NURS 6730 Week 10 strategic plan example

Four Priorities and Two Refusals: A Strategic Plan for a Three-County Health District Funded Mostly by Restricted Money

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College of Nursing, Walden University

NURS 6730: Public Health Nursing Leadership

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Month Day, Year

Four Priorities and Two Refusals: A Strategic Plan for a Three-County Health District Funded Mostly by Restricted Money

Mission and Vision

Mission. The district protects the health of every resident of its three counties by preventing disease, keeping water and food safe and reaching families where they live.

Vision. Every household in the district, on a farm road or in the county seat, can count on the same basic public health protection.

Environmental Scan

The scan is organized around the three forces that decide what this district can actually do: funding, mandates and politics. A generic strengths and weaknesses grid was considered and set aside because it tends to list assets without showing which of them the district controls.

Funding. Most district revenue is restricted to single programs through state and federal grants and permit fees. The flexible share, state per-capita aid and the three-county levy, covers the salaries of the epidemiologist, the health officer and some administrative staff. National estimates show that public health spending in the United States has been small relative to health care spending and uneven across places and years (Leider et al., 2018). An analysis of local health departments over more than a decade found that increases in public health spending were associated with later declines in deaths from preventable causes (Mays & Smith, 2011). The plan reads those findings as a reason to protect flexible money, not as a promise that more of it will come.

Mandates. State law requires communicable disease investigation, well and septic permitting and food service inspection. Grants carry their own required work. Anything else the district does, including the community health assessment, is chosen by the board.

Politics. Three county commissions appoint the board and set the levy in proportion to population. The smallest county watches for services drifting toward the county seat, a concern sharpened by the recent satellite clinic consolidation. The farm community is wary of anything resembling new regulation.

Priority 1: Protect the Foundational Services Floor

The Foundational Public Health Services describe a minimum set of capabilities and program areas every health department needs, and they have been used to estimate what that floor costs (Resnick et al., 2017). This priority comes first because every other one depends on it.

Goal. The district sustains communicable disease control, environmental public health, assessment and communications at the level the state requires. Objectives. Keep the epidemiologist position funded from flexible revenue each year; complete the community health assessment on its scheduled cycle. Lead. Health officer. Funding. State per-capita aid and levy. Yearly measure. Share of required disease investigations started within the state's time standard. Risk. A levy reduction in any county would reach this priority first, because it is the only one paid mostly from flexible money.

Priority 2: Safe Water for Households on Private Wells

Goal. More households on private wells know what is in their water. Objectives. Adopt the point-of-sale testing rule proposed to the board; offer subsidized test kits at two county fairs each year. Lead. Environmental health supervisor. Funding. Permit fees for administration of the rule; kit subsidy from a state drinking water grant the district will apply for. Yearly measure. Number of private wells with a recorded test result. Risk. Organized opposition from realtors or the farm bureau at the rule hearing could stall the rule for a year; the district's answer is to keep the rule limited to information, with no treatment requirement.

Priority 3: Sustain Maternal and Infant Home Visiting

Goal. Families with infants in all three counties keep access to nurse home visits. Objectives. Bill Medicaid for eligible visits in every quarter; hold the smallest county's caseload at or above its level before the satellite closed. Lead. Community health nursing supervisor. Funding. Medicaid reimbursement and a dedicated share of levy, replacing the lost state grant. Yearly measure. Number of families visited, by county. Risk. Reimbursement varies with enrollment and billing rules, and if it falls short the board would have to choose between this priority and the reserve.

Priority 4: Keep the Workforce Intact

Goal. The district keeps the people it cannot quickly replace. Objectives. Name a trained backup for each single-incumbent role; offer flexible scheduling and remote data work where duties allow; propose a pay review to the board in the second year. Lead. Health officer with the administrative services manager. Funding. Existing position budgets; any pay change requires a board decision. Yearly measure. Number of single-incumbent roles with a trained backup. Risk. Nurses can earn more at the regional hospital for the same work, and no measure in this plan closes that gap alone.

Supporting Role: The Farm Stress Coalition

The district convenes the farm stress and behavioral health coalition, and the extension office chairs it. The plan commits a few hours of a nurse's time each month and assessment data, and it does not list the coalition as a district priority because the district does not control its resources or its outcome.

Proposals the District Declines

Strategic planning for public organizations requires deciding what not to do as much as what to do (Bryson, 2018). Two popular proposals are declined for the plan period.

A mobile clinic van. Commissioners in the smallest county proposed one after the satellite closed. The district has no stable money for a vehicle, a driver and a nurse, and grant-funded vans often park when the grant ends. Home visits reach many of the same families.

A district-run youth vaping campaign. Parents and one school board asked for it. Both school districts already deliver prevention curricula, and a separate district campaign would duplicate their work with money the foundational floor needs. The district will share data with the schools instead.

Alignment With the Community Health Improvement Plan

The community health improvement plan, developed with partners through the Mobilizing for Action through Planning and Partnerships process, names access to care, safe drinking water and mental health among its priority areas (National Association of County and City Health Officials [NACCHO], 2023). Priorities 2 and 3 carry the district's part of the first two; the coalition carries the community's work on the third. Priorities 1 and 4 have no line in the improvement plan because they concern the district's own capacity, and the plan says so openly rather than stretching the alignment. The board will review each yearly measure at its first meeting of the year and revise the plan when funding or mandates change.

References

Bryson, J. M. (2018). Strategic planning for public and nonprofit organizations: A guide to strengthening and sustaining organizational achievement (5th ed.). Wiley.

Leider, J. P., Resnick, B., Bishai, D., & Scutchfield, F. D. (2018). How much do we spend? Creating historical estimates of public health expenditures in the United States at the federal, state, and local levels. Annual Review of Public Health, 39, 471-487. https://doi.org/10.1146/annurev-publhealth-040617-013455

Mays, G. P., & Smith, S. A. (2011). Evidence links increases in public health spending to declines in preventable deaths. Health Affairs, 30(8), 1585-1593. https://doi.org/10.1377/hlthaff.2011.0196

National Association of County and City Health Officials. (2023). MAPP 2.0 user's handbook.

Resnick, B. A., Fisher, J. S., Colrick, I. P., & Leider, J. P. (2017). The Foundational Public Health Services as a framework for estimating spending. American Journal of Preventive Medicine, 53(5), 646-651. https://doi.org/10.1016/j.amepre.2017.04.015