National Public Health
Performance Standards Program (NPHPSP)
Facilitators Guide for Local Public Health
System Assessment
1. Begin your group session, introduce yourself, your recorder, and any
technical advisors and describe your roles. Ask all workgroup
participants to introduce themselves and sign the workgroup sign-in
sheet. State that the purpose of the groups work is to assess the extent
to which the local public health system meets or does not meet optimal
performance standards on their assigned Essential Services.
2. Review the ground rules, which you will find on a list on the
wall of your assigned room. Ask the group if they want additional ground
rules. If yes, add them to the list.
3. Review materials provided to participants: color voting cards, pencils
and paper. Also point out that you have a glossary of terms in
case questions about terminology arise.
4. Review charts on the wall:
1) Essential
Services: chart of all 10 Essential Services that provide the
framework for the NPHPS by describing those things that should be
undertaken by the public health system.
2) The Public
Health System picture emphasizing all the different sectors comprising
the system as a WHOLE. This is a good time to remind participants to keep
in mind that the assessment is of the entire system and not just the
organization they are representing.
3) Voting scale:
to be used as a reminder when it is time to vote. Point out that you will
come back to this
4) Ground Rules: Review and ask if they would like to add others.
5) Orient the Group
to the Essential Services: read aloud the Essential Services you
will be covering.
5. Review the Assessment Tool.
There are four
categories which represent major activities or practice areas for each
Essential Service:
- Planning
and Implementation
- Technical Assistance and Support
- Evaluation and Quality Improvement
- Resources
Each category includes:
- The LPHS
Model Standard that describes optimal performance for a public health
system
- 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.
6. Review the
Process
LPHS participants will arrive at consensus responses by discussing the
model standards and then voting. Participants will discuss each model
standard for a set period of time (e.g., seven minutes). After discussion,
participants vote (using color-coded cards) on responses to each stem
question.
# 1 Discussion:
Describe the process.
For example, you may state: I will read each model standard. We will
then open up the floor to a discussion on what your division/organization
does to contribute to meeting this standard and what we do collectively as
a public health system in meeting this standard. We will then rate/vote on
the stem questions related to the model standard.
#2 Voting
Make sure each
participant has an orange, pink, yellow and green card. Review what each
card represents according to the voting scale (also depicted on the wall
chart).
Yes:
greater than 75 percent of the activity described within the question is
met within the local public health system (in other words, we may not
have a 100% optimal system related to the question, but we do have a very
high level of system-wide functioning related to the question)
High
Partially:
greater than 50 percent, but no more than 75 percent of the activity
described within the question is met within the local public health system
(in other words, we have a good system-wide effort going on related to
the question, but we still have a way to go to meet the standard)
Low
Partially:
greater than 25 percent, but no more than 50 percent of the activity
described within the question is met within the local public health system
(in other words, we have some activities going on related to the
question, but not enough to put us into the higher ratings)
No:
no more than 25 percent of the activity described within the question is
met within the state public health system (in other words, we may have
a few activities going on related to the question, but they are minimal at
best)
How much systems
activity is enough in deciding how to vote? (This relates to the last two
questions for each model standard.) It may be helpful to reiterate some
basic parameters in thinking about how well the local public health system
is functioning. Think about the focus of the question in terms of:
Dispersion:
is the activity in the question disseminated/dispersed across the
state geographically or does it exist in only one area?
Is the activity done in only one area of public health concern (e.g.
maternal and child health) and not in other areas of interest
(e.g. chronic disease, infectious disease, injury prevention, etc.)?Participation
among many system partners:
is the activity done only in one sector and not others (e.g. done in
hospitals, but not governmental public health agencies)?
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?
#3 Further Discussion
In the event there are
diametrically opposed answers, you may open it up for further discussion
and ask if the group would like to vote again.
7. Review tasks and timeframes.
Point out that there are a total of ______ hours to complete the assessments
for your assigned Essential Services. It will be important to think
through approximately how much time you have to spend on each Essential
Service, keeping in mind the number of indicators and assessment
questions. Some indicators may go faster than others, and you can
readjust. Keep in mind that it goes more quickly the more familiar
participants become with the process.
8. Complete the
Assessment
Step #1 Discussion:
a. Read the Essential
Service and the activities included.
b. Read the first
Indicator and then the first Model Standard.
c. 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.
d. Ask the group to
take a few minutes and think about what their division/organization
does to contribute to meeting the standard?
e. Ask the question, what is the collective picture of how we are doing in Florida related
to this standard?
f. Allow time for
discussion. The discussion is
over when the facilitator determines enough time has been spent on the
discussion or there seems to be no further discussion needed.
Step #2 Voting:
a. Read the first stem
question under the Model Standard pointing out that the question relates
back to the Model Standard. The facilitator may suggest that participants
take a moment to read the sub-questions. Then ask if anyone wishes to
have further discussion on this specific question. Are we ready to vote?
Begin moving through the questions and ask participants to hold up their
votes.
b. The facilitator may
want to briefly review the color coded cards.
c. After participants
hold up their cards, read aloud the vote e.g. 5 yes, 7 high partially, 3
low partially.
Step #3 Further
Discussions, if appropriate
In the event there are diametrically opposed answers, (this will
happen rarely) the facilitator asks if the group would like more
discussion. If so, open up the discussion again for an allotted amount of
time. Ask if the group would like to have a re-vote.
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 questions for those who scored it high. As an
alternative you can also ask the low scores why they didnt score higher
and the high scores why they didnt score lower.
Facilitation 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
- Remind
participants that the purpose is to get an honest and accurate perception
of the strengths and weaknesses of the system to help with quality
improvement initiatives. Participants and/or organizations are not being
judged by their answers.
- Encourage concrete examples of activities, but discourage anecdotes!
- Encourage voting
without discussion on the assessment questions.
- Emphasize
similarities and points of agreement
- Keep track of time!
Ground Rules for
Facilitators
- Clearly define roles
- Make sure
participants are physically comfortable
- Share meeting ground
rules and enforce them when necessary
- Act in a neutral
manner (refrain from giving personal opinions)
- Maintain a positive
group atmosphere
Suggested Meeting
Ground Rules
- One person speaks at
a time
- Be respectful of
others
- Stay on task, limit
anecdotes
- No sidebar
conversations
- Honor time limits
- Cell
phones/blackberries on mute/vibrate
