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2013 Model Practices (Public)

Practice Title
Milwaukee's Laboratory System Improvement Program
Submitting LHD/Agency/Organization
City of Milwaukee Public Health Laboratory
City
Milwaukee
State
WI
Submitting LHD/Agency/Organization Web Address (if applicable)
milwaukee.gov/health

Provide a brief summary of the practice in this section. This overview will be used to introduce the model or promising practice in the Model Practices Database. Although this section is not judged, the judges use it to get an overall idea about your practice. You must include answers to the following questions in your response:

• Size of population in your health department’s jurisdiction
• Who is your target population/audience, what is the size of your intended population/audience for this practice and what percent of your target population did you reach?
•Provide the demographics of your target population (i.e. age, gender, race/ethnicity, socio-economic status) 
• Describe the nature and gravity of the public health issue addressed
• List the goal’s and objective(s) of the practice and clearly link them to the problem or issue the practice is addressing.
• Describe the potential public health impact of the practice, and the likely effectiveness of the practice being implemented as intended, and the ease of adoption of the practice by other LHDs.

In your description, also address the following
• When (month and year) the practice was implemented.
• Briefly describe how the practice was implemented, what were major activities, and any start-up and in-kind costs and funding services.
• Outcomes of practice (list process milestones and intended/actual outcomes and impacts.
• Were all of the objectives met? 
• What specific factors led to the success of this practice?

The Centers for Disease Control and Prevention, in conjunction with a number of national associations, has developed tools to measure performance of state and local public health systems. Each tool uses the 10 Essential Public Health Services as a framework and is focused at the system level. In 2004, APHL launched the Laboratory System Improvement Program, L-SIP, to measure performance of state public health laboratory systems based on the 10 Essential Public Health Services and 11 Core Functions of Public Health Laboratories. L-SIP provides: • A framework for continual quality improvement of public health laboratory systems • A basis for considering the work of public health laboratory system performance in the broadest context of public health performance • A means for improving relationships with public health, private, and other governmental laboratories that comprise the broader laboratory system • A means to collect data to measure systems improvement and progress toward meeting Healthy People 2020 objectives • A means to increase the evidence-based foundation for public health practice Nearly two years ago, the City of Milwaukee Health Department Laboratory (MHDL) became the first – and still remains the only local system – to adapt and implement the Association of Public Health Laboratories’ (APHL) Laboratory System Improvement Program (L-SIP) at the local level. As designed by APHL, the intention of L-SIP is to target improvement of the public health laboratory system through the collaborative work of partners to assess system performance, plan for system improvements, implement improvement strategies, and periodically evaluate and re-assess the system as measured against pre-defined optimal levels against the 10 Essential Services of Public Health. After laying the groundwork, the MHDL officially began its L-SIP process by conducting an L-SIP Assessment in November 2010. About 75 stakeholders representing over 30 different agencies participated in Milwaukee’s assessment. Assessment results were analyzed and interpreted, 14 stakeholders – the Milwaukee Laboratory Advisory Committee (MLAC) – convened in June 2011 to lead strategic planning efforts for system improvements. The MLAC determined L-SIP improvement efforts should address public health issues related to Essential Service # 8-Assure a Competent Public Health and Personal Health Care Workforce, and Essential Service #10-Research for Insights and Innovative Solutions to Health Problems. Through multiple meetings and discussions and with the assistance of over 15 subject matter experts, the MLAC narrowed the focus of improvement efforts to the following three main goals: • Establish leadership and objectives to facilitate LPHL system research; • Promote the work of the LPHL system; and • Collaborate, systematize and strengthen internship opportunities across the LPHL System. MLAC members and subject matter experts were then divided into three separate committees, led by four community co-chairs, to develop and oversee the progress of implementation strategies for each area – Research, Workforce Development-Promotion and Workforce Development-Internships. L-SIP process has shown that, when given the opportunity, LPHL system stakeholders are eager to be involved in shaping the public health priorities of the community and recognizing the benefits for their own agencies as well. Based on Milwaukee’s observation, as well as that of many state assessments, the buy-in by local stakeholders would likely hold true for other LPHL systems. The L-SIP process has generated a strategic action plan and stakeholders continue to enthusiastically participate and offer encouragement and support as improvement strategies are actualized.

