Strategic Plan September 2015

Onondaga County Health Department Strategic Plan 2015-2019 September 2015 Onondaga County Health Department Joanne M. Mahoney, County Executive Indu Gupta, MD, MPH, Commissioner of Health ongov.net/health facebook.com/ongovhealth

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Onondaga County Health Department Strategic Plan 2015-2019 Table of Contents Message from the Commissioner...4 Onondaga County Demographics...5 Ten Essential Public Health Services...8 Mission, Vision, and Values...9 Strategic Priorities...10 Appendices...15

Onondaga County Health Department Strategic Plan 2015-2019 Dear Friends of Public Health, It is my pleasure to present the updated Onondaga County Health Department s 2015 2019 Strategic Plan. This plan establishes the department s long range priorities and provides a road map to assure our community that the Onondaga County Health Department (OCHD) is committed to continuously improving the way we provide public health programs and services. In our effort to address the most pressing local public health challenges, this strategic plan is closely aligned with the OCHD s 2014 2017 Community Health Assessment and Improvement Plan, which can be viewed at www.ongov.net/health. In today s ever changing health care landscape, it is important to recognize the need for accountability, transparency, and flexibility throughout our efforts to improve the public s health. We urge you to consider this strategic plan to be a living document. We welcome your suggestions on how we can improve both this plan and the way we provide programs and services to the residents of Onondaga County. We will update the plan periodically to incorporate community input and to address changing public health needs. This plan was thoughtfully developed by the health department s strategic planning committee with input from staff and numerous community partners. I want to acknowledge Catherine M. Gerard, MA, MPA and her students from the Maxwell School of Syracuse University for their support and guidance during the initial development of this plan. I also want to recognize all Health Department staff for the work they do each day to improve and protect the health of our community. Sincerely, Indu Gupta, MD, MPH, MA, FACP Commissioner Onondaga County Health Department

Onondaga County Health Department Strategic Plan 2015-2019 Onondaga County Demographics * Geography Onondaga County is located in central New York State (Figure 1). It covers 780 square miles and is bordered by Oswego County to the north, Cayuga County to the west, Cortland County to the south, and Madison County to the east. The population of Onondaga County is 466,852 (2012) making it the sixth most populous county in upstate New York (i.e., New York state excluding New York City). Onondaga County consists primarily of forests and agricultural lands, resulting in a population density of 600 persons/mi 2. The County seat is the city of Syracuse, located near the center of the county as seen in Figure 2. In addition to the city Syracuse, 19 towns, 15 villages, and the Onondaga Nation territory lie within the County s borders. Of note, Onondaga County also contains the intersection of Interstates 90 and 81 which are major east-west and north-south thoroughfares. Figure 1. Map of New York State Source: http://en.wikipedia.org/wiki/file: Map_of_New_York_highlighting_Onondaga_ County.svg Syracuse is the largest city in the central New York (CNY) region with a population of 145,135, accounting for almost one-third of the total county population. Syracuse is the fourth largest upstate NY city, after Buffalo, Rochester, and Yonkers. Other heavily populated towns in Onondaga County include Clay, Salina, and Cicero in the northwest sector and Dewitt and Manlius in the southeast. Figure 2. Map of Onondaga County Source: New York State. http://www.nysegov.com/map-ny.cfm *All data in this section are from the U.S. Census Bureau, 2009-2011 American Community Survey, unless otherwise noted. 5

