Department of Epidemiology&Community Health Course Descriptions

Public Health Organization and Management
Semester course; 3 lecture hours. 3 credits. This course addresses management and organizational issues in regards to public health agencies. Students will learn about the different models for structuring public health agencies, personnel management issues, evidence-based public health program planning, financing and budgeting issues.
Fall semester

At the completion of this course students should be able to state why knowledge of public health administration is important to the daily activities of a state, local or federal health agency.

The student should be able to discuss the role of the following issues in managing an agency or department within agency, or a program within a department.

Major topics to be covered

Organization into departments, offices, bureaus, and programs.
Development of a financial structure
Development of a budget
Different types of budget: Performance Budgets, line item budgets, program budgets
Expenditure and management accountability
Development of Strategic Plans
Development of objectives within a budget framework
Development of a staffing plan
Hiring, development, evaluation and control of personnel.
Understanding the interface between agency management and organizational politics.
Development of short range, medium range and long range plans
Use of disease , disability and death data to formulate community PH plans
Interface between mangers at different levels with an emphasis of the unique role of state employees performing on behalf of local entities.
The interface between cooperating agencies within the human services and environmental; services efforts.
The varied expectations of a public health agency by the public it serves
Management of program areas and development of grants for their support with an emphasis on the MCH, Infectious Disease and Environmental areas.
Development of a balance between health protection and health promotion.
Use of health informatics the enhance effectiveness of public health efforts (including GIS and PH)
The role of the assurance functions of the health agency, When to deliver clinical services, when to contract for their delivery.
Statutory services vs. desired services.
Communicating with the public
About programs & services
About Hazards
A day in the life of a health director

Session responsibilities . (A session is an evening's set of three lectures.)

Each evening has learning objectives set for the evening, found below the topics for the evening.

For each evening the student will have six days to complete an approximately 100-150 word essay on the VCU Discussion Board which will be marked by the evening lecturer(s) & Dr Buttery with a grade from A to D (A=92 and above, B = 82-91, C =70 =81 D=<70) information should be placed on the discussion board no later than midnight of the day prior to the next class.

The scores will be weighted so that each week's discussion contributes 2.5% toward the final course total, the mid Term Exam counts for 28 points and the Final Exam for 20 points for a course total of 100. The grades for all members of a group will be the same for the mid term and final exams so it is important for each group to work as a team.

Dr. Buttery's Essays

PowerPoint Support presentations

Required Textbooks - Governing by Network from the Brookings Institute and Essentials of Public Health Management

