Consolidated Regional Information Technology Support Service Hub

State: FL Type: Model Practice Year: 2019

The Capital Consortium consists of ten counties in the Panhandle of Florida with 473,521 population covered by ten CHDs. The Consortium is comprised of one urban (Leon) and nine rural counties (Liberty, Calhoun, Gulf, Franklin, Jefferson, Madison, Wakulla and Taylor). Include demographics: Describe public health issue The Capital Consortium Information Technology Regional Office (CCITRO) was established to offer a consolidated technical support service for the ten members of the Capital Consortium. The creation of the CCITRO arose from long-standing concerns among member counties about the efficiency and effectiveness of local [BJ1] information technology (IT) services. Issues included: difficulty recruiting and retaining qualified IT staff, especially in the rural areas; lack of policies and procedures; lack of supervisory oversight; poor customer service, outdated equipment and lack of inventory control. Public health services are reliant on consistent, stable IT infrastructure. When the network is down, service is interrupted forcing service providers to revert to inefficient methods of conducting business. Goals and objectives of the proposed practice: Provide a standard level of technical support and guidance for technical standardization in conjunction with the Department of Health's (DOH) Office of Information Technology (OIT) to produce a consistent technical environment across all member counties. Establish regional standard technical processes and procedures following the IT service management (ITSM) as directed by DOH, OIT and Local County policies. Establish a technical awareness marketing environment to promote user education and adoption of existing DOH IT services and software. The process for implementing the CCITRO followed the Project Management Institute's (PMI) methodology. A CCITRO Implementation Roadmap was established outlining the two-year implementation project. This plan focused stabilized CCITRO operation supporting Member County's IT needs and supporting DOH's strategic IT goals. A CCITRO Evaluation Report provided an independent evaluation on the progress of the Capital Consortium Information Technology Office one year after its creation. The CCITRO Evaluation Report was funded by the Center for Sharing Public Health Services. The Center for Sharing Public Health Services has served as a national resource on cross-jurisdictional sharing (CJS), building the evidence and producing and disseminating tools, methods and models to assist public health agencies and policymakers as they consider and adopt CJS approaches. The Center is a national initiative managed by the Kansas Health Institute with support from the Robert Wood Johnson Foundation. Results/Outcomes (list process milestones and intended/actual outcomes and impacts). The formal evaluation funded by the Sharing Public Health Services grant measured accomplishments of process objectives important to accomplishing the goals stated above: To hire a Manager by the end of the 1st quarter completed six months prior to implementation of CCITRO. Provide consolidated technical assistance evaluated by measuring Administrative Goals: IT Inventory Assistance, IT Purchasing Assistance, Information Security Standardization, IT Awareness & Education and Website Support Services outcomes were met Technical Operation Goals: Tier Support System established outcome met. Were all of the objectives met? Overall the objectives were achieved. David Parker was hired as the IT Manager. The ten CHDs in the Capital Consortium are currently using a consolidated technical support system. The implementation of a consolidated system is well coordinated as supported by the coverage. The CCITRO model is a solid model. Seventy-Six percent of the participants, which was 132 people, were aware of the CCITRO Program. The total number of respondents were 173. Most of the participants were aware of CCITRO. What specific factors led to the success of this practice? A primary success factor was the support and buy-in of all stakeholder. All Capital Consortium Health Officers actively participated throughout the project. A second primary factor leading to the success of the project was all technical services offered and supported by CCITRO were in conjunction with the DOH-OIT. A collaborative partnership was maintained and support services adhered to the operational standards as defined by CCITRO and OIT. Public Health impact of practice. All Capital Consortium county members now receive stable and consistent technical services. Website for your program, or LHD Website is secure and only accessible through internal network connections.
