Feedback Form

LHD HAI/AR Strategy Pilot FeForm Approved

OMB Control No.: 0920-XXXX

Expiration date: XX/XX/XXXX

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LHDs with Review Capacity Only

Feedback Form

TITLE OF INFORMATION COLLECTION: Feedback form for soliciting feedback from local health departments (LHDs) on CDC’s Interim Local Health Department (LHD) Strategy for Response, Control, and Prevention of Healthcare Associated Infections (HAI) and Antibiotic Resistance (AR).

PURPOSE: CDC will collect feedback from LHDs on the interim strategy and supplemental materials to
inform updates to the strategy based on the needs and experiences of LHDs.

Dear Reviewer,

Thank you for agreeing to review CDC’s Interim Local Health Department (LHD) Strategy for Response, Control, and Prevention of Healthcare Associated Infections (HAI) and Antibiotic Resistance (AR). CDC requests your open and detailed feedback on the strategy and accompanying materials, with a particular focus on the perceived feasibility of strategy implementation, the relevancy of the strategy goals and objectives for your local health department/jurisdiction, the utility of the strategy materials and activities for your local health department/jurisdiction, and any specific changes to the strategy or materials that can be made to improve clarity of language or intent. The information you provide will be used to inform updates to the strategy and considerations for supplemental resources based on the needs and experiences of LHDs. We value your privacy and would like to assure you that all responses will be aggregated with those from other participants and deidentified before they are shared.

Guidance for LHDs with Review Only Capacity

For LHDs with review only capacity, please carefully work through the entire LHD HAI/AR Strategy webpage and its subpages and reflect on how it can be used to outline a strategic plan for your LHD to enhance your LHD’s work in HAI/AR. We are not expecting you to develop a formal strategic plan, but we encourage you to reflect on how the strategy content might help your LHD define strategic priorities. Once you have reviewed the strategy and reflected on your priorities, please complete this form to provide comprehensive feedback. You will be asked to provide feedback on key sections of the strategy in addition to its subpages, including the Framework for Implementation, the State HAI/AR Program Facilitation Guide, and the One Pager webpages as well as the Action Planning Tool and the Glossary and Resources webpages. CDC estimates that your review of the strategy webpage and subpages will take approximately up to 4 hours, including the time it takes to complete this feedback form. Please note, review of strategy materials and completion of the feedback form is self-paced. This form does not have to be completed all at once. You may revisit this form at any time during the review period.

Guidance for LHDs with Review and Implement Capacity

For LHDs with review and implement capacity, please carefully work through the entire LHD HAI/AR Strategy webpage and its subpages and use it to outline a strategic plan for your LHD to enhance your LHD’s work in HAI/AR. Once you have reviewed the strategy and outlined your strategic plan, please complete this form to provide comprehensive feedback. You will be asked to provide feedback on key sections of the strategy in addition to its subpages, including the Framework for Implementation, the State HAI/AR Program Facilitation Guide, and the One Pager webpages as well as Action Planning Tool and the Glossary and Resources webpages. CDC estimates that your review of the strategy webpage and subpages will take approximately up to 4 hours, including the time it takes to complete this feedback form. Please note, review of strategy materials and completion of the feedback form is self-paced. This form does not have to be completed all at once. You may revisit this form at any time during the review period. Once you have completed this form and submitted it to SSET, you will begin implementing the strategy components based on your strategic plan outline with consult from CDC and partners through ad hoc touchpoints. At year-end you will complete a survey, using your Feedback Form for additional guidance as necessary.

Feedback Form Guidance for All Participants

This feedback form is organized by the strategy’s goals, objectives, and activities. For each set, there are two types of questions

1. Overall set questions – Please provide an answer based on each goals / objectives and levels / activities set as a whole.

2. Goal and objective specific questions – Please provide an answer based on the individual goal or objective within the set.

Note: For questions that require you to rank your responses on a scale from 1-5, please use the following assignment for rank:

1. 1 – Not at all

2. 2 – Slightly

3. 3 – Moderately

4. 4 – Very

5 – Extremely

To complete and submit the feedback form, please complete the following steps:

• Access the survey at this link

• For open-ended questions, type in your responses to each question in the space provided

• For questions that require you to rank your response on a scale from 1-5, click on the box to the right of the number that best describes your experience

• Save and submit the form by clicking the ‘submit’ button after completing all required questions

• Reach out to [email protected] if you have any questions

For additional assistance or questions about this tool, including questions about the deadline, please contact the pilot team at [email protected].

Thank you for your participation and continued support,

State Strategy and Evaluation Team

Division of Healthcare Quality Promotion

Name:
Email Address:
Local Health Department:

OVERALL – Strategy Goals and Objectives

Please read through and reference Table 1: Strategic Goals and Objectives for LHDs of the LHD HAI/AR Strategy webpage to answer the following questions:

1. Would you add to or eliminate anything from the three goals to make them more fitting for LHDs looking to strengthen their capacity to respond to, control, and prevent HAI/AR? Please elaborate for each goal.