Week 1	August 30 Introduction
Read Essay 1 GxN Chapter 1 Org Chart-VDH Board of Health Public Health Foundation Assn of State & Terr. HOs	Hour 1 – Dr Robert Stroube Slides	Course Introduction and The Role of the State Health Commissioner, the Board of Health and the State and Local Health Departments in protecting and promoting the Public's health
DHHS DHHS Org Chart CDC FDA NIH ATSDR	Hour 2 – Jeff Lake	Organization of Federal Public Health Agencies and relationships to State Health Departments
Read essay 2, and Chap 3 Intro to PH by Schneider, 2nd Edn State PH Workforce Issues Local Health Districts NACCHO Operational Definition of a LPHA Read Chapter 1 of assigned textbook (also p 71-74)	Hour 3 – Jeff Lake	Organization of State and Local health agencies and their support groups
Spreadsheets for study (See Tips) Chesterfield Crater Hanover Henrico Rappahanock District Team Assignments Key Word/Phrases : Board of Health, Commissioner, Local Health Director, Advisory Boards, Legislators, General Assembly, Cabinet, Federal Agencies, programs, staff, responsibilities At the conclusion of this evening's lectures the students should be able to describe: The administrative functions of a state health commissioner and the dual responsibility of the Commissioner to a governor, cabinet secretary and advisory/administrative board. The alternative development of local health districts from single administrative districts such as Richmond City or Fairfax County to multiple jurisdiction districts such as the Three Rivers district, and the different management challenges affecting the local director. The relationship between state & federal agencies and should be able to name the major federal agencies with which state & local health districts/departments have to work Different state organizations for local districts. Some of the national resources available for local health directors .
Week 2	September 6 - A Day in the Life of a PHD
All: Slides, Handouts PHM Chapter 3	Hour 1	Dr Bill Nelson
Slides, Handouts	Hour 2	Dr Michael Royster
Slides, Handouts	Hour 3	Dr Mark Levine
Key Words/Phrases: district, responsdiblity, staffing, community reaction, community information, community partnerships, rapid reaction, staffing, hazards, management Following these presentations the students will be able to describe and discuss The day of local health director The scope of issues the director and staff will be required to manage on a daily basis Common issues Uncommon issues Problems of dealing with the public Successes dealing with the public Plans for program improvement The tasks we do best The tasks that are most difficult Future plans
Discussion Board Question What do you believe are some of the best and most difficul responsibilities of being a State Heath Director?
Week 3	September 13 - Budgeting
Read essay 3 GxN Chapter 2 PHM Chapter 21	Hour 1 – Nancy Roberts focuses on budgeting in health services, financial statement preparation, information systems Budget .pdf Handout	Define and describe types of budgets and developing a financial structure for an agency
The Cooperative Budget - Mechanics The Local Health Department Budget	Hour 2- Joanne Wakeham Ph D Slides Handouts (.pdf) formulation of strategic business plans within the context of economic health policy. Students learn managerial theory and practice pertaining to organizational behavior,	Development of a budget
Identify 5 LHDs and ask groups of 5-6 students to review their 2005 budget presentation and present suggestions for improvement in class as the mid tem exam	Hour 3 – Dr. Bill Nelson Slides Handouts (.pdf) C consensus building and prioritization of goals, conflict resolution, and negotiation strategies	Management of a budget
Key Words/Phrases: line item, program, budget, financing, spread sheets, descriptions, databases, budget office, internal auditor, economic plan, strategic plan, goals and objectives, cooperative budgats At the end of this set of lectures the students should be able to describe: The different types of budgets used in Public Health administration They should be to describe the financial base for budget development They should be able to describe the work flow in development of a budget They should be able to describe the purpose for development of a budget?
Discussion Board Question What are the most important responsibilities in developing a budget?
Week 4	September 20 - Fiscal Accountability
Read GxN Chapter 6 Slides Handouts	Hour 1 ??Steve Sullivan?? Developing budgets with multiple sources of funds. Allocating priorities within resources	Accounting principles in management of state and local funds
