Attachment F Facilitators Guide

National Public Health Performance Standards Program

Governance Assessment Instrument, Version 2

Facilitator’s Guide

PREPARATION

There are several methods for completing the assessment instrument:

• Complete one essential service per board meeting over a period of months

• Allow 1 hour before or after regular meetings to complete one or more essential services

• Convene special meetings to complete a number of essential services at a time

• Conduct a “retreat” to complete the entire instrument at one time

SUPPORT ROLES
You will need a facilitator, recorder, and health official or key health department staff.

Facilitator: Convenes and leads the process.

Recorder: Records discussion and scores.

Health Official or Key Staff: Provides input on activities and current capacities of the health department.

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 local board of health and/or public health system. This is a good time to remind participants that they should answer the assessment questions with the health department and public health system in mind.

Note: This set of three posters – one for each NPHPSP instrument – can be obtained by contacting a NPHPSP partner organization.

• Voting Scale (or Color Voting Cards): Response options for answering assessment questions. You will need six (6) colored cards for each participant. Five of the colored cards should represent the voting options described below. The sixth card can be used by participants as a discussion card to indicate “Let’s discuss this further.”

Note: Use a flip chart or hand-out to post the voting scale.

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.

• Ground Rules: list of rules to guide the process.

Note: Use a flip chart or hand-out to list your ground rules.

• Governance Assessment Instrument: copy of the instrument.

OVERVIEW OF ASSESSMENT PROCESS

Discuss the model standards with follow-up voting on each question:

Read the essential service and the model standard. Discuss what the BOH is doing to contribute to meeting this Standard. Vote on each question related to the model standard.

TIPS

1. Let participants know that if they answer “yes” to all of the questions in a section, their performance should look like the model standard. However, because the model standards describe optimal or “gold standard” level of performance, few boards of health would find that they are doing everything.

2. When voting, it may be helpful to reiterate some basic parameters in thinking about how well the BOH is functioning. Think about the focus of the question in terms of:

• Dispersion: is the activity in the question done throughout many areas or only in one area of public health concern and not in other areas of interest? For example, the board of health may have good policy development for certain areas of health concern (e.g., environmental health) but not others (e.g., infectious disease, injury prevention, maternal and child health).

• 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. Encourage open discussion of each model standard. Allow all voices to be heard, and strive to reach consensus through discussion rather than concession.

4. In the event there are diametrically opposed views when voting, or a participant has a strong need to discuss an issue, you may have further discussion. This is often noted by participants raising their “Let’s discuss further” card. After a few minutes of further discussion or clarification, the facilitator can then ask for a new vote.

5. Consider voting on sub-questions before voting on main/stem questions.

6. The group should have a recorder to document not only the responses to each question, but also key messages to take away from the discussion. These may include but are not limited to: strengths of the BOH for this essential service, weaknesses of the BOH for this essential service, recommendations for immediate improvements of the BOH for this essential service and any priorities of the BOH for this essential service.

7. Keep an eye on the time. You should use approximately 30 minutes to complete the assessment for each Essential Service.

STEP BY STEP FACILIATION

1. Introduce yourself as the Facilitator.

2. Introduce your recorder.

3. Introduce the health official or other key health department staff. Note that the health official or key staff will be able to provide input on activities and current capacities of the health department. The health official/key staff does not vote.

4. State that the purpose of the group’s work is to discuss and review the activities and capacities of the board of health. To do this, the group will be using a national tool designed to assess the extent to which the local board of health meets or does not meet optimal performance standards.

5. Review the essential services chart, voting scale, and ground rules. Answer any questions, and ask if additional ground rules are needed.

6. Let the group know which Essential Service(s) you will complete that day.

7. Review the Assessment Tool. For each Essential Service the Governance Instrument has: an indicator, the major activity for the board of health; a Model Standard that describes optimal performance for the board of health; and questions related to the elements of the model standard that serve as measures of performance in how that standard is being met.

Note: Some questions also 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 related assessment question.

8. Briefly review the process that will be used to do the assessment (option A or B, above).

Discussion:

1. Read the Essential Service and the activities included.

2. Review (with the health official or other key health department staff) what is being done by the health department and system relative to this Essential Service.

3. Read the Indicator and then the Model Standard.

Note: Volunteers from the group can also be asked to do this if you would like to engage them in this manner.

4. Allow time for discussion about what the BOH is doing to meet this standard. 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: Encourage participants to consider the elements within the “Discussion Toolboxes” in forming a vote on assessment questions that have a related toolbox.

Tips

• Encourage all participants to contribute.

• Draw out different points of view.

• Keep discussion relevant to the Model Standard.

• Remind participants that the purpose is to get an honest and accurate perception of the strengths and weaknesses of the BOH to help with quality improvement initiatives.

• Try to encourage concrete examples of activities.

• 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.

Voting:

1. Read each question under the Model Standard pointing out that the question relates back to the Model Standard.

2. Begin moving through the questions and ask participants to hold up their votes.

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

Note: the group may decide a certain number of similar votes are needed to assure consensus – this should be established as part of the ground rules.

Further discussion, if needed:

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 should raise their “Let’s discuss” 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. After further discussion, take another vote.

Tips

• Discussion during voting should be minimal.

• 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 BOH is performing.

• Keep track of time!

Take Away Messages:

After voting is complete, review and record the take away messages that have come up during discussions. Suggested categories include: strengths of the BOH for this essential service, weaknesses of the BOH for this essential service, recommendations for immediate improvements of the BOH for this essential service, and any priorities of the BOH for this essential service.

4