Onondaga County Health Department Strategic Plan 2015-2019 Population Age and Gender Age distribution can have a major impact on the health outcomes and the health care needs of a community. The median age in Onondaga County is 38.7 years. There are over 27,000 children under age 5, representing 5.9% of the population, and over 65,000 residents are age 65 years and older (14.0%). Projections from the Cornell Program on Applied Demographics indicate that by 2030, nearly 20% of Onondaga County s population will be age 65 years or older. With respect to gender distribution, women comprise 51.8% of the population of Onondaga County. Race and Ethnicity Among Onondaga County residents, 97.6% identify as being one race. Of these, 81.6% self-identify as white and 10.9% as black. Asians and American Indian/Alaska Natives comprise additional racial groups represented in comparatively large numbers. Approximately three percent of Onondaga s total population self-identifies as Asian and 0.7% self-identifies as Native American. Hispanic ethnicity is reported by over 19,000 County residents of all races (4.1%). This represents a 70.1% increase in Hispanic ethnicity from the 2000 U.S. Census. Currently, nearly two-thirds of local Hispanics reside in the city of Syracuse. Since 2007, over 6,000 refugees have resettled in the Syracuse area, primarily from Southeast Asia, Africa, and the Middle East. Social Determinants of Health Onondaga County is made up of a variety of social environments that can impact an individual s health. Characteristics of the population with respect to poverty, employment, and education are presented here. Poverty The median household income in Onondaga County is $52,520. Among all residents, 14.7% had income in the last 12 months that was below the federal poverty level. There is a significant disparity in income between Onondaga County and Syracuse residents. Especially striking is the poverty rate among children in Syracuse, where 49.0% of those under age 18 live in poverty, compared to 21.0% in Onondaga County. Another important factor relating to health outcomes and access to care is the presence of health insurance. In Onondaga County, 9% of residents do not have any health insurance; this increases to 13% in Syracuse. Employment According to the U.S. Bureau of Labor Statistics, the unemployment rate in Onondaga County was 7.1% in April 2013, and has declined slowly from a high of 8.8% in January 2010. The current unemployment rate is nearly identical to the statewide unemployment rate of 7.3% in April 2013. Consequences of unemployment can include a decrease in health care-related expenditures and a decrease in access to employer-sponsored health insurance programs, which may lead to higher rates of uninsured persons. 6

Onondaga County Health Department Strategic Plan 2015-2019 Education Among adults age 25 years and older in Onondaga County, 89.3% have a high school education or higher, and 32.6% have a bachelor s degree or higher. These fall to 80.2% and 26.1% in Syracuse, respectively. Suburban school districts in Onondaga County have an average graduation rate of 84.4%, compared with 52.0% for the Syracuse City School District. Disparities Within the social determinants of health examined above, significant racial and ethnic disparities exist. Overall, Syracuse has a younger and more racially and ethnically diverse population compared to the rest of Onondaga County. In addition, there is higher poverty and lower educational attainment in Syracuse than in the surrounding suburban and rural areas. These factors are important predictors of health outcomes and should be considered when evaluating populations at risk and allocating resources for public health activities. Much more information on the social determinants of health and health outcomes, including disparities in Onondaga County and Syracuse, can be found in the Community Health Assessment and Improvement Plan. 7

Onondaga County Health Department Strategic Plan 2015-2019 Ten Essential Public Health Services 1 2 3 4 5 6 7 8 9 10 Monitor health status to identify and solve community health problems. Diagnose and investigate health problems and health hazards in the community. Inform, educate, and empower people about health issues. Mobilize community partnerships to identify and solve health problems. Develop policies and plans that support individual and community health efforts. Enforce laws and regulations that protect health and ensure safety. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. Assure a competent public and personal health care workforce. Evaluate effectiveness, accessibility, and quality of personal and population-based health services. Research for new insights and innovative solutions to health problems. Centers for Disease Control and Prevention. The Essential Services provide a working definition of public health and a guiding framework for the responsibilities of local public health organizations. 8

Onondaga County Health Department Strategic Plan 2015-2019 Mission To protect and improve the health of all Onondaga County residents. Vision A community of partners working together for the physical, social, and emotional well-being of all. Values REACH: Respect Excellence Accountability Collaboration Health Equity 9

Onondaga County Health Department Strategic Plan 2015-2019 Summary of Our Strategic Priorities The Strategic Plan highlights the areas in which the OCHD intends to focus in order to better serve our community. Please note however, it is not designed to address the broad range of programs and services offered by the OCHD every day: from protection of the water supply to the provision of cancer screening services to those who cannot afford them; from the prevention of the spread of communicable diseases to the provision of nutrition and education to women, infants, and children. For a description of all the programs and services offered by the OCHD, please see the Annual Report at www.ongov.net/health. The plan is organized into four overarching strategic priorities: Health Protection, Health Improvement, Public Engagement, and Organizational Excellence. Each strategic priority identifies a specific goal to be addressed through the implementation of several strategies using a cross-cutting approach. Each of the goals and their related strategies were determined through an analysis of Onondaga County health data, community input, and departmental evaluations. Each of these strategies are associated with detailed work plans to enable us to measure our progress and to adapt our strategies to effectively respond to community need. The plan emphasizes the use of data and systematic approaches to improve how we can work together both within the organization and within the community. Strategic Planning Committee 10