Read essay 5	Hour 2	Principles of managing grant funds
Use case studies from PHF web site?	Hour 3	Principles for managing funds for purchases of goods and services Performance Management – See PHF Infrastructure site
Key Words/Phrases: Accounting, budget managemnt, financial accountabilty, program accountabiity, merging multiple fund sources, contracting principles, objective accountability, cooperative funding. Grants accountablity. Management accountablity, administrative acountabliity. At the conclusion of this set of lectures students should be able to describe The elements of a performance budget The elements of a program budget Multiple sources of funding and problems of merging resources Principle of managing grant funds Principles of bidding and managing contracts.
Discussion Board Why is accountability important?
Week 5 PHM CHapters 13 & 17	September 27 - Personnel Management Purposes of Position Descriptions and How to Write Them
Read GxN Chapter 7	Hour 1 VDH – George Pilarinos	Developing a job position
Supporting Documents/Handouts	Hour 2 George's Slides Handouts (.pdf)	Selecting staff Staff development & Training
	Hour 3	Managing staff, including job performance
Key Words/Phrases: Job description, periodic evaluation, performance expectations. hiring, firing, probation, supervision, promotiojn, EOP, coaching, referral. At the and of this series of lectures students should be able to describe Personnel Profiles Development of a job description Hiring Evaluation Constructive advice firing Equal opportunity requirement Referral for behavioral misbehaviors
Discussion Board Why are standards important in evaluating employees?
Week 6	October 4 - Planning
Read essay 3 Read GxN Chapter 5, also pp 40-48, 51 PHM Chapter 6	Hour 1 Dr. Bill Nelson Slides, Handouts	At the LHD
	Hour 2 Joanne Wakeham,PhD Slides, Handout	PHPPO NPHPSP NALBH Public Health Preparedness and infrastructure
The Public Health Information Programs	Hour 3 Jeff Caldwell Slides, Handouts	What is it. What & how to present How to present difficult issues
Key Words/Phrases: Departmental Planning, short range, long range, objective setting, plan description, objectives, community definiton, stakeholders, surveys, datasets, measurements After these lectures students should be able to describe The elements of a district health plan Elements of public health performance Resources for evaluation What to included in a plan What is “turning point” What is the public health program office How a local plan relates to a state plan and to the “Healthy People” objectives.
Week 7	October 11 – Mid Term Test
This session will be used by teams to present their evaluation of a current health department budget . The student group will identify strengths and weaknesses and determine the focus of the budget and what alternatives they could suggest for its presentation. What they believe is missing and why. This will take 15 minutes. The remainder of the class will have 10 minutes to question-critique the presentation.
Read essay 11	Hour 1	2 group presentations on budgets
See Tips	Hour 2	2 group presentations on budgets
Mid Term Evaluation sheet	Hour 3	group presentations on budgets
Discussion Board Where would you look for the best advice in developing your local health department plan, and why?
Week 8	October 18 –Epidemiology & Community Assessment
Read essay 3 again Slides	Hour 1 ? (Tools)	Expand on CA from Intro to PH course (3rd week)
Read GxN Chapter 4 Also pages 99-110 Handouts (.pdf)	Hour 2 Healthy Communities (Virginia Atlas)	Data available to local health department staff – Use Virginia as an example
also read Chap 11, Schneider, Intgro to PH, 2nd Edn. PHM Ch 4	Hour 3 Healthy Communities	Development of partners in assessment, how to develop a statement of the assessment and the community's expected response.
Key Words/Phrases: Communtiy Assessment, objective evaluation, community definiton, stakeholders, surveys, datasets, measurements, partnering, networking After this set of lectures the student should be able to describe The elements of an assessment Selection of assessment target Identification of financial resources Identification of assessment partners Use of surveys Use of medical/hospital resources Use of citizens The report
Discussion Board Question What major changes to policy at VDH coccurred from the work of Turning Point.? What data sets do you believe were most important to the Turning Point assessment.

