Meeting Guide State

National Public Health Performance Standards Program
State Public Health System Assessment, Version 2
Assessment Meeting Guide:

Information for Facilitators

Overview

This Assessment Meeting Guide is designed to provide guidance for individuals providing hands-on facilitation during the NPHPSP assessment process using the small group approach in a retreat setting (typically 1 – 1.5 days). These materials may be revised to accommodate different approaches to using this instrument.

In a retreat format, all participants typically attend a common orientation session in which a brief overview of the NPHPSP, the Essential Public Health Services, and the concept of a “public health system” is provided. Often, such orientation sessions will include an opportunity for participants to share initial thoughts about their organization’s contributions to the Essential Services. This discussion provides information for the completion of the assessment instrument, as described below. Some groups will help generate ideas and discussion about each organization’s contributions to the health of the public by posting flip charts – one per Essential Service – and asking participants to write their organization names and activities as they relate to that service. The flip charts are then useful reference tools when each Essential Service is later discussed (as described in the outline below).

Materials Needed

For each participant:

• State NPHPSP Instrument (Assessment Tool)

• Voting Cards

In the room:

• The Public Health System Picture (i.e., the “egg map”)*

• Flip Chart List of Ground Rules*

• Relevant Essential Service Flip Chart Lists (from orientation exercise)

• Flip Charts with Tape and Markers

• Paper, Pens/Pencils, Sticky Notes

For recorder:

• Laptop loaded with Instrument Score Sheets (downloadable)*

Supporting Roles

Recorder – to record votes and discussion

* Additional Resources

See the NPHPSP User Guide and a variety of other implementation resources in the NPHPSP Online Tool Kit, available at www.cdc.gov/od/ocphp/nphpsp.

Assessment Format

1. Introduction and Overview

1. To begin your group session, introduce yourself and your Recorder, and describe your roles. Ask all small group participants to introduce themselves.

2. State that the purpose of the group’s work is to assess the extent to which the state public health system (SPHS) meets or does not meet optimal performance standards for the two Essential Services that the group has been asked to address. Read aloud the Essential Services that will be covered in the small group to make sure the participants are in the appropriate breakout group.

3. Review the Assessment Tool. There are four model standards (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

Note that each category includes:

• A description of optimal SPHS performance for that particular Model Standard.

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

Some questions include discussion toolboxes which contain even more specific elements or characteristics associated with optimal performance. These may be used as checkboxes or prompting points to inform responses to related assessment questions.

4. Review the color voting cards provided for each of the participants, specifying what each card represents according to the response scale. Note that the sixth card (blank) may be used as a discussion card when voting to indicate that further discussion is needed for a particular assessment question.

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.
MODERATE ACTIVITY	Greater than 25%, but no more than 50% of the activity described within the question is met within the public health system.
SIGNIFICANT ACTIVITY	Greater than 50%, but no more than 75% of the activity described within the question is met within the public health system.
OPTIMAL ACTIVITY	Greater than 75% of the activity described within the question is met within the public health system.

5. Review display materials (or additional handouts)

• 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.

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

6. Briefly review the four-step process that will be used to complete assessment:

Step # 1: Discussion

We will read each model standard together. 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.

Step # 2: Voting

Every participant will utilize the six colored cards to cast their vote or to indicate a need for further discussion. Note that the group will want to consider how much system activity is enough when determining their 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 done in only one area of public health (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?

Step # 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.

Step # 4: Recording (Final Votes and Take Away Messages)

We will have a recorder to document not only our final vote on each assessment question, but also key messages we want to take away from our discussion. These may include but are not limited to: strengths of the SPHS, weaknesses of the SPHS, recommendations for immediate improvements, and any priorities of the SPHS.

7. Begin the assessment!

Step-by-Step Process for Facilitation

• 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.

• Use the steps below to work through all the questions in the first Model Standard. Move on to the next Model Standard until the Essential Service is completed.

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 Model Standard and its description.

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. Remind participants that some questions include a discussion toolbox, which may be used as checkboxes or prompting points to inform responses to related assessment question.

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

TIPS:

• 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.

• Inform participants and/or organizations that they 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. (When answering a question that includes a discussion toolbox, 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. Ask, “Are we ready to vote?” Begin moving through the questions one-by-one, and ask participants to hold up their votes.

2. After participants hold up their cards, read aloud the vote, e.g., 5-optimal, 7-significant, 3-moderate. The vote will be determined by a majority vote. If there is any participant who cannot accept that vote, they should use their discussion card to indicate the need for further discussion.

Step #3 Further Discussion, as needed

In the event there are diametrically opposed answers or any participant strongly feels the need for discussion, the facilitator asks if the group would like more discussion. Each person wishing to speak will raise their discussion 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. Conclude the discussion with another vote. If the group still hasn’t arrived at a consensus response, the facilitator may have another discussion period followed by a vote. Alternately, the facilitator may make sure that any participants who have concerns about the majority vote have the opportunity to have their concerns recorded (by having the participants write them on sticky notes, flip chart paper, etc. or by asking the recorder to capture them in the meeting notes.)

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.

TIPS:

• Discussion during the actual voting period 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 system is performing.

• Keep track of time!

# 4 Take Away Messages

After all votes have been recorded, review the take away messages that have come up during discussions. Fill in any new information regarding each Essential Service using the framework of strengths of the SPHS, weaknesses, recommendations for immediate improvements of the SPHS, and any priorities of the SPHS.

TIPS:

• Make sure that all participants are aware of the final responses for each assessment question.

NPHPSP Assessment Meeting Guide

State Instrument, Version 2

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