2. Do the three goals and corresponding objectives represent your LHD’s priorities in HAI/AR work? Are there other goals or objectives that your LHD is prioritizing? Please explain.

GOAL SPECIFIC – Goals and Objectives

Goal 1

Grow and expand networks across state, regional, and local levels through increased LHD communication and collaboration within the public health sector and among public-private sector partners.

Please read through and reference Table 1: Strategic Goals and Objectives for LHDs of the LHD HAI/AR Strategy webpage to answer the following questions:

1. Please rate Goal 1 on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

2. Would you add to or eliminate anything from Goal 1 to make it more useful for your LHD?

3. Would you recommend Goal 1 move forward for full implementation and inclusion in the final strategy? (select one)

Yes	☐
Yes, with modifications stated above	☐
No	☐

Goal 2

Build LHD operational capacity to conduct and promote sustainable HAI/AR infection prevention and control activities.

Please read through and reference Table 1: Strategic Goals and Objectives for LHDs of the LHD HAI/AR Strategy webpage to answer the following questions:

1. Please rate Goal 2 on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

2. What would you add to or eliminate from Goal 2 to make it more useful for your LHD?

3. Would you recommend Goal 2 move forward for full implementation and inclusion in the final strategy? (select one)

Yes	☐
Yes, with modifications stated above	☐
No	☐

Goal 3

Expand LHD HAI/AR infection prevention, outbreak response, and stewardship activities using data for action and prioritizing activities that increase impact on health equity.

Please read through and reference Table 1: Strategic Goals and Objectives for LHDs of the LHD HAI/AR Strategy webpage to answer the following questions:

1. Please rate Goal 3 on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

2. What would you add to or eliminate from Goal 3 to make it more useful for your LHD?

3. Would you recommend Goal 3 move forward for full implementation and inclusion in the final strategy? (select one)

Yes	☐
Yes, with modifications stated above	☐
No	☐

OVERALL – Levels and Activities

1. Is it easy to tell what ‘level’ you’d consider yourself? What additional information would you need to help determine which level your LHD most aligns to? How would this additional information help you determine this?

2. What ‘level’ would you categorize your LHD in relation to Goal 1?

Level 1	☐
Level 2	☐
Level 3	☐

3. What ‘level’ would you categorize your LHD in relation to Goal 2?

Level 1	☐
Level 2	☐
Level 3	☐

4. What ‘level’ would you categorize your LHD in relation to Goal 3?

Level 1	☐
Level 2	☐
Level 3	☐

OBJECTIVE SPECIFIC – Levels and Activities

Goal 1

Grow and expand networks across state, regional, and local levels through increased LHD communication and collaboration within the public health sector and among public-private sector partners.

Objective 1.1

Engage with the state HAI/AR program to determine priorities, state and local roles and responsibilities when working together, and to maintain coordination between the LHD and the state.

Please read through and reference the Objective 1.1 HAI/AR Activities section of the LHD HAI/AR Strategy webpage to answer the below questions. It is optional for you to answer questions pertaining to levels that are not applicable for your LHD. For example, if you categorize your LHD as Level 1, you may choose to skip questions pertaining to Level 3.

1. Please rate the Level 1 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

2. Please rate the Level 2 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

3. Please rate the Level 3 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

4. Would you recommend modifying the activities or their levels? (i.e., moving an activity to a different level?)

Objective 1.2

Grow and sustain relationships between healthcare and public health at the local level tailored to meet the LHD’s, healthcare facilities’, and providers’ needs.

Please read through and reference the Objective 1.2 LHD HAI/AR Activities section of the LHD HAI/AR Strategy webpage to answer the below questions. It is optional for you to answer questions pertaining to levels that are not applicable for your LHD. For example, if you categorize your LHD as Level 1, you may skip questions pertaining to Level 3.

1. Please rate the Level 1 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

2. Please rate the Level 2 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

3. Please rate the Level 3 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

4. Would you recommend modifying the activities or their levels? (i.e., moving an activity to a different level?)

Objective 1.3

Engage public health, healthcare, academic, and community partners in growing the partnership network to prevent HAI/AR in all patient populations within the local jurisdiction.

Please read through and reference the Objective 1.3 LHD HAI/AR Activities section of the LHD HAI/AR Strategy webpage to answer the below questions. You may, skip questions pertaining to levels that are not applicable for your LHD. For example, if you categorize your LHD as Level 1, you may skip questions pertaining to Level 3.