Overflow: Please finish the response to the question above by using this text area.  Please be mindful of the word limits.

L-SIP efforts thus far have been funded primarily through grants from APHL, including a mini grant and two $20,000 Innovations in Quality Public Health Laboratory Practice grants, one awarded in 2011 and one in 2012, as well as some internal MHD funding. While L-SIP efforts remain ongoing, with many goals yet to be achieved, one of the most positive outcomes of the process, as well as one of the most significant determinants of its success, thus far has been the enthusiastic support and participation from stakeholder partners. In addition to strengthening existing partnerships between the MHDL and area organizations, L-SIP has facilitated the formation of new partnerships as well. L-SIP and the MHDL are clearly filling a community need to lead cross-disciplinary research and workforce development initiatives with a host of community stakeholders, and our innovative and significant actions have therefore enhanced the laboratory system. While the Milwaukee Health Department primarily serves the City of Milwaukee, which has an estimated population of 597,867 people, the population impacted by Milwaukee’s L-SIP encompasses all of Milwaukee County. Milwaukee County comprises an estimated 952,532 people, based on 2011 census estimates.
You may provide no more than two supplement materials to support your application. These may include but are not limited to graphs, images, photos, newspaper articles, etc.
Describe the public health issue that this practice addresses. (350 word limit)
L-SIP addresses the issue of strengthening public health laboratory (PHL) systems. Through local application, Milwaukee’s L-SIP has engaged a diverse group of LPHL system stakeholders to assess the capacity of the LPHL system and target areas for improvements. Those areas identified for improvement in Milwaukee through this process are workforce development and research – Essential Services #8 and #10, respectively. Particularly, Milwaukee’s L-SIP aims to facilitate and support cross-institutional, multidisciplinary laboratory-related research that addresses community health needs and to address workforce shortages while taking steps to promote the LPHL system and attract and build a competent workforce, thus improving the capability of the system to meet the public health needs of the community.
What process was used to determine the relevancy of the public health issue to the community? (350 word limit)
Milwaukee’s L-SIP process began nearly two years ago, with the November 2010 assessment of the LPHL system, which called upon the input of 75 LPHL system stakeholders from more than 30 agencies to evaluate the LPHL system and pinpoint its strengths and weaknesses. Stakeholders of the LPHL System are those entities that either generate or utilize public health laboratory information. Partners ranged from clinical laboratory scientists, epidemiologists and environmental professionals, to academicians, researchers and first responders. Other key stakeholders also included professionals from the Milwaukee Medical Examiner’s Office, the Milwaukee Metropolitan Sewerage District, the Milwaukee County Zoo Veterinarian, the Wisconsin Crime Laboratory, the Milwaukee Water Works and environmental and clinical laboratory regulators from the State of Wisconsin. Stakeholders, representing a cross-section of the community and drawing on their own experience serving that community, were able to expertly evaluate the LPHL system and identify the areas most in need of improvement in order to best serve the community. After the assessment 14 lead stakeholders representing a cross section of disciplines agreed to come together as an advisory committee to identify strategic goals to improve the System. Once strategic goals were identified, subject matter experts joined the advisory committee in hammering out a strategic plan over the following months. Finally, community co-chairs with public health laboratory managers proceeded with three separate committees in an action plan with defined goals.
How does the practice address the issue? (350 word limit)
In order to identify and address research and workforce development related issues in the LPHL system, L-SIP has depended heavily on leveraging stakeholder partnerships and resources. Stakeholders participating in the process have pooled their expertise in order to develop detailed outcomes and timelines, including designating first-year accomplishments, calendar milestones and success indicators, for each of the three areas targeted for improvements – Research, Workforce Development-Promotion and Workforce Development-Internships. The four community co-chairs overseeing the three subcommittees met extensively in the first half of 2012 to plan and oversee the progress of strategic goals.
Does this practice address any of the CDC Winnable Battles? If yes, select from the following
Please list any evidence based strategies used in developing this practice. (Provide links or other materials for support)
http://www.aphl.org/MRC/Documents/Local_L-SIP_Assessment_Tool_2010.pdf http://www.aphl.org/AboutAPHL/publications/Documents/LSS_2012March_Laboratory-System-Improvement-Program-LSIP-Flyer-Fact-Sheet.pdf http://www.publichealthreports.org/archives/issueopen.cfm?articleID=2421 http://www.publichealthreports.org/archives/issueopen.cfm?articleID=2419 http://www.aphl.org/aphlprograms/lss/performance/Pages/default.aspx
Is the practice new to the field of public health? If so, answer the following questions.
No

