County Board of Health Planning Process
CITY OF DUBUQUE, IOWA
MEMORANDUM
December 15, 1999
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
SUBJECT:
County Board of Health Planning Process
Public Health Specialist Mary Rose Corrigan has provided information on the
planning process that will be used for the transition of public health services with
the dissolution of the City Board of Health.
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Attachment
cc: Barry Lindahl, Corporation Counsel
Tim Moerman, Assistant City Manager
Mary Rose Corrigan, Public Health Specialist
Paul Buss, Director, Dubuque County Health Department
Mary Rose Corrigan, Public Health Specialist, City of Dubuque
Mary Pat Breitfelder, Director of Community Health Services, Hillcrest Family Services
Barbara Moran, Director, Visiting Nurse Association
Rod Tokheim, Vice-President Marketing and Planning
Art Roche, Director of Planning, both from Mercy Medical Center
The County Board of Supervisors also approved this process at their December 6, 1999 meeting.
will keep you informed as we proceed.
. '
To: Dubuque County Board of Public Health & Dubuque County Board of Supervisors
From: Rod Tokheim, Mercy Medical Center - Dubuque
Re: Planning Process Recommendations
BACKGROUND
At the joint meeting of the Dubuque County Board of Supervisors, Dubuque County Board of Health
and representatives of the City of Dubuque on Tuesday, November 16, I volunteered to develop a
process that the Board of Health and the Supervisors might use to help establish next year's county
public health funding priorities. To help me in this effort, I convened a task force made up of a
subgroup of the Healthy Dubuque Steering Committee. The task force met on Friday, November 19
to brainstorm with the resulting ideas contained in this memo. It is the task force's desire that I
distribute a written summary of our ideas regarding a possible county public health planning process
to members of the County Board of Health and Supervisors prior to their next meeting on December
8. Members of the task force will be present at the December meeting to answer any questions.
ADVISORY TASK FORCE
The following are members of the task force:
Julie McMahon - Bureau Chief, Iowa Department of Public Health
Paul Buss - Director, Dubuque County Health Department
Mary Rose Corrigan - Public Health Specialist, City of Dubuque
Mary Pat Breitfelder, Director of Community Health Services, Hillcrest Family Services
Barb Moran, Director, Visiting Nursing Association
Rod Tokheim, Vice President Marketing and Planning, Mercy Medical Center
Art Roche, Director of Planning, Mercy Medical Center.
In addition to providing recommendations regarding a process, members of the task force have
expressed willingness to volunteer their time to help support the proposed process. Specific task
force member assignments are listed below. While many of the members are happy to playa role,
it is anticipated that Paul Buss will serve as staff to this process and coordinate proposed activities.
RECOMMENDATIONS
Both short term and long range recommendations are listed below. However, given rapidly
approaching deadlines for budget development and the completion of the Iowa Department of Public
Health (IDPH) community assessment, the task force focused its initial attention on these issues
first. In addition the task force felt strongly that the County Board of Health and the Supervisors
should pursue public health planning and budgeting on a joint basis this year. The primary rationale
for this recommendation is to avoid duplication of effort and to facilitate consensus. (See figure #1
for a flow chart of these two processes.)
PROPOSED PROCESS FOR
PUBLIC HEALTH BUDGETING
AND STATE REPORTING
(figure # I)
IDPH COMMUNITY
AsSESSMENT
-
BUDGETING PROCESS
I Board of Health &
Supervisors review &
approve process
/
"
-
Staff & task force
develop educational
program
!
Staff distributes
IDPH reporting form
for comment
!
Board of Health &
Supervisors
education session
Staff & Healthy
DubuQue data assess-
ment sub-committee
complete rough draft
of IDPH reporting form
Public forum held to
review first draft of
IDPH communi~
assessment
Board of Health &
Supervisors first pri-
ori~ setting meeting
., Board of Health &
- ~ Supervisors second
priori~ setting
meeting &
public hearing
Edit IDPH communiry
assessment
form in light of counry
prioriry setting process
Staff complete
final public health
budget
....
