Sexually Transmitted Diseases  >  Program Guidelines  >  Leadership and Program Management

Program Operations Guidelines for STD Prevention
Leadership & Program Management

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Sections on this page:

• Operational Plan
• Goals and Objectives
• Program Evaluation
• RESOURCE DEVELOPMENT AND MANAGEMENT
• Personnel
• Training
• Professional Development
• Career Development
• Fiscal & Material
• Research and Technology
• Advocacy
• Media Relations
• Legislation

PROGRAM MANAGEMENT: OPERATIONAL PLANNING AND EVALUATION

Operational Plan

An operational plan organizes and directs program efforts to prevent disease, provides feedback on the progress of those efforts, and should be developed in collaboration with relevant public, private, and community partners. A plan should accomplish the following:

• Identify problems, needs, and resources.
• Develop problem statements that describe what is occurring, what should be occurring according to project area data and objectives, the deviation between what is and what should be occurring, and whether the deviation is significant enough to commit or, in some cases, divert resources (needs assessment).
• Develop overall prevention strategies that describe general program approaches to solve the problem and monitor progress.
• Develop objectives consistent with prevention strategies that, if achieved, will address or correct the problems.
• Develop a plan of operation consisting of interventions, activities, program organization infrastructure, time lines, and funding that will accomplish the objectives.
• Develop an evaluation mechanism that will periodically monitor progress, indicate necessary modifications, and measure objectives.
• Describe the procedures for gathering and analyzing outcome and process performance information.
• Include instruments, time lines, and frequencies for reporting process and outcome information to each level of management.
• Describe how outcome and performance information are used to provide quality assurance for various program activities.
• Establish and maintain a quality assurance system for all appropriate components that support disease prevention.
• Specify acceptable levels of productivity from each essential component and the qualitative standards of performance expected.

Operational plans are elaborated in documents periodically prepared by state and local health agencies and in their annual STD prevention project grant applications to CDC. Careful consideration should be given to the organization and contents of such documents because each has the potential to influence decisions about resources needed for program operations. Plans should be current, consistent, realistic, and should address factors that affect disease intervention. Plans may be developed at different levels depending on the amount of oversight a program has over particular areas. These are described below.

• Those areas over which the program can exert direct influence, e.g., the quality of clinical services and disease intervention outreach activities
• Those areas over which the program has indirect influence, e.g., the sexual behavior of patients and the performance of health service providers who participate in STD prevention program activities such as screening, morbidity reporting, and serologic reactor notification
• Those areas which involve individuals or groups who are beyond the program's purview, but whose behaviors affect disease intervention. For example, STD educational outreach efforts may be necessary to reduce the congenital syphilis morbidity among high risk populations, such as undocumented workers who frequently do not seek prenatal care.

Periodically, an STD prevention program must carefully review its operational plan for achieving various long-term objectives. This plan should relate to each short-term objective and should detail specifically how various activities will be conducted to achieve the expected results that the objectives stipulate. As new objectives are established, or as current ones are revised with different levels of expected achievement, the operational plan needs to be amended. The operational plan is revised when problems result in unsatisfactory achievement of any established short-term objectives or when improved methods are devised to pursue particular objectives.

Goals and Objectives

Goals, long-term objectives, and short-term objectives are related in a hierarchy of levels. Goals form the broadest level of a program's purpose and are developed in the strategic planning process. They are in turn supported by levels of objectives that become successively more specific and explicit. Long-term objectives contribute directly to the attainment of program goals; short-term objectives support the achievement of long-term objectives. Long-term and short-term objectives and goals form a blueprint for the design and implementation of a program. Their articulation becomes the basis for the development of a plan of work for each project area activity.

Program Evaluation

Program evaluation is the systematic collection and analysis of information to determine the quality of a given program's design, implementation, or effectiveness, with the intent of using that analysis to improve program performance. Measuring how much activity is taking place, how quickly it is occurring, and the quality with which it is being accomplished is a critical function of management. Managers at all organizational levels must routinely monitor process performance along with output to accurately identify strengths and weaknesses affecting overall program performance. This is accomplished by establishing an evaluation plan for each program component that supports disease intervention efforts, e.g. surveillance, screening, case management, etc.

Evaluation should always be incorporated from the beginning of the planning stages for all program activities. Evaluation plans should clearly relate to objectives, methods employed to accomplish them, procedures for gathering and analyzing outcome and process performance information, and instruments, time lines, and frequencies for reporting to each level of program management.

Outcome indicators are used to assess a program's effectiveness, identify strengths, and identify areas that may need improvement. However, they cannot explain why a problem is occurring. Operational plans should not be revised on the basis of outcome evaluations alone. Placing too much emphasis on outcome indicators runs the risk of creating an environment where the indicator becomes a goal in and of itself, resulting in pressure to achieve an ideal number rather than focusing on process performance or the overall program goals. Program goals that were developed in the strategic planning process should always be kept in mind when analyzing outcome indicators.

 

RESOURCE DEVELOPMENT AND MANAGEMENT

STD program managers are responsible for ensuring that human, material, financial and technological resources are used in the most cost-effective way to reach the program's stated objectives.

Personnel

STD Program Managers are responsible for the appropriateness and the quality of services provided by STD programs' clinical, intervention, and support staff. Managers must ensure that staff members are adequately trained to perform their assigned tasks efficiently and effectively. Quality assurance reviews, needs assessments, and other monitoring systems must be in place so that managers obtain information to help them identify and address skill deficiencies that may exist. Three systematic approaches supporting the development of high quality personnel performance are training, professional development, and career development. First line supervisors and program managers have a key role in the development of new employees.

