Strategic Planning
Toolkit Inter Tribal Council of Arizona Inc.
Tribal Epidemiology Center
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TableofContentsListofFigures ..................................................................................................................... ivInterTribalCouncilofArizonaInc.:TribalEpidemiologyCenter ................................. 6Background...............................................................................................................................................................................6
PurposeoftheToolkit ........................................................................................................ 8TheOpioidCrisis ............................................................................................................... 10AnOverviewoftheOpioidCrisis .................................................................................... 11Background............................................................................................................................................................................11
TheOpioidCrisisinIndianCountry..........................................................................................................................12
HealthandHumanServicesFive-PointStrategy................................................................................................14
IntroductiontoStrategicPlanning ................................................................................. 16StrategicPlanningPrinciples .......................................................................................... 17BenefitsofaStrategicPlan .............................................................................................. 18WithoutaPlan.......................................................................................................................................................................18
WhySomeProgramsorOrganizationsChooseNottoDevelopaPlan...................................................19
WithaPlan..............................................................................................................................................................................19
PlanningforSuccess:TheIntegratedApproach.................................................................................................20
BuildingaStrategicPlan .................................................................................................. 22PlanningStepstoBuildingaStrategicPlan................................................................... 23PlanningStep1:IdentifythePurposeofYourStrategicPlan.....................................................................23
PlanningStep2:IdentifyLeadership’sRoles&Responsibilities..............................................................23
PlanningStep3:IdentifyOrganization’sCoreValues.....................................................................................23
PlanningStep4:VisionandMissionPlanning....................................................................................................24
PlanningStep5:CreateaRealisticTimeline........................................................................................................26
PlanningStep6:ResourceAllocation......................................................................................................................28
PlanningStep7:Budgeting&FinancialAssessment........................................................................................28
StrategicActionPlanning ................................................................................................. 32Step1:ConductSWOTAnalysis...................................................................................................................................33
Step2:ImplementSMARTMethodology-EstablishingSMARTgoals...................................................35
Step3:GoalSettingResponsibilities........................................................................................................................35
Step4:PrioritizingGoals................................................................................................................................................36
Step5:EstablishTimelineExpectations................................................................................................................37
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Step6:ObjectiveandActionStepPlanning..........................................................................................................37
Step7:MeasuringSuccess.............................................................................................................................................38
Appendices ......................................................................................................................... 42AppendixA.MoreExampleStrategicPlanningProcesses...................................................................43
AppendixB.ActionPlanfor[CommunityorInitiativeName]..........................................................44
References.......................................................................................................................... 46
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ListofFiguresFigure1:TECServiceAreas………………………………………………….…………………….….…… 6Figure2:DefinitionsofKeyOpioidTerminology………………………………………….….…… 12Figure3:HHS5-PointStrategytoCombattheOpioidCrisis…………………………..……… 14Figure4:HowDoWeGetThere……………………………………………....…………………...……… 17Figure5:AnIntegratedApproach………………………………………….……………………..…..…. 20Figure6:ConsiderationsinBudgetPlanning&Implementation………………………….… 30Figure7:SWOT-Strengths,Weakness,Opportunities&Threats….………………..……... 34Figure8:GoalSettingProcess……………………………………………………….……......................... 36Figure9:EisenhowerDecisionMatrix…………………………………………….……....................... 37Figure10:MeasuringSuccess……………………………………………………………...…….…..……. 38Figure11:The10EssentialPublicHealthServices…………………………….………………… 39Figure12:ContinuousImprovementModel……………………………………...….……...….……. 41Figure13:StrategicPlanningProcess(1).………………………………………..……….…….……. 43Figure14:StrategicPlanningProcess(2)………………………………………..…………..………. 43
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InterTribalCouncilofArizonaInc.:TribalEpidemiologyCenter
BackgroundInterTribalCouncilofArizonaInc.
TheInterTribalCouncilofArizonawasestablishedin1952 to provide a united voice for Tribalgovernments in the state of Arizona to addresscommon issues of concerns. On July 9, 1975, theCouncilestablishedaprivate,non-profitcorporation,InterTribalCouncilofArizona,Inc.(ITCA),underthelaws of the State of Arizona to promote AmericanIndian self-reliance through public policydevelopment.ITCAprovidesanindependentcapacitytoobtain,analyze,anddisseminateinformationvitalto American Indian community self-development.Themissionof ITCAis toprovide itsMemberTribeswithaunitedvoiceandthemeansforunitedactiononmattersthataffectthemcollectivelyorindividually.
TribalEpidemiologyCenter
TheInterTribalCouncilofArizona,Inc.TribalEpidemiologyCentervaluestrust,service,andintegrityaboveallelse.Weprovideresponsive,confidential,reliable,practical,high-qualityprofessional epidemiologic services and products that address current and future publichealthchallengesamongtribalnations.Wedothisbypromotingtribalself-determination,partnerships,innovation,resourcefulness,accountability,andsustainability.OurgoalistoeliminatehealthinequitiesamongAmericanIndianNationswithinthreegenerations.