Submit IDPH
communi~
assessment report
-
Counry Board of Health and Healthy DubUQue Screening committee work to determine role and goal
statements for their respective organizations. Establish planning and budgeting calendar for the next fiscal year.
1. Budgeting - Our group identified the following steps related to the development of a
county public health budget: general education regarding public health responsibilities and
expenditures; a mechanism for gathering input from impacted groups or organizations; and
a formal process of setting priorities for county expenditures in public health. It should be
noted that when we speak of the county health public budget we are referring to the entire
Board of Health budget and all other health related community service dollars expended by
the county. This second group would include a number of programs funded by various
IDPH grants that channeled through the county board of Supervisors and not the Board of
Health.
Education - Based on comments by members of the County Board of Health and
Supervisors during their November meeting, the subcommittee assumed that both groups
were interested in an educational session before proceeding. The task force tentatively
identified the Board of Health's January 18 meeting as a possible date for such an
educational session. listed below are the tentative topics for this session. Additional topics
may be covered. However, in order to provide appropriate preparation time, these topics
should be shared with the task force at your December 8 meeting.
· A review of county responsibilities relative to the provision of core public health
functions as identified in Chapter 137 of the Iowa Code and Chapter 77 of the Iowa
Administrative Code. While it is the task force's understanding that such an
education program has already occurred, a brief review is still seen as appropriate.
Mary Pat Breitfelder has agreed to develop this presentation for the joint educational
session.
· A review of how Dubuque County compares to the state of Iowa on a number of
traditionally measured public health dimensions. Paul Buss and Mary Rose Corrigan
will be responsible for organizing and presenting this portion of the session.
· A high level review of the source and use of public health funds in Dubuque County
by core public health functions/ essential public health services. This information will
be prepared by Julie McMahon.
· A three year analysis of Dubuque County public health statistics including but not
limited to information on the number of clients served and dollars expended. While it
is intended that Barb Moran will present this topic, others including Paul Buss, Mary
Rose Corrigan, Julie McMahon, Jan Hess and Rod Tokheim will help prepare this
information.
· A profile of public health service providers in Dubuque County including: specific
services provided, clients served, total expenditures by service and corresponding
unit costs by service. Again Barb Moran will present, and Paul Buss, Mary Rose
Corrigan, Julie McMahon, Jan Hess and Rod Tokheim will help prepare the
information.
· A comparison of how other urban Iowa counties organize and fund their public health
functions. This information has already been compiled, and Jan Hess is in the
process of obtaining a copy of the information. Presentation of information will
probably be made by Jan Hess with one or more of the Directors of Public Health
from either Scott, Lynn or Blackhawk available to answer questions. No confirmation
of the latter group is yet available.
Another educational opportunity for the County Board of Health and Supervisors is the
results of the Community Assessment of Human Needs recently completed by Mercy
Medical Center. This study was commissioned by Mercy's Institutional Ethics Committee to
help direct where the hospital's future charitable efforts should be focused. The study was
conducted by Art Roche, Mercy's director of planning. The study involved interviews with
approximately 50 community leaders, members of social service agencies, school faculty
and selected members of the actual poor residing in our community. The purpose of the
study was to develop a profile of what these individuals consider to be the most important
social needs in the Tri-State area. Art Roche would be glad to share the actual written
study and make a presentation on it just before the first priority setting session.
The final recommendation regarding education involves community education and the role
of media in the process. It is the recommendation of the task force that local media be
invited to attend any and all meetings and that press releases be prepared in advance of
these meetings to highlight and explain key points of the process. Paul Buss, Mary Rose
Corrigan and the City Public Information Officer would be responsible for preparing these
releases.