1. Please rate the Level 1 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

2. Please rate the Level 2 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

3. Please rate the Level 3 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

4. Would you recommend modifying the activities or their levels? (i.e., moving an activity to a different level?)

5. Would you add to or eliminate anything from the three objectives (Objective 1.1, 1.2, and 1.3) listed for Goal 1 to make them more useful for LHDs?

6. Would you recommend the three objectives (Objective 1.1, 1.2, and 1.3) listed for Goal 1 move forward for full implementation and inclusion in the final strategy? (select one)

Yes	☐
Yes, with modifications stated above	☐
No	☐

Goal 2

Build LHD operational capacity to conduct and promote sustainable HAI/AR infection prevention and control activities.

Objective 2.1

Increase local public health staff capacity, expertise, and confidence to conduct HAI/AR activities, in alignment with the overall state HAI/AR program strategy.

Please read through and reference the Objective 2.1 LHD HAI/AR Activities section of the LHD HAI/AR Strategy webpage to answer the below questions. It is optional for you to answer questions pertaining to levels that are not applicable for your LHD. For example, if you categorize your LHD as Level 1, you may skip questions pertaining to Level 3.

1. Please rate the Level 1 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

2. Please rate the Level 2 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

3. Please rate the Level 3 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

4. Would you recommend modifying the activities or their levels? (i.e., moving an activity to a different level?)

Objective 2.2

Increase local public health awareness of the latest HAI/AR guidance, data, programs, and policies that impact your community.

Please read through and reference the Objective 2.2 LHD HAI/AR Activities section of the LHD HAI/AR Strategy webpage to answer the below questions. It is optional for you to answer questions pertaining to levels that are not applicable for your LHD. For example, if you categorize your LHD as Level 1, you may skip questions pertaining to Level 3.

1. Please rate the Level 1 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

2. Please rate the Level 2 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

3. Please rate the Level 3 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

4. Would you recommend modifying the activities or their levels? (i.e., moving an activity to a different level?)

Objective 2.3

Increase interjurisdictional infrastructure and sustainability of local HAI/AR infection prevention and control activities, in alignment with the overall state or regional strategy (see also Goal 1, objective 1.3).

Please read through and reference the Objective 2.3 LHD HAI/AR Activities section of the LHD HAI/AR Strategy webpage to answer the below questions. It is optional for you to answer questions pertaining to levels that are not applicable for your LHD. For example, if you categorize your LHD as Level 1, you may skip questions pertaining to Level 3.

1. Please rate the Level 1 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

2. Please rate the Level 2 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

3. Please rate the Level 3 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

4. Would you recommend modifying the activities or their levels? (i.e., moving an activity to a different level?)

Objective 2.4

Develop and/or update local healthcare preparedness and response plans to have capacity for responding to healthcare outbreaks.

Please read through and reference the Objective 2.4 LHD HAI/AR Activities section of the LHD HAI/AR Strategy webpage to answer the below questions. It is optional for you to answer questions pertaining to levels that are not applicable for your LHD. For example, if you categorize your LHD as Level 1, you may skip questions pertaining to Level 3.

1. Please rate the Level 1 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

2. Please rate the Level 2 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

3. Please rate the Level 3 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

4. Would you recommend modifying the activities or their levels? (i.e., moving an activity to a different level?)

5. Would you add to or eliminate anything from the four objectives (Objective 2.1, 2.2, 2.3, and 2.4) listed for Goal 2 to make them more useful for LHDs?

6. Would you recommend the four objectives (Objective 2.1, 2.2, 2.3, and 2.4) listed for Goal 2 move forward for full implementation and inclusion in the final strategy? (select one)

Yes	☐
Yes, with modifications stated above	☐
No	☐

Goal 3

Expand LHD HAI/AR infection prevention, outbreak response, and stewardship activities using data for action and prioritizing activities that increase impact on health equity.

Objective 3.1

Implement HAI/AR outbreak and response strategies using data to identify appropriate participation in local, regional, and state-wide approaches.

Please read through and reference the Objective 3.1 LHD HAI/AR Activities section of the LHD HAI/AR Strategy webpage to answer the below questions. It is optional for you to answer questions pertaining to levels that are not applicable for your LHD. For example, if you categorize your LHD as Level 1, you may skip questions pertaining to Level 3.

1. Please rate the Level 1 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

2. Please rate the Level 2 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

3. Please rate the Level 3 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

4. Would you recommend modifying the activities or their levels? (i.e., moving an activity to a different level?)

Objective 3.2

Implement infection prevention activities using available data to tailor and focus efforts.

Please read through and reference the Objective 3.2 LHD HAI/AR Activities section of the LHD HAI/AR Strategy webpage to answer the below questions. It is optional for you to answer questions pertaining to levels that are not applicable for your LHD. For example, if you categorize your LHD as Level 1, you may skip questions pertaining to Level 3.