Ourmission is to build Tribally-driven public health and epidemiologic capacity amongTribesinthePhoenixandTucsonIndianHealthServiceAreasbyassistingTribeswithhealthsurveillance,research,prevention,andprogramevaluationforplanningandpolicydecisionmakinginordertoimprovecommunityhealthandwellness.
We envision our group to be a strong, interwoven group of centersworking together todevelop a National Tribal Epidemiology Center narrative; enhanced data access andstewardship; respected multi-directional public health collaborations; and a diversesustainablefundingbase. WeworktogetherforthebettermentofthehealthofAmericanIndianandAlaskaNativepeoplelivinginavarietyofsettingsintheUnitedStates.
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TheITCATEC’smissionistobuildtribally-drivenpublichealthandepidemiologiccapacityamongtribesinthePhoenixandTucsonIndianHealthServiceareasbyassistingtribeswithhealthsurveillance,research,prevention,andprogramevaluationforplanningandpolicydecisionmakinginordertoimprovecommunityhealthandwellness.ThegoaloftheITCATEC is to build independent tribal capacities to collect and use community healthinformation indirectingprograms,managingresources,andbuildingrelationswith local,state,andfederalpublichealthsystems.
TheITCATECprovidestechnicalassistanceinthefollowingareas:n Improvingdiseasesurveillancecapabilitiesthroughdataanalyses,interpretation,
anddisseminationofinformation;n Providingcommunicationandeducationfordiseaseoutbreakinvestigationand
response;n Developingepidemiologicstudies;andn Assistingwithdiseasepreventionandhealthpromotionactivities.
Figure1:TECServiceAreas
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PurposeoftheToolkit
Thistoolkitservesasaplanningtooloutliningthestrategicplanningprocesscompletewithtoolsthatcanbefoundintheappendix.Eachstepoutlinedintheprocesscanbetailoredtofit your Tribe’s strategic planning needs to develop and improve your Public HealthInfrastructure.
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TheOpioidCrisis
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AnOverviewoftheOpioidCrisis
BackgroundTheBeginningoftheOpioidCrisisIn 2017, Health and Human Services declared a public health emergency regarding theOpioidCrisis.Nationalpublicawarenessof theOpioidCrisisbegan inthe late1990’s, thecombinedresultofthepharmaceuticalindustry,healthcaresystems,andmedicalproviders’underestimationoftheharmprescriptionopioidsposedtothepublic.Thepharmaceuticalindustry did not communicate the addictive possibilities of their opioids effectively tomedicalpractitioners.Opioidpainrelieverswereusedtotreatpaininhighdosesforlongdurations,occurringparalleltogrowthinprescriptionrates.Additionally,therewasalackofcapacityattheonset,bybothprovidersandhealthcaresystems,toidentifyandengagewithpatientswhoweremisusingprescribedopioids.1Together, these systemic failures resulted in the death of more than 300,000 opioidoverdosessince2000.Opioidoverdosedeathswerefivetimeshigherin2016thanin1999.Asof2016,116peoplediedailyfromopioid-relatedoverdoses.2
1Jones,ChristopherPharmD,MPH.(March2018)2CenterforBehavioralHealthStatisticsandQuality.(2017).
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Figure2.DefinitionsofKeyOpioidTerminology345
TheOpioidCrisisinIndianCountry IndianCountryhasnotbeensparedduringtheOpioidCrisis;substanceanddrugabusehavebeenprevalentissuesfordecadesinIndianCountry.IdentifyingandassessingthefulleffectopioidshaveinIndianCountryisdifficultduetothelackofconsistentdata.Misidentificationof American Indian and Alaska Natives (“AI/AN”), occurs when health records, deathcertificates,andotherformsofofficialrecordsmarkAI/ANasracesotherthansaidrace.6Data derived from governments in regards toAI/AN’s are often limited and use varyingdefinitionsofAI/AN’s;theresultsarealackofconsistentdatawithunder-andover-countsofsaidpopulation.78
3NationalInstituteonDrugAbuse(2018)Opioids.NationalInstituteofHealth.4CenterforDiseaseControlandPrevention(August2017)PrescriptionOpioids.5CenterforDiseaseControlandPrevention(December2018)SyntheticOpioidOverdoseData.6JoshiS,WeiserT,Warren-MearsV.Drug,Opioid-Involved,andHeroin-InvolvedOverdoseDeathsAmongAmericanIndiansandAlaskaNatives—Washington,1999–2015.7NationalCongressofAmericanIndians:PolicyResearchInstitute(October2018).TheStateofTribalDataCapacityinIndianCountry:KeyFindingsfromtheSurveyofTribalDataPractices.8Tipps,RobinT.,Buzzard,GregoryT.,McDougall,JohnA.(Summer2018).TheOpioidEpidemicinIndianCountry.
• Aclassofdrugsthatinlcudetheillegaldrugheroin,syntheticopioidssuchasfentyanyl,andpainreliversavailablelegallybyprescriptionsuchasoxycodone,hydrocodone,codeine,morphine,andmanyothers.