Onondaga County Health Department Strategic Plan 2015-2019 Strategic Priority 1: Health Protection Goal 1.1: Reduce incidence of preventable communicable disease. Strategy 1.1.1: Utilize multidisciplinary teams to investigate and respond to communicable disease outbreaks. Decrease transmission in facility-associated communicable disease outbreaks through utilization of multidisciplinary teams Strategy 1.1.2: Increase education about communicable diseases to key stakeholders. Reduce the incidence of targeted communicable diseases through increased education and collaborations with key stakeholders Strategy 1.1.3: Improve internal processes to streamline data analysis during communicable disease outbreaks. Develop, implement, and evaluate a data reporting and analysis process for use by multiple bureaus during a communicable disease outbreak Goal 1.2: Promote an environment that minimizes exposure to disease and potential hazards. Strategy 1.2.1: Develop and implement a comprehensive Healthy Homes model. Improve home environments to promote health and reduce disease by training OCHD staff about Healthy Homes Improve home environments to promote health and reduce disease by training key external stakeholders Goal 1.3: Improve preparedness and readiness to respond to public health emergencies. Strategy 1.3.1: Engage community based organizations, businesses, and schools to develop or update their preparedness plans or to contribute to community plans. Improve the community s capacity for preparedness and readiness to respond to public health emergencies by assisting community based organizations to develop closed point of distribution plans Strategy 1.3.2: Increase capacity for public health and disaster preparedness, response, and recovery in the community. Increase the community s capacity to recruit and retain volunteers to assist in response and recovery in the event of a public health emergency Increase the department s capacity to effectively utilize social media to enhance communication with the public 11

Onondaga County Health Department Strategic Plan 2015-2019 Strategic Priority 2: Health Improvement Goal 2.1: Optimize partnerships to improve population health. Strategy 2.1.1: Increase community engagement by building and strengthening existing external partnerships and by assessing, identifying gaps, and developing new partnership opportunities. Increase engagement and collaboration within OCHD and within other county departments and local governments Ensure that all bureaus/divisions are optimally engaging with community partners Goal 2.2: Promote population health with a focus on prevention through education. Strategy 2.2.1: Develop and implement an educational campaign for at least one prevention priority each year. Identify and communicate the top three prevention priorities each year Implement and evaluate one targeted educational campaign annually Strategy 2.2.2: Increase the visibility of the OCHD. Promote the availability of OCHD staff to provide educational sessions on public health topics to diverse audiences across the community Increase awareness of the services provided by the OCHD Goal 2.3: Reduce health disparities and promote health equity. Strategy 2.3.1: Create a Health Department culture that supports and implements culturally appropriate models of service delivery. Develop a plan to provide training to increase awareness of health disparities Develop or enhance programs that specifically address the social determinants of health associated with disparities in maternal and child health outcomes Promote best practices to address health equity in all programs Strategy 2.3.2: Engage all community partners to increase access to health services for underserved populations. Engage all sectors (health care delivery system, employers/ businesses, media, academia, government, health and human service agencies, policy makers, and the public) to increase access to health services for underserved populations 12

Onondaga County Health Department Strategic Plan 2015-2019 Strategic Priority 3: Public Engagement Goal 3.1: Facilitate community dialogue to address public health challenges. Strategy 3.1.1: Engage the community to align the OCHD s services to best meet public need. Research, implement, and evaluate service delivery models that best meet the health needs of the community Strategy 3.1.2: Identify and optimize technology to innovate public health. Ensure that technology supports the use of innovative approaches to increase educational opportunities for the community Increase the public s access to information on current health issues using a wide variety of delivery platforms Enhance the OCHD website to provide additional services and educational messages to the community Strategic Priority 4: Organizational Excellence Goal 4.1: Attract and retain a high quality workforce. Strategy 4.1.1: Create a workforce development plan to ensure a well-prepared and highly competent workforce. Assess current workforce competencies and identify gaps in education and training Develop and implement strategies to address identified gaps Strategy 4.1.2: Increase employees identification and engagement with the OCHD s mission, vision, and core values. Develop, implement, and evaluate an internal communication plan to promote the OCHD s mission, vision, values, programs, and priorities Strategy 4.1.3: Increase employee satisfaction. Implement action plans to address the top three concerns identified by staff in the Employee Satisfaction Survey 13