Training

A training program is essential to developing individual job-related skills. It is the responsibility of management to assure that employees have received appropriate training to perform assigned tasks, and that the training has been successful. Needs assessments may indicate that specific performance problems should be addressed through training.

Professional Development

Professional development efforts include training, as well as orientation, formal education, information seminars, and on-the-job work experiences designed to develop or enhance expertise. A systematic approach should be applied to the development of employees involved in the delivery of STD prevention services.

Career Development

Career development includes professional development, but it is a more comprehensive management commitment to staff development. It is an important component of STD prevention programs because it provides advancement opportunities to help ensure that trained, experienced employees are available to move into higher-level positions.

For details on training, professional development, and career development, see the chapter "Training and Professional Development."

Fiscal & Material

Program managers are responsible for assuring that resources are allocated according to program priorities and managed according to rules and conditions as specified by the funding agency. When developing budgets, program managers should clearly describe line-items and document within the budget justification the relationship between all costs and specific objectives and activities. Detailed budgets are generally developed for 12-month periods; however, it is important to plan for up to five years so that anticipated changes in funding levels can be reflected in program plans.

STD programs often contract with other agencies, public or private, to carry out program activities. When developing contracts, it is important to identify the contractor, the period of performance, the method of selecting a contractor, the description of activities and deliverables, and an itemized budget. Different project areas may have different methods by which they may contract for services. It is important that program managers explore all of the contracting options and choose the one most appropriate for the scope of work and type of contractor.

Research and Technology

Program management is responsible for assuring that prevention strategies are based on sound research findings and scientific principles. Managers should stay abreast of current, relevant research findings and incorporate these appropriately into program practice. As relevant research findings will modify program practice so, too, will the development of new technologies. The transfer of research concepts and the implementation of new technologies require the systematic involvement of staff who will have primary responsibility for implementing the change.

ADVOCACY, MEDIA RELATIONS, & LEGISLATION

Advocacy

Unlike many other health problems , there are limited patient-based constituent groups for STD who advocate publicly or lobby for STD-related programs. This is primarily because having a STD is still considered by some to be socially unacceptable. This stigma hinders public discussion and community activism around the issue of STD prevention. In addition to tapping into existing groups it is important for STD programs to identify and reach out to public and private agencies that have a demonstrated or potential stake in STD prevention because of constituents they represent or serve. As STD prevention programs improve awareness and knowledge of STDs and encourage the adoption of healthy behaviors, stakeholders will need to be aware of the potential benefits that will be gained as a result of becoming actively involved in STD prevention.

Media Relations

For many years and with few exceptions, STD programs have reacted to news media, responding to inquiries regarding STD topics and issues and reacting to breaking news stories rather than initiating them. A broader approach is needed to communicate key STD messages. STD programs must consider how to develop more proactive media efforts and how to build relations with key media representatives so that target audiences may be reached. Within each state or local public health agency, there exists a mechanism for communicating with the media, often through a person or office that coordinates such activities. It is important that STD program managers understand this mechanism for communicating strategies in their agencies and use it to cultivate relationships with media representatives that will promote the prevention goals of the STD program.

Legislation

Public health law should be viewed primarily as a tool of prevention. State legislation related to STD and other infectious diseases acts as a framework for promoting public health and assisting public agencies in creating conditions in which people can maintain sexual and reproductive health. The careful exercise of state laws can be an effective and cost beneficial opportunity to improve the prevention and treatment of STD. Law can define the objectives of public health and set its policy agenda, authorize and limit public health actions, serve as a tool for prevention, and facilitate the planning and coordination of governmental and nongovernmental health activities.

Congress has specifically authorized and appropriated federal funds for projects and programs to prevent and control sexually transmitted diseases. These appear in section 318 of the Public Health Service Act, 42 U.S.C. section 247C. There are no federal laws mandating domestic STD prevention and control activities. All legal authorities emanate from statutes or regulations enacted by states or their political subdivisions. Although laws vary widely, certain authorities are common to most states and are necessary for STD programs to operate effectively. The first general category of authority involves enabling legislation or regulations that allows program administration and operations and generally includes:

• Definition of STDs
• Administrative requirements and rule-making authority (e.g., how health regulations are established)
• Funding
• Investigation of disease occurrence and outbreaks
• Quarantine, isolation, or compulsory testing and treatment of persons refusing needed examination and treatment
• Diagnostic, treatment, and counseling services to be provided
• Case and partner notification
• Provision for minors to consent to testing and treatment
• STD prevention education (e.g., as part of the public school curriculum)
• Authorization for field staff to collect specimens in non-clinical settings (e.g., venipuncture)
• Court proceedings, penalties, criminal exposure
• Confidentiality of STD patient services and STD records and consent for record release

The second general category of STD legislative authority contains case detection and disease surveillance statutes or regulations that allow for disease intervention activities. They typically include four areas of concern:

• Reporting of test results indicative of STD by clinical laboratories
• Reporting of disease occurrence by health care provider
• Premarital testing - IOM strongly recommends against this. Most states have rescinded this law
• Appropriate screening protocols for certain at-risk populations

The third general category contains medical and public health practice authorities or those authorities that address appropriate procedures necessary to ensure optimal patient care and preventive medicine. They typically include the following:

• Prenatal STD
• Ophthalmia neonatorum prophylaxis requirement by health professionals attendant at childbirth
• Prophylactic methods, principally condoms, which may be advertised and sold in localities other than through licensed pharmacies

STD program managers should review existing laws and statutes to assess their current utility and contribution to STD prevention policy, goals, and objectives. Consideration should be given to the reform of laws that no longer contribute to the goals of STD prevention and to the promotion of laws that reflect both sound scientific and technological developments. When revisions are needed, the program manager normally takes the initiative and works in concert with the state health department's legal counsel to bring about the needed revisions.

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