The example scenarios below illustrate how PHAB’s Tools for Transformation can be used independently, or in conjunction with one another, to both inform and support transformation and modernization efforts. It is important to note that these are examples only. The Tool(s) that a department or system chooses to deploy should be based on the data or information needed to support that health department/system’s transformation efforts and ultimately the outcome that is to be achieved. The Tools for Transformation Selection Matrix may be helpful in Tool selection. If you have questions regarding the Tools or would like help with Tool selection, email [email protected].

Example Scenarios

A state health department worked in collaboration with their local health departments and the state’s association of county and city health officials (SACCHO) to develop a shared vision for public health for their de-centralized state. They used the FPHS Planning Guide to inform their planning efforts. As part of the visioning process, they identified the need for more data and information on the system’s current capacity related to Foundational Public Health Services (FPHS) service provision, workforce, and cost. They determined that this information could best be obtained in a consistent way by having all local health departments, and the state health department, complete the FPHS Capacity and Cost Assessment Tool. With support provided by the state health department, the SACCHO, PHAB, and an external consultant, every health department completed the assessment. Those data were included in PH-LIFT to allow for benchmarking against similar health departments. The results were provided for each individual health department and were also rolled up into a statewide summary report. The resulting data identified gaps in overall staffing and financing across the system as well as gaps in service delivery in two rural regions of the state. Based on the results, two transformation-related action items were identified: 1) use PHAB’s Roadmap to Develop Sharing Initiatives in Public Health to identify and implement shared service arrangements in the two rural regions experiencing gaps in overall capacity, and 2) advocate for an increase in state budget allocations for public health to support delivery of the FPHS across the state using data and information gleaned from the assessment to inform both the budget request and associated justification . As an added bonus, the accredited health departments in the state had the option to count this capacity and costing work towards their annual report submission, receiving credit for the “Reflection and Learning” requirement.

A centralized governmental public health system comprised of a state health department and six regional health departments received a multi-year federal grant to support expanded infrastructure and public health transformation efforts. A collaborative was formed at the state level with representatives from the state health department and each regional health department to begin planning an approach to the work. The collaborative adopted the national FPHS Framework and used the FPHS Planning Guide to support their efforts. They also joined PHAB’s 21st Century Learning Community to have access to ongoing peer learning, resource sharing, support, and technical assistance. The collaborative established a shared vision that all health departments in the state would achieve PHAB Accreditation by the year 2030. The collaborative agreed this would ensure delivery of the 10 EPHS and FPHS across the state, give community members confidence in services being provided by health departments, and place the system on a solid path of continuous quality improvement and innovation.

The state and regional health departments each completed the Accreditation Readiness Assessment. Each department received a report outlining their strengths and opportunities for improvement and a summary report was developed for the state system. Each department established a 2-year plan for addressing gaps identified through their individual assessments, a handful of joint, system-wide initiatives were also selected, and the state was also able to identify and package state-wide documentation for use by the regional health departments for accreditation. The collaborative also realized that more information regarding current and anticipated spending on the delivery of FPHS would also be needed to inform future regional/state budget requests. Plans were put in place to complete the FPHS Capacity and Cost Assessment in Year 2 of the grant leveraging some of the data that had been collected for the Accreditation Readiness Assessment. The Capacity and Cost Assessment would supply the collaborative with quantitative data on current vs. necessary financial resources and staffing needed to deliver on the FPHS, and help make the case for expanded investments in public health by the state legislature. These investments would further support achievement of the state’s vision of all health departments being fully accredited by 2030.