What process was used to determine that the practice is new to the field of public health? Please provide any supporting evidence you may have, e.g. literature review.

How does this practice differ from other approaches used to address the public health issue?
Is the practice a creative use of an existing tool or practice? If so, answer the following questions.
Yes
What process was used to determine that the practice is a creative use of an existing tool or practice?  Please provide any supporting evidence you may have, for example, literature review.
The MHDL Laboratory Director has been an active member of APHL and served on the Laboratory Systems Improvement Program (L-SIP) subcommittee of the Laboratory Systems and Standards Committee of the Association of Public Health Laboratories for several years. As a local PHL member serving with mostly state PHL members all efforts regarding L-SIP were directed to have all 50 state PHL’s implement L-SIP as a major initiative of the Association. Local PHLs were not included in this plan. As of this writing 28 state PHLs have performed the L-SIP assessment and Milwaukee is the only local PHL system (1,2) to do so. Milwaukee took the initiative to develop and tailor the assessment tools for a local system, with the assistance of APHL and the L-SIP subcommittee members. (1)http://www.aphl.org/aphlprograms/lss/performance/PublishingImages/LSIPmap.jpg (2)http://www.aphl.org/AboutAPHL/publications/Documents/Lab_Matters/COM_2011Winter_LabMatters.pdf

What tool or practice (e.g., APC development tool, The Guide to Community Preventive Services, HP 2020, MAPP, PACE EH, etc.); did you use in a creative way to create your practice?  (if applicable) (300 word limit total)
a. Is it in NACCHO’s Toolbox; (if not, have you uploaded it in the Toolbox)?
b. If you used a tool or practice to implement your practice, how was your approach to implementing the tool unique and innovative for your target area/population?

The CDC/APHL LSIP assessment tool and process for state public health laboratory systems was modified and adapted for the first time for the assessment of a local public health laboratory system by MHDL (1). The MHDL’s application of L-SIP (2) and the preparation leading up to it showcases how MHDL has taken an existing state system practice – APHL’s L-SIP – and creatively modified it to fit a local system Particularly, MHDL worked with APHL to modify the Laboratory System Improvement Program Performance Measurement Too (3), designed to evaluate a State PHL system’s performance in each of the 10 Essential Services of Public Health, and used it at the local level. MHDL also developed a definition of an LPHL system (4). (1) http://www.aphl.org/AboutAPHL/publications/Documents/Lab_Matters/COM_2011Winter_LabMatters.pdf (2) http://www.aphl.org/aphlprograms/lss/performance/Pages/default.aspx (3) http://www.aphl.org/MRC/Documents/Local_L-SIP_Assessment_Tool_2010.pdf (4) http://www.aphl.org/MRC/Documents/Definition_of_a_Local_Public_Health_Laboratory_System.pdf

How does this practice differ from other approaches used to address the public health issue? 

