The document presents performance improvement recommendations for the Ohio Department of Health, identifying key gaps in organizational, process, performer, and technology levels. It highlights the need for enhanced partnerships, improved training, and more relevant deliverables to bolster emergency preparedness and reduce performance gaps. The proposed prioritized recommendations focus on delivering relevant outputs, optimizing training evaluations, and developing robust training programs for emergency response coordinators.

1. PI Recommendations
Ohio Department of Health
Thomas Muldrow
Instructional Design Department, Franklin University
IDPT 670: Capstone
Professor Nicole Hyatt
June 26, 2022

2. ODH Performance Improvement Recommendations
Organizational Level improvementopportunities
 Gap: A gap at the organizational level notedinthe State HealthAssessment(SHA) findingsfrom
2019 iscross-sectorpartnershipstoaddressthe manyfactorsthat shape our health.
 Conclusionsfrom the performance analysis:
o The current state of performance forOhioisanoverall score of 6.4 whichisbelow the
national average of 6.8, and significantlylowerthanthatof Pennsylvania(6.9).Additionally,
Ohiohas an index score of 5.2 for CommunityPlanning&Engagement Coordinationdomain
whichisbelowthe national average of 5.4 andlowerthanPennsylvania(5.6).
o The primarycause forthisperformance gapis environmental.There isalack of clearand
relevantguidestoperformancebeingprovidedtothe local healthdepartments.
Additionally,there isamotivationcause forthisgapat the local healthdepartment(LHD)
level.EmergencyPreparednessisonlyafractionof LHD responsibilities therefore most
individuals the focusonotherareasof publichealthmeansthat the recruitmentof the right
people isanissue aswell asthe motivesof the individualsputtingintothe positionsdue to
the lack of qualifiedcandidates.
 Performance Recommendations: The CentersforDisease Control andPrevention(CDC) is
mitigatingthisgapwithpublichealthgrantsintendedtohelpmeetcritical infrastructureand
workforce needsinthe short-term.ODHhowever,needstodevelopworkplansforeachbudget
periodthathighlightthe needtopartnerwithlocal/regionalorganizationsto advance
emergencypreparednessinOhio.Thatincludeseducation,clearexpectations,andmethodsfor
frequentandrelevantfeedback.
RecommendProcessLevel improvementopportunities
 Gap: A processlevel performance gapidentifiedbyODHisthe timely completionof deliverables
by the EmergencyResponse Coordinators (ERCs).
 Conclusionsfrom the performance analysis:
o The current state of performance demonstratedbylow-performingjurisdictionswithan
average of 6-10 denialsoverthe currentbudgetperiod.Manyof the denialsamonglow-
performingjurisdictionsare due tono submissionbythe due date or notmeetingthe
thresholdforapproval.
o The primarycause forthisperformance gapis environmental.The percentage of alocal
healthdepartment’sbudget thatisbasedonemergencypreparednessfundingisonly
around10%, meaningthe lossdue toa denial isrelativelyinsignificantcomparedtothe
savingsinmanhours.Additionally,federalrequirementsdictatethatthe funds
earmarkedforLHDs are reallocatedbacktothe departmentsif there iscarryover
fundingfromdenials.
 Performance Recommendations: Providingmore relevantdeliverablestothe LHDs should
decrease the denial rate.The lackof motivationdue toincentivescanbe overcome bynon-
monetaryincentiveslike tasksthatalignwithlocal priorities.If ODHincorporatesthe concerns
of local publichealthintothe deliverablesthroughamore wholisticinterpretationof the federal
requirementsorcan articulate the linkagesbetween CDCgoalsandlocal objectives,thenthe
denialsshoulddecrease.

