Public Health Strategic Planning: Don’t Skimp on the SWOT

Strategic Planning, CON/CHNA/Regulatory, Public/Population Health

As Covid-19 slowly transitions from pandemic to endemic status, state and county governments all across the country are reckoning with the lessons of a two-year public health emergency. One area getting a lot more focus: public health strategic planning.

The Build Back Better Act requested more than $16 billion for healthcare infrastructure, including $7 billion specifically reserved for public health departments at the state and local level. While the future of the bill is very much in question, those spending priorities suggest that public health is more visible and more valued than ever before in Washington.

Meanwhile, at the state and local level, public health departments are getting unprecedented – and sometimes unwelcome – attention as politicians grapple with the pandemic’s social and economic fallout. Departmental budgets and boundaries are suddenly matters of intense debate, and public health experts are being drawn into the political fray like never before.

We can’t predict how all of this will end, but we can say with certainty that local departments with a strong strategic plan will be in the best position to weather the storm. Of course, “strong” is a relative term, but we’re seeing a clear desire among our clients to do planning that gets “out of the weeds” of the pandemic and focuses on a future vision for the organization and its leadership role in community health.

Based on our 25-year history in public health strategic planning, we suggest starting with a thoughtful SWOT analysis supported by three stages of research: statistics, setting, and surveying.

In this post, we’ll detail each step of the research process, including tips for saving time and money.

Statistics

Strategy can’t be defined in a vacuum. Every need or opportunity is relative, so it’s critical that public health leaders understand the context in which they operate. The right statistics allow you to measure your county’s health indicators against other counties in the state and around the nation. Gathering these numbers used to be a laborious and expensive prospect, but recently that has changed for the better, thanks to publicly available databases.

To get a helpful, high-level view of some key socioeconomic data, a great place to start is the Community Need Index (CNI) from Dignity Health and Truven Health Analytics. Searchable down to the Zip code level, CNI looks at factors such as income, education, insurance, and housing to calculate a standardized score for health disparities. The index ranges from 1.0 (lowest need) to 5.0 (highest need), and communities with a higher CNI generally see higher rates of healthcare utilization. For instance, admission rates in a community with a 5.0 CNI score are about 60 percent higher than admission rates for a community with a CNI score of 1.0.

The Robert Wood Johnson Foundation offers an even more powerful tool with its County Health Rankings (CHR). Based on 35 health factors and health outcomes, CHR ranks every county in a given state from Healthiest to Least Healthy. There are graphs showing how the factors have changed over time, and users can drill down to isolate disparities based on race, income, and other characteristics.

Of course, consulting firms like Ascendient will go much deeper, using additional data to break out disparities or analyze trend lines in ways that just aren’t possible using freely available sources. Still, CHR and CNI can provide public health leaders with a solid baseline for understanding the healthcare needs in their area – without resorting to expensive, proprietary data sets.

Setting

Statistics are a must, but they can only provide a snapshot, while health and healthcare are more like an epic movie. To really keep up, you need a sense of the larger story – how the environment is changing and what that could mean for your community. When we’re engaged for public health strategic planning, we typically analyze six to twelve key trends affecting our clients, including demographic shifts, healthcare expenditures, chronic disease rates, and federal priorities and innovations.

Keeping up with national forces that impact local health and healthcare might just be the most time-consuming part of the entire strategic planning process. Every day, hundreds of thousands of words are published on the latest data and trends. At the very least, it’s worth keeping up with the public health channel from Kaiser Health News and of course The Nation’s Health, published by APHA.

Just absorbing all the information can be overwhelming, but it’s not enough: The real value lies in connecting the dots to get a clear picture of the threats and opportunities emerging within a two- to five-year time frame. National conferences might help at a high level, but trends can play out very differently in a local context.

Our best tip: If you’re not ready for a full consulting engagement, at least reach out to several firms to inquire about a customized, day-long education session for your executive leaders. (Better yet, ask local hospitals if they’d like to share the cost.) It’s a one-time investment that can help provide you with direction for years to come.

Surveying

Surveying the local health and healthcare landscape is easy, thanks to an IRS requirement that nonprofit hospitals must publish a triennial Community Health Needs Assessment (CHNA). Reviewing these assessments is a good way for public health leaders to “gut check” their priorities for outreach, access, and health factors. Of course, an individual hospital may have different priorities than the county overall, but it’s always a good exercise to talk through those differences and justify the county’s position.

In addition to surveying the landscape, we also recommend surveying leaders in the community, including education, public agencies, nonprofits, healthcare, and major employers. A good survey would include about 10 to 15 questions, focused mostly on perceptions and awareness of the health department:

• What do you think we do best?
• Where do we most need to improve?
• What do you think of our staff?
• How are we doing with community partnerships?

There is no substitute for this kind of primary research, and an independent research team is an absolute necessity for getting transparent, useful feedback. If an outside consulting firm is too much of a budgetary stretch, we recommend reaching out to a local university for help in designing, fielding, and analyzing your community leaders survey. However you go about it, this is one of the smartest investments you can make in public health strategic planning, because your SWOT analysis depends on clear, honest survey responses.

SWOT Analysis

This is where everything comes together to answer the all-important question, “Where are we?” By clustering key research findings under the headings Strengths, Weaknesses, Opportunities, and Threats, public health leaders can begin to visualize their strategic position within a constantly shifting environment.

If the SWOT nomenclature seems redundant or unclear, it can be helpful to remember that Strengths and Weaknesses are internal to the organization, while Threats and Opportunities are part of the external environment. To unpack that further with a few examples:

• Strengths are internal positives, such as effective grant writers or strong community awareness
• Weaknesses are internal negatives, such as outdated IT or duplication of services
• Opportunities are external positives, such as a growing population or new federal funding programs
• Threats are external negatives, such as wage inflation or new Covid outbreaks

At Ascendient, we like to plot Strengths, Weaknesses, Opportunities, and Threats on a matrix to create a kind of “heat map” for our public health clients.

By this point, it should be clear why good research is so important. If you haven’t done the hard work of gathering good inputs ­– statistics, setting, and surveys – you won’t have the outputs needed to populate your heat map. Even with good research, you’ll need to think carefully about where you fall on the matrix, because each quadrant has its own “strategic mindset” regarding growth, investment, programming, and so forth.

This blog post is just the first section of a longer white paper entitled The Ascendient Guide to Public Health Strategic Planning. Click here to read the entire Guide.