LPHSA: East Tennessee Region Vignette
Local Public Health System Assessment
The East Tennessee Regional Health Office (ETRO) serves a predominantly rural 15-county region which surrounds but does not include Knox County. The regional office has oversight responsibilities for the 15 local health departments in the region, which serve a total population of 600,000. Each county conducts a community assessment and planning process that is overseen by local health councils. ETRO, which assists in these efforts, began its own internal organization planning process to supplement local efforts and to devise a plan for future efforts. As part of this organizational assessment, ETRO used the Essential Public Health Services to analyze its internal activities.
After using a Vision Quest process to develop a vision, mission, and slogan for the organization and to identify four priority strategy areas, ETRO used the essential services to define common threads and areas across programs within the four strategy areas. Cross-disciplinary strategy teams attempted to redefine the essential services using common language developed by each team. For example, the outreach team and a strategy team focusing on case management redefined the essential services from the outreach point of view, keeping mind that all health department programs have an outreach component. This activity helped build participants' ability to think in terms of the essential services and to establish the foundation for performance measurement work.
ETRO then used the performance measurement tool to review the activities for each essential service across all health department levels (local, regional, and state). Using the performance measurement instrument, ETRO county and regional staff walked through each essential service and discussed the activities taking place in each indicator. To facilitate a dynamic discussion, only the model standards (or paragraphs describing the ideal community) were shared with all participants. The group discussed how health department activities matched those in the model standard. The facilitator used the objective questions to prompt the discussion. For each indicator, the groups discussed the level of importance and current status (similar to the methodology in APEXPH Part I) and used the results to identify challenges and opportunities.
The internal performance measurement process was conducted in anticipation of working through the same tool with local health councils and other community representatives. Although ETRO is still deeply involved in this process, it has already seen benefits from using the essential services. The essential services provided a good framework for ETRO to use in educating staff about public health activities, analyzing what is being done, and identifying areas for improvement.