Milwaukee’s L-SIP takes a model originally designed for application at the state level and modifies it for local use in order to improve the LPHL system. Further, because Milwaukee’s L-SIP involves the participation of diverse system stakeholders, it enables the system to pool resources and expertise to collectively address system shortcomings in the areas of research and workforce development, as opposed to organizations individually and/or internally facing those issues. Furthermore, no other assessment tool or platform exists that would evaluate or bring together this diverse group of agencies and institutions for a common purpose of addressing a public health laboratory system. The overwhelming and continued response ongoing after two years indicates a need has been and continues to be filled in the public health community around the identified issues.
If this practice is similar to an existing model practice in NACCHO’s Model Practices Database (www.naccho.org/topics/modelpractices/database), how does your practice differ? (if, applicable)
No
Who were the primary stakeholders in the practice?
Milwaukee’s L-SIP began with those who participated in the L-SIP assessment – a group of about 75 LPHL system stakeholders from over 30 different local and regional agencies, such as the Milwaukee Health Department, Wisconsin Department of Public Health, Wisconsin State Laboratory of Hygiene, Medical College of Wisconsin, University of Wisconsin-Milwaukee, Milwaukee Water Works, the Milwaukee County Medical Examiner’s Office, and many others. (1) To guide and support LPHL system improvement efforts following the assessment, the Milwaukee Laboratory Advisory Committee (MLAC) was later established. The MLAC consists of 14 individuals (2) representing the diversity of the LPHL system. About 10 additional subject matter experts (3) were later recruited for strategic planning as well, and four members from the collective group volunteered as community co-chairs (4) to oversee the activities of three subcommittees – Research, Workforce Development-Promotion and Workforce Development-Internships. (1) http://city.milwaukee.gov/LSIP (2) http://city.milwaukee.gov/ImageLibrary/Groups/healthAuthors/LAB/PDFs/L-SIP/2-MLACparticipants.pdf (3) http://city.milwaukee.gov/ImageLibrary/Groups/healthAuthors/LAB/PDFs/L-SIP/MLAC-8.2/MLACParticipantList.pdf (4) http://city.milwaukee.gov/ImageLibrary/Groups/healthAuthors/LAB/PDFs/L-SIP/2012InnovationsGrantReport.pdf
What is the LHD's role in this practice?
The Milwaukee Health Department Laboratory (MHDL) initiated the L-SIP process, with the full support of the local health department administration and Commissioner’s Office. MHDL has provided the leadership and served as the coordinator of all L-SIP related activities. The Milwaukee Health Department has provided staffing and some financial assistance to help support L-SIP efforts. Revenue from the laboratory initially supported the hiring of a consultant to facilitate meetings and coordinate L-SIP communications. Subsequently grant funding allowed continuation of the process. MHDL has been responsible for and engaged over two years, over 100 community stakeholders in the LPHL System in various capacities and collaborations. Several grants and community financial support have been acquired as well in support of L-SIP.
What is the role of stakeholders/partners in the planning and implementation of the practice?
The stakeholders and partners are the driving force in implementing the practice: L-SIP. This is a community committee driven process, assessment and evaluation as are similar system assessments such as the MAPP process used by local health departments. It has been the input of stakeholders that determined how the LPHL system was evaluated and which areas should be targeted for improvement. The dedicated participation of stakeholders throughout the process that has guided strategic planning and action steps to enhance research and workforce development activities of the system. Without the active role of stakeholders, L-SIP would not be serving its purpose. In addition to committee volunteers, community co-chairs have stepped up and given their valuable time for the last two years in moving the process forward. These busy community leaders recognize the value of the objectives as witnessed by their continued support.

What does the LHD do to foster collaboration with community shareholders?
Describe the relationship(s) and how it furthers the practice's goals.