Input - The task force feels the County Board of Health and Supervisors should seek
additional input this year into their state reporting / annual planning and budgeting
processes. This extra effort is seen as particularly important in light of possible funding
short falls and changing public health priorities.
The first way that the task force recommends additional input be sought is by having the
county sponsor a public forum to gather feedback on information collected as a part of the
state reporting / annual planning process. (More will be written about this in the section on
state reporting and annual planning.) While task force members are willing to lead this
meeting, it is hoped that County Board of Health and Supervisors will attend in order to
directly hear community comment. Paul Buss and Jan Hess would be responsible for
4
setting up the meeting. Paul Buss and Mary Rose Corrigan would facilitate it, and prepare
possible pre-meeting materials and media release.
A second way additional input might be sought is through a public hearing that is part of
the second priority setting meeting. At his meeting Paul Buss will highlight which public
health initiatives he recommends funding in light of available dollars and the priorities
established by the County Board of Health and Supervisors at their last joint meeting.
Affected groups should be invited to this meeting and given an opportunity to make
comment on the director's recommendations before the County Board and Supervisors
approve the final priority list.
Priority Setting - Priority setting could be handled during the Board of Health's regularly
scheduled meetings in February and March. Representatives of the media and groups or
organizations which may be affected by a reprioritization of county funding should be
encouraged to participate in the priority setting sessions . The length of the February
meeting may need to be extended to accommodate all the issues to be covered. The first
meeting would take place in late February with the following proposed agenda:
· Review core public health functions and essential public health services
· Review input from public forum and state reporting priorities identified by public
health staff
· Review list of programs presently funded by the county
· Brainstorm additional public health needs not presently served
· Rank order existing programs and newly identified needs.
Mary Rose Corrigan, Paul Buss and Rod Tokheim will facilitate this first meeting. Once the
County Board of Health and Supervisors have rank ordered programs, Paul Buss and Jan
Hess will meet to identify projected costs for the prioritized programs. Paul Buss and Jan
Hess will then create a list that identifies which rank ordered programs can be funded given
the county public health budget submitted in January. This list should also include
unfunded prioritized programs as well. The March priority setting meeting will then involve
the review and approval of the list of programs to be funded as identified by staff. The
task force recommends that representatives of affected organizations and media be invited
to this meeting. Once the final list of projects has been approved, Paul Buss should provide
formal notification to both funded and unfunded organizations. A previously prepared
media release developed by Paul Buss and Mary Rose Corrigan should be distributed that
5
night to members of the media who are present. Those not present should be faxed a copy
of the release the next morning. Once the prioritization process has been completed Paul
Buss will complete a formal public health budget.
2. IDPH Community Assessment - The importance of completing this process can not be
understated. Results of the Dubuque County assessment will be used in conjunction by
our local Empowerment Board and the State of Iowa as it makes decisions regarding
Dubuque area requests for funding. In future years the task force recommends that the
IDPH Community Assessment be completed in advance of the budgeting process.
However, this year the task force sees these two processes running concurrently rather
than sequentially. Integration of the two processes will take place at the time of the open
public forum discussed earlier. The task force identified the following steps as necessary
for the successful completion of the IDPH Community Assessment.
First, Paul Buss and Mary Rose Corrigan will take the form that the county needs to
complete as a part of this process and distribute sections of the form to the organizations
that are responsible for the issues covered by that particular section
Paul Buss and Mary Rose Corrigan will meet with Art Roche to determine what information
he and/or the Data Assessment Sub Committee of Healthy Dubuque might be able to
provide them to complete the Community Assessment.
Paul Buss, Mary Rose Corrigan and Art Roche will collect and synthesize input and
information from the various organizations that were solicited in order to complete the state
report.
Paul Buss and Mary Rose Corrigan will make a presentation to County Board of Health and
Supervisors regarding results outlined in IDPH Community Assessment. Art Roche will
present findings of Community Assessment of Human Needs study commissioned by
Mercy. The study includes the results of interviews with over 50 area human service
providers and actual program recipients. Focus of the study was identification of what
various groups identified as the most critical human services issues facing the Dubuque
area at this time.