A small, rural health department in a decentralized state adopted the FPHS Framework as a guide to ensure the minimum package of public health services were available to all community members in their jurisdiction. The Health Department Director (HDD realized the need to first understand the agency’s current capabilities related to the delivery of the FPHS. She worked with her leadership team to collectively complete the PHAB Readiness Assessment. The resulting report showed areas of strengths as well as gaps in service delivery related to the Foundational Capabilities. More specifically, gaps were identified in Assessment/Surveillance and Communications capabilities. To address the gaps, the leadership team decided to look at staffing levels. The HDD worked with the HR Director to complete the Public Health Workforce Calculator which estimates the number of staff needed to deliver on the Foundational Capabilities and Areas, in relation to similar sized health departments. The HDD and HR Director compared the estimates from the Calculator to current staffing levels devoted to those two capabilities and determined they needed an additional 1.5 FTE for Assessment/Surveillance and 1 FTE for Communications. The HR Director used this information to estimate the costs associated with the new positions and the HDD then made a successful expansion request to the County Commissioners for an additional 2.5 FTE using the FPHS Framework, Readiness Assessment results, and Public Health Workforce Calculator estimates as justification.

Staff in a chronic disease program at large, accredited metropolitan health department were interested in expanding equity-related initiatives within their youth tobacco program. The use of flavored e-cigarettes, especially among male youth was continuing to increase and traditional programs were not achieving the desired outcomes. The Division Administrator was very supportive as this work as it would: 1) support a priority within the department’s strategic plan; 2) have the potential to improve both reach and impact among affected populations, 3) address the need for new, innovative approaches to outreach and prevention efforts; and 4) support the department’s reaccreditation efforts particularly related to applying an equity lens across programs/services and fostering innovation. At the urging of the Division Administrator, staff reached out to the department’s Accreditation Coordinator (AC) for guidance to ensure their approach was aligned with requirements set forth in the Reaccreditation Standards and Measures. They also invited a colleague from the Office of Epidemiology to join the team as they knew that data would be needed to identify disproportionately affected populations, inform decision making, and support evaluation efforts.

The AC was aware of two additional PHAB resources that he shared with the team – the Moving into Equity Guide and the Innovation Playbook. The Moving into Equity Guide provided a set of practical ideas from the field and served as a starting point and a frame for thinking about what it meant for the program to move into expanded equity work. This guide helped staff define what they were trying to accomplish and provided some initial ideas to get their creative juices flowing.  The Innovation Playbook guided them through the process of generating creative, innovative strategies to address the issue – which included engaging youth from the community to understand the problem and identify solutions more clearly. The team set to work and are currently piloting a new innovative initiative, designed with the input of the youth, to address the use of flavored e-cigarettes in five high sale census tracts in their community. If the pilot is successful it will be adopted as a standard program for their community and expanded to other high sales/use areas throughout the jurisdiction.

A Tribal Health Department had just updated their three year strategic plan. An objective under the Advance a Culture of Quality priority was to become fully accredited by the end of the current strategic planning cycle. Leadership and staff wanted this designation to: 1) increase their Tribe’s trust in the quality of services being provided by the Department; 2) place them on a path of continuous quality improvement; and 3) increase their ability to compete for grant funding. They reached out to [email protected] to inquire about approaches and were encouraged to begin by completing the Accreditation Readiness Assessment. The Department’s leadership team, with input from staff, completed the assessment. PHAB provided a report that outlined the Department’s strengths and areas for improvement. One significant gap was the Department’s capacity related to data sharing (Measure 1.2.2). During the review call, PHAB pointed them to the Roadmap for Sharing Services and the Tribal Epi Centers as potential resources for addressing gaps related to this measure. The leadership team also expressed concerns about their readiness to apply for Accreditation based on the assessment results. PHAB suggested they consider the Pathways Recognition Program as a possible starting point. This would allow the Department to achieve some level of recognition for their work related to the Foundational Capabilities while serving as an intermediate step towards initial accreditation. Leadership decided to go this route. They spent the next year engaged in PHAB’s Pathways Cohort as they worked to address gaps identified through the Readiness Assessment. The Department received Pathways Recognition in year 2 of their strategic plan cycle. Leadership was aware that another benefit of Pathways Recognition was that if they applied for initial accreditation within 2 years of completing a Pathways track, they could transfer all Largely and Fully Demonstrated scores, would not need to be reassessed on those measures, and also benefit from a reduction in fees. Staff were so engaged and the Department had made so much progress towards addressing gaps in their original assessment, Leadership decided to leverage this positive momentum and apply for Initial Accreditation. The Department received their accreditation designation a year later.