2011 Model Practice Application (Public)

Public Health Budgeting Using Decision Support Software

Spokane Regional Health District

Public Health Budgeting Using Decision Support Software

Funding has and continues to be a major issue facing LHD’s. Using your discretionary dollars to the best advantage for maximum results is an ongoing goal. Trying to rank and compare the multitude of programs in a local health district is very challenging. Allocation of resources should follow the agency priorities and strategic goals. With a wide array of programs, it can be difficult to compare them in a meaningful way in order to allocate limited dollars with justification that can be defended with data.

Our role is that of a leader in the community who is able to define and defend the decisions made regarding our budget. After all, where you spend your resources speaks volumes about your values. We base those decisions on data reflective of our strategic plan, our program’s foci, and our agency priorities.

Prioritizing and sustaining priority programs, particularly in challenging economic times requires Local Health Jurisdictions to maximize their discretionary funds use. By using decision analysis software in the budgeting process, agencies can use criteria and measures that align with national and state standards and local missions and goals. The results create strong data driven decisions for a program being included or excluded from a budget. The Spokane Regional Health District’s goal was to establish a data driven process to guide allocation of general fund dollars in alignment with agency priorities and strategic plan. In support of this goal, the agency established two key objectives: 1) develop a system that engages a broad segment of employees, and 2) assure that the system is science based and repeatable with evolutionary capability. The Spokane Regional Health District has used a decision support software tool called Logical Decisions for Windows in three consecutive budget periods beginning in May, 2007. The goal of making logical, data driven decisions regarding public health fund distribution has been realized. Our objective was to assure community and agency priorities are addressed and occurring, and we would like to share with others the results and strategies to utilize decision support software in ways that have benefitted Spokane's health district through challenging, diminishing budgets. Following the training, we began to structure our system. The process begins by developing a structural hierarchy that defines the scope of the variables you choose to compare programs across your agency. Furthermore, it illustrates the relationships between multiple complex and diverse variables. As such, it becomes possible to compare clinical services, liquid waste, public health nursing and laboratory programs, and others when seeking how much general funding to apply across the agency. Using a spreadsheet-like matrix, it is possible to visualize the variables as probabilities are assigned to each variable. Ultimately, the outcomes can be presented in ranked order by any variable or group of variables to test and validate that the structure and values assigned are functioning as desired. A portfolio of weighted options is presented that is a statistical representation of the relative value of the scoring of all programs. We have achieved our objectives with broad engagement of staff and refinement of the annual process. Each year, we rotate leadership of the decision analysis process, which assures different aspects gain attention. This is a new, fascinating, visionary strategy in the leadership aspect that NACCHO is looking for to share at the 2011 Annual Conference.

Our process is evaluated annually by the executive leadership team and via feedback from our Board of Health. We identify variables that are scored inconsistently, that lack sufficient clarity and those with no variability in order to refine them for the following year. The overall process is examined for opportunities to streamline scoring and comparison for perceived value with the portion of funds applied to each program. Since using the Logical Decisions for Windows process, we have had all of our budgets passed as presented, improved understanding across the agency when programs receive additional or reduced funding, and have improved community understanding of the challenges facing public health in our community.