Opioids
• Heroinisanillegal,highlyaddictivedrugprocessedfrommorphine,anaturallyoccurringsubstanceextractedfromtheseedpodofcertainvarietiesofpoppyplants
StreetDrug-Heroin
• Prescriptionopioidscanbeusedtotreatmoderate-to-severepainandareoftenprescribedfollowingsurgeryorinjury,orforhealthconditionssuchascancer.Inadditiontotheseriousrisksofaddiction,abuse,andoverdose,theuseofprescriptionopioidscanhaveanumberofsideeffects,evenwhentakenasdirected.
PrescriptionOpioids
• Aclassofdrugsthatisdesignedtoprovidepainrelief,mimickingnaturallyoccuringopioids(i.e.codeineandmorphine).Syntheticopioidstendtobehighlypotent,whichmeansonlyasmallamountofthedrugisrequiredtoproduceagiveneffect,theycanbebothlegallyandillegallymade.Tremadolandfentanylarelegallyprescribedbydoctors,fentanylcanbemadeillegallyaswell.
SyntheticOpioids
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Data that has been collected indicates AI/AN are disproportionately affected by opioidscomparedtoothergroups.From2013to2015,AI/ANoverdosemortalityrateswere4.1timeshigherthanthatofWhites.9Opioid-relatedfatalitiesaffectAI/ANsthreetimesmorethanthatofBlacksandHispanic-Whites.10Overall,themortalityrateofopioidoverdosehasrisenoverthepasttwodecades.In1999,theage-adjustedratewas2.9deathsper100,000;in2016,itwas13.9.11NationalHealthSurveydataindicatesthatAI/AN’saged18andolderreportedmisusingaprescriptiondrugat5.2%(n=72,000)during2015,thissamegroupalsoreportedat4%(n=56,000)themisuseofprescriptionpainrelieversin2015.12Whiledatamaynotbeconsistent,theevidenceindicatesaclearanddistressingsignoftheongoingandgrowingopioidcrisisinIndianCountry.OpioidPreventionthroughHealthPolicyInregardstoFederalhealthpoliciesfocusingonAI/ANopioidprevention,theIndianHealthManual (“IHM”) has two current policies,with additional pending policies.The IHMwasdevelopedasareferenceforIndianHealthServices(“IHS”)employeestounderstandandfollow policy and procedural instructions. The two current policies focus on painmanagement and/or opioid prescription oversight. In addition to the current policies inplace,therearetwopendingpolicies:thefirstfocusesonexpandingaccesstonaloxoneinTribalCommunities,specificallyforfirstresponders;thesecondutilizestelehealthservicestoincreaseandexpandprovidersdesignationtoaccessmedication-assistedtreatment.13
n IHMPart3,Chapter30–ChronicNon-CancerPainManagement:AddedtotheIHMinJune2014,thisprovidesbestpracticeguidelinesforthemanagementofchronicnon-cancerpain.Currently,itisunderrevisiontoalignwiththeCDCGuidelinesforPrescribingOpioidsforChronicPain2016.14
n IHMPart3,Chapter32–StatePrescriptionDrugMonitoringPrograms:AddedtotheIHMinJune2016,thisfocusesonestablishingrequirementsforIHStoworkwithStatePDMPtobeabletorequestreportsonnewandcurrentpatientsbeingprescribedopiatesforacuteandchronicpain.Additionally,itestablishedrequirementsforIHS
9JoshiS,WeiserT,Warren-MearsV.Drug,Opioid-Involved,andHeroin-InvolvedOverdoseDeathsAmongAmericanIndiansandAlaskaNatives—Washington,1999–2015.10Murphy,T.,Pokhrel,P.,Worthington,A.,Billie,H.,Sewell,M.,&Bill,N.(2014).UnintentionalinjurymortalityamongAmericanIndiansandAlaskaNativesintheUnitedStates,1990-2009.11Tipps,RobinT.,Buzzard,GregoryT.,McDougall,JohnA.(Summer2018).12CenterforBehavioralHealthStatisticsandQuality.(2017).2016NationalSurveyonDrugUseandHealth:DetailedTables.13NationalCongressofAmericanIndiansPolicyResearchCenter(March2018)TheOpioidEpidemic:IHSResponsetoaNationalCrisis14NationalCongressofAmericanIndiansPolicyResearchCenter(March2018)
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PharmaciestoreportdispensingdataandconductPDMPqueriespriortodispensingoutsideprescriptions.15
HealthandHumanServicesFive-PointStrategy HealthandHumanServicesannouncedaFive-PointStrategytoempowerlocalcommunitiestoaddresstheopioidcrisisin2017,including:
1. Improve access to prevention, treatment, and recovery support services toprevent the health, social, and economic consequences associated with opioidaddictionandtoenableindividualstoachievelong-termrecovery;
2. Targettheavailabilityanddistributionofoverdose-reversingdrugstoensurethebroadprovisionofthesedrugstopeoplelikelytoexperienceorrespondtoanoverdose,withaparticularfocusontargetinghigh-riskpopulations;
3. Strengthenpublichealthdatareportingandcollectiontoimprovethetimelinessand specificity of data and to inform a real-time public health response as theepidemicevolves;
4. Support cutting-edge research that advances our understanding of pain andaddiction,leadstothedevelopmentofnewtreatments,andidentifieseffectivepublichealthinterventionstoreduceopioid-relatedhealthharms;and
5. Advance the practice of pain management to enable access to high-quality,evidence-basedpaincarethatreducestheburdenofpainforindividuals,families,andsocietywhilealsoreducingtheinappropriateuseofopioidsandopioid-relatedharms.