1. Please rate the Level 1 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

2. Please rate the Level 2 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

3. Please rate the Level 3 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

4. Would you recommend modifying the activities or their levels? (i.e., moving an activity to a different level?)

Objective 3.3

Implement antibiotic stewardship activities using data to tailor and focus efforts.

Please read through and reference the Objective 3.3 LHD HAI/AR Activities section of the LHD HAI/AR Strategy webpage to answer the below questions. It is optional for you to answer questions pertaining to levels that are not applicable for your LHD. For example, if you categorize your LHD as Level 1, you may skip questions pertaining to Level 3.

1. Please rate the Level 1 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

2. Please rate the Level 2 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

3. Please rate the Level 3 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

4. Would you recommend modifying the activities or their levels? (i.e., moving an activity to a different level?)

Objective 3.4

Support HAI/AR activities that promote health equity and are aligned with state health equity priorities.

Please read through and reference the Objective 3.4 LHD HAI/AR Activities section of the LHD HAI/AR Strategy webpage to answer the below questions. It is optional for you to answer questions pertaining to levels that are not applicable for your LHD. For example, if you categorize your LHD as Level 1, you may skip questions pertaining to Level 3.

1. Please rate the Level 1 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

2. Please rate the Level 2 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

3. Please rate the Level 3 Activities for this objective on a scale from 1-5 in terms of the extent to which it meets each of the criteria below

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for program improvement in HAI and AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

4. Would you recommend modifying the activities or their levels? (i.e., moving an activity to a different level?)

5. What would you add to or eliminate from the four objectives (Objective 3.1, 3.2, 3.3, and 3.4) listed for Goal 3 to make them more useful for your LHD?

6. Would you recommend the four objectives (Objective 3.1, 3.2, 3.3, and 3.4) listed for Goal 3 move forward for full implementation and inclusion in the final strategy? (select one)

Yes	☐
Yes, with modifications stated above	☐
No	☐

OVERALL – Supporting Materials

Please read through and reference the Framework for Implementation, State HAI/AR Program Facilitation Guide, and One Pager webpages as well as the Action Planning Tool and the Strategy Resources webpages to answer the following questions:

1. Which of the above strategy materials are most helpful for LHDs looking to expand their capacity to prevent and respond to HAI/AR and why?

2. What strategy materials would you add to or eliminate from this list to improve the strategy’s utility for LHDs and why?

MATERIAL SPECIFIC – Framework for Implementation

Supporting Material

Framework for Implementation

Please read through and reference the Framework for Implementation webpage to answer the following questions:

5. Please rate the Framework for Implementation on a scale from 1-5 in terms of the extent to which it meets each of the criteria below:

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for providing instructions on how to use the strategy	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

6. Do the expected outcomes written in the “Expected Outcomes by Level” section for Goal 1, 2, and 3 represent priority areas in HAI/AR work for LHDs? Why or why not? What outcomes would you add to or eliminate from this section?

7. Do the expected outcomes written in the “Expected Outcomes by Level” section for Goal 1, 2, and 3 seem likely to occur as a result of conducting the activities outlined in the strategy for each goal?

8. What additional information could be added to the “Step 3. Develop an Action Plan” section that would help your LHD to develop an Action Plan for HAI/AR?

Supporting Material

Facilitation Guide

Please read through and reference the State HAI/AR Program Facilitation Guide webpage to answer the following questions:

1. Please rate the State HAI/AR Program Facilitation Guide on a scale from 1-5 in terms of the extent to which it meets each of the criteria below:

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for facilitating conversations with your state HAI/AR program on key roles, responsibilities, and priorities	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

2. In what ways could the Facilitation Guide be improved to help LHDs better understand the state’s HAI/AR priorities?

Supporting Material

Action Planning Tool (only relevant to select LHDs)

If applicable, please read through and reference the Action Planning Tool to answer the following questions:

1. Please rate the Action Planning Tool on a scale from 1-5 in terms of the extent to which it meets each of the criteria below:

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for planning and documenting the strategic goals, objectives, and activities related to your LHD	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

2. If you used this resource, how can the “Action Planning Tool” be improved to make it more useful for LHDs in terms of planning and documenting their strategic goals, objectives, and activities?

Supporting Material

Strategy Resources (only relevant to select LHDs)

If applicable, please read through and reference the Strategy Resources webpage to answer the following questions:

1. If applicable the Strategy Resources webpage on a scale from 1-5 in terms of the extent to which it meets each of the criteria below:

Relevant to LHDs seeking to enhance their work in HAI/AR	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐
Useful for providing additional context and guidance	1 ☐	2 ☐	3 ☐	4 ☐	5 ☐

2. If you used this resource, how can the “Strategy Resources” be improved to make it more useful for LHDs in terms of providing additional context and guidance?

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