This transcript is auto-generated and may contain inaccuracies.

Colton Anderson:
All right, everyone, we will get started. Thanks all for joining this session. There’s a lot of good sessions going on around it’s been a long day. I know this is your last concurrent session block before you break for dinner time. So we appreciate you showing up and listening to our session.

So my name is Colton Anderson. I’m from ASTHO. I’m joined by my colleagues, Melissa Touma and Kristin Sullivan, also from ASTHO. We’re here to support this session and facilitate what these three jurisdictions will be talking about today. What we’re talking about is organizational capacity and administrative readiness. This is something that our team at ASTHO focuses on, and I’ll touch on it in a few slides here. A little bit more detail on the definitions and really what that looks like from an ASTHO perspective.

But then we have our wonderful presenters. We have Marie, which you saw, she’s going to be our virtual presenter. She’s from Maryland, and she’s joined by Katherine Feldman, also from Maryland. And you’ll be talking about a specific service and tool that ASTHO has. And then we’ll move on to a different service, and Lauren Marsh will speak about her experience with Austin Public Health. And then we’ll also talk to Amy Ferris from the Washington Department of Health, who will touch on a different service.

So we kind of have these three areas we’re touching on today. Kristin, Melissa, and I will do the level-setting for those, and then we’ll have our jurisdictions talk about their experiences working through those processes. So like I said, it’ll be a level set. The panel will go, and we’ll have some time at the end for Q&A with all of you. So hopefully we leave roughly 15 minutes, if we time this all correctly here today.

So, just to level-set broadly on what we’re talking about today. Just want to make sure we’re all on the same page about the same terms here, and knowing the definitions of each of these when I say organizational capacity and administrative readiness. So organizational capacity refers to an organization’s ability to effectively utilize its resources and capabilities to achieve its goals and mission includes assets like finance and infrastructure. And elements like leadership, strategic planning, and employee skills are crucial to have for long-term success and also for adapting to change, improving performance, and better serving our stakeholders. So that’s how we’ll define our organizational capacity. And then administrative readiness is the ability. Be able to apply fiscal, legal, and administrative authorities and practices that govern funding, procurement, contracting, and hiring efficiently and effectively to respond to both population health improvement needs and address emerging threats.

So just want to lay that out there, because that will be kind of talked about throughout the presentation, and that’s really what we’re here, broadly speaking, based on what these other services that we’ll talk about later. So we’re defining this under the umbrella of what’s called the ASTHO STAR Center, with STAR standing for State and Territorial Administrative Readiness. Although this goes beyond states and territories, we have local representation, and there are a lot of locals here at the PHIG Convening.

So this does go beyond state and territories, but broadly speaking, the STAR Center does a few different things, and we have been bullet-pointed here. One that is modernizing and strengthening organizational capacity and administrative readiness. Another is connecting high quality resources, tools and model practices, along with proactive capacity building and technical assistance products that we have, and then technical assistance just responding to different TA that comes in, whether that be through the PHIVE system or reaching out to us directly through our STAR Center, and then also doing some consulting and project management and leadership is another aspect of what we do through the STAR Center.

The STAR Center encompasses a few different services and tools, which you can see is what we’re talking about today. One of which the Maryland team will discuss is our peer assessment of organizational capacity. Another one we’ll have Austin Public Health talk about is our administrative policy assessment and gap analysis, or just policy management in general. And then we’ll have Washington talk a bit about grant management optimization. And so then we also offer other TA offerings, but these are what we’ll touch on today. So with that, I’m going to turn it over to Kristin, who will start us off with the peer assessment program.

Kristin Sullivan:
Great. Thank you. Welcome everyone. So I like to highlight one of the technical assistance opportunities and start with the peer assessment program. We provide that through the STAR Center, and then we’ll hear from Maryland about their recent experience with the program.

Some of the key features I just want to cover here. So ASTHO works with you in defining your challenge or your need in one to three of the 10 theme areas that are located on the right side of your screen here, and these theme areas contain evidence-informed indicators we based on your priorities, we assemble a peer review team comprised of public health peers across the country and subject matter experts in public health. We then conduct a point in time assessment of capacity against those evidence informed indicators in the one to three priority theme areas that you identify, and then the assessment is generally conducted during a site visit, which, depending upon your needs and goals, that length can vary. It’s usually 3.5 days. Sometimes it’s two and a half days. And the content can vary. So it could include facilitated group discussion, key informant interviews, or intensive working sessions, all based on what your needs and goals are. And then the last day, that point five, right? I keep saying 2.5, 3.5, that point five days, we usually present the findings and the recommendations, and we hand you a copy of the reports. You get all that before, before we leave.

So I think some of the, some of the things, some of the things that you get is those immediate, actionable findings and recommendations you get the option of additional TA to help implement the recommendations, and then some of the things that we’ve heard from the sites that have taken advantage of this is that they really love, that there’s a tailored approach, that it’s adapted to meet their needs. It’s objective, impartial facilitation. We bring added capacity and public health expertise that has time to focus on these things. You all have expertise, but we bring that capacity to focus on these things, along with fresh perspectives and valuable insights. And of course, because we’re looking across jurisdiction, we’re able to kind of bring that context to better understand some of the challenges that you’re facing across your jurisdiction. So those are some of the key features.

So I want to give you an example of a couple of programs that have gone through the peer assessment program and some of the outcomes. So the first to take advantage of it was Texas. They use it to help develop a roadmap for their workforce modernization and transformation, and they focus on the Workforce Development and the Human Resources theme areas. So if we go back, just want to go back to that over there. So these little theme areas focus on the first two and number 10, learning organization and innovation. And then they asked us for really broad engagement of their internal and external stakeholders, and we did that through a series of group interviews over the course of two days.

Based on that, ASTHO and our peer review team provided a report on strengths, challenges, and recommendations, which contributed to a new workforce strategy they now have and are working on. The next one, the next one’s Maryland, and I really have to hand it to Maryland. They’ve been very smart. They look for opportunities, they look for help, and they say yes to opportunities. So they’ve been able to leverage two different TA programs to help address the challenge they’ve been having. So one was for business process improvement. They were looking at their procurement process, and then they leveraged the peer assessment program to help them advance some of those improvements. So they had more of a there’s a little bit different. They had a complex problem that they wanted us to help them work through, whereas Texas wanted that straight-up assessment. So that’s the tailoring aspect of the program, and that’s what we can bring to their tailored approach.