Figure3.HHS5-PointStrategytoCombattheOpioidCrisis16
15NationalCongressofAmericanIndiansPolicyResearchCenter(March2018)TheOpioidEpidemic:IHSResponsetoaNationalCrisis.16HealthandHumanServices.(March2017)5-PointStrategytoCombattheOpioidCrisis.
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IntroductiontoStrategicPlanning
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StrategicPlanningPrinciples
WhatisaStrategicPlan?
n EvaluatesWHEREaprogramororganizationcurrentlystandsn DeterminesWHEREaprogramororganizationisgoingbyansweringthequestions:
o “WHATisourpurpose?”o “WHATdowesetouttoachieve?”
n IdentifiesHOWaprogramororganizationisgoingtogettheren OutlinesWHATneedstobedone,byWHOandbyWHEN?n Providesbothdirectionandflexibilitytoreachachievement
HowDoWeGetThere?17
n IdentifyingResourcesn RolesandResponsibilitiesn Fiscal/BudgetPrinciplesn RoleofCommunication
TheElementsofaStrategicPlan
n Vision–Whatwouldsuccesslooklike?
n Mission–Whydoyouexist?
n Values–Howweact,individuallyandtogether
n Goals–Specific,Measurable,Attainable,Relevant,Timely,toachieveyourVisionandMission
n Objectives–Strategiestoattaingoalsn ActionSteps–SpecificstepstoimplementyourObjectivesn Measures–Howyoutrackprogressandmakeadjustments
17BlueStoneStrategyGroup.(2016).HowDoWeGetThere?
Figure 4: How Do We Get There?17
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DevelopingBestPractices–ElementsthatContributetoOrganizationalSuccess
n LeadershipCommitmentn SharedVision/UnitedFront/Valuesn CommunicationtoStaffandCommunityn FinancialUnderstandingn DefinedRolesandResponsibilitiesn StrategicRoadmapn SMARTGoalstiedtoAccurateBudgetsn PrioritizationofKeyObjectives
BenefitsofaStrategicPlan
n Valuableinbothorganizationsandprograms/departmentsn Ensuresclarityofpurposethroughoutaprogramororganizationn Establishesrealisticgoalsandobjectivesinlinewithoverall“bigpicture”n Focusesavailablefundingandstaffingresourcesonkeyobjectivesn Communicatesgoalsandobjectivestoallintheprogramororganization(Inform,
Motivate,Involve)n Buildsconsensusanddevelopsownershipofgoalsn Establishesbenchmarksformeasurementofprogress
WithoutaPlan
n Staffcanbecomecomplacentn Systembecomesreactiven Syndromeof“we’vebeentalkingaboutthatformanyyears–whenarewegoingto
DOsomething?”n Don’tknowexactlywhereyouaregoing,soyoudon’tknowhowtogetthereorhow
longitshouldtaken Unsureofthecostsassociatedn Mayresultinalotoffalsestartsn Youmayeventuallygettherebutafteralotofwastedtime,energy,andmoney
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WhySomeProgramsorOrganizationsChooseNottoDevelopaPlan
n Unfamiliaritywithplanningasatooln Becausesomepastplansweren’timplementedorthinkplanningisuselessn Discomfortwithprioritizing–everything’simportantn Lackofcommitmentn Lackofresourcesorskillsetsn Theremaybeacrunchincashfloworleadershippositionsneedtobefilledfirstn Managementoverwhelmedwithdailytasks/puttingoutfiresn Toooccupiedwithmultiplechallengesthatonecan’tkeepthebigpictureinmind
WithaPlan
n Roadmapforsuccessisdeveloped,focusedonprioritygoalsandobjectivesn Informeddecisionsbasedonvariousoptionsandtheiroverallcostsandimpactsn Objectivesareidentified-actionstepsareclearandconcisen Betterhandleofday-to-daydutiesofimplementationwhilemakingprogresson
majorinitiativesn Helpstoreducecrisisandminimizeconfusionn Responsibilitiesareclarified,currentresourcesarefocusedongoals,andadditional
resourceneedscanbeidentifiedn Accountabilityisincreasedn Keygoalsandobjectivesareachieved
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PlanningforSuccess:TheIntegratedApproach
Successfulplanningintegratesseveralelementstoensurecompleteness18.
