Government Booklet C

Governance

Priority Questionnaire

Local Public Health Governance Performance Assessment Instrument

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Governance

National Public Health Performance Standards Program
Local Public Health Governance Assessment Supplemental Questionnaire - Priority of Model Standards
OVERVIEW: This optional questionnaire is made available so that governing bodies may consider the priority of each model
standard to their system. Governing bodies choosing to complete this supplemental questionnaire will receive an additional
component to their reports which will depict their performance scores in relation to how they have prioritized model standards.
This information may serve to catalyze or strengthen the performance improvement activities resulting from the assessment
process.
INSTRUCTIONS: Using a scale of 1 to 10 (with 1 being the lowest and 10 being the highest), please rate the priority of each
model standard without regard to performance scores or rank order. In considering this questionnaire, the following questions
may be helpful for participants. Example A: “On a scale of 1 to 10, what is the priority of this model standard to our public health
system?” Example B: “On a scale of 1 to 10, how important is it to improve our performance in this activity (e.g., through a quality
improvement process, increased emphasis or resources)?” Governing bodies may complete this questionnaire in a single group,
either at the same time of the assessment or shortly thereafter, so that there is a consistent approach to responding to the
questions across the model standards.

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Local Public Health Governance Performance Assessment Instrument

Governance

Model
Standard
Number

Response
(please circle)

Question

Essential Service #1 - Monitor health status to identify health problems
P1

On a scale of 1 to 10, what is the priority of this model standard – Oversight
for Community Health Monitoring – to our board of health?

1 2 3 4 5 6 7 8 9 10

Essential Service #2 - Diagnose and investigate health problems and health hazards
P2

On a scale of 1 to 10, what is the priority of this model standard – Oversight
for Public Health Surveillance and Response – to our board of health?

1 2 3 4 5 6 7 8 9 10

Essential Service #3 - Inform, educate and empower people about health issues
P3

On a scale of 1 to 10, what is the priority of this model standard – Oversight
of Public Health Information, Education and Empowerment Activities – to our
board of health?

1 2 3 4 5 6 7 8 9 10

Essential Service #4 - Mobilize partnerships to identify and solve health problems
P4

On a scale of 1 to 10, what is the priority of this model standard – Oversight
for Constituency Development and Partnership Building – to our board
of health?

1 2 3 4 5 6 7 8 9 10

Essential Service #5 - Develop policies and plans that support individual and statewide health efforts
P5

On a scale of 1 to 10, what is the priority of this model standard – Oversight
of Public Health Planning and Policy Development – to our board of health?

1 2 3 4 5 6 7 8 9 10

Essential Service #6 - Enforce laws and regulations that protect health and ensure safety
P6

On a scale of 1 to 10, what is the priority of this model standard – Oversight
of Enforcement of Public Health Laws and Regulations – to our board
of health?

1 2 3 4 5 6 7 8 9 10

Essential Service #7 - L
 ink people to needed personal health services and assure the provision of health
care when otherwise unavailable
P7

On a scale of 1 to 10, what is the priority of this model standard – Oversight
for Public Health Outreach and Linkage to Personal Health Services – to our
board of health?

1 2 3 4 5 6 7 8 9 10

Essential Service #8 - Assure a competent public health and personal health care workforce
P8

On a scale of 1 to 10, what is the priority of this model standard – Oversight
of Public Health Workforce Issues – to our board of health?

1 2 3 4 5 6 7 8 9 10

Essential Service #9 - E
 valuate effectiveness, accessibility, and quality of personal and population-based
health services
P9

On a scale of 1 to 10, what is the priority of this model standard – Oversight
of Evaluation for Personal and Population-based Health Services – to our
board of health?

1 2 3 4 5 6 7 8 9 10

Essential Service #10 - Research for new insights and innovative solutions to health problems
P10

On a scale of 1 to 10, what is the priority of this model standard – Oversight
of Public Health Innovation and Research – to our board of health?

1 2 3 4 5 6 7 8 9 10

Local Public Health Governance Performance Assessment Instrument

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