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Setting
Priorities and Objectives
Overview
The process of setting priorities and objectives is
challenging. With limited resources, competing agendas,
and precious time, certain guidelines need to be agreed
upon up front. Steering committee or advisory group
members should decide how quantitative and qualitative
data, assets, political agendas, public opinion, or
other factors will inform the priority setting process.
Once priorities are agreed upon and in place, it sets
the tone for a smoother objective setting process. RC/EZ/ECs
can adopt and adapt the models and tools developed by
national health planning efforts such as Healthy
People 2010 and the Healthy
Communities Initiative.
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Stories
and Models from the field
EZ Considers Rural-Specific Healthcare Problems
When Setting Priorities
Southwest Georgia United Empowerment Zone (Round II)
The Southwest Georgia United Empowerment Zone is a
rural EZ located in Cordele, Georgia, that serves Crisp
and Dooly Counties. While rural healthcare systems face
many problems that are also found in urban systems,
rural systems are also affected by their own specific
problems. The Southwest Georgia United EZ investigated
the problems specific to its rural community to help
it determine health priorities.
Rural systems, like the Southwest Georgia United EZ,
serve small markets, have significantly smaller hospitals,
and generally lack resources available to urban systems.
Even with good roads and telecommunications, they are
still considered isolated by many medical professionals.
Due to the limited market size, broader market forces
fail to penetrate the rural areas. Many rural hospitals
are still using a reimbursement mode of operation, with
the hospital considered a profit center. Most urban
systems have moved toward a capitated managed care mode,
with the hospital considered a cost center. Rural EZs
also have limited healthcare resources, personnel, and
facilities.
Considering the rural specific health concerns in addition
to the needs and assets of the EZ, the Southwest Georgia
United EZ developed a list of priority healthcare issues,
which include:
- Lower Medicare reimbursements than in urban area,
while up to 70% of all patients are Medicare or Medicaid
eligible
- A lack of home healthcare, caused by provisions
of the 1997 Balanced Budget Act
- Racism and continuing racial prejudice
- High percentages of indigent care
- A need for additional public education to inform
area residents of the services available through the
healthcare system and make them aware of the system's
accessibility
- How to address cultural issues ("I don't want charity")
The EZ will continue to work with healthcare providers
and the broader community to address these issues and
seek additional resources to resolve them.
Presented by Robert B. Cooke during the "Integrating
Health Planning into EZ/EC Community Development" conference.
December 5, 2000. For additional information please
contact Robert Cooke. rcooke@sowega.net.
Wilmington EC Sets Priorities and Objectives
The Wilmington, Delaware, Enterprise Community established
preliminary health priorities based on a community health
needs and assets assessment and the consensus of the
EC Health Benchmarking Task Force. Work groups used
these health priorities to clarify issues around which
they would develop goals and objectives. The Wilmington
EC work group, "Support Healthy Behaviors" drafted goals,
objectives, strategies, and responsible parties based
upon priority health issues and by utilizing the "Identifying
Goals, Objectives, Strategies, and Responsible Parties"
tool. To view Wilmington EC preliminary health priorities
and objectives, click
here.
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Tools
Identifying Goals, Objectives, Strategies, and Responsible
Parties
Provides explanations, tips, and examples of four elements
of a measurable health improvement plan: goals, objectives,
strategies, and responsible parties. Developed to help
the Wilmington EC work groups develop plans in a uniform
format. Designed to be used with Worksheet 1 below.
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Goal
Examples:
- Increase regular exercise among older
adults
- Ensure all children have access
to health care
- Eliminate second hand smoke in public
places
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What do you want to happen?
(Broad, indicates general purpose)
Tips:
- Begin with action words such as reduce,
increase, eliminate, ensure, establish,
etc.
- Focus on the end result of the community's
work.
Consider whether the goal is community-wide
or if it is important to specify a particular
population (by age, race, gender, ability,
socioeconomic status, or area).
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Objective
Examples:
- By June 2001, reduce tobacco use among
teens to 23% and young adults to 27% (target).