CommunityNeeds
n TribalServicesn JobOpportunitiesn LocalEconomicBenefit
Strategy
n PurposeofServices/Programs
n CommunityInvolvement
DataGathering
n CommunityDemographicsn EvaluateAwareness
Financial
n Cost/BenefitofServicesn ReturnonInvestment
18BlueStoneStrategyGroup.(2018).AnIntegratedApproach.
Figure 5: An Integrated Approach18
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BuildingaStrategicPlan
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PlanningStepstoBuildingaStrategicPlan
PlanningStep1:IdentifythePurposeofYourStrategicPlan
n Definethepurposeoftheorganization’splan.Forexample:1. Healthbetterment2. Sustainablehealthprograms3. Newservices4. Opportunitytopartnerwithlocalentities
n Whataretheprogram(s)/department(s)corecompetencies*?Forexample:
1. HealthPromotion2. HealthEducation3. Leadership4. Technology5. Customerservice
*Notnecessarilyindustryfocusedbutcorecompetenciesthataretransferable
PlanningStep2:IdentifyLeadership’sRoles&Responsibilities
n Leadership/BoardofDirectors,etc.1. Establishlong-termvision2. Overallexpectation,direction,andculturalrelevance3. Buildthecapacitytowardsself-sufficiency4. ExerciseSovereigntyandSelf-Determination5. Establishandprioritizegoals,objectives,andactionsteps6. Gatherrelevantdataandstakeholderinput7. ReviewandapprovefinalStrategicPlanfordistributionandimplementation
PlanningStep3:IdentifyOrganization’sCoreValues
n WhatAreProgramCoreValues?1. Theyaredevelopedtoframeanethicalcontextfortheprogram
a. “Ethicalstandards”oftheprogram2. Theyarethefoundationfordecisionmakingwithintheprogram
n WhyCoreValuesareImportant19
1. Valuesaretheprinciplesandidealsthatbindtheorganizationtogetherincludingtheclients/patients,employees,vendors,andallstakeholders
2. Areintendedtosetthestandardofpracticeforallprofessionals 19BureauofPrimaryHealthCare.(2016).VisionStatement,MissionStatementandCoreValues.
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3. Whendirectors’,managers’,andemployees’valuesdonotmatchthoseoftheorganization–statedorimplied–theresultscouldbeturnover,decreasedproductivity,dissatisfaction
4. Sharingthesamevaluesystemstendstoleadtosuccesswithintheprogram5. Themissionandvisionoftheprogramaresupportedbythevalues6. Valuesshouldproactivelyguidethebehaviorsineverydaypractice
n ExamplesofCoreValuesfromotherorganizations
CoreValuesNorthwestTribalEpidemiologyCenter
• TribalSovereignty• ModelLeadership• HolisticHealthPromotion• DiseasePrevention
RockyMountainTribalEpidemiologyCenter
• HighQualityWork• HonestandOpenCommunication• Integrity• RespectandTrust• ServiceandHumility• UnityofPurpose• IntellectualCuriosity
PuyallupTribalHealthAuthority
Inacknowledgingtherichdiversityofculturethatourpatientsandco-workersshare,thePTHAanditsemployeesupholdandseektoemulatethefollowingorganizationalvalues:• Respect:Treatingeachpatientsandco-workerswithhonor,
compassion,andcourtesy;• Honesty:Dealingwithpatientsandco-workersinasincere,
trustingandfairmanner• Quality:Strivingforthehighestlevelofexcellence
PlanningStep4:VisionandMissionPlanning
n VisionStatement1. WhatisinaVisionStatement?
a. Aclearguideofwhereaprogramwillbeinthefutureb. Defineswhatsuccessoftheprogramwouldlooklikec. Intendedtoserveasaclearguideforchoosingcurrentandfuturecoursesof
action
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n WhyaVisionisImportant?1. Useyourvisionasthebasisforestablishingstrategy2. Itestablishesyourcoreideologyandhelpsidentifyasetofcorevalues3. Itistheenvisionedfuture4. Itisadescriptionofwhatthingsshouldlooklikewhenyouachieveyourgoals
n KeyConsiderationsWhenDevelopingYourVisionStatement
1. Itshouldbeshortphrasesorsentencesthatconveyyourprogram’shopesforthefuture
2. Useyourvisiontoinspireanduplifteveryoneinvolvedinyoureffort3. Thevisionshouldbefuture-oriented,bigpicture,andeasilymemorable4. Useyourvisionandexternaltrendsastheprimarysourceofinformationfor
establishingdirection5. Establishagreaterfocusonexternalmeasuresofperformanceratherthan
internalfinancialmeasures6. Thinkingofthingsinalong-term,broadsense,withoutsoundinggeneric
a. Ifyou’retoospecific,youwilllimityourvisionanditwon’tbeapplicabletenyearsdowntheroad20�
n ExamplesofVisionStatements
VisionStatementsNorthwestTribalEpidemiologyCenter
Wellnessforthe7thGeneration
RockyMountainTribalEpidemiologyCenter
HealthyTribalcommunitiesthataresustainedthroughlasingcollaborativepartnerships
SaultTribeHealthDivision
TheVisionoftheHealthServicesProgramsasdefinedbytheGoverningDirectoris:• Toplananddevelopacomprehensive,integratedcommunity-
basedhealthcaredeliverysystem,withinputandparticipationoftheTribalBoardofDirectors,healthcommittee,Healthstaff,andmembersofeachofourtribalcommunityareas.