The MHDL has used many strategies to foster collaboration, including numerous face-to-face meetings among the Laboratory Advisory Committee members, subject matter experts/committee members, community co-chairs, as well as electronic communications, and outreach to potential partners. Reports to members and a regularly updated website (http://city.milwaukee.gov/LSIP) to keep the stakeholders informed. Many incidental system-strengthening activities and collaborations have been initiated as well, such as interfacing efforts with other local research consortia or speaking engagements regarding public health and/or L-SIP at local universities. MHDL’s collaborative relationship with stakeholders is the backbone of L-SIP and the furthering of L-SIP goals. Particularly, the four community co-chairs overseeing the three L-SIP subcommittees (Research, Workforce Development-Promotion and Workforce Development-Internships) met regularly with MHDL staff to develop objectives to fulfill strategic goals and maintain communication with MHDL staff in overseeing the progress of those goals. The local health department laboratory is becoming more integrated into numerous community efforts related to collaborative research and workforce development through ongoing committee relationships such as participation by speaking engagements, reciprocal agency visits and tours and collaborative grant discussions with major research institutions, institutes and agencies that would not have developed had it not been for the L-SIP process. Examples include collaborations with the Clinical and Translational Science Institute of Southeast Wisconsin and its Community Engagement in Research Group, the University of Wisconsin – Milwaukee’s Children’s Environmental Health Sciences Core Center, the Medical College of Wisconsin and its Annual Midwest Microbial Pathogenesis Conference Interactive Forum on Careers, the Wisconsin Department of Workforce Development Clinical Laboratory Science Workforce Report Reflection Panel, to name a few resulting from L-SIP stakeholder meetings. The latest L-SIP research subcommittee of 20 area researchers generated a research database and numerous new potential collaborations which were identified within the stakeholder community that had not been recognized prior to this engagement.
Describe lessons learned and barriers to developing collaborations.
MHDL, similar to other PHLs, has not typically had a forum for involving multiple system stakeholders. However, the L-SIP process has shown that, when given the opportunity, LPHL system stakeholders are eager to be involved in shaping the public health priorities of the community and recognizing the benefits for their own agencies as well. Based on Milwaukee’s observation, as well as that of many state assessments, the buy-in by local stakeholders would likely hold true for other LPHL systems. As a result of L-SIP, many connections have been forged or strengthened, and partners now better understand one another’s roles in the LPHL System. The post-assessment survey that participants responded to showed that stakeholders see overwhelming value in the L-SIP process and are committed to remaining involved. The L-SIP process has generated a strategic action plan and stakeholders continue to enthusiastically participate and offer encouragement and support as improvement strategies are actualized for L-SIP. Some barriers identified include the difficulty of scheduling committee members and community co-chairs who have considerable responsibilities and commitments outside of their L-SIP roles. In the future, more L-SIP meetings may be conducted via conference call or the web. Likewise, with regard to developing or forming new collaborations, it can be difficult for MHDL to find the time to reach out to other potential partners regarding L-SIP. Having a dedicated staff person for L-SIP could make regular outreach more feasible.

Evaluation assesses the value of the practice and the potential worth it has to other LHDs and the populations they serve. It is also an effective means to assess the credibility of the practice. Evaluation helps public health practice maintain standards and improves practice.


Two types of evaluation are process and outcome. Process evaluation assesses the effectiveness of the steps taken to achieve the desired practice outcomes. Outcome evaluation summarizes the results of the practice efforts. Results may be long-term, such as an improvement in health status, or short-term, such as an improvement in knowledge/awareness, a policy change, an increase in numbers reached, etc. Results may be quantitative (empirical data such as percentages or numerical counts) and/or qualitative (e.g., focus group results, in-depth interviews, or anecdotal evidence).

List up to three primary objectives for the practice. For each objective, provide the following information:  (750 word limit per objective)

• Performance measures used to evaluate the practice: List the performance measures used in your evaluation. Depending on the type of evaluation conducted, these might be measures of processes (e.g., number of meetings held, number of partners contacted), program outputs (e.g., number of clients served, number of informational flyers distributed), or program outcomes (e.g., policy change, change in knowledge or attitude, change in a health indicator)
• Data: List secondary and primary data sources used for the evaluation.  Describe what primary data, if any were collected for each performance measure, who collected them, and how.
• Evaluation results: Summarize what the LHD learned from the process and/or outcome evaluation. To what extent did the LHD successfully implement the activities that supported that objective? To what extent was the objective achieved?
• Feedback:  List who received the evaluation results, what lessons were learned, and what modifications, if any, were made to the practice as a result of the data findings.


