Instrument Word Version

Attachment G: Instrument MS Word Version

Form approved

OMB No. 0920-0879

Expiration date: 04/30/2017

PHIT Follow Up Assessment 2014

Your input is essential to help us serve your needs.  Please take a few minutes to share your thoughts about the Public Health Improvement Training: Advancing Performance in Agencies, Systems and Communities” on April 24-25, 2014 (PHIT 2014) in Atlanta, Georgia.  Your input will be used to inform the PHIT 2015 agenda.

Q1 Which type of agency are you affiliated with?

•  State health department

•  Tribal health department

•  Local health department

•  Territorial health department

Q2 Please rate how useful the information from PHIT 2014 has been in your work:

•  Not useful

•  Somewhat useful

•  Very useful

If  Not useful Is Selected, Then Skip To Please explain what would have made...

Q3 How has PHIT 2014 been useful?  Please check all that apply.

• Has increased my knowledge to prepare for accreditation

• Has helped me to take actionable steps to prepare for accreditation. If so, what were/ are your next steps? ____________________

• Has increased my knowledge of health assessment and improvement planning processes

• Has helped me to take actionable steps to implement health assessment and improvement planning. If so, what were/ are your next steps to plan and implement? ____________________

• Has increased my knowledge of performance management

• Has helped me to take actionable steps to manage performance. If so, what were/ are your next steps? ____________________

• Has increased my knowledge of public health improvement and quality improvement tools

• Has helped me to take actionable steps use public health improvement and quality improvement tools. If so, what were/ are your next steps? ____________________

• Other ____________________

Q4 Please explain what would have made  PHIT 2014 more useful?

Q5 Were there any topics from PHIT 2014 you wish you had attended or were offered in-person (e.g. PHIT 2015) to take your next steps?

• Quality improvement

• Facilitating group processes

• Performance management and performance measures

• National voluntary accreditation

• Strategic planning

• Other ____________________

Q6 Are there any topics from PHIT 2014 you wish would be offered via webinar to take your next steps?

• Quality improvement

• Facilitating group processes

• Performance management and performance measures

• National voluntary accreditation

• Strategic planning

• Other ____________________

Q7 Overall, we want to know your opinion of the following based on your participation in PHIT 2014. Please rate your agreement with the following statements:  I would feel comfortable explaining the concepts of public health improvement a colleague.

• Strongly Disagree

• Disagree

• Agree

• Strongly Agree

Q8 I gained valuable information and/or skills from my participation in PHIT 2014. 

• Strongly Disagree

• Disagree

• Agree

• Strongly Agree

Q9   I have applied what I have learned through PHIT 2014 in my work.

• Yes

• No, why not? ____________________

• Not applicable

Q10 Currently, where would you rate your skill level in public health improvement on the scale below?

• I have heard about this

• I have an understanding

• I can explain it to others

• I can do this with an improvement team

• I can teach this

Q11 Are you interested in attending PHIT 2015?

• Yes

• Yes, but depends on finances

• Maybe

• No

• Other ____________________

Q12 Please describe successes, experiences, and/or results from your work that you would be interested in presenting (presentation format could be through a break out session, poster session, or panel discussion):   *Note: this will not obligate you to present.

Topic area:

Brief summary of activity/findings:

Name and contact info for person regarding this topic:

Other successes, experiences or results?

Q13 Please list any presenter recommendations you have

Topic area:

Brief summary of topic:

Name and contact info for person regarding this topic:

Other speaker recommendations?

Q14 For the following accreditation readiness topics, we want to understand which topics you most prefer and least prefer.   Please select and drag items on the left column into  the appropriate boxes on the right.  After dragging the items to the boxes, the order within the boxes does not matter.  If you feel neutral about a specific topic, please leave the item on the left side column.

Potential Topics	Most Preferred	Least Preferred
______ Accreditation 101
______ Developing and implementing a Health Assessment
______ Developing and implementing a Health Improvement Plan
______ Developing and implementing a Strategic Plan
______ Taking Accreditation Readiness Assessments/ identifying gaps in meeting Public Health Accreditation Board (PHAB) standards through self-assessment
______ Developing QI activities to address deficiencies related to a specified PHAB standard or measure
______ Organizing PHAB Documentation
______ Developing Accreditation Teams or Workgroups
______ Preparing the Agency Workforce for Accreditation
______ Other
______ Other
______ Other

Q15 For the following Performance Improvement (PI)/ Quality Improvement (QI) topics, we want to understand which topics you most prefer and least prefer.   Please select and drag items on the left column into  the appropriate boxes on the right. After dragging the items to the boxes, the order within the boxes does not matter.  If you feel neutral about a specific topic, please leave the item on the left side column.

Potential Topics	Most Preferred	Least Preferred
______ QI 101
______ Performance Management 101
______ Relationship between QI Plan, Strategic Plan, Performance Management, etc.
______ Developing a Performance Management System
______ Developing and Tracking Performance Measures
______ Measuring QI Return on Investment (ROI)
______ Evaluating QI initiatives for effectiveness and efficiency
______ QI Approaches (e.g. PDSA, Sigma, Six Sigma, Kaizen)
______ QI Tools (e.g. Affiinity diagramming, root cause analysis, process mapping)
______ Developing a Culture of QI
______ Engaging Leadership, Management, Staff, and Partners
______ Health Equity
______ Social Determinants of Health
______ Cross Jurisdictional Sharing
______ Facilitating group processes
______ Strategic Planning
______ Other
______ Other
______ Other

Q16 Please share any other recommendations or comments that may help inform planning of PHIT.

Q17 Your feedback is highly valued.  May we contact you in case we have any additional questions?  (optional)  

Name

Agency

Email

Phone number

To complete and submit your responses, please click ">>".  Thank you for providing your valued input! 

Public reporting burden of this collection of information is estimated to average 10 minutes per response, including the time for reviewing the instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Rd, NE, MS D-74, Atlanta, GA 30333; ATTN: PRA (0920-0879).