Paul Buss and Mary Rose Corrigan will present results of IDPH Community Assessment at
open public forum.
Paul Buss will integrate results of open public forum and county prioritization process into
the IDPH Community Assessment and submit on April 1.
6
3. Long Range Planning and Organizational Issues - Once the more pressing budgeting and
state reporting/annual planning issues have been resolved, the task force and the rest of
the Healthy Dubuque Steering Committee would like to work with the County Board of
Health to clarify our respective roles. The Healthy Dubuque Steering Committee has
enjoyed a productive relationship with the County Board of Health over the years. As a
result of changing public health demands and increasingly limited dollars for direct care and
planning, members of the Healthy Dubuque Steering Committee have come to feel that the
time is right for the committee to review its role and annual activities or goals. However,
as we have attempted to do this, it has become clear that we can not accomplish this
without a better understanding of the County Board of Health's needs. That is why we
would like to work jointly with the County Board of Health to define both our purposes and
goals. The benefit to the county is that if we are successful the Healthy Dubuque Steering
Committee can continue to serve as a cost effective resource to the county. Another
expected outcome of such an effort would be development of a new job description for the
County Director of Public Health that clearly defines how this individual will support and
work with both groups. Outlined below our the task force's ideas on how our two groups
might engage in such a joint visioning process.
Paul Buss collect mission statements and director job descriptions from county health
department around the State of Iowa.
Rod Tokheim and Paul Buss draft Role and Goals statement for the County Board of Health.
New statement to be presented at their May meeting.
County Board of Health review, edit and approve role and goal statement. County Board of
health appoint a subcommittee to be chaired by Jan Hess, Dubuque County Personnel
Director, to 1) develop a new job description for the County Director of Public Health and
2) develop a new state reporting/annual planning and budgeting calendar for the next fiscal
year.
Rod Tokheim will work with the Healthy Dubuque Steering Committee to develop a new
role and goal statement for the committee. Healthy Dubuque Steering Committee will then
establish new activity calendar for the next fiscal year.
7
DUBUQUE COUNTY PUBLIC HEALTH PLANNING & BUDGETING PROCESS CALENDAR
Activity Person Responsible Date
1. Distribute planning process outline to Rod Tokheim 11-30-99
members of the County Board of Health
and Supervisors
2. Draft sample media release Mary Rose Corrigan 12-3-99
3. Review proposed process and make County Board of Health 12-8-99
recommendation on future directions Supervisors
4. If approved, distribute release to Paul Buss 12-8-99
media Mary Rose Corrigan
5. Finalize Planning & Budgeting Paul Buss 12-15-99
Calendar Jan Hess
6. If approved, edit proposal based on Rod Tokheim 12-17-99
Board of Health and Supervisor input
7. Distribute sections of IDPH Paul Buss 12-17-99
Community Assessment reporting form Mary Rose Corrigan
to key constituent organizations and
solicit input from them for inclusion in
final report
8. Reserve space for community forum Paul Buss 12-17-99
to take place in early February
9. Invite Directors from other eastern Paul Buss 12-17-99
Iowa Public Health Departments to
attend County Board of Health and
Supervisor January education session
10. File status quo initial budget Paul Buss 1 -1 -00
estimates for county public health
expenditures
8
11 . Complete materials for Board of 1 - 7 -00
Health and Supervisor education session
* County Responsibilities Mary Pat Brietfelder
* Public Health Measures Mary Rose Corrigan &
Paul Buss
* Source & Use of Funds Julie McMahon
* Dubuque County Activity statistics
Barb Moran
Paul Buss
Mary Rose Corrigan
Jan Hess
Rod T okheim
Julie McMahon