I’m going to let them talk about this in more detail, but just a quick overview: it included a two-and-a-half-day site visit. We did intensive work group sessions to engage internal units and prioritize activities, and key informant interviews to assess capacity. They asked us to go a little bit farther with those capacity indicators and look at change management, culture of improvement, and internal communication. So we actually expanded some of those theme areas. So to speak with that. We also provided them, upon request, with best practices and procurement and document management systems. We gave them that report out at the end, and we followed up on the request for some peer-to-peer connections with other states on procurement innovations. So I’m going to turn it over to Katherine, right? You’re going to start by letting them tell you about their experience and outcomes so far.

Katherine Feldman:
Great. Thank you so much, Kristin, this is really tremendous opportunity to highlight so many things, the first being the incredible TA, technical assistance, from ASTHO and other national partners. So my primary message is, take advantage. Take advantage because it is, it is hugely helpful. I’m also just pretty much opening this up because I want to turn it over to the star. Get it, the star of the show, Marie Stratton, who is not with us today, but she is in Maryland, and she’s really the one who championed this technical assistant peer assessment program and made it happen. So I’m just going to set the stage to say, introduce you to Maryland and the Maryland Department of Health, and also talk to you about how this project, which was actually through Overdose Data to Action TA, totally aligns with PHIG and inter-relates.

So in Maryland, we are a geographically small, densely populated state. We have 24 local health departments, with our State Health Department, where Gabrielle, who’s here, and I, Marie, serve 6.3 million residents. This particular project demonstrates a number of PHIG-related principles. We’re aligning multiple funding streams, in this case, PHIG and Overdose Data to Action. We are leveraging technical assistance from our national partners. Do it, do it. Do it, if you haven’t already. And it’s boosting a number of our foundational capabilities, whether that’s procurement or quality improvement. And we all know that procurement timeliness is one of our PHIG performance measures. So this ties directly into that.

In Maryland, we’ve been rebuilding a lot of our infrastructure that was eroded a bit during the pandemic, including our quality improvement infrastructure. And so this activity really supports the maturation of our culture of quality at the Department and helps build relationships across the agency. It helps to introduce processes and tools. And then this project itself serves as a model for other quality improvement projects. But let me hand this over to Marie Stratton, who is our Overdose Data to Action Program Manager, and is joining us from Maryland, and it looks like you guys can’t. Yes, you can see her. So over to you, Marie, and I’m here to back you up.

Marie Stratton:
Great. Thanks, Katherine. Can you all hear me? Okay, okay, great. Well, I will jump right in. I’ll share a little bit of background.

As Kristin mentioned, the Maryland Department of Health has been leveraging this ASTHO technical assistance since the fall of 2023, almost two years now, I learned about this opportunity at the Overdose Data to Action (OD2A) recipient meeting in Atlanta, where, like today, I got to hear from other states and other cities that had worked with ASTHO on business process improvement. So really, that timing was great for us. We were kicking off a new five-year OD2A award. We had new leadership in our administration, as well as new leadership in the Office of Contract Management and Procurement, all of which were interested in that process improvement work, and were really grateful to receive that additional capacity, expertise, and the structure that this TA opportunity provided.

So our year one work really had three phases. We started with a hot-wash exercise to identify lessons learned from recently completed contracts and grants. We had a really amazing three-day process-mapping workshop in January of 2024, where we built extremely detailed current-state maps for our three major spending mechanisms, identified value waste and root causes in our current processes, and identified opportunities for improvement. And then we had a final workshop in June of 2024, where we updated those maps and completed our recommendation plans.

So we had really some pretty amazing outcomes from that first year again, these really detailed process maps for what our process is right now, for these three spending mechanisms, which also included some other layers and roles involved in those processes, including our fund certification with fiscal, as well as purchase order creation. We had over 40 colleagues collaborate to develop those maps with ASTHO facilitating, along with those improvement recommendations and implementation plans, and we got so much feedback about how much they learned about everyone’s different roles in the process. What does a program manager do to initiate these things or move things through the process? What does the operation staff do, etc, that they weren’t aware of before those workshops?

Also, really helpful, we had multiple multi-level engagements. So we had really high levels of leadership participating to, you know, program folks doing the day-to-day work, learning from each other throughout. There was a ton of just organic resource sharing kind of happening live during the workshops, like, oh, we have a template for that. Or, you know, we can share the cheat sheet that we use to understand that process, that sort of thing. And then ultimately, you know, again, that structure, that engagement from key staff, and the momentum really helped us with initiating some new process improvements or continuing that work across the Department.

So at the start of last year, our second year of engaging ASTHO support, we had a ton of really great process improvement work happening, but we were struggling with communicating about that work across our different administrations and offices. We were facing some implementation challenges, and then really needed to get some feedback from our different partners about what our current priorities should be. You know, we’ve got limited capacity, resources. Which parts of this really detailed recommendation plan should we focus on?

So when we met with ASTHO, and they described this peer assessment program, we really jumped on board very quickly. It sounded extremely helpful to us. We had to pause a little bit during the legislative session, but we coordinated to host this meeting series just this past May. After that session wrapped up, we could make sure we had a lot of engagement from leadership and staff in the work ahead. So, as Kristin mentioned, the meeting series for the peer assessment program included a full-day workshop, over a dozen key informant interviews, and a final presentation to leadership and staff, all within one week.

So again, some really strong outcomes from this meeting series. On the first day, we were able to provide status updates to this kind of cross-cutting group on how things are going from that year one recommendation plan building that shared awareness. ASTHO helped facilitate a few different ranking exercises so we could build shared agreement on what to focus on next. And it’s really helpful to have a third-party facilitate that type of exercise. And then again, just that ongoing team building and change management support and encouragement for you know, the continued effort that people are putting in on this work.