Statement of the Problem: Inconsistent and unreliable IT services in ten county health departments that are part of the Florida Department of Health in the Florida Panhandle. Issues included: difficulty recruiting and retaining qualified IT staff, especially in the rural areas; lack of policies and procedures; lack of supervisory oversight; poor customer service, outdated equipment and lack of inventory control. Public health services are reliant on consistent, stable IT infrastructure. The target population is 512 employees in ten CHDs serving a population of 473,521. 100% were reached with this solution. It is better than the previous model because it standardized staff, processes, equipment and support. It centralized the IT knowledge and increases accessibilitly to the entire region. It is a creative use of existing tools and best practices. The model was implemented based on best practices cited by Gartner, a leading global research and advisory company. Implementation was done using a hub and spoke (urban/rural) and project management model.
Define a strategy for implementing standardized IT processes and procedures. Implement an IT service model to bring all Member Counties to the same consistent level of IT services. These goals were achieved using several industry standard practices including the Project Management Institute (PMI) methodology ( The Regional manager consulted each CHD by facilitating meetings with staff, conducting research, identifying customer support requirements and gathering the necessary data to develop the strategic plan for the service operation. These findings were used to develop the implementation documents that were provided to the Capital Consortium leadership for approval. The IT Regional Manager's approach focused on customer service improvement results with an emphasis on change management and stakeholder engagement. A comprehensive five-phase shared services strategy directly addressed the common challenges encountered within each CHD to ensure success. Step One: PLAN – An assessment of the existing IT infrastructure at each CHD was completed and the analysis was used to design a shared services strategy for CCITRO. Once a situation assessment was complete, senior leadership reviewed the objectives for establishing shared services. While cost reduction may have been a primary driver, other objectives such as improving internal control, enhancing employee satisfaction (through better tools, processes and employee relationships), and building a consolidated talent pool were considered. Step two: EVALUATE - After the development of high-level strategic plans, a consensus about the general strategy was reached by the Capital Consortium Leadership. A more detailed plan that outlined the roadmap from the current reality to the preferred future was crafted. This included: 1) creating a strategy to re-engineer or develop standard processes, 2) identifying the technology required to effectively run shared services, 3) determining which locations will be responsible for what services, 4) allocating resources, and 5) deciding how to deal with the impact on employees. Step Three: DESIGN - The design was a modification of the original concept envisioned by DOH-OIT. Changes to the original vision were informed by the assessment findings and resulted in a hub and spoke model with centralized leadership. Step Four: IMPLEMENT - Implementation was guided by the detailed plan (described in step 2) and included a communications plan to assure preparation of stakeholders for each step of the process. A smooth transition was accomplished using a phased approach and a change management communication tool. Step Five: OPTIMIZE - In order to acheive the best possible outcomes for each phase, a continuous quality improvement (CQI) approach was used. The methodology used to role out change along with CQI were fundamental to the institutionalization of CCITRO. The implementation was a 30-month project initiated in January 2016 and included all Capital Consortium CHDs along with multiple DOH headquarter divisions. The project followed the general vision and scope of the original service model design created by DOH-OIT in the spring/summer of 2015. The collaboration and support of external DOH divisions (Administration, Human Resources) were critical to the success of the project. Due to the nature and scope of the project, the budget was established based on existing cost. The impact to individual CHDs varied; however, the overall cost of providing IT services was maintained during the first budget year and reduced during the second budget year. Salaries increased in year three but were offset to some extent by further consolidation of resources, infrastructure and equipment. For example, servers were reduced from 87 to 7 avoiding the replacement costs at a rate of one third per year. There was an overall cost reduction, even with across the board raises for IT staff, of 3.4% in three years. Budget Year 2016/2017 Change -/+% Budget Year 2017/2018 Change -/+% Budget Year 2018/2019 Overall -/+% Salary & Benefits $570,032.00 $16,948 -2.97% $553,084.49 $43,534.51 7.87% $596,619.00 4.67% Expenses $68,229.00 $19,219 -28.17% $49,010.00 -$29,210.00 -59.60% $19,800.00 -70.98% Total $638,261.00 $36,167 -5.67% $602,094.49 $14,324.51 2.38% $616,419.00 -3.40%
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 improve 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). What did you find out? To what extent were your objectives achieved? Please re-state your objectives. Did you evaluate your practice? List any primary data sources, who collected the data, and how? (if applicable) List any secondary data sources used. (if applicable) List performance measures used. Include process and outcome measures as appropriate. Describe how results were analyzed. Were any modifications made to the practice as a result of the data findings? Please enter the evaluation results of your practice The Capital Consortium Information Technology Regional Office (CCITRO) received a small grant ($10,000) from the Center for Sharing Public Health Services to hire an outside evaluator to review progress on the implementation of the model, make recommendations for continued improvement and advice for others wishing to use the same model. The evaluation was completed 10/31/2017. An evaluation of CCITRO (following the first year of implementation) was conducted. The evaluation consisted of: 1) a survey of 37% of CCITRO customers 2) individual interviews with each health officer and key staff and 3) a review of administrative activities to determine compliance with the CCITRO year one plan (IT inventory, IT purchasing, information security standardization, IT awareness and education and website support services). The overall findings indicated that CCITRO objectives had been accomplished as planned. The following opportunities for improvement were identified: 1) ticketing system needs revamping and this is planned as part of an enterprise-wide project, 2) establish a quarterly, biannual or annual mandatory training schedule for staff, 3) establish a skills assessment tool for staff, 4) more written procedures for accountability with verification of access of procedures by staff; 5) timely communication to end users regarding request for purchasing information. A draft improvement plan was created based on the evaluation results. A meeting will be scheduled with CCITRO health officers in April to review, edit and finalize the plan. The only obstacle to completing the project was an inability to adequately analyze tickets because of the limitations of the legacy ticketing system. This lack of categorization of end users and their requests to CCITRO results in uninformed planning and analysis of trends which obfuscates a clear understanding of priority issues. The timeframe for evaluating the CCITRO initial year was compressed and might have been more thorough if we had more time. More time would have allowed more feedback from potential vendors regarding their plans for conducting the evaluation. The small amount of funding limited vendor choice. More focus is needed at the start of the project to better define survey questions and increase survey participation. The evaluation informed our hunches and provided for planning purposes. Advice regarding IT hub implementation: Gather baseline data to inform future evaluations and quality improvement initiatives. Analysis: The evaluation was a descriptive analysis of the quantitative and qualitative data collected from each CCITRO representative's area. There was as full audit of the computer system procedures and processes. The following opportunities for improvement were identified and addressed as follows: 1) Ticketing system needed revamping and CCITRO is in a pilot for a new ticketing system (Cherwell) as part of an enterprise-wide project, 2) Establish a quarterly, biannual or annual mandatory training schedule for staff and this has been done, 3) Establish a skills assessment tool for staff. This is in process as part of the Leon CHD strategic plan. This will be rolled out across the region if successful in FY 2018-19. 4) More written security procedures for accountability and verification of access for staff. Sharepoint forms have been implemented with security protocols in place. Additional forms are under development. 5) Timely communication to end users regarding request for purchasing information. Process and standards for response have been implemented.
Lessons learned in relation to practice: CCITRO has been in place for two and a half years and sustained evaluation has taken place through bi-annual customer satsifacion surveys geared more towards the CCITRO Manager vs. IT staff. The survey will be revised in January to get a more complete picture of satisfaction. Calls to the help desk are 6-8/day and the majority of requests come through the ticketing system. Staff is currently stable and absences/vacancies have been covered through scheduling adjustments. Major upgrades to hardware, conference room IT equipment, phone systems and copiers have been made in the past year and a half. Our system has been tested twice by major hurricanes and power outages. In both cases, access to IT services was restored within 48 hours. Lessons learned in relation to partner collaboration: Regularly scheduled meetings with the IT Manager and each health officer at their health department, along with attendance at the quarterly Consortium meetings and email communication regarding significant issues is critical. We did a simple cost analysis included under LHD and Community Collaboration. Overall, there was a cost reduction of 3.4% from year one to year three, primarily due to efficiencies in managing equipment. There is sufficient stakeholder commitment to sustain the practice. CCITRO is baked into the budgeting process of the ten participating county health departments. The CCITRO Manager submits a budget based on cost per FTE each year and shared expenses, presents and seeks approval from the Consortium health officers and then works with the budget manager from the hub to incorporate it into the budget. Costs are allocated on a bi-weekly basis to the participating counties.
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