 

Objective 1:

Objective 1: Establish leadership and objectives to facilitate LPHL system research. • Performance measures used to evaluate the practice: This objective was successfully met through the appointment of two community co-chairs to oversee research goals and related implementation plans and timelines, as well as establish the members of a full Research Subcommittee. The co-chairs met three to four times between April and June 2012, including a Research Subcommittee meeting in June which brought together about 20 local researchers to discuss their current research and research interests. As a result of that meeting, researchers learned of current research efforts they were not previously aware of and identified several possible research collaboration opportunities in the LPHL system. Participants filled out a survey about their research capabilities and interests, the results of which were compiled into an inventory of research in the Milwaukee area that will help connect researchers by showcasing themes of research in the area and providing them with contact information. • Data: Cards containing current research topics, research topics of interest, and capabilities/resources filled out at the June 2012 Research meeting were compiled and organized by MHDL staff. A synthesis of an extremely diverse group of researchers identified seven current research disciplines, six research areas of interest, and five categories of resources available among the group. As a result of this meeting, nine researchers identified 15 new potential collaborations of interest that would complement their ongoing work. Further discussions have been initiated to link community research databases from the various networks.

Overflow (Objective 1): Please finish the response to the question above by using this text area.  Please be mindful of the word limits.

• Evaluation results: Through outcome evaluation of the results of these research efforts, MHDL can infer that it is filling a need in the Milwaukee LPHL system to connect researchers with one another and foster research collaboration. The MHDL fully implemented its goal of establishing leadership for system research efforts, and made significant strides toward facilitating LPHL system research in that local researchers are now more aware of research currently happening in the system, research interests that may be pursued in the future, and the resources available within the system to conduct certain research. As a result of research-related L-SIP efforts, local researchers now are more informed on the researching landscape of the LPHL system and the opportunities available for collaborative research endeavors. • Feedback: Researchers have expressed interest in continuing this process and a survey will determine the short term and long term impact of these efforts.

Objective 2:

Objective 2: Promote the work of the LPHL system. • Performance measures used to evaluate the practice: The community co-chair overseeing the Workforce Development-Promotion Subcommittee met three times with the co-chairs of the other subcommittees between April and June 2012. Once members were recruited to the Workforce Development-Promotion Subcommittee, the six-member group met once in late April to brainstorm strategies for promoting the system. • Data: Storytelling has been developed as a tool to promote public health laboratory careers and three such stories developed by an AHEC intern dedicated to assisting with the L-SIP process. These stories were shared at a job fair and on the MHDL website. A local college radio station has been identified to share these stories with prospective students and MHDL has participated in a job fair at the local area technical college. • Evaluation results: Process evaluation of the steps taken thus far indicate that Milwaukee’s L-SIP is making progress with regard to promoting the LPHL system to the general public. Particularly, the MHDL reached a significant population at the MATC Job Fair and presented valuable information on laboratory careers to those who interacted with the booth. Two additional job fairs have been identified to promote public health and public health laboratories as career options. • Feedback: The MHDL garnered feedback from MATC Job Fair attendees regarding knowledge of and interest in the LPHL system and laboratory-related careers. The general lack of knowledge about what the MHDL does, lab career tracks available and the education required to pursue them indicates there is a need to promote the LPHL system to the general public, and that participation in the job fair was a positive first step toward meeting that need. 271 word count

Overflow (Objective 2): Please finish the response to the question above by using this text area.  Please be mindful of the word limits.