(Baseline: teens, 26%; young adults, 30%)
- By December 1999, reduce by 75% the
number of sales outlets where teens may
purchase cigarettes. (Baseline: to be
determined)
- By June 2000, increase physician use
of smoking cessation advice to patients
by 10%. (Baseline: CareFirst, 20%; Medical
Society members, 20%; Westside Health
Center, 40%)
- By December 2000, increase to 50% the
proportion of estimated eligible City
children who are enrolled in the State
Healthy Children Program (CHIP). (Baseline:
13%).
- By March 2000, increase to 90% the proportion
of City health care providers who have
bilingual staff on-site or who use trained,
on-call translators for non-English speaking
patients.
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How will we know if we reached the
goal?
(Offers specific and measurable milestones,
or benchmarks; sets a deadline; narrows
the goal by adding "who, what, when, and
where;" clarifies by how much, how many,
or how often)
Tips:
- Consider a wide range of things that
could indicate community progress toward
achieving health goals. Among these are
individual behaviors, professional practices,
service availability, community attitudes
and intentions, insurance status, service
enrollment, policy enactment, voluntary
participation in employer programs, organizations
that offer particular programs, policy
compliance/ enforcement findings, results
of population screening or environmental
testing, or the occurrence of events that
suggest breakdowns in the public health
system.
- Get ideas for your City from the state's
Year 2000 objectives, other state objectives
and the nation's draft Year 2010 objectives
(Healthy People 2010).
- Objectives need a target (the
desired amount of change, reflected by
a number or percentage) and a baseline
figure (where the community is now) drawn
from a specific data source. Exceptions
include policy or organizational objectives
that can be measured simply by being established.
- Don't be afraid to consider non-traditional
objectives that may resonate with citizens
of EC neighborhoods (e.g., "increase by
50% the percentage of pizza outlets that
deliver to neighborhoods after dark,"
as a proxy for violence).
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Strategy
Examples:
- Increase tax on cigarettes by at
least 16 cents. (State legislative bill,
advocate State Congressional delegation
support federal cigarette tax.)
- Provide skills training to 60 physicians
on effective smoking cessation counseling.
Provide free self-help smoking cessation
materials to health care providers.
- Enforce laws prohibiting tobacco
sales to minors, using undercover teen
customers to help monitor and enforce
seller compliance. (SYNAR)
- Coordinate private sector job programs,
linked to support services, for younger
siblings of parenting young adults, gang
involved youth, and other at-risk youth.
- Simplify CHIP eligibility application.
Expand sites promoting CHIP and application
assistance to employers, neighborhood
agencies, parish nursing, YWCA, and others.
- Expand insurance coverage for parents
of CHIP-eligible children. Tie to State
initiative on insuring adults, partner
with employers, and allow CHIP to contribute
to employee-based health plan.
- Provide targeted community outreach
to families not enrolled in CHIP. Use
health ambassadors in door-to-door recruitment
(Healthy Start), and apply for RWJ or
other grants to expand program.
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How will the objective be reached?
(Specifies the type of activities
that must be planned, by whom, and for whom)
Tips:
- Generate a list of strategies that gives
various sectors a job to do (e.g., businesses,
voluntary organizations, government, health
care organizations, social services, faith
organizations, and citizens). Consider
strategies that require sectors to work
together throughout the EC.
- Consider the specific assets of your
city and its Enterprise Community to choose
strategies that are achievable.
- Ask the Public Health Foundation for
technical assistance if you need more
information on strategies that have worked
around the country to address objectives.
Effective strategies may include:
- targeted economic development
- health education
- social marketing
- assessment & referral
- policy (legislation, regulation,
program policy)
- enforcement
- capacity building (new or improved
programs)
- coordination of services
- changing the social or physical
environment
- employer programs
- Consider strategies recommended in your
state or local Healthy People plan and
by other groups (such as PATCH, Planning
Councils, HIV Prevention Community Planning
Group, and the Tobacco Prevention Coalition).
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| Responsible
Parties |
Who will coordinate and do most of
the work?
Who else will be involved?