• Toprovidewidespreadtraditionalhealingandpreventioncomponentsalongwithtimely,appropriate,andefficientaccesstocare.
• Tohavealltribalmembershaveadefinedbenefitpackageofbasichealthcareservicesdeliveredbywellqualifiedhealthcareprofessionals.
• Tohaveahighlyintegratedhealthcarenetworkwithinandoutsidethetribalgovernmentwiththegoalofimprovingthehealthstatusoftribalmembersandthetribalcommunity.
20AbarisConsulting.(2012).BestPractices:IsYourStrategicPlanuptoSnuff?
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n MissionStatement1. WhatisaMissionStatement?
a. Shortnarrativedescribingthegeneralfocusorpurposeoftheprogramb. Providesdescriptionofthecurrenteffortsofaprogramc. Differentfromthevisionstatement,butsimilar–itshouldinspireaction
n WhyaMissionStatementisImportant?
1. ItestablisheshowyouwillfulfilltheVisionoverthenext3–5years2. Helpsguideinthedevelopmentofgoalsandobjectives3. Explainsthefundamentaloutcomestheprogramisworkingtoachieve4. Describesthecurrentfocusofaprogramandwhatisimportant5. Italsomayreflectthephilosophybehindtheprogram
n ExamplesofMissionStatements
MissionStatements
NorthwestTribalEpidemiologyCenter
EliminatehealthdisparitiesandimprovethequalityoflifeofAmericanIndiansandAlaskaNativesbysupportingNorthwesttribesintheirdeliveryofculturallyappropriate,highqualityhealthcare.
RockyMountainTribalEpidemiologyCenter
TheRockyMountainTribalEpidemiologyCenterempowersAmericanIndianNationsandurbanIndianpopulationsbybuildingdrivenpublichealthandepidemiologicalcapacitythroughoutreachandcreativepartnerships.
UrbanIndianHealthInstitute
ThemissionoftheUIHIistosupportthehealthandwell-beingofurbanIndiancommunitiesthroughinformation,scientificinquiryandtechnology.
SouthernUteIndianTribe
Strengtheningthecircleofwellnessbyprovidingprogressive,traditionallybalanced,compassionate,comprehensivehealthcaretomembersoftheSouthernUteIndianTribe.
PlanningStep5:CreateaRealisticTimeline
Itisimportanttosetarealistictimelineinordertoprovideyourteamwiththenecessarytimetobesuccessfulthroughouttheplanningstages.Thefollowinggraphicisanexampletimelinewithtasks/activities,responsibleparty,identifiedresourcesneededandtimelines.
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ExampleTimeline21
21BlueStoneStrategyGroup.(2018).ExampleTimeline.
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PlanningStep6:ResourceAllocation
n Thisisimportanttoincludesothatresourcesareallocatedaccordingly.1. IdentifyingallResources2. WhatResourcesdoyouhavetoaccomplishyourgoals?Forexample:
a. Facility/LandBaseb. Communitysupport/buy-inc. Proximitytohightrafficareasd. MedicalTourismDestinationse. Strongtradition,culturalhistory,andcommunity
n Identifyallresourcesandidentifyiftheyareworkingincoordinationorworkingindependently.Createalistincludingall:
1. Ongoingactivities2. Newactivities3. Proposedactivities
PlanningStep7:Budgeting&FinancialAssessment
n BestPracticesinFinancialPlanning:Developafinancialplanandabudgetthatcreatestheframeworktoallocateresourcestoachieveyourstrategicgoalsandobjectives:
1. Create/conductannual,bi-annual,quarterlyreviews:a. Tokeepinlinewithproposedbudgetallocationb. Todetermineiftherewillbecostoverrunsc. Todetermineifbudgetmodificationsareneededd. Tomaintainexpendituresareconsistentwiththepurpose
2. IdentifyMetricsforTrending&Forecastinga. EachmonthDirectors/Managersshouldreceiveanupdatedbudgetreportto
reviewactualfundingandexpensesinordertocomparepriorplannedfundingandexpenses.
b. ProvidesDirectors/Managersanideaofwhethertheyareoperatingaccordingtoplanornot,includingwheretheywillneedtocutdownonexpensesandpursueadditionalfundingormodifythebudget.
3. ParticipateinEfficiencyPlanninga. Becomemoreefficientinprovidingservicesb. Reviewtheprogram’sfinancialsituationandopportunitiesc. Rationalize,restructure,andstreamlined. Increasefundingstreamsthroughadditionalfundingsources(grants,
foundations,loans,etc.)e. Betterutilizationofexistingfacilitiesandresourcesf. Capitalprojectplanningandfundingneedsg. Postponeimplementingsomeactivitiesuntilplansaredevelopedand
approved
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n TheRoleofFiscalPrinciples
1. FinancialManagementPolicya. Clearlydefinesfiduciaryresponsibilitiesfromthe
Leadership/Board/Director(s)/Managementleveltothestaffleveli. Costallocationii. Budgetadministrationiii. Receipts,bankingdisbursing,andfundauthorizationiv. Financialplanningandinvestmentsv. Procurementvi. Auditandinternalcontrolvii. Internalpoliciesandproceduresforday-to-dayoperations
2. BudgetAdministrationa. SystematicBudgetMonitoringandReporting
i. Timely(monthly/quarterly)reviewsincoordinationwiththeDirector(s)andtheBoard(s)
ii. Reviewactualbudgetandexpensesiii. Comparisonofpriorplannedfundingandexpensestoactualexpensesiv. Processtoidentifycostoverrunsandtomakemodificationsasneededv. Ensuringthebudgetmatchesserviceexpectations
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Figure6:ConsiderationsinBudgetPlanning&Implementation22
22BlueStoneStrategyGroup.(2016).BudgetPlanning&Implementation.
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StrategicActionPlanning
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StrategicActionPlanning
Step1:ConductSWOTAnalysis
n ASWOTanalysisguidesyouinidentifyingyourprogramororganization’sstrengths(S)andweaknesses(W),aswellasbroaderopportunities(O)andthreats(T).23Strengthsandweaknessesareinternalandwithintheorganization’sscopeofworkandcontrol.Opportunitiesandthreatsareexternalandaretrendsoutsidetheprogramororganization’sdirectcontrol.
o PriortodevelopingaSWOTanalysis,youshouldidentifytheinternalandexternalentitiesthatwillaffectsuccessfullyplanningforyourprogram.Belowisacharttohelpidentifyinternalandexternalentities.
Internal External
• DepartmentCulture• Department/ProgramImage• OrganizationalStructure• KeyStaff/ProgramStaff• Accesstoresources• Efficiencyandcapacityof
program/department• AwarenessofProgram/Department• FinancialResources
• Customers:Community/TribalMembers• Competitors:IHS,County/StateHealth
Departments,Non-ProfitHealthPrograms• Partners:HealthDepartment,IHS• SocialChanges:Federalgovernment
agenda/budgettrends• Newtechnology• EconomicEnvironment• PoliticalandRegulatoryEnvironment
23WorkgroupforCommunityHealthandDevelopmentattheUniversityofKansas.(2016).
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Figure7:SWOT–Strengths,Weakness,Opportunities&Threats24
24BlueStoneStrategyGroup.(2016).SWOT.
Strengths•Whatadvantagesdoesyourcommunity/organizationhave?•Whatdoyoudobetterthananyoneelse•Whatisuniqueaboutyourorganization?
Weakness•Whatcouldyouimprove?•Whatshouldyouavoid?•Whatdopeopleinyourindustryseeasweakness?
Opportunity•Whatareasofopportunityforimprovement?• Technology• Policies• Collaboration•Whatinterestingtrendsareyouawareof?
Threats•Whatobstaclesdoyouface?•Whatarecompetitorsdoing?• Doyoumeetqualitystandards?• Budgetingalignment?• Areanyofyourweaknessesthreats?
S W O T
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Step2:ImplementSMARTMethodology-EstablishingSMARTgoals
Step3:GoalSettingResponsibilities
n Leadership,Board,Director/Manager,andOrganizationalResponsibilities1. Settingoverallservice/programprioritiesandgoals
a. Definingprogrammingdirectionandcontrolsb. Ensuregoalsarealignedwithmissionandvision
2. Definingmanagement’sresponsibilitiesandimplementationa. Definingaccountabilityandoversight
3. Conductingregularevaluationandreviewofprogressa. Settingdepartmentalperformanceexpectationsb. Fiscalmonitoring,trending,andforecasting
36
GoalPlanningBestPractices:GeneralPlanningImplementation
Thisprocesschartdepictstheelementstoidentifyinthedevelopmentofeachgoal.Figure8:GoalSettingProcess25
Step4:PrioritizingGoals
n PrioritizingGoals:Considerationsinprioritizinggoals1. Whereistheorganizationtoday?2. Whatdowewantourorganizationtobelikeinthefuture?3. Whatareourstrengthsandadvantagesaswemoveintothefuture?4. Howcanweeffectivelymovetowardthefuture?
n BestPractices:Prioritizationofkeygoalsanddefiningresponsibilities
1. Definegoalsincontextoftoppriorities2. Workwithdepartments/stafftolistissues/hurdlesandpotentialsolutions3. Seekadvicefromlikeorcommondepartments4. Identifycosts,assignbudgetlineitemsandmaptorevisedgoals,activities,&
timelines5. Createspecificactionstepsandassignresponsibilities
25BlueStoneStrategyGroup.(2016).GoalPlanning.