Objective 3:
Objective 3: Collaborate, systematize and strengthen internship opportunities across the LPHL System. • Performance measures used to evaluate the practice: The community co-chair overseeing the Workforce Development-Internships Subcommittee met three times with the co-chairs of the other subcommittees between April and June 2012. As a result of action steps identified through those meetings, a meeting was arranged with the Director of Workforce Development and Public Health Workforce Development Project Coordinator for the Wisconsin Department of Health Services in late May 2012. A potential workforce shortage in the area of Certified Medical Laboratory Technicians identified through these meetings and committee discussion was targeted as the focus for this survey. As a direct result of the meeting in May, questions developed by the Workforce Development-Internships Subcommittee related to MLT/CLT students and internship capacity were incorporated into the 2012 Wisconsin Clinical Laboratory Science Workforce Survey. The results of the survey, which reached laboratories throughout the state, are now being reviewed and interpreted. With the assistance of a student intern, the MHDL also surveyed some of its partners on the ease of filling laboratory positions and attracting student interns. • Data: Survey data was collected through the 2012 Wisconsin Clinical Laboratory Science Workforce Survey conducted by the Wisconsin Department of Health Services, and through the MHDL’s email survey to laboratory partners. • Evaluation results: Process evaluation of the internship improvement efforts taken thus far indicate that Milwaukee’ L-SIP was successful in effectively gathering input from laboratories throughout the state on MLT/CLT students and internship capacity. Now that the MHDL has a better pulse on where laboratories stand on the issue, it is better positioned to identify steps that can be taken to strengthen internship opportunities within the LPHL system. • Feedback: Feedback has been gathered through responses to the above described surveys, and results are being reviewed to determine how workforce development efforts related to internships should be tailored to better meet the needs of the LPHL system in Milwaukee.

Overflow (Objective 3): Please finish the response to the question above by using this text area.  Please be mindful of the word limits.

What are the specific tasks taken that achieve each goal and objective of the practice?
In addition to the task undertaken by community co-chairs and MHDL leadership to diligently develop and guide research and workforce development efforts, other specific tasks that have been taken to achieve or position the MHDL and LPHL system stakeholders to achieve L-SIP goals are as follows: Research • A group of researchers was convened to discuss current research, research interests and resources and identify opportunities to collaborate on research. • A research inventory was developed based on the results of the researcher meeting. • Five community researchers have written grants that included the local public health laboratory as a result of L-SIP efforts. • Several stakeholders have visited the local public health laboratory for tours and discussions related to potential collaborations. • MHDL has been invited to participate in community forums, provide seminars and present posters related to public health laboratory activities and their impact on the community’s health Workforce Development-Promotion • MHDL staff attended a storytelling conference and began establishing best storytelling practices. • A MHDL intern drafted stories on the experiences of MHDL laboratorians, which were edited and compiled into a newsletter. • The MHDL set up a booth at a local technical college’s job fair, at which it distributed the newsletter promoting lab careers and other promotional materials. • The Workforce Development - Promotion committee has developed numerous potential action plans to promote the public health laboratory system and laboratory careers in general Workforce Development-Internships • The MHDL worked with the Wisconsin Department of Health Services to incorporate questions related to MLT/CLT students and internships on the 2012 Wisconsin Clinical Laboratory Science Workforce Survey. • The MHDL surveyed partner clinical laboratories on their workforce and internship needs.
What was the timeframe for carrying out these tasks?
Once the assessment was completed and results were compiled, an advisory committee was formed to determine strategic direction for the System. This took approximately six months. Committees were then formed with supplemental subject matter experts, who over the following six months defined elements of a strategic plan. Starting in 2012 community co-chairs developed actions with quarterly goals and deliverables through the summer of 2012. While these formal activities were ongoing, numerous informal interactions of various stakeholders, as documented above, related to grants, teaching, seminars, and discussions of mutual interests were also in process strengthening system objectives.
Please provide a succinct outline of some basic steps taken in implementing your practice.
An assessment of the Local Public Health Laboratory (LPHL) system in Milwaukee was conducted by 75 stakeholders in November 2010. Following the assessment, the Milwaukee Laboratory Advisory Committee was convened in June 2011 to review the assessment results and to identify system improvement priorities. Research and workforce development were identified as priority areas for process improvement to support the MHD in its mission to become an academic health department. Based on this prioritization, subcommittees comprising subject matter experts were convened to engage in strategic planning and action planning. Over the next six months, LSIP continued to engage multi-disciplinary LPHL system stakeholders to begin implementation and improvement of the LPHL system. Community co-chairs were secured in late 2011 to assure LPHL system organizational and stakeholder ownership and commitment to the project. The co-chairs met three times in 2012 to provide coordinated leadership for LSIP and the work of the three subcommittees that identified the three strategies for implementation. Quarterly target dates were designated throughout the year for completing designated tasks. Community co-chairs met regularly in the first half of 2012 to provide updates on the status of their subcommittees’ goals.