They presented that final report to leadership and everyone who participated in the meeting series, including the best practices, some recommendations, which I’ll share shortly, and resources like the infographic I’ll share on the next slide. And again, that continued relationship building and just dedicated time to look at the big picture. You know, we’re often just caught up in the day-to-day, responding to the next big issue. So having that time to look a little bit more long-term, celebrate our strengths is really helpful. And this is just one example of, you know, some of the resources that, again, with their capacity and expertise, they were able to develop for us, that’s going to be really helpful for us moving forward in onboarding training for that high-level overview of what this process looks like in Maryland.

So I wanted to share briefly, you know, what some of those kinds of findings and recommendations look like in that peer assessment report? Again, it was really helpful that ASTHO presented this to our leadership, along with staff who are involved in process improvement work. It was extremely helpful for them to call out our strengths, including all the staff who work really hard and are committed to this work, and to name all the excellent work already underway to improve our processes in Maryland. Really important and helpful for ASTHO to acknowledge the context and environment we’re all working within, in Maryland and nationally, that impacts our ability to implement the recommendations.

They also had a lot of discussion and review of the different challenges and opportunities that we faced ahead. So how could we continue building on that culture of improvement that Katherine was talking about, opportunities to leverage existing IP systems or look for some new to invest in, as well, as you know, challenges with supporting change management or standardizing approaches across our whole department, there’s always the need for that clear defining of roles and responsibilities across these processes, but then also a lot of opportunities to build on our really strong customer first approach in Maryland.

So some of the recommendations I’ll share here, we have selected a handful that we’re starting with, as Kristin mentioned, they were all really immediately actionable for us, and so we selected some to prioritize in the next six months, the first being establishing cross-functional work groups. So this is really going to be the driver for us of how we implement those priority action steps, how we continue to move forward with that implementation plan, and collaborate across roles, across offices, and continue to share things like templates and tools across different teams.

The second being, which will be a focus of the work group to guide how do we do this? How do we operationalize this in Maryland by establishing a clear and consistent point of contact for procurement-related questions? And so that will be one of the first things that the work group is focused on

Next, we have supporting staff in managing change and change resistance. So I have a little yellow star here. While it’s not something that the cross functional work group is going to be focused on, this is something concurrently that we’re going to be acting on through our public health services QI Council, so we have kind of a variety of program and operations and procurement staff that we’re recruiting to join that Council so that they can get that ongoing support and training and tools that really help with managing change. At the bottom here, number six: establishing standard operating procedures for processes across administrations will be another priority for that cross-functional work group to start with in the first six months.

And then lastly, the work group will be focusing on the training needs. We know a lot of our offices have developed their own trainings. Our Office of Contract Management and Procurement hosts different trainings, has forms and templates. So by having that cross-functional work group, they’ll be able to share those different resources in a central place that will be accessible to everyone.

Okay, so where we’re at now, we are again focusing on those three to four recommendations from the final report, with that cross-functional work group really driving the implementation. Again, we’ve recruited some operations and procurement staff to join that QI Council for that ongoing support, these types of things take time, and so having those monthly check ins and trainings through the QI Council be really helpful. And then we’re looking forward to hopefully getting continued technical assistance starting this winter, as we’re a little bit further along in our implementation and identifying what our more precise needs are for support. I will wrap up there, but please feel free to reach out if anybody has any questions. As Katherine said, the main message is to take advantage. This was an incredible resource for us here in Maryland.

Kristin Sullivan:
Thank you so much, Marie, and I think it just shows the good work. They they just, they don’t give up, and they keep moving one foot in front of the other. And it’s really paying off for you all. So congratulations. Really good, nice work. This is hard to work too, so I just want to, and if I could get back to our slide deck, here, here comes. Okay, I think I’ve gone the wrong way. Sorry about this, folks. I’m trying to get down to ours. Okay, so my last thought is, who’s next? How can you what I want to leave you with is, how can you utilize or leverage the peer assessment program to advance your PHIG goals? So this is a resource that’s sitting here. It’s free, but we would love to come out and you know, learn about your challenge and see how we could leverage this resource to help you meet your PHIG goals, and with that, I will turn it over to Melissa, and she can talk about the next service.

Melissa Touma:
Wonderful. Thanks. Kristin. Hello, everyone. Good afternoon. My name is Melissa Touma. I’m with the Public Health Infrastructure Program at ASTHO. I’ve had the opportunity to work with many of you, which is really exciting to see you all here today, and I’d like to just share a little bit more about the administrative policy assessment and Gap Analysis Guide, tools, and service that we offer under ASTHO STAR if you’re ever looking for it, the guide and the tools can be found on ASTHO website. Under the ASTHO STAR Center. You can also follow this QR code, and it will get you there.

The main resource you’ll find is a guide that was originally developed with input from public health agencies. And the purpose of the guide is to help agencies conduct an internal assessment and an analysis of gaps of their administrative and operational policies. The tools in the guide can also be adapted, as Kristin described with the peer assessment program. The tools can be adapted and scaled to fit the public health department operations, their needs, and their environment. And it also includes some tips and templates for conducting that gap analysis, building an action plan, and collaborating with staff and leadership to prioritize and address improvement opportunities.

So in addition to that, guide and tools, ASTHO also offers TA to support health agencies in establishing, and often re-establishing, a systematic approach to agency policies. As you can see on the right-hand side of the slide, we’ve had the opportunity to support several jurisdictions over the last couple of years, with many lessons learned. We supported them through process mapping their policy review and development process, conducting a gaps analysis and assessment, establishing their cross-agency work groups like a policy committee or policy review committee, and also providing guidance for agencies to focus their efforts on high-impact areas for improvement.

We also have a couple of published resources on the PH Infrastructure website and on the ASTHO website about our work with Missouri last year, and some of you may remember Missouri speaking during a similar session like this at last year’s PHIG convening. And today we’ll get to hear from Austin about their experience modernizing their public agency’s policy infrastructure.

But before I hand it over to Lauren, I did just want to talk really quickly about the connections between a strong administrative policy infrastructure and how that can improve administrative readiness, and also all of the work that we’re doing under PHIG to strengthen the systems and the structures that underpin our public health operations. And actually, you’ll hear a lot of these themes from this list echoed in Lauren’s presentation in just a little bit.

So you know, we know that having strong policies is not just about compliance. It’s also about making sure that our administrative systems actually support the missions and the goals of our public health work. And so if you remember back to the definition that Colton had shared earlier about administrative readiness. It consists of the ability to apply administrative practices to efficiently respond to both population health needs, improvement needs, and also emerging threats.