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Worksheet 1: Writing Objectives
This tool will help RC/EZ/EC work groups clarify and
record goals, objectives, strategies, and responsible
parties for a priority health area. Designed to be used
with the explanatory handout above, "Identifying Goals,
Objective, Strategies, and Responsible Parties."
| Priority Area: |
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Goal |
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| Available
Data Sources |
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| Potential
Objectives |
A. |
| B. |
| C. |
| Potential
Strategies |
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Potential Responsible Parties
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Worksheet 2: Initial Assessment
A tool as simple as a questionnaire completed by partners
will help clarify priorities and potential strategies.
As an initial step after reviewing needs assessment
data, ask members of the planning group to describe
the three most important health areas of concern for
the RC/EZ/EC in the next decade. For each issue, list
the primary goal and the primary strategy that has been
or could be used to approach it. After consensus on
the priorities has been achieved, consider this input
in ranking potential goals and issues to address.
| 1. |
Issue:
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| Primary
Goal: |
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| Strategy:
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| 2. |
Issue:
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| Primary
Goal: |
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| Strategy:
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| 3. |
Issue:
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| Primary
Goal: |
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| Strategy:
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Planned
Approach to Community Health (PATCH)
PATCH Chapter 4 - Setting Priorities and Objectives
- Provides examples, tools and resources for communities
on setting priorities and objectives.
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These technical assistance resources for RC/EZ/ECs were
funded by the Office of the Assistant Secretary for Planning and Evaluation,
U.S. Department of Health and Human Services (HHS), through a cooperative
agreement administered by the Health Resources and Services Administration
(HRSA), and prepared by the Public Health Foundation. Duplication
and adaptation, with credit, are encouraged. |
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Tips
for RC/EZ/ECs
- Learn what the community and key partners see as
important health issues.
- Build on community perceptions to gain broader
support for priorities.
- Establish priorities and objectives that resonate
with businesses in your
RC/EZ/EC .
- Make sure everyone understands and accepts the
process for recommending and adopting final priorities
OR consider if you want to set priorities at all.
- Assign accountability for the priority and objective
setting process.
- Strive for measurable objectives, but don't neglect
important health areas where measures need to be developed
and objectives may drive new data sources.
- Align priorities, objectives and strategies with
your RC/EZ/EC's strengths, assets, opportunities,
and tax incentives where possible.
- Organize objectives according to priority areas
in the RC/EZ/EC plan.
- Show respect for what already has been accomplished
to address priorities.
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Keep your objectives realistic.
- Don't chose a priority setting method that will
require data if it's not available for the RC/EZ/EC.
- Commission national surveys or use questions from
these surveys -
National Health and Nutrition Examination Survey
, National
Health Care Survey ,
National Health Interview Survey , or the
Behavioral Risk Factor Surveillance. System
- Look at projects local college or universities
are working on.
- When writing objectives, make them SMART:
Specific, Measurable, Appropriate,
Realistic, and Time-bound.
- Objective outline: "Who will do how
much of what, by when?"
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Links
EZ/EC
Health Benchmarking Demonstration Project - Lessons
Learned
Tools
and Resources From the EZ/EC Health Benchmarking Demonstration
Project
Community
Toolbox - Creating Objectives Chapter
Use this site to obtain information to help you
define and create objectives for health planning.
Healthy
People 2010 Toolkit - Setting Priorities and Objectives
Chapter
The Healthy People 2010 Toolkit provides guidance, technical
tools, and resources to help states, territories, and
tribes develop and promote successful state-specific
Healthy People 2010 plans. It can also serve as a resource
for communities and other entities embarking on similar
health planning endeavors. RC/EZ/ECs can find tools,
tips, and resources to help them set priorities and
objectives.
Health Care
Forum Outcomes Toolkit
"The Outcomes Toolkit provides a comprehensive approach
to planning and evaluating collaborative, cross-sectoral
efforts. The Toolkit integrates the process of defining
mission and outcomes, setting performance goals over
time, liking budget to performance, reporting results,
and ensuring accountability." In particular, the toolkit
establishes a process for setting priorities and tracking
progress against strategic goals.
PATCH
(Planned Approach to Community Health): Choosing Health
Priorities
This section of PATCH provides information on using
data to identify health problems, identifying programs
that already exist, assessing social, political, and
economic issues, and assessing the changeability of
a health issue.
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