What were some lessons learned as a part of your program's implementation process?

As L-SIP continues, efforts will shift to being more action and results oriented in order to carry out the goals and meet outcomes that have been set. Translating strategies into action takes weeks and often months. Consequently, additional time will be required before the true results of L-SIP become apparent: measurable improvements in workforce development and research in the LPHL System. While measuring those outcomes will be challenging, the ongoing activities, interactions and partnerships accomplished to date offer encouragement and are visible signs of system strengthening. Factors contributing to delays in meeting the goals of the L-SIP strategic action plan have included scheduling conflicts of busy stakeholders, reflecting the need to plan meetings in advance as much as possible. Another challenge observed is that over time committee members may change, and logistics and strategies require modification in order to keep the process moving. Means to achieve the goals will change to meet the realities that new stakeholders bring to the table, along with new opportunities, experiences and ongoing dynamic programs that each new stakeholder can bring to bear in achieving desired results. Through L-SIP, MHD is clearly filling a community need to lead cross-disciplinary research and workforce development initiatives with a host of community stakeholders. Innovative and significant actions have enhanced the laboratory system, and therefore public health delivery.
Provide a breakdown of the overall cost of implementation, including start-up and in-kind costs and funding services.
Initial cost of a consultant for the first year was approximately $50,000 through lab revenue. After that three competitive grants from APHL/CDC totaling $24,000 sustained a part-time consultant for the following 18 months. The local health department provided some in-kind support during this time as well. Two of the local stakeholders also supported the consultant over the final 3 months through the summer of 2012.
Is there sufficient stakeholder commitment to sustain the practice?  Describe how this commitment is ensured.
Milwaukee’s L-SIP process has shown that, when given the opportunity, LPHL system stakeholders are eager to be involved in shaping the public health priorities of the community and recognizing the benefits for their own agencies as well. Based on Milwaukee’s observation, as well as that of many state assessments, the buy-in by local stakeholders would likely hold true for other LPHL systems. As a result of L-SIP, many connections have been forged or strengthened, and partners now better understand one another’s roles in the LPHL System. The post-assessment survey that participants responded to showed that stakeholders see overwhelming value in the L-SIP process and are committed to remaining involved. The L-SIP process has generated a strategic action plan and stakeholders continue to enthusiastically participate and offer encouragement and support as improvement strategies are actualized for L-SIP.
Describe plans to sustain the practice over time and leverage resources.
Without question, monetary resources must be leveraged in order to support the continuation of Milwaukee’s L-SIP efforts. The availability of grant funding to support a consultant/facilitator with a strong PH background has contributed significantly to the success of Milwaukee’s L-SIP. Therefore, future funding would enable the continuation of Milwaukee’s L-SIP, particularly the ongoing implementation of the workforce development and research strategies. Without such a grant, efforts and progress will be greatly diminished. However, the creation of a new job position, Laboratory Operations Manager, will entail some responsibilities to sustain L-SIP activities. Also, several stakeholders and consortia have expressed support and interest in maintaining L-SIP momentum. Grants from APHL have enabled the MHDL to carry the project to this point, and we continue to seek other grant opportunities. In July, the MHDL and community co-chairs applied for a four-year grant through the Medical College of Wisconsin’s Healthier Wisconsin Partnership Program (HWPP) to continue L-SIP efforts. We recently learned that we will not be awarded any funding for L-SIP, but we are researching grant opportunities that may be more suitable to our project.
Practice Category Choice 1:
Community Assessment
Practice Category Choice 2:
Public Health Infrastructure
Practice Category Choice 3:
Quality Improvement
Other?
No

Please Describe: