How to Win Friends and Influence People in Public Health: Landing that First Big Job

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How to Win Friends and Influence People in Public

Health: Landing that First Big Job!

Presented by Glenn Czarnecki, TOH Regional Director-SE

ETSU December 1, 2015

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How to Win Friends and Influence People in Public

Health: Landing that First Big Job!

Presented by Glenn Czarnecki,

TDH Regional Director-SE ETSU

December 1, 201 5

II - .Health


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Overview Everything you wanted to know about Public

Health but were afraid to ask:

• Core functions of PH

• PH Structure in TN

• Funding

• RVU's

• Services

• How to Build a HD

• TPHA

• How to not get fired

• New Initiatives

ml Health


3. Overview Everything you wanted to kno...

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TENNESSEE DEPARTMENT OF HEALTH

• One of the largest departments in state government

• Over 5,000 employees

• Diverse programs

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4. TENNESSEE DEPARTMENT OF HEALTH One o...

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MISSION STATEMENT

To protect, promote and improve the hea Ith and prosperity of people in

Tennessee!

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5. MISSION STATEMENT To protect, promo...

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The Law-TCA68-2-601-901

• 601- Boards of Health - County may establish . . .

• 603-Establishes a County Health Department - Each county shall establish a health department. . ...

• 604-Appropriations - County is required to appropriate money . ..

• 901-Special Needs - A special needs fund shall be maintained ...

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6. The Law-TCA 68-2-601-901 601- Boards...

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·~ The Public Health System Process

~ A continuous cycle of gathering information, deciding, acting , evaluating

~ Public health is always evaluating the health of the community

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7. The Public Health System Process A co...

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Assessment

) Monitor health status to identify and solve community health problems (eg , community health profile, vital statistics, behavioral risk factor surveys, disease registries)

) Diagnose and investigate health problems and health hazards in the community (eg , epidemiologic surveillance systems, outbreak investigations, state laboratory)

m O.rartment of - .Health


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Assessment






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Assessment






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Assurance > Enforce laws and regulations that protect health and ensure safety

(e.g., restaurant inspections, quarantine, TB control, child safety seats).

> Link people to needed personal health services and ensure the provision of health care when otherwise unavailable (Identity populations with barriers to care, EPSDT outreach, primary care se/Yices, health access projects).

> As:sure competent public and personal health care workforce (e.g., training tor health care providers, health care facility inspections, /icensure veriflcation).

> Evaluate effectiveness, accessibility, and quality of personal and populationba sed health services (e.g., continuous evaluation of public health programs).

> Research for new i nsi ahts and innovative solutions to health problems (linkages with institutions of nigher learning, encourage new directions in scientiflc researcll)



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Policy Development

:» Inform, educate, and empower people about health issues (health education, health promotion and social marketing)

:» Mobilize community partnerships and action to identify and solve health problems (identifying stakeholders and building community coalitions, convening and facilitating county health councils)

:» Develop policies and plans that support individual and community health efforts (eg , tobacco legislation, vending machine res[rictions)



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Department's Structure

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13. Department’s Structure 10

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·~

Commissioner John J . Dreyzehner

MD, MPH

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15. We are Here! 12

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Rural Health Regions

~lid-Cumberland

Southeast

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16. Mid-Cumberland Rural Health Regions ...

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Metro Health Regions

Nashville/Davidson

Kingsport-BristoV Sullivan

Memphis/Shelby Jackson/Madison Chattanooga/Hamilton

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17. Metro Health Regions Memphis/Shelby ...

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STRUCTURE OF A TYPICAL LOCAL HEALTH DEPARTMENT

I Regional Director I I

I County Director I I

I I I I I Public Health Nursing I Nutritionist I Health Health

Office Supervisor Supervisor Educator Officer

I I I PH Office Nurses Nurse Assistants I Clinician

Nurse Assistants

Shown in gray are not directly supervised by the County Director but by Discipli Specific Supervisors. County Director provides input on performance evaluatio

L--'----'--------'---_:_---'-----'------~-!!! .Health


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·~ SE Region-County Directors & Staff

I Vicki Carr

B-(6)

CB-(2)

I Eloise waters


27. Rhea(14) Meigs(14) McMinn(20) Bradle...

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What's Unique About Our Staffing?

• State Employees

•County Employees

• Contract Employees

The Regional Office (Chattanooga) employs about 65-70 staff

10 Local Health Departments employ another 180-200 depending on vacancies

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Southeast Region's Annual Budget Exceeds 13 Million

Dollars

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How Health Departments Are Funded

35 o/o

30o/o

25 o/o

~

20o/o

l S o/o

l Oo/o

- S o/o

Oo/o

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30. How Health Departments Are Funded 23

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So What's Unique About Our Funding?

• We have multiple funding sources---all our eggs aren't in one basket

• Our productivity has a direct impact on our livelihood

• We have a lot of flexibility

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100°/o of POVERTY

Family Size MaximumAnnual Income

1 $11,170

2 $15,130

3 $19,090

4 $23,050

5 $27,010

6 $30,970 II - .Health


32. 100% of POVERTY $11,170 ...

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LIVING IN POVERTY

Southeast Total Population

Population Below 100o/o Poverty Level

320,969

56,169

17.5% of our population live with incomes below 100 percent of poverty!!

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How do we measure productivity?

Relative Value Units (RVU's)

• This system relies on the Medicare Resource-Based Relative Value Scale developed by Medi care and approved by Congress in 1992 to support a Physician Fee Schedule published at least annually in the Federal Register.

• For each type of clinical service, from the simplest office vi sit to complex surgical procedures, the fee schedule assigns a number of RVUs intenaed to reflect the resources involved in tile service. m

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Relative Value Units (RVU's) continued:

3 components are added together to get the total value of the RVU.

• Work - represents the provider's level of training and skill needed as well as the amount of ti me necessary to complete the vi sit.

• Practice expense (overhead) - represents staff salary and fringes, facility expenses, etc.

• Li ability/Malpractice - represents the amount related to malpractice and Ii ability expense

NOTE: Not all health department activities produce RVU's, for example health promotion, emergency response.

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RVUs As a Method of Measuring Staff and Clinic Efficiency

Staff Efficiency Example

• My Health Dept. • Your Health Dept.

• RVUs per day- 75. • RVUs per day- 75.

• Full time staff- 15.

• Staff Efficiency- 5 RVUs per staff person per day.

• Full time staff- 12.

• Staff Efficiency-6.25 RVUs per staff person per day.

alth


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RVUs As a Method of Measuring Staff and Clinic Efficiency

Clinic Efficiency Example

• My Health Dept. • Your Health Dept.

• Total one year cost - $750,000.

• Total RVUs provided - 16,000.

• Clinic Efficiency-$46.87 per RVU.

• Total one year cost -- $750,000.

• Total RVUs provided - 22,000.

• Clinic Efficiency-$34.09 per RVU

alth


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FY 2014 Encounters and RVU's by County

70.000 ~-----1

60.000 +----

50,000 +----

4-0,000 +----

30,000 +--~-

20,000 +----I 10.000 +----I

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Services We Provide In Every Health Department

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39. Services We Provide In Every Health ...

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•Immunizations

·Family Planning

•Well Child Exams

•WIC/Nutrition & Breastfeeding Counseling

•STD Testing And Treatment

•TB Testing And Treatment

•Health Council Facilitation

•Birth And Death Certificates

•Health Education and Promotion

•Case Management

•General Environmental Health

•Emergency Response


40. ImmunizationsFamily PlanningWell Chi...

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Den al ""ti - Clinical Services in the following counties: ...

Bradley Bledsoe _

McMinn

Facilities in Grundy, Rhea, Marion, Meigs and Polk

School Based Sealant Program

11 m - .Health


41. Dental Clinical Services in the follo...

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Primary Care- As of January 1, 2006

Designed for acute/episodic care and chronic disease management for uninsured residents

Primary Care is provided by either a Physician or Nurse Practitioner at the following health departments.·

• Bradley • Grundy • Meigs • Sequatchie


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How Building Projects Get Funded

All facilities are built with a combination of funds:

•Appalachian Regional Commission (ARC)

•Community Development Block Grants (CDBG)

•TDOH Special Needs

•Sale of Existing Facility

•Low Interest Loans Taken out by the County

•County Funds II - .Health


43. How Building Projects Get Funded All ...

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·~ Sequatchie County Health

Department

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44. Sequatchie County Health Department 38

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How Counties Benefits from Local Health Departments

• Direct Return on Investment Between the LOA and state appropriation most counties will dedicate less than $5 per capita towards the health department operations and services. In return for their investment counties receive t>etween $40 and 50 dollars per capita of state and federal operational funds, an average of $8 for every local dollar spent. These come in the form of direct funding and through contracts with the local government.

• Services While $40-50 per capita of operational funds come into the county each year millions of additional dollars in services are provided to health departmenl patients, most of which slide based on their income.

• WIC The supplemental nutrition program Known as Women, Infants and Children (WIC) provides residents at or t>elow l 85% of poverty millions of dollars in vouchers each year. On average over $55,000 of vouchers are cashed in each county every month!

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45. Direct Return on Investment Between ...

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TPHA is .. ..

The Tennessee Public Health Association

• the leading professional organization recognized as the voice for public health in Tennessee

• the official professional organization for those engaged or interested in public health services

• endorsed by the administration of the Tennessee Department of Health

• an affiliate member of the Southern Health Association and the American Public Health Association

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The Tennessee Public Health Association

Membership is encouraged for any person who is engaged in the practice of public health, either directly or indirectly, or who is interested in the

advancement of public health in Tennessee.

Memberships

Individual - $30

Student - $15

Agency - Starting at $200

Go to www.tnpublichealth.info for membership appli. ns

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How not to get Fired

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·~ Basic Tenets

Dedicated to Customer Service On the phone .. .. ·:· 86 percent of the message your customers receive on the telephone is through tne tonality of tne voice tney hear. Only 14 percent of the message they near are tne words used.

And in person .. ... ·:· If your customer's last impression in a transaction isn't favorable it may be literally be your last with tnem

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Basic Tenets

Maintain strict confidentiality • Do not look at, read, use or tell others about an

individual's information (PHI) unless it is a part of your job.

WHAT YOU SEE HERE

WHAT YOU HEAR HERE

WHEN YOU LEAVE HERE, LET IT STAY HERE

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50. Basic Tenets Maintain strict confiden...

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Basic Tenets

Free of workplace harassment Our workplace will be free of the following:

• \Vorkplace Harassment

• Sexual Harassment

• Bullying

• Quid Pro quo

• Hostile \Vork Environment

• Inappropriate Conduct

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New Initiatives

•!• Baldrige

•!• Tobacco Settlement

•!• PPI

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52. New Initiatives BaldrigeTobacco Settl...

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Baldrige

TN Center for Performance Excellence and the Baldrige

Excellence Framework

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53. Baldrige TN Center for Performance E...

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·~

Tobacco Settlement Dollars

Each region in the state received Tobacco Settlement Dollars for a three year period.

Projects had to focus on reducing second hand smoke, smoking during pregnancy and youth initiation.

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54. Tobacco Settlement Dollars Each regi...

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·~ Baby and Me Tobacco Free

Quit Smoking Get Free Diapers Sign Up Today!

Help for Pregnant Women Quit Smoking and Stay Quit II - .Health


55. Baby and Me Tobacco Free 49

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·~ Tennessee Uses Tobacco Settlement Dollars to Reduce Low Birthweight Births

47 ~<>;Y>~ght &lbots Expt<tedto bt born to Smo""ng V<ims

oQ 25 $90K1~h low BirthW<>ight --~··~ Healthcare Costs Saved Births Prevented per Lo.-; B'thwe1gtit Babyaom

No:'mal Weight

----- (tSU!til'lg (I

1111 $2.25SAVE D · 11 · Healthcare Costs during m I I 0 nthe First Year of

Baby & Me Tobacco Free

mltMI ... II - .Health


56. 50

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Primary Prevention Initiatives (PPI)

Focuses on the notion that moving needles in TN will take more than what we have done so far ... we must step beyond our four walls

• VRLAC • School Located Vaccine • Life Maze • Healthy Horizons • WIC in Head Starts • Building Vaccine Confidence

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57. Primary Prevention Initiatives (PPI)...

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Primary Prevention Initiatives (PPI)

Focuses on the notion that moving needles in TN will take more than what we have done so far ... we must step beyond our four walls

• VRLAC • School Located Vaccine • Life Maze • Healthy Horizons • WIC in Head Starts • Building Vaccine Confidence

II - .Health


58. Primary Prevention Initiatives (PPI)...

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In Conclusion

When in interviews ....

•!• Demonstrate your kno\vledge of the structure of the department

•!• Mention RVUs and PPI

•!• Don't discount customer service experience

•!• Show enthusiasm (the AG Approach)

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59. In Conclusion When in interviews….Dem...

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Ill Health - ·


60. 53

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Health & Medicine

How to Win Friends and Influence People in Public Health: Landing that First Big Job