So here are just some of the impacts a strong policy infrastructure can have on an agency’s ability to pivot and respond effectively to public health challenges. I’m sure there is more that you all can come up with as well, but to go through this list, you know a strong policy infrastructure can ensure consistent compliance and operational efficiency across departments.

Clear policies also reduce ambiguity and bottlenecks, which speed up approvals, procurement, hiring, and other time-sensitive processes. Well-structured policies support better recordkeeping, which can facilitate smoother audits and reduce the risk of findings or corrective actions. Policies can serve as foundational training materials for new and existing staff learning a new role or process. I think we can all relate to this one. Practices that might otherwise be informal or undocumented can be codified in policies to reduce reliance on someone’s memory and to support that continuity through turnover and retirement, and everything that an agency goes through. Strong policies also ensure that administrative functions are not just reactive but proactively support mission-driven work, and a strong policy infrastructure can adapt to new funding sources or program changes, so that agencies can scale operations without compromising compliance or efficiency.

So, you know, ultimately, the work improving policies really helps agencies move from reactive proactive, and so kind of thinking about that line of thought, I’m really happy to introduce Lauren Marsh, the workforce director and the PHIG Grant Manager with Austin Public Health (APH), and she’s going to share how her team has been strengthening administrative policies at her agency.

Lauren Marsh:
These podiums are so tall at this conference, so I hope I can see y’all better. The last one was taller, actually. So hi everyone. I am our Public Health Workforce Director as well as our I manage our Infrastructure Unit, so I oversee a lot of processes related to infrastructure, so strategic planning, accreditation, performance improvement. So I do touch on a lot of areas that relate to infrastructure, and that’s part of how I got plugged into this process. I also really want to acknowledge that we are very much mid-process, and so we are going through this gap analysis and TA request right now, and so I’ll really be speaking about my experience and our health department’s experience as we’re going through the process. Oh, what? Was looking for the computer, looks a little different.

So just APH at a glance, real quick. Our mission is to prevent disease, promote health, and protect the well-being of all. And I was planning to say we area relatively large health department. I’m learning there are much larger health departments from presentations I’ve been at, but for our local jurisdiction, we are, we are pretty large, sitting at 617 full time employees. We do have six divisions, including two offices, our Office of the Director and our Office of the Medical Director, and we are serving approximately 1.2 million staff. I have our org chart up here, just because, when we’re talking about the work we’re doing with ASTHO, we’re really focusing on those department-wide policies that impact all staff. Most of these lie in our Office of the Director within the Chief Administrative Office; that’s where our program lives, as well as Human Resources, our Office of the Medical Director, and our administrative support services. And so those are most of the areas we’re focusing on with our technical assistance. But the goal is to have a process that works for the whole department.

All right. So, some background on how we came to request the TA and take on this process. So, in 2018 through 2019, there was an initial policy quality improvement project. This was taken on by our Records Administrator, and there was a lot of really good groundwork done to get a policy inventory, identify those department-level owners, and then revise the guidance and update those timelines. There was a lot of progress made, but unfortunately, following that, when COVID hit, a lot of that work halted. Updating policies really became a low priority for staff.

And so between 2020 and 2022, like every health department, we were going through our COVID response. We were also preparing for re-accreditation during that time. And so we did get some extensions, but we were going through the process of getting ready for reaccreditation. A lot of that does involve looking at our policies and our processes and our systems to make sure that we are meeting that guidance. So we’re kind of having to balance both responding to COVID and then kind of getting ready for this next reaccreditation. We were reaccredited in 2023, and one thing that I do love about reaccreditation, I used to be an accreditation manager, is that it really does give a kind of an overall department process review and process improvement. And so, as we were going through the process, we realized there were gaps in our policies and that we were struggling to meet some requirements and timelines. And so we had identified that kind of on our own side of things to improve going forward.

So coming out of reaccreditation, we knew we wanted to improve our policy process and system so that we had a sustainable process that worked for the whole department, so we didn’t have to have these big pushes of updates. Some of our challenges are with our relatively large health department; we have more than 120 policy documents, and I’m not talking about procedures and guidelines and work tools, but just policies. And so we were wanting to really just, that was just one of our challenges. And our process was very manual. So the process for developing, reviewing, and approving was very lengthy and cumbersome. It was time-intensive for staff developing policies. It was a time intensive for the review teams and then for the approval process. So it just made for a very long process to get from the start to finish of the policy cycle. And then our policy library was housed on SharePoint. Still is, and it was outdated. It’s not very user-friendly. There’s no metadata attached to policy. Some of the policies are like scanned PDFs that you can’t search, very not user-friendly. And so we had identified the need to really update and modernize that ownership and turnover.

This is from our most recent PHWINS Assessment. Of the staff who completed that survey, 64% have been with the department for less than 5 years, which aligns with what our HR Department is reporting, so we are seeing a lot of turnover. And so that’s where some things do fall through the cracks, as far as who’s managing a policy, staying on top of updates, and updates and that kind of thing. And then just capacity, COVID-19 did put a lot of policy work on the back burner, and so we identified the need to re-engage.

So what were some of our improvement goals? And I should say, we’ve been working on this since we started the process and the conversation back in 2023, so really, we wanted to establish a modern policy information management system with a clear kind of policy on policies. What is our process? We were convened as an ad hoc committee by our Deputy Director and our Chief Administrative Officer, and the initial request had been update the policy on policies. And then once we dug into it, we were like, this is so much bigger than just updating this policy; it’s the whole process. And so we kind of had to take a step back and be like, it’s not just updating the policy, it’s really doing an assessment so that we can have a really strong policy that works for our department.

We really wanted to have that whole policy life cycle. So, from creating policies, revising and retiring those policy records, and then modernizing, there are so many tools that are now available to our health department that were not available in 2018, and so really utilizing those tools for automations, for approval processes, so that we can reduce some of the administrative burden on staff. We wanted to make sure that we were aligned with our PHAB requirements and the best practices. So just going through those policies that are really using those guidelines to make sure that we are meeting those standards and able to meet those PHAB requirements, and then making sure that we’re preparing our staff, both for engaging and understanding policy requirements and how they apply to their work.