Onondaga County Health Department Strategic Plan 2015-2019 Strategic Priority 4: Organizational Excellence, continued Goal 4.2: Ensure efficient and cost-effective programs and operations. Strategy 4.2.1: Achieve a department-wide culture of quality improvement. Develop a department-wide QI plan to support, expand, and enhance QI activities Strategy 4.2.2: Develop and implement a performance management system throughout the department. Utilize a logic model framework to identify core activities and metrics for each program Strategy 4.2.3: Increase capacity to obtain external funding and maximize reimbursement and revenue. Identify means to further increase availability of external funds to increase local public health capacity Strategy 4.2.4: Enhance utilization of evidence-based practices in programs and operations. Increase capacity to identify, implement, and evaluate evidence-based or promising practices Strategy 4.2.5: Improve technology and data systems to maximize the efficiency of IT resources. Review OCHD software and technology needs to ensure staff have the necessary tools to maximize efficiency 14 12

Onondaga County Health Department Strategic Plan 2015-2019 Appendices Organizational Chart Budget/Fiscal Information Strategic Plan Development Timeline SWOT Analysis Employee Survey SU Summary of Needs Assessment 15

Disease Control Onondaga County Health Department 2015 Organiza onal Chart County Legislature County Execu ve Administra ve and Financial Human Services Physical Services Medical Directors Health Department Commissioner Deputy Commissioner Public Health Compliance Informa on Technology Public Health Preparedness Fiscal Office Volunteer Services Environmental Health Healthy Families Health Promo on and Disease Preven on Family Planning Surveillance and Sta s cs Advisory Board of Health The Wallie Howard, Jr. Center for Forensic Sciences Medical Examiner s Office Forensic Laboratories

2014 Expenses $62,412,153 Grants $9,215,169 13% Public Health $16,266,381 23% Center for Forensic Sciences $7,254,366 10% Special Children Services $38,891,406 54%

The Onondaga County Health Department Strategic Planning Process The Onondaga County Health Department (OCHD) Strategic Planning and Accreditation Resource Committee (SPARC) is created and tasked to develop an understanding of Public Health Accreditation Board (PHAB) standards and measures, identify key deliverables, advise the Commissioner of Health, facilitate creation of OCHD Strategic Plan, and promote Accreditation to the workforce. Strategic Plan SWOT analysis conducted. Community forums conducted by Central New York Masters in Public Health Program students to identify issues needing attention in the areas of the public health system and health status of individuals. Department-wide employee survey conducted, with assistance from the Program for the Advancement of Research on Conflict and Collaboration (PARCC), executed to identify factors driving employee satisfaction, commitment, performance, and retention. External environment analysis facilitated by PARCC staff to identify trends and factors that might impact service delivery. Late 2011 Early-Mid 2012 Early Winter 2012 Spring 2012 Early-Late Spring 2012 Identified OCHD mission, vision, and core values. Early-Mid 2012 Developed OCHD strategic priorities through engagement with OCHD staff and leadership, including: Senior Staff meetings, SPARC Strategic Planning retreat, OCHD Health Advisory Board. Developed program- and bureau-level goals and objectives for Annual Work Plan through: SPARC weekly meetings, SPARC and Senior Staff meetings, Senior Staff meetings, program and bureau staff meetings, and individual meetings with Commissioner of Health. Submitted Community Health Assessment (CHA) and Community Health Improvement Plan (CHIP) to New York State Department of Health (NYSDOH). Identified linkages with the OCHD CHA, CHIP and NYSDOH Prevention Agenda 2013-2017 and revised strategic priorities, program- and bureau-level goals and objectives. Presented Strategic Plan to the community, County Legislature, and key stakeholders. Solicited, evaluated and incorporated feedback from key stakeholders. Finalized Department Strategic Plan and Program/Bureau Annual Work Plans. Identified and implemented process for reporting on and revising Bureau-level plans. Mid-Late 2012 Spring-Fall 2012 Fall 2012 Throughout 2013 Late 2013 Late 2013 Late 2013-Mid 2014 Late Spring Early Summer 2014 Early-Mid 2014 Mid 2014

Revised the plan to streamline the focus on priority strategies. Identified new strategy leaders and created groups with members from different programs in the department. Implemented a new reporting structure for strategy activities. Throughout 2015

Onondaga County Health Department SWOT Summary Strengths Weaknesses Opportunities Threats Committed staff Internal communication Evidence based public health Revenue loss Strong leadership Community partnerships External grant funding Good reputation in the community Diversity of services Strong field operations Fiscal responsibility Restrictions of Civil Service Lack of training/utilization Limited resources Outdated technology Public awareness of agency Slow response to change Demographic changes in population Potential for consolidation of services Advances in technology Increased partnerships with academia Increased partnerships with community agencies PHAB accreditation Poverty Continued poor health outcomes Public Health Mandates Low education and literacy Poor economy Inflexible service delivery Increased demand with decreased funding New funding opportunities

