strategic planning toolkit - tribalepicenters.org...the opioid crisis in indian country indian...

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


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.


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

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.

46

References

47

References1. Jones,ChristopherPharmD,MPH.(March2018)TestimonyfromChristopherM.

JonesPharmD,.,MPHonOpioidsinIndianCountry:BeyondtheCrisistoHealingtheCommunitybeforeCommitteeonIndianAffairs.

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9. Murphy,T.,Pokhrel,P.,Worthington,A.,Billie,H.,Sewell,M.,&Bill,N.(2014).UnintentionalinjurymortalityamongAmericanIndiansandAlaskaNativesintheUnitedStates,1990-2009.Americanjournalofpublichealth,104Suppl3(Suppl3),S470-80.

10. NationalCongressofAmericanIndiansPolicyResearchCenter(March2018)TheOpioidEpidemic:IHSResponsetoaNationalCrisis.Retrievedfrom:https://www.youtube.com/watch?v=qPsepeuwPJk&feature=youtu.be

11. HealthandHumanServices.(March2017)5-PointStrategytoCombattheOpioidCrisis.Retrievedfrom:https://www.hhs.gov/opioids/about-the-epidemic/hhs-response/index.html

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48

14. BureauofPrimaryHealthCare.(2016).VisionStatement,MissionStatementandCoreValues.RetrievedFrom:http://bphc.hrsa.gov/archive/technicalassistance/resourcecenter/general/visionmissioncorevalues.pdf

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16. BlueStoneStrategyGroup.(2018).ExampleTimeline.17. BlueStoneStrategyGroup.(2016).BudgetPlanning&Implementation.18. WorkgroupforCommunityHealthandDevelopmentattheUniversityofKansas.

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http://communityfutures.biz/business-planning-workbook/unit-8/section-three-objectives-and-action-plan/

22. BlueStoneStrategyGroup.(2016).MeasuringSuccess.23. NationalInstitutesofHealth.(2015).NIHClinicalCenterStrategicandAnnual

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24. ColoradoStateUniversity.(2014).Tri-EthnicCenterforPreventionResearch.CommunityReadinessforCommunityChange

25. ColoradoStateUniversity.(2014).Tri-EthnicCenterforPreventionResearch.CommunityReadinessforCommunityChange

26. 24Point.(2016).StrategicPlanning:TheRightGamePlanCanTakeYouPlaces!RetrievedFromhttp://24point0.com/powerpoint-sample-use-strategic-planning-chart/

27. 24Point.(2016).StrategicPlanning:TheRightGamePlanCanTakeYouPlaces!RetrievedFromhttp://24point0.com/powerpoint-sample-use-strategic-planning-chart/

28. BlueStoneStrategyGroup.(2016).ActionPlanSteps.

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