)Conduct periodic measurement of outcomes
e)Evaluate outcomes and revise policies/procedures to improve outcomes

Provide outcomes-based data to local and state partners as appropriate

/ Health Officer
Division Administrators / June, 2011
August, 2011
August, 2011
September/October, 2012
November, 2012
TBA / 2/9/11: Administrative Team review of Quality Assurance/Improvement process. “Embracing Quality in Local Public Health” materials provided for each administrator to use to train and work with staff. Request that administrators submit plans that are developed and status to the Health Officer periodically .

GOAL 1: TO ASSURE THAT THE HEALTH DEPARTMENT MAINTAINS THE ABILITY TO PROVIDE PRIORITY HEALTH DEPARTMENT SERVICES IN LIGHT OF CHANGING RESOURCES

Strategy / Responsible / Projected / Progress
Entity / Completion Date / C= Completed, OS= on schedule, D= delayed

Define staff engagement, staff morale and factors which affect employee performance and efficiencies
Identify markers and measurement for staff engagement
Determine current levels of staff engagement
Identify policies, activities, etc. that could improve staff engagement
Implement policies/activities
Evaluate

/ Administrative Team / March, 2011
June, 2011
July, 2011
September, 2011
2012
2013

GOAL 2: Improved staff engagement leading to improved work climate, improved customer relations and increased efficiencies

The Gallup Q12

(From the Gallup Management Journal, “Feedback for Real”

Author: John Thackray)

The Gallup Q12 is a survey designed to measure employee engagement.

The instrument was the result of hundreds of focus groups and interviews.

Researchers found that there were 12 key expectations, that when satisfied, form

the foundation of strong feelings of engagement. So far 87,000 work units and

1.5 million employees have participated in the Q12 instrument.

Comparisons of engagement scores reveal that those with high Q12 scores

exhibit lower turnover, higher sales growth, better productivity, better customer

loyalty and other manifestations of superior performance.

The Gallup organization also uses the Q12 as a semi-annual employee

engagement Index – a random sampling of employee across the country.

The engagement index slots people into one of three categories.

• Engaged employees work with passion and feel a profound connection to

their company. They drive innovation and move the organization forward.

• Not-Engaged employees are essentially “checked out.” They are

sleepwalking through their workday. They are putting in time, but not

enough energy or passion into their work.

• Actively Disengaged employees aren’t just unhappy at work; they’re

busy acting out their unhappiness. Every day, these workers undermine

what their engaged co-workers accomplish.

The results of the latest engagement index:

Engaged employees – 28 %

Not-engaged employees – 54%

Actively Disengaged – 17%

In other words, 71% of the workforce is either under performing or actively

undermining their work.

The Q12 Index

1) Do you know what is expected of you at work?

2) Do you have the materials and equipment to do your work

right?

3) At work, do you have the opportunity to do what you do best