37
Figure9.ExampleofEisenhowerDecisionMatrix
Step5:EstablishTimelineExpectations
n Considerationsinestablishingtimelineexpectations:1. Determinebothshort-andlong-termexpectations2. Makesurethatexpectationsarerealistic3. Considerfunding/budgetguidelinesandlimitations4. Establishmilestonestomarkprogress
Step6:ObjectiveandActionStepPlanning
n GuidelinesforSettingObjectivestoAchieveGoals261. Specifyatimeframe(forexample,oneyear).2. Takeintoconsiderationthestrengthsandweaknessesofyourbusinessand
competition.3. Addressannualrevenueandprofitgoals.4. Takeintoconsiderationcurrentresources5. Alwaystrytowriterealisticobjectives.6. Keepthenumberofobjectivesmanageable(probablynomorethanfiveorsix
objectives).n UtilizingtheActionPlanningtemplateinAppendixBhelpstooutlinesomeofthesekey
guidelines.
26CommunityFutures.(2018).ObjectivesandActionPlan.
38
Step7:MeasuringSuccess
n Re-validatethateachproject/priorityremainsalignedwithyourmissionandvisionn Applymetricsandkeyperformanceindicatorsn Ensureproject/priorityperformancemeetsorexceedsprogram/departmentgoalsand
objectivesn Identifywhowillberesponsibleforthefollowing:
1. BudgetMonitoring2. Benchmarking3. EnforcingAccountability
Figure10:MeasuringSuccess27
27BlueStoneStrategyGroup.(2016).MeasuringSuccess.
39
The10EssentialPublicHealthServicesPublicHealthinfrastructureprovidesthenecessaryfoundationforundertakingthebasicresponsibilitiesofpublichealth,whichhavebeendefinedasthe10EssentialPublicHealthServices1. Monitorhealthstatus
toidentifyandsolvecommunityhealthproblems.
2. Diagnoseandinvestigatehealthproblemsandhealthhazardsinthecommunity.
3. Inform,educate,andempowerpeopleabouthealthissues.
4. Mobilizecommunitypartnershipsandactiontoidentifyandsolvehealthproblems.
5. Developpoliciesandplansthatsupportindividualandcommunityhealthefforts.
6. Enforcelawsandregulationsthatprotecthealthandensuresafety.
7. Linkpeopletoneededpersonalhealthservicesandassuretheprovisionofhealthcarewhenotherwiseunavailable.
8. Ensurecompetentpublicandpersonalhealthcareworkforces.
9. Evaluateeffectiveness,accessibility,andqualityofpersonalandpopulation-basedhealthservices.
10. Researchfornewinsightsandinnovativesolutionstohealthproblems.
Figure 11: The 10 Essential Public Health Services
40
41
Figure12:ContinuousImprovementModel28
28NationalInstitutesofHealth.(2015).NIHClinicalCenterStrategicandAnnualOperatingPlan.
42
Appendices
43
AppendixA.MoreExampleStrategicPlanningProcessesThefollowingfiguresareexamplesofsimilarprocessestodevelopingaStrategicPlan.
Figure13.StrategicPlanningProcesses(1)29
Figure14:TheStrategicPlanningProcess(2)30
2924Point.(2016).StrategicPlanning:TheRightGamePlanCanTakeYouPlaces!3024Point.(2016).StrategicPlanning:TheRightGamePlanCanTakeYouPlaces!
GatherFacts
SWOTAnalysis
ReviewInputs
StrategicMatrix
DefineStrategies
ReviewInput:• All stakeholders• Reviewinputs• Review SWOT
analysis• Define3-4key
statements
DefineStrategies:• Objectives• Key strategies• Shortandlongterm
goals
Strategic Matrix:• Allstakeholders• Define strategiesto
addressSWOTcombinations
SWOTAnalysis:• Externalanalysis• Internal analysis• Strategic questions• Strategicissues
GatherFacts:• Fromall
stakeholders• Customeranalysis• Competitoranalysis• Company strategies
StrategicPlanning
44
AppendixB.ActionPlanfor[CommunityorInitiativeName]31
GoaltoBeAddressed:__________________________________________________________________________________Objective:________________________________________________________________________________________________ACTIONSTEPS
ActionSteps ByWhom ByWhen ResourcesandSupportAvailable/Needed
PotentialBarriersorResistance
CommunicationPlanfor
Implementation
Whatneedstobedone?
Whowilltakeactions?
Bywhatdatewilltheactionbedone?
ResourcesAvailable
ResourcesNeeded(financial,human,political,andother)
Whatindividualsandorganizationsmightresist?How?
Whatindividualsandorganizationsshouldbeinformedabout/involvedwiththeseactions?
Step1:
Step2:
Step3:
Step4:
31BlueStoneStrategyGroup.(2016).ActionPlanSteps.
45
46
References
47
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