Attachment F FacilitatorGuide State v

National Public Health Performance Standards Program
State Public Health System Assessment, Version 2
Facilitator’s Guide

(Using the SPHS instrument and a full day meeting setting – can be revised to accommodate other instruments or settings)

1. To begin your group session, introduce yourself, your Scorer, your Recorder(s), and your Technical Advisor, and describe your roles. Ask all breakout group participants to introduce themselves. State that the purpose of the group’s work is to assess the extent to which the state public health system meets or does not meet optimal performance standards.

2. Review materials provided to participants: color voting cards, the instrument for their essential service, and the voter’s guide.

3. Review display materials:

   • Essential Services: wall chart of all 10 Essential Services that provide the framework for the NPHPS by describing the activities that should be provided by the public health system.

   • The Public Health System picture emphasizing all the different sectors comprising the system as a WHOLE. This is a good time to remind participants to keep in mind that the assessment is of the entire system and not just the organization they are representing.

   • Voting scale: table displays to be used as a reminder when it is time to vote. Point out that you will come back to this.

   • Ground Rules: Review and ask if they would like to add others.

4. You have been assigned two “Essential Services” to address in your group. Read aloud the Essential Service and related activities you will be covering that day.

5. Review the Assessment Tool. There are four categories, which represent major activities or practice areas for each Essential Service:

   • Planning and Implementation

   • State-Local Relationships

   • Performance Management and Quality Improvement

   • Public Health Capacity and Resources

6. Each category includes:

   • The SPHS Model Standard that describes optimal performance for a public health system

   • Questions related to the category (the number of questions may be few to many) that serves as measures of performance in how that standard is being met.

7. Briefly review the process that will be used to do the assessment:

# 1 Discussion

I will read each model standard. We will then review some of the activities participants wrote on the newsprint today relative to what various organizations are doing to contribute to meeting this Standard, add to these through discussion, talk about what we do collectively as a public health system in meeting this standard and what should be occurring that is not. We will then rate/vote on each question related to the model standard.

#2 Voting

1. Make sure each participant has six colored cards representing each response option and a discussion card. Review what each card represents according to the response scale (also depicted on the table display).

NO ACTIVITY	0% or absolutely no activity.
MINIMAL ACTIVITY	Greater than zero, but no more than 25% of the activity described within the question is met within the public health system.
LOW PARTIAL ACTIVITY	Greater than 25%, but no more than 50% of the activity described within the question is met within the public health system.
HIGH PARTIAL ACTIVITY	Greater than 50%, but no more than 75% of the activity described within the question is met within the public health system.
YES / OPTIMAL ACTIVITY	Greater than 75% of the activity described within the question is met within the public health system.

b. How much systems activity is enough in deciding how to vote? It may be helpful to reiterate some basic parameters in thinking about how well the public health system is functioning. Think about the focus of the question in terms of:

• Dispersion: is the activity in the question disseminated/dispersed across the state geographically or does it exist in only one area? Is the activity dispersed among programs or carried done in only one area of public health concern (e.g. maternal and child health) and not in other areas of interest (e.g. chronic disease, infectious disease, injury prevention, etc.)?

• Participation among many system partners: is the activity done only in one sector and not others (e.g. done in hospitals, but not governmental public health agencies)?

• Frequency: is the activity in the question done routinely or on an ad hoc basis?

• Quality: is the activity in the question done in a high quality manner, or is it a new activity just getting started and not of sufficient quality yet?

#3 Further Discussion

In the event there are diametrically opposed answers or a participant has a strong need to discuss an issue, you may open it up for further discussion and ask if the group would like to vote again. If someone wants to talk they must raise their discussion card. They will then be given 1 minute to talk. Anyone else wishing to talk may do the same.

# 4 Take Away Messages

We will have a recorder to document key messages we want to take away from our discussion. These may include but are not limited to: strengths of the SPHS for this essential service, weaknesses of the SPHS for this essential service, recommendations for immediate improvements of the SPHS for this essential service and any priorities of the SPHS for this essential service.

8. Keep an eye on the time. You have approximately 1 hour to complete the assessment for each Essential Service, with a 15-minute break at a time determined by the group.

Step by Step Process for Facilitation

Step #1 Discussion:

1. Read the Essential Service and the activities included.

2. Review the newsprint completed by all participants on what is being done around the state relative to this Essential Service.

3. Ask the group to take a few minutes and think about what their organization or others with which they are familiar do to contribute to meeting the Standard?

4. Ask the question, what is the collective picture of how we are doing across the State related to this essential service.

5. Read the first Indicator and then the first Model Standard

6. On the first time through, ask participants to skim the assessment questions under the Model Standard pointing out that the assessment questions mirror each of the items in the Model Standard.

7. Allow time for discussion. Discussion is over when 1) the facilitator determines enough time has been spent on the discussion; or 2) there seems to be no further discussion needed.

Note: Some questions include a discussion toolbox, containing specific elements or characteristics associated with optimal performance, which may be used as checkboxes or prompting points to inform responses to the preceding assessment question.

Keeping In Mind:

• Encourage all participants to contribute

• Draw out different points of view

• Keep discussion relevant to the Model Standard

• Keep people focused on system as a whole

• Remind participants that the purpose is to get an honest and accurate perception of the strengths and weaknesses of the system to help with quality improvement initiatives. Participants and/or organizations are not being judged by their answers.

• Try to encourage concrete examples of activities, but discourage anecdotes!

• Try to have people frame their discussion in the categories of strengths, weaknesses, recommendations for immediate improvement and priorities to help the recorder get these thoughts down in an organized way.

Step #2 Voting:

1. Read the first stem question under the Model Standard pointing out that the question relates back to the Model Standard. The facilitator will ask participants to vote first on the sub questions and then the first stem question. (When answering a question that includes a discussion toolbox, facilitators should encourage participants to consider the elements within the toolbox in forming their vote on the assessment question to which it is related.) Then ask if anyone wishes to have further discussion on this specific question. Are we ready to vote? Begin moving through the questions and ask participants to hold up their votes.

2. The facilitator may want to briefly review the color-coded cards.

3. After participants hold up their cards, read aloud the vote e.g. 5 yes, 7 high partially, 3 low partially. The vote will be determined by a majority vote.

Step #3 Further Discussion, if appropriate

In the event there are diametrically opposed answers or people strongly feel the need for discussion, the facilitator asks if the group would like more discussion. Each person wishing to speak will raise their pink card and be given one minute to share their thoughts. Ask if the group would like to have a re-vote. The facilitator has the authority to determine when discussion needs to end to keep the group moving.

A useful question to draw the answers closer together is: “For those of you who scored the activity low, could you talk about why you scored it low? I will ask the same question for those who scored it high.” As an alternative you can also ask the low scores why they didn’t score higher and the high scores why they didn’t score lower.

Keeping In Mind:

• Encourage voting without discussion on the assessment questions.

• Emphasize similarities and points of agreement

• Point out relevant information in the discussion and how it pertains to the Model
  Standard

• Ask participants if they learned anything new about activities the system is performing

• Keep track of time!

After further discussion, take another vote.

Work through all the questions in the first indicator. Move on to the next indicator until you have completed the entire standard.

# 4 Take Away Messages

At the end of the voting all questions review the take away messages that have come up during initial and further discussions. Fill in any new information using the framework of strengths of the SPHS for this essential service, weaknesses of the SPHS for this essential service, recommendations for immediate improvements of the SPHS for this essential service and any priorities of the SPHS for this essential service.

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