So why is this important for APH? Really, we just needed ethical, effective operations, and with that came a strong governance framework to help us operate effectively, standardizing and improving efficiency. We found that different divisions were using different processes. Not everyone’s clear on the process that exists, and so really standardizing what is our process? How are we communicating that out with staff? And I feel like I’m doing this because it’s all a cycle, but then reducing those burdens for staff for complying with policies and engaging the stakeholders in our policy development cycle. Ultimately, we really are just trying to support our workforce, making sure that they have the infrastructure in place to do their jobs well and through the policies that we have available.

All right. So this really is just one big process improvement project, and so I’m not going to read through everything, but this is one of our objectives that we are working through with with the team, just trying to make sure that we have a clear process in place and a timeline for updating, maintaining and updating those policies and procedures on an ongoing basis. This is some of our impact, some of the need on why we needed it, and then just making sure that we are being responsive to staff.

Yes, it’s hard to read. Yes, I can go through them absolutely. So really, we just wanted to make sure these are just some highlights from one of our CQI projects that our Records Administrators started, and so the impact. This project is really just to ensure that Austin Public Health staff know their responsibilities as they relate to policy. There is a sense of urgency there, because new employees need to know how to access and understand the policies that apply to their positions, and there are risks for non-compliance, so audit findings, potential disciplinary action, and then community safety. Just an update on our progress. So we are about 30% through progress, as far as we had that fiscal year 18 project. And then, in fiscal year 22-23, it was re-engaged. And so we have convened that ad hoc committee that’s really working on re-engaging our policy review team and building out that policy cycle. Some of our dependencies are just, you know, those internal approval, approval processes, and then some of the federal, state and local laws and requirements that we want to make sure that we’re meeting. And then who’s impacted by this project? So all staff, really, because we’re focusing on the department, and then our stakeholders are those policy administrators, leadership, and those SMEs that are really working on developing those policies.

Two minutes, all right. This is just a timeline of the work we are doing. I feel like I skipped a slide. No, it’s okay. So this is just a timeline of the work that we are doing with the ASTHO team. They have been so helpful in helping us stay on track with this project. I’m going to go back. I think I did skip a slide. I realized one second. Okay, this slide, I skipped over it.

All right, so why did we engage ASTHO? So I had a colleague who attended a similar session last year, and she came and found me after the session and was like, You’ve got to talk to the ASTHO team, because you are working on policies, and they are doing so much to help, I think it was Texas. They had heard about the peer assessment, so we heard about it at the last meeting, and we also wanted to; we were utilizing PHIG funding to support a Policy Administrator, so really, we wanted to take advantage of all the TA available. I still can’t believe this is accessible to us at no cost, because we are really getting such great value from it. They are providing really specialized knowledge and making sure that we have a structured approach to our policy assessment and our gap analysis. They have we kind of submitted everything that we possibly could ask for, and they are really delivering on that. They develop clear action planning for our project. They’re offering monthly coaching calls that are helping us brainstorm. They’re providing reviews on documents, and they’re really just helping us get through work through the policy improvement process. They’re also providing support for our stakeholder engagement. So they’ve been providing guidance on that, and they will then facilitate an on-site workshop to map the future state and conduct a gap analysis.

I missed the meat of the presentation when I skipped over that one. So this is our timeline that we’re working with. So April to May. We drafted our team charter and onboarded the policy administrator that we are supporting through PHIG. We’ve gone through, and we’ve identified, re-identified, some policy owners and administrators that are going to be supporting the project. We’ve started doing an evaluation with our CQI team. Our CQI team serves as the policy review team. We have a subcommittee that we’re re-engaging that’s going to be focusing on that, and so we’ve started that process this month, and we’ve been re-engaging that team. We’ve been identifying people to serve on that and also finalizing that team charter. We are moving forward with modernizing our library. So that is very much happening in progress. We are working with our city technology team to really build out a system that’s going to work for APH, and then we’ve got the gap analysis tool coming in October, or a workshop in October. And really our goal is to get kind of that whole cycle finalized with the support of ASTHO, and then get our policy plan and roll out moving forward.

All right, so early insight. So these monthly meetings have really just kept our progress on track. We were an ad hoc team convened by our Deputy Director, kind of identifying people who were frequently touching the process, and so everybody was at capacity and very busy, and this project was moving very slowly. And so once we engage ASTHO, it’s almost like an accountability partner too, like it makes us know we have a meeting coming up, we know we have action items we need to do between that. And so it really has sped up the momentum of the project pretty significantly. We do have this ad hoc policy advisory committee structure, and so we are doing a lot of that heavy lifting right now. The plan is for this work to be absorbed by that subcommittee. Once we kind of get that process built out, they are informing the process. They’ll be participating in the workshop. And so we want their input so that they can, kind of, we can get it into a manageable state for sustainability.

We did come up with some system improvements. You know, we have made improvements to our policy library, but there are continued improvements on that cycle that we want to keep moving forward. And then stakeholder engagement. This is very much something that we are continuing to work on, but just making sure that we are engaging the stakeholders, people impacted by the policies, staff who are reviewing the policies, and staff who are creating them. So just making sure they’re engaged in the process and with our leadership.

Advice for other agencies is truly, I feel like I’m echoing what everyone is saying. Just take advantage of the TA. I am honestly shocked at the value that we’re getting from this TA request. I feel like you pay consultants a lot of money, and I know they’re getting paid by PHIG, but I’m not sure if it’s at no cost to our health department, so really, just take advantage of what’s available while we have it. They are providing us with so much that this project would not have had that momentum. They are providing us with so much support through those coaching tools, resources, guidance, and the workshop support.

We did start with a comprehensive assessment. This has been a very long, ongoing project. And so having that comprehensive assessment really helped us, like, meet with our Deputy Director and be like, “It’s not just an update; here’s why, and here’s what’s going on.” And so we were able to use that assessment even before we got to the continued process of doing the gap analysis and undertaking this project. And then just engaging the stakeholders broadly from all levels, so everyone who may be touching the policy cycle, engaging them in the process, so that we’ll know that it’s working for our agency. All right, that’s all.

