Attachment F Meeting Guide

National Public Health Performance Standards Program
Governance 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 with a board of health or other governing body. This Guide may be adapted to one of several approaches to completing the assessment:

• One Essential Service per board meeting over a period of months;

• One or more Essential Services within the hour before or after regular board meetings;

• A number of Essential Services during specially convened meetings; and/or

• All Essential Services during a board retreat.

Some board members may complete the assessment instrument individually and then convene together for discussion and consensus voting. If this is the approach taken, the information in this Guide may be adapted for orientation session and the follow up discussion and voting session.

Materials Needed

For each participant:

• Governance NPHPSP Instrument (Assessment Tool)

• Voting Cards

For the meeting:

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

• Flip Chart List of Ground Rules*

• Flip Charts with Tape and Markers

• Paper, Pens/Pencils, Sticky Notes

• One-pager brief overview of NPHPSP*

For recorder:

• Laptop loaded with Instrument Score Sheets (downloadable)*

Supporting Roles

Recorder – to record votes and discussion

Health officer or key health department staff – to provide an overview of activities and current capacities of the health department

* 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, the Recorder, the health officer and any other health department staff.

2. State (or remind the group) that the purpose of the group’s work is to assess the extent to which the board of health (BOH) provides or does not provide an optimal level of oversight to the local health jurisdiction pertaining to 10 Essential Services. Read aloud the Essential Service(s) that will be covered during the meeting. Refer to the one-page NPHPSP overview.

3. Review the Assessment Tool. The Assessment Tool is organized around one model standard for each of the 10 Essential Services, for a total of 10 Model Standards. The Model Standard relates to all aspects of the governance and oversight activities for each of the Essential Services.

Note that each Model Standard includes:

• A description of optimal board of health 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 participant, 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 that in addition to keeping in mind the role and responsibilities of the BOH to provide oversight to the public health activities, they should answer the assessment questions with the health department and public health system in mind.

• 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. The health officer (or other health department staff) will provide an overview of the current activities and capacities of the health department related to this Essential Service. (Note: this inventory may be made available as a fact sheet ahead of time. Also, if the BOH is completing this assessment after the Local NPHPSP Assessment has been completed, that data may be shared and discussed with board members at this time.) We will then discuss the standard and related activities, after which we will 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. It may be helpful to reiterate some basic parameters in thinking about how well the board is functioning. Think about the focus of the question in terms of:

• Dispersion: is the activity in the question disseminated/dispersed across the jurisdiction geographically or does it exist in only one area? Is the activity dispersed among programs or done in only one area of public health concern? For example, the BOH 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, etc.).

• 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?

NOTE: Boards often question how to score themselves if they have no official responsibility or jurisdiction over the topic in question. Their best option is to select the most appropriate response, even if it is “No Activity.” The recorder should note the reason for this vote so that the board addresses the issue appropriately when they review their report and begin addressing areas of low performance.

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 BOH, weaknesses of the BOH, recommendations for immediate improvements, and any priorities of the BOH.

7. Begin the assessment!

Step-by-Step Process for Facilitation

• Keep an eye on the time. You have approximately 30 minutes to complete the assessment for each Essential Service.

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

Step #1 Discussion:

1. Read the Essential Service and the activities included.

2. Allow the health officer or other key health department staff to review what is being done by the health department and/or local public health system relative to the Essential Service.

3. Read the related Model Standard and its description. NOTE: Volunteers from the group may also be asked to do this if you would like to engage them in this manner.

4. 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.

5. 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.

6. 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 and the role of BOH members.

• 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.

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. NOTE: Health department staff, including the health officer, should NOT vote.

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 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!

# 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 and weaknesses of the BOH, recommendations for immediate improvements of the BOH, and any priorities of the BOH.

TIPS:

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

NPHPSP Assessment Meeting Guide

Governance Instrument, Version 2

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