3. RecommendPerformerLevel improvementopportunities
 Gap: A performance gapidentifiedbyODHisthe inabilitytoincrease the complexityof
preparednessplanninginLHDsdue to increasedturnoveranda lackof continuityinthe
EmergencyResponse Coordinator(ERC) position.
 Conclusionsfrom the performance analysis:
o The current state of performance isthatthere is$1,338,618 (12% of the total allotment)
inPHEP fundingstill outstandingforthe budgetperioddue toLHDdenials.Notably,
$935,390 isstill outstandingdue tonoinitial approval orresubmissionmeaningitwill
mostlikelygounclaimed.
o The primarycause forthisperformance gapis rootedinthe individualworker.There isa
lack of knowledge atthe local leveltoproperlyaddressthe more complexrequirements
of advancedplanning.Mostof the individualshave apublichealthorincident
managementbackground (Firefighter/Police/EMS) andthereforetheyrequire
specificallydesigned emergencypreparedness trainingtobe able tomeetexpectations
of the role.
 Performance Recommendations:ODH can minimize the lossof institutional knowledgethrough
the developmentof more robustPHEP101 trainingforthe incomingERCs.Additionally,the
abilitytobaseline newemergencyresponse staffinthe fundamentalsshouldpositionthemfor
success.Lastly,buildingarelationshipwithnew ERCsshouldhelpthe transitionwithopen
dialogue andtechnical assistanceearlierinthe deliverablesubmissionprocess.
RecommendTechnologyimprovementopportunities
 Gap: A technology relatedperformance gapidentifiedbythe ODH team isthe lackof a process
for determiningthe impactof the PHEP101 training
 Conclusionsfrom the performance analysis:
o The clienthasdevelopedthe revisedPHEP101 trainingfocused onprovidingamore
interactive wayto presentthe informationresultinginthe bestlearnerexperiencefor
the newERCs. Initiallythere was noapparenttechnologyperformance gaprelatedto
thisprojecthoweverwithadditional discussionitwasevidentthatthere wasno way to
properlyindoctrinatethe ERCs.
o The relationshipbetweenODHandthe LHDs is sensitivebecause Ohioisahome rule
state – providingthe local municipalitieswiththe powertolegislateonissuesof most
concernto that locality. Additionally,the LHDsreceive PHEPfundingfromCDCbyway of
the state as a subrecipienttherebyaddingtoanalready contentious relationship. The
notedchallengeshave made itdifficultin the pastto evaluate individualERC
competencies.
 Performance Recommendations:The technologyusedforthe trainingsupportsthe integration
of variousinstrumentsthatcan be usedto assesslearnerreaction,knowledgeincrease, andthe
impactit has withinthe first30 and 90 dayson the job. ODH can use Kirkpatrick'sModel of
Evaluation torevise the training,ensurethe fundamentalsare taught,andthe ERCs are better
preparedtowork intheirlocal healthdepartments. Due tothe sensitivityof the information

4. beingcollectedinthe evaluation,andtomaintainanonymity the recommendationisto use
Mentimeterforthe instrumentsbeingdevelopedatall three levels.
Assessclientreceptivitytowardperformance improvementrecommendations.
 The prioritizationof performancerecommendationsis significantlyinfluencedby whatiswithin
the Bureauof HealthPreparedness abilitytocontrol. Additionally,amajorcomponentof the
operational level recommendationinvolvesfundingtoaddressthe publichealthworkforce.
Withthat in mind the otherthree performance improvementrecommendationswouldbe
rankedbasedonthe largerimpacton the environment –the local healthdepartmentsabilityto
effectivelyrespondto publichealthemergencieswithintheirjurisdiction.
o PriorityOne – Providingmore relevantdeliverablestothe LHDs shoulddecrease the
denial rate (ProcessLevel)
o PriorityTwo – Integrationof variousinstrumentsthatcanbe usedto assesslearner
reaction,knowledge increase,andthe impactithaswithinthe first30 and90 days on
the job.(TechnologyLevel)
o PriorityThree - The developmentof more robustPHEP101 trainingfor the incoming
ERCs (WorkerLevel)
 The clientisreceptable toall three of the above priorities fromdevelopingamore robust
trainingtoprovidingmore relevantdeliverablesforthe LHDs. And this three-prongedapproach
shouldaddressthe majorperformance gapsif implementedproperly. The opportunitiesare that
the ProjectManager understandsthe evaluationprocessandhasalready beguntoimplement
otherchangesbasedon a similarmethodology.The biggestchallengewillbe the abilityto derive
validdatafrom the instrumentscreatedinalessthanfavorable political environment.
 I do feel however,thatthe approachdecidedupon,and socializingthe plan(andinstruments)
withthe B-team,shouldimprove the odds withregardstogettingafavorable outcome
The biggestissuesthatarose duringthe designprocesswas how toutilize the instrumentstoassessthe
PHEP 101 trainingwithout negativelyimpactingthe relationshipbetweenthe LHDand ODH. Once it
was decidedtotargetinternal staff inapilotto evaluate the initial contentandlevel of knowledge it
made everythingmore manageable. Inthe endthe level 1instrumentwillbe usedforthe pilotasthe
clienthasalreadydevelopedan evaluationinstrumentforthe learnerreaction. The questions
developedinthe level 2instrumentwillbe usedthroughoutthe finaltrainingtotestparticipant
knowledge real timewithoutconductingafull pre- andpost-test. Andfinally,the level 3instrumentwill
be usedas developed atthe 30- and 90-day mark to assess whetherthe learnerbenefitedfromthe
providedtraining.
 At thispointinthe projectthere doesnotappearto be any otheroutstandingissuesorconcerns
that should significantlyimpactimplementation.