Colton Anderson:
Thank you, Lauren. I know we’re looking forward to our continued work, and I’m excited to go to Austin in a couple of months. It’ll be fun. So I am going to kind of wrap us up with our last tool and service talking about grants management optimization. And what we have at ASTHO is a Grants Management Toolkit that, if I talk to you in great detail, you’ll probably be asleep by the end of it. So I’m just truly going to touch on a few points of this, because this isn’t really what Amy is going to be touching on, necessarily, but it’s what helped inform her agency, and what we believe can inform other agencies.

Because what we do know about the toolkit is it started with Puerto Rico piloting this quite a few years ago now, and they kind of helped us make some new versions of it to figure out what really works for different agencies. And so after Puerto Rico pilot it, we were like, All right, let’s throw it out to all other agencies and see who wants to try this, and see what we can gather and improvements we need to make. And what we found thus far is that it’s really hard to find an agency that’s at the point right now where they have the capacity to truly take on this toolkit for its intended purpose.

So we’ve worked with two different jurisdictions over the last six months. One is Chicago, and the other is North Carolina, and they’ve just taken a piece out of the toolkit, I would say, although I find that it has been really helpful for them, but they did not do it in the full capacity of its intention. They took a few different programs and put them through our toolkit process, but I think the results would be similar regardless. And I think what they’re able to do is now inform the other programs and teams within their agency to kind of look at this in a different way. And I think the toolkit can be used as an informative tool, and it’s a planning tool, too. It’s really one big assessment, is how I like to look at it.

So it’s really to help you organize your grants and help you figure out a better way to manage your grants. As it started, it’s as Puerto Rico piloted it. It’s meant to centralize your grants management. But we’ve also found that that’s not what everyone’s looking for, which is centralizing all grants. So what the toolkit does is help figure out what grants should be centralized, what grants may be duplicative, and what things you’re not doing. So it’s really a good tool to figure out your current state, and it helps you clarify different roles and improves communication, which I would echo again, improving communication is one of the biggest things we found from Chicago and North Carolina, that there were teams like your programs and finance folks that just weren’t talking. So going through a process like this and a full assessment of your grants management process is really what helped them break down those silos, start communicating a little bit more. It’s like, oh, this is what you manage. This is what you do, that’s really what I found so far through that work, which is a big value, is just figuring out the current state of how grants are being managed.

And again, this is one of those, like, fall asleep things. So I’m not going to go into great detail on this, but this is a nice graphic on the process of the toolkit. There are all these different input forms that we gather from an agency, like their FTEs, you know, the number of grants, and what the dollar amount of those grants is. And so we put all this in a separate Excel document, then ran it through a Power BI system, which helped spit out three different areas and recommendations. An organizational framework for transitioning to a centralized structure, and then recommendations for what that looks like, staffing-wise, where staff may be able to get pulled or new staff that needs to be hired. And then also determine the cost to operate a structure like that, a more centralized structure that you would want to go to. So again, this is just a part of what ASTHO offers, and if you’re looking for information on that, feel free to Google the ASTHO STAR Center to find more. But I do want to turn it over now, because this is just something that informs the great work that Washington and Amy and her team are doing in grants management. So, Amy, I will turn it over to you.

Amy Ferris:
All right. Well, Amy Ferris, Chief Financial Officer, yes, did someone clap? Great job, Colton. Great job, Colton. So, Washington State Chief Financial Officer. I get the pleasure of being the PI for the PHIG grant. And so this has been my next slide. It’s going to just kind of show you that this has been a little bit of a journey. I have the same issue. What button do I push? Need to see me? So this has been a little bit of a journey for us. As you can imagine, some things you just don’t know you’re going to get to till you get there. And so we have been on this path of really looking at our organization and how we manage our finances overall. We were very decentralized across our organization. So we’re at the state level, and we currently have about 3,000 employees, plus we have, you know, about 2.7 billion in biennial funding that supports our organization. So we are a standalone public health agency, and we have to work with our partner, sister agencies that are Medicaid, you know, Department of Social and Health Services. So we still get the pleasure of working with our key partners, but our organization was very decentralized.

And in 2018, we had an effort we called one DOH, which looked at our communications, finance, and policy work. And really looking at the work that we’re doing and how we do it, and what are the goals of the agency, and what do we need to do differently? So part of that effort was we actually centralized all of our fiscal folks because they sat in the program. I grew up at the Department of Health. I sat in the program and supported them directly. So we had this big effort that went on for, you know, several months, where we engaged people who were impacted. We engaged programs, leaders, all levels across the organization, and we decided to centralize. Again, that was just the financial support positions. And so as we then COVID hit, and we’ve got the pleasure of really getting to experience coming together in a whole new way as an organization, and quickly realized, with all the money flowing at us from FEMA, CDC, multiple grants, you know that we needed to really think about how we’re supporting these funding investments that are coming to us in a way that we can support them across programs, because they weren’t just for one program, they were for the whole agency.

So we quickly started to identify lessons learned and things that happened. So fast forward to where we are now, we started an initiative called our funding transformation, which is, how do we make our agency priorities drive our investments versus our investments driving our funding priorities. So we, as you can imagine, are in public health; all of you are probably in a similar situation. Our programs are very passionate about the work that they do. They are eager to do anything and everything that they can to support our communities. And so, they’re looking for every opportunity to fund and apply for those things. And so what we found is that we were letting our funding drive our agency priorities, and it was getting diluted a bit across the organization and spreading our resources pretty thin. And that’s a challenge at the administrative level. How do you support all of these services?

So we started this, this journey around funding transformation. It has five phases, really focused on funding streams, first and foremost. So early on, we definitely targeted our most discretionary funds, which were our general fund state, our foundational public health services, and then our COVID-19. And really, what do we need to do now? Because those are the services that. Really, we have the opportunity to ensure they are aligned with our agency priorities. And then we recognized we needed to build some leadership awareness around managing finances. We do have a statewide training called the budgeting for non-financial managers, which people are always eager to take when they move into those roles, and we just wanted to make sure we’re building that awareness and that accountability.

And then phase three was federal grants. And this is where we recognize that, you know, we manage over 140 different grants at one time, and we have this spread out across the organization. Programs are determining, yes, we know at a high level they want to apply for this grant. Generally, what it’s for. We give them the okay to do it, but then they determine what those activities are, and sometimes that’s in a silo, sometimes that is in a partnership with another program. And so we knew we needed to really look at this: how do we increase transparency and make sure we’re fully utilizing those funding opportunities? We found that we were leaving money on the table and weren’t spending those. So what can we do differently? So phase three was really about increasing that love, agency-level transparency, and ensuring that it aligns with our agency priorities. And then, you know, we did a full life cycle of what does grants look like now, and our processes and how we do it, and what is the ideal state.

So we pulled together representatives from across the agency, again, those programs, people impacted those who work on these things, so that we could do this together and build what that looks like together. We came up with 23 process improvement ideas that we wanted to look at what this looks like. I’ll say we were in this beginning stage of building this when ASTHO said, hey, Puerto Rico is doing this thing and using this grant management tool. Are you interested? And we said, yeah, we saw it. It was great. It is data-heavy, and we were at that point where we just weren’t ready with 140 different grants, and the stage we were in in this process to really, and again, invest those resources. But we did get some nuggets from it that really helped us kind of inform what we did going forward. And so we did these maps, got these improvement ideas, and we I’ll do this on the next slide.

So what were some of the things that we achieved? We quickly recognized that, so we have a subrecipient monitoring program called our fiscal monitoring unit that was established several years ago, and we were having programs determine if the contract was a subrecipient. If they thought it was, then it went to our fiscal monitoring review to do their review. And we quickly found that, hey, we might have some risk here, because, you know, maybe our programs don’t fully understand the difference between the two. So this body of work looked at that and decided, hey, let’s get all of our federal contracts to go through this process so we can make sure we’re categorizing them correctly.

And then the big piece that I wanted to highlight here is our agency grants coordination team. With the investment from PHIG, we were able to hire a Strategic Investments Manager. We were able to hire two grant coordinators and two grant writers. And because we knew that generally, through this process, improvement and these conversations with our programs, there were some gaps. You had program managers who were applying for grants and writing the grant applications, and they do it once a year, so they’re struggling. Okay, what do I have to do again, and what’s the process, and what’s the system? And so we recognized we had some gaps and needed centralized resources to really support them. So PHIG gave us that opportunity to make those investments and start to build that capacity.

And then this is the piece where we had this moment of, you know, we hadn’t really thought about like fully centralizing grants management, but through the ASTHO tool, it gave you that role clarification, where you start to think about what the different roles are and who does what functions when it comes to grants management. So we had this conversation with that group where we talked about what the essential roles are and who’s best suited to do what function across the agency. So, grants management, that’s the key piece, really, should be at the program level, because they’re the ones that know the body of work. They have to know the deliverables, they are implementing the activities, but they need support from a grant coordinator who may help them with the development of the grant, and those general reporting requirements you have. Oh, I need to do a budget redirect. How do I do that? You know? So they need some resources that can help them with that coordination. So we started to delineate those activities and functions.

And here’s kind of more details, like what you do at the beginning stage and then throughout, who does what. And so we started to, again, identify those and say, what would we want a centralized team to provide a support function for? And that’s where the grant coordinators came into play. We had grant coordinators out in the programs, so we did an analysis, met with them, their supervisors, and their leaders, and just talked through what’s working well. What’s a challenge? Is, what’s the opportunity if we pulled the team together? Is there an opportunity to learn from each other? We found that we had some grant coordinators who came into a role, and they became grant coordinators, and they had no previous training or orientation. Just from someone who did a little bit before, who just shared, hey, here’s what I do and what I’ve experienced.

So we quickly found that we really wanted to centralize this function around grant coordination, bring the folks together, give them an opportunity to learn from each other, and have a peer group that they can work with. And we recognized that we needed some standardization. We needed some good tools and templates, guidance, and resources for our programs as they develop these applications and the process, and to really help us pull that information into a format we can look at agency-wide. And so I won’t go into the next slide quite yet.

The other piece I would add here is that we learned from this that there are so many different approaches that different programs take around it, and so we wanted to make sure that tools and resources were going to be helpful for them. So sometimes it’s a standard with an exception, and we want to make sure that it’s, you know, feasible and works with their processes. So we found that change management was key through this process. Some people were excited, some people felt a sense of loss. Some people felt they wouldn’t be able to partner closely with their program if they weren’t embedded in it. So we had to work through a lot of these different stages to really help our teams and our programs to understand that this is a service for you. We’re developing it together. We aren’t doing it to you. We’re doing it with you. And so we need your help to make sure that this does function and work well and supports the needs that you have.

Feedback is the other big thing that I would add that you need to make sure that you have that regular feedback loop. We do lots of communications. We do what we call open office hours. We do, we have an agency-wide communication called the Daily Dose that comes out each day that’s got, like, tidbits of information and updates. We make sure we’re, you know, getting messages out where we can. We did find that we did a lot of top-down at the beginning, and then direct, you know, first front-line folks that we were working with, and we missed the middle.

We recognized quickly that we’ve got this work we need to do around change management to the middle management, and those folks that aren’t on the front line or are the leaders, because they seem to be supportive, they’re ready, they’re eager, and we’ve got this middle management that we really need to get that feedback from and see what’s working well and what’s not working well. We do have, like I said, lessons learned. So these are good, positive thoughts. We got a lot of great feedback. People appreciated having someone they could go to as a resource, because before they would just say, hey, program, do you know how to do this? Have you done this before? Can you find someone who can help? And some programs had great, robust resources that could support that. So we found that we got a lot of positive feedback and had many opportunities for continued improvement in the model we were implementing. I think I’ll stop there.

Colton Anderson:
Okay, one note I just want to make is that I was listening to all of them, I was thinking, I think if you’re going to take on any sort of process improvement project, it really does take a champion, and that’s what these four folks up here are, is champions within the agency. So if that’s not you, go find that champion within your agency. If this is of interest to you, or if you’re wanting to do any sort of process improvement or change management project, lean on those champions, because those are the ones that are going to lead you to greater success, and that’s what we found with these jurisdictions. So why don’t we open it up now for some Q and A if anyone has any questions, and we may, we’ll see if we need a mic, but go ahead, sir.