Week 9 PHM Chapter 34	October 25- Program Management – Clinical
Essay 9 Family Health Services MCH Slides-1 Handouts	Hour 1 Dr. Suttle	MCH Programs
Essay 7 Dr Armstrong's Slides: Handouts	Hour 2 Dr. Carl Armstrong	Infectious Disease
MCH Slides 2; Handouts	Hour 3 Dr. Suttle	Special Programs
Key Words/Phrases: Programs, program budgets, program objectives, program effectiveness, grants clinical emphasis After this session the students will be able to describe Programs within a state/local organization with examples from the MCH, Infectious Disease and specialized program areas. The goals of the programs The objectives of the programs How progress is measured Problems with measuring progress.
Discussion Board Question What are at least 5 major differences between managing a district budget and a developing budgets for state Public Health Agency divisions such as Maternal & Chlid Health or Epidemiology Divisions?
Week 10	November 1 - Program Management Environmental
Essay 8 Read GxN Chapter 3	Hour Bob Hicks Slides, Handouts	Politics of septic tanks and alternatives.
Slides, Handout	Hour 2 – Dr.Khizer Wasti	Toxic/Hazardous wastes
Slides, Handouts	Hour 3 - Kim Buttery	Housing & Health ( The Built Environment)
Key Words/Phrases: Programs, environment, waste disposal, sewage, water, acquifers, septic tank, alternatives, toxic wastes, toxicity, disposal, evaluation, hosuing standards. After this set of lectures to students will be able to describe: The administrative/management issues of issuing septic tank and well permits The interested parties to issuance of such permits How complaints of failed systems are resolved administratively & legislatively What make a chemical toxic The federal and state agencies involved in resolution of toxicity disputes. When the state health department becomes involved in issued of toxicity. How a toxicity notice is developed and information transmitted How the state health department becomes involved in issues of adverse housing What health problems may be associated with unsafe houses The role of local health departments in unsafe housing review
Discussion Board Question 1)Why do you believe politics can plays an important part in environmental management?OR 2) After working in the the Housing Project model, what do you believe are important steps in developing any public health related project?
Week 11 PHM Ch 31	November 8 - Program management
Essay 9: Slides, Handouts	Hour 1 Joe Hilbert	Health promotion principles
Slides, Handouts	Hour 2 Ramona Schaeffer	Promotion vs. Protection
Slides, Handouts	Hour 3 Dr. Thorpe	Examples of programs
Key Words/Phrases: Health promotion, disease prevention, primary prevention, secondary prevention, tertiary prevention, Healthy People (US, Canada, UK) state programs, Public awareness Following these presentations students will be able to describe and discuss The state health department's initiatives in chronic disease prevention and amelioration The policy development issues in developing a SHD initiative The interested parties in development of this policy The various programs that can reduce chronic disease prevalence in the state How goals and objectives are set and measured Various initiatives developed at the state and local levels. How a local health department/district becomes involved Management issues involved in development of these programs.
Discussion Board Question What is the difference between health promotion and prevention? Give at least two examples of each.
Week 12 PHM Scan Chs 3, 5, 8	November 15 - Public health programs and the political System
Where do we discuss PH in state exercises to reduce medical errors ? Slides, Handouts	Hour 1 Jack Lanier	Role of Chairman & members of the State Board of Health
PH role in Death & Dying, from Larry Gostin Slides, Handouts	Hour 2 Leonard Vance	how & when do public health staff need legal advice
Federal Role in EDPS Slides, Handouts	Hour 3 Lisa Kaplowitz	Emergency Response & Planning
Key Words/Phrases: Boatd of Health, State Policy, Legislative policy, Legal awarenss, Legal reponsiblities, Legal mandates, Legal limitations, 9/11 and changes of state responsibilities, Emergency Preparedness, public health role in community protection. After these lectures the students will be able to describe and discuss How and why State Board develops state wide policy Administrative steps in developing policy Who the board involves in setting state policy (legislators, citizens, interest groups) What legal exposures affect agency and department heads Who advises administrators about legal exposure How is legal exposure minimized Why is bio-terrorism an issue for local health departments How does the state set bio-terror prevention standards How is training developed for bio-terror prevention.
Discussion Board Question How do policies set by the state board or a program influence management activities?
Week 13	November 22 – Health Informatics
GXN Read pages 16-21, p119 PHM Ch 7 and 31	Hour 1 Dr Jim Burns	Why? What is It? The federal plan for EMR
	Hour 2	Linkages in public health NHIP
Essay 14	Hour 3	Hardware and software, how to select a IT provider
Key Words/Phrases: Data systems, Electronic Medical Records (EMR), state networks, data transfer district to district, state to federal, future tehcnology, public health linkages, district intranets After this set of lectures studenst will be able to describe and discuss The definition of health informatics The scope of activities encompassed by a SHD informatics program The state health department network Linkages between state, local and federal health and environmental agencies Types of data collected and managed Special informatic programs (immunization registries, cancer registries, vital data registries) Use if data in program evaluation Pitfalls in data collection Types of hardware and software standardized within health agencies Resources available to local managers The future of informatics
Discussion Board Question. What is the most important issue emerging in public health informatics and why?
Week 14 No vember 29 - Thansgiving Eve. VCU Closed
Week 15 Same groups as for midterm to present 5 year plans for PH improvement for selected LHDs or programs identified for midterm exam. Each will have 15-20 minutes to present and 10 mins. for critique by other teams and guests..	December 7 – Final exam. Final Exam - Grade Card	2 presentations each hour
Week 15 Group Community Assessmments Guide for Final Presentation: Present as a PowerPoint slide show (Bring a copy for me to put on the class web). I also expect each of you hand in to me a points score, from 1 to 10, on each your team mates. In assessing the contribution of your team mates consider the proportion of the final product contributed by each team member,. How much did the team members individually contribute toward the design of the final presentation? How much research did each member perform, Do you believe each member contributed the same effort? In performing the Community Assessment project for the final evening of the course you already know how much money is in the district budget for the various programs. What I want to know from you is: What do you propose as the important health indicators for your district? What are the death and birth rates? What is the need for environmental services (e.g.: soil, food, animal control)? How much prematurity compared to the state? What proportion of births out of wedlock ( why is this important?). What are the major causes of death? Are they different from the 2010 or state objectives? Can you find out from the Virginia Information Statistics what the main causes were for hospital discharge? Can you find data about the district immunization level? How much STD is there in your District? (is this incidence or prevalence? How complete is this data?) What does the BRFFS data for your district tell you about any need for changes in behaviors? When you have collected enough data to give you a picture of the district health status look at the budget and determine whether you would use the same budget priorities. If not, why not? If you would make changes how would you re-allocate the base budget ( making no assumptions about permission from the state budget office or the Secretary)? Where would you look for additional funds ( new fees, federal funds, grants, non profit funding agency, research grants?). Are there unmeet PH needs in the district? How would you make a case for additional resources to your local City Council or Board of supervisors? Remember you only have 15-20 minutes to present this material