* Dubuque County Provider Profile Barb Moran
Paul Buss
Mary Rose Corrigan
Jan Hess
Rod Tokheim
Julie McMahn
* Comparison with other urban county Jan Hess
public health functions
12. Distribute Joint Education Session Paul Buss 1 -1 2 -00
materials Jan Hess
13. Draft news release regarding joint Mary Rose Corrigan 1-1 2-99
educational session Paul Buss
14. Joint Educational Session County Brd of Health 1 -1 9-00
and Supervisors
15. If approved, distribute news release Paul Buss 1 -1 9-00
to media if approved Mary Rose Corrigan
9
16. Collect input from key constituent Paul Buss Mid to late
organizations and for IDPH Community Mary Rose Corrigan January
Assessment Art Roche (Mercy)
17. Invite participants to Community Paul Buss Late
Forum Mary Rose Corrigan January
* Mail invitations to key organizations
* Develop and distribute media release
inviting general public to forum
18. Community forum Rod Tokheim Early
Mary Rose Corrigan February
* Provide input into IDPH Community Paul Buss
Assessment priorities
19. Conduct first priority setting meeting Paul Buss Late
Rod Tokheim February
20. Draft and distribute media release on Mary Rose Corrigan Day after
outcome of prioritization meeting Paul Buss prioritizatio
n meeting
21. Develop estimated costs for Paul Buss March
prioritized list of public health priorities Jan Hess
22. Contact organizations affected by Paul Buss March
new prioritization and invite to second
priority setting meeting / public hearing
23. Conduct second priority setting Paul Buss March
meeting and public hearing Jan Hess
24. Complete and file IDPH Community Paul Buss 4-1 -00
Assessment report Mary Rose Corrigan
25. Draft Board of Health role and goal Paul Buss April
statement Rod Tokheim
10
26. Board of Health meets to review and Paul Buss May
comment on role and goal statement. Rod Tokheim
Board appoints subcommittee to work on Jan Hess
new job description for Director of Public
Health consistent with new role and
goal statement
27. Board of Health of Health reviews Jan Hess June
and comments on new job description County Brd. of Health
for director Subcommittee
28. Healthy Dubuque Steering Rod Tokheim June
Committee meets to discuss their role in
light of new Board of Health role and
goal statement
29. Complete final budget
* Draft Paul Buss ??????
* Community Board of Health Approval Community Board of ??????
Health
* Supervisors Approval Supervisors ??????
11
MEDIARElEASE
City of Dubuque Health Services Department · City Hall Annex, 1300 Main St. · Dubuque, IA 52001-4732 · (319) 589-4181
For Immediate Release
Date:
Contact:
Phone:
December 9, 1999
Mary Rose Corrigan
(319) 589-4181
OR
Paul Buss
(319) 557-7396
The Dubuque County Board of Health approved a public health planning process at their
December 8, 1999 meeting. The process will incorporate a transition from having a City and
County Board of Health to one County Board of Health, and will also facilitate a community
health assessment prioritization process, followed by appropriate public health budgeting for
the County Board of Supervisors.
Members of the County Board of Health appointed task force who will work on this process
include:
Dr. John Viner, MD, Chair, County Board of Health
Julie McMahon, Bureau Chief, Iowa Department of Public Health
Paul Buss, Director, Dubuque County Health Department
Mary Rose Corrigan, Public Health Specialist, City of Dubuque
Mary Pat Breitfelder, Director of Community Health Services, Hillcrest Family Services
Barbara Moran, Director, Visiting Nurse Association
Rod Tokheim, Vice-President Marketing and Planning, Mercy Medical Center
Art Roche, Director of Planning, Mercy Medical Center
The process is anticipated to be completed in April 2000 with the culmination of a final public
health budget for the County and the submission of a community health assessment report to the
Iowa Department of Public Health. Additional duties will include long range planning and
organizational issues for the County Board of Health, including the role of the Healthy Dubuque
Steering Committee.
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