Audience Member #1:
I have a question for Washington. Within the context of a grants management process, I heard a lot of it was oriented towards making application for a grant and making that process easier and a more centralized system, free so that people didn’t have to find or create pieces on their own. We’re wrestling with how to manage grants, especially financially, post-award. Do you folks have any experience in that portion of Grants Management?

Amy Ferris:
We are not fully through that process. That is like the next piece of really looking at the management side. We have made some improvements around that, but we knew we needed to get some core capacity set up first, and we knew that started with the application process. But yes, that is one of the phases we will be going into: how do we best support the programs, and what tools and timelines do they need to do their work? So we do have a tip sheet for them, but we haven’t gotten too far into that body of work.

Katherine Feldman:
I have a question for Washington. So this has all been really fascinating. So thank you. You mentioned that grants coordination, you thought was better centralized, but the grants management left with the program. So, but then it wasn’t clear to me if there was grants management, if the intent is to leave it with the program.

Amy Ferris:
Yeah, the intent is definitely to leave it with the program, because, again, they’re the ones implementing the services, but they need to have those regular touchpoints with the grant coordinator. And this is, I think, what that gentleman back there was talking about is grants management isn’t just a one, it’s an ongoing piece, and so we still have a role centrally to support that function, but we do know that that is where how do we train our programs to know, hey, to manage a grant means you’re doing contract management. You’re making sure you stay aware of where you are with your grant spending. You’re making sure you know what’s coming up in those reporting requirements, and you know what’s allowable and not allowable within that grant application. We’ve got a fiscal support person that’s already assigned to support these people that also helps with that, and a grant coordinator, so we have support services around them, but they still also need to know that information.

Katherine Feldman:
So what does this look like personnel-wise, are you shifting responsibilities, or is it a one to one? Do you need to save people? Lose people?

Amy Ferris:
What we did is we shifted people that were truly we looked at, I don’t even know how many position descriptions and positions that we reviewed to see, are they majority a grant coordinator, or are they doing grant management? If they were doing grant management, we said, you need to stay in the program, because this is the part of the program side. If they were doing majority grant coordinator, we did shift them centrally. So we shifted over about six people centrally into this agency grants coordination team. And we, like I said, had the big investment that could support. We definitely know that we have some additional gaps. Because when you come into the spring of each year when it’s grant application season, the team is a little overwhelmed, so we know we’ve got some work to do.

Valentina (Audience):
Hey, I’m Valentina from the Tulsa Health Department. I’m the evaluator for the PHIG grant. For Washington, I’ve been trying to do a very manual process to figure out how many people within our agency are health or grant-funded, what those grants are. What percentage of their salary is grant-funded? How many of those grants are at risk? All the questions you could think of, but I’m just one person, so I’m curious. The rough number that I have is that about 36% of our agency is grant-funded right now. I have no way of verifying that right now, but I’m curious, if you know for your. Um, health department, what does that look like? And you guys are a state, so it’s probably totally different. But I’m just curious.

Amy Ferris:
Well, that is a great question, and it is one that we are tackling right now. We don’t. We can run reports. I’ve got an amazing data team who can run me any report that I need, and what they’re working on now, because of our federal fiscal environment, is, what are all the grants we have? When do they come up for renewal? How many people are funded by these grants? Who are the people funded by these grants, who are the contracts that we invest in these grants? Who are those organizations? And how much, and how much have they spent of the funds we’ve given them? So that is what we have been focused on, so that we could look 90 days out to say which grants are coming up for renewal and how, and how much that is going to impact our employees. How much is that going to impact our partners that we invest in? And so, like I said, they were using Power BI, we’re using Excel. We don’t have a data system. Those are just the tools we’re using to download data and put it into reports we can use to help us do the analysis.

Valentina (Audience):
Sorry, follow-up question. We currently don’t have Work Day, but we’re hoping to do it for you guys. Is there anybody in the room? Is Work Day any help? No. Okay, perfect. Thank you.

Michael (Audience):
I’ll start with Michael from Seattle, King County, Washington. Just on the last question, just recently, set aside about a half of an FTE to manually track every federal funding source and all the ways Amy just said, so we can track when the funds expire under what risks are coming, and the number of positions funded in it, because it’s manual, we just have to put a resource there, because there’s so much uncertainty and 10s of millions of dollars at risk. My question is, potentially Austin or Melissa. So when auditors come and review our policies and whether they’re being complied with, they often give us feedback. Why is this a policy? You’re increasing your risk by putting something in a policy that could have been in a procedure. And so, how do you decide what goes into a policy versus a procedure?

Lauren Marsh:
I can start with what we’re doing at Austin Public Health, and then let me turn it over to Melissa. Part of our problem that we are working on now is that the words policy and procedure were used interchangeably, and by me, previously, by staff throughout the department. And people were also kind of building policies with the procedure right in attached. And so it got very messy very quickly. And so we are trying through this process, really trying to clearly define what a policy is, relying on whether it’s a city policy, can we follow that policy, and just have procedures that support it? If not, because we’re a health department, we have other requirements related to HIPAA and other items, keeping those policies. So we are actually trying to reduce our policy load right now and move towards what we have actually being true policies, and then moving more towards procedures, work guides, work instructions. And so that’s a lot of the work that we’re having to do right now.

Melissa Touma:
Yeah, and that’s what I was going to say too. I think we a lot of conversations we have with jurisdictions who are going through the TA is, what is the balance of how many policies an agency needs to have? You don’t want too many, you don’t want too few. And so clearly defining the policy versus a procedure is a part of, you know, the guide and the tools we we also have tools around risk assessment and that gap analysis tool also helps jurisdictions identify which policies are needed based on federal requirements or state requirements or grant requirements, maybe PHAB requirements and that and that will also help balance that load between what needs to be in policy or what could be in a procedure maybe doesn’t need to be written down, or maybe it’s in a training, right?

Colton Anderson:
Any other questions for any of our presenters? Okay? Well, I know we’re standing in front of you, and it’s dinner time, so I will not stretch this out any longer. If you heard any of these services that ASTHO offers and are interested or want to learn more about them, Google ASTHO STAR, or reach out to Colton, Melissa, or Kristin at ASTHO, our Performance Improvement team will be able to help you out. So we appreciate you all. Please. Round of applause for all of our presenters, too. Thank you so much.