2012 Onondaga County Health Department Employee Survey Achieving our Vision Together Maxwell School of Syracuse University Program for the Advancement of Research on Conflict and Collaboration (PARCC) 400 Eggers Hall / Syracuse NY 13244 / parcc@maxwell.syr.edu

Contents About this Report... 2 The 2012 Onondaga County Health Department Employee Survey... 3 When were employees surveyed?... 3 Which employees participated in the survey?... 3 What did the survey measure?... 3 What do the survey results represent?... 3 SNAPSHOT - The Department s survey respondent characteristics... 4 Figure 1 Survey Respondent Breakdowns... 4 Departmental Strengths... 6 Departmental Challenges... 7 Responses to Quantitative Items... 10 Responses to Open-ended Questions... 14 Bringing It Together Quantitative and Open-ended Questions... 31 Quantitative Response Items Divisional Comparisons... 32 1

About this report In March 2012, the Onondaga County Health Department, with assistance from the Program for the Advancement of Research on Conflict and Collaboration (PARCC) at Syracuse University, launched a Department-wide employee survey. Invitations were sent to all of the Department s 293 employees. A total of 276 employees responded to the survey, an exceptional response rate of greater than 94%. The survey was designed to gather information across multiple categories to determine important factors driving employee satisfaction, commitment, performance and retention. These categories are: Employee work experience The employee s specific program or work unit The Department The employee s supervisor Leadership in the Department Employee satisfaction Work/Life balance and The Department s vision The survey includes questions on the demographic characteristics of the respondents (divisional affiliation, supervisory status, and tenure with both the County and the Health Department), quantitative questions that were answered on a five-point scale system, ranging from strongly agree to strongly disagree or excellent to poor, and five open-ended questions addressing work experience likes and frustrations, job satisfaction, work/life balance and ways to achieve the Departmental Vision. This report presents the results of the employee survey for the Department as a whole. It includes the strengths and weaknesses of the Department, and also identifies themes and subthemes that emerged from employee responses to open-ended questions. Subsequent reports will present more detailed findings for individual divisions or bureaus within the Department. It begins with the 10 most positively scored questions (strengths) and the 10 lowest scored questions from the survey (challenges). Responses to all close-ended questions follow including comparisons by division. 2

The 2012 Onondaga County Health Department Employee Survey When were employees surveyed? Syracuse University s Program for the Advancement of Research on Conflict and Collaboration (PARCC), administered the survey on February 24 th, 2012. Employees were given approximately three weeks to respond and the survey period was closed on March 12 th, 2012. The survey was administered electronically and paper copies were available for employees upon request. Which employees participated in the survey? The survey was sent to all employees within the Onondaga County Health Department. The response rate was an outstanding 94%. What did the survey measure? The survey consisted of 86 items, covering demographics (four items), employee perceptions about the overall work experience, program and work units, Department, supervisors, leadership, job satisfaction, worklife balance and the Departmental Vision. There were a combination of rating-scale based questions and open-ended questions to elicit a broad spectrum of perceptions about the Department. What do the survey results represent? The survey presents a snapshot in time of the employee perceptions about the work of the Health Department. Departmental strengths and challenges, as well as Divisional differences, will provide leadership and staff valuable information on areas in which to focus in order to maintain and improve the work of the Department and develop a strategic plan to achieve the 2017 vision. Subsequent surveys may be administered to identify trends and changes in the employee perceptions of the Department. 3

SNAPSHOT - The Department s survey respondent characteristics Figure 1 Survey Respondent Breakdowns 4

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Departmental Strengths Table 1 displays the Department s ten highest percent positive responses. These were determined by combining the percent who responded either strongly agree or agree for each survey item. The Department s strengths center on themes of personal effort, the fulfilling nature of the work and the Department mission, and an understanding of expectations and accountability. Table 1. Overall Department Strengths Percent Positive Responses 7. When needed I am willing to put in the extra effort to get a job done. 95 30. How would you rate the overall quality of work done by your program? 91 13. The work I do is important. 91 6. I know what is expected of me on the job. 88 8. I am constantly looking for ways to do my job better. 86 5. I like the kind of work I do. 84 41. The mission of the Onondaga County Health Department is "to protect and improve the health of all residents of Onondaga County." I believe the Department is successful at accomplishing its mission. 12. I know how my work relates to the agency's goals and priorities. 83 83 51. My s upervis or treats me with respect. 31. The workforce has the jobrelevant knowledge and skills necessary to accomplish organizational goals. 83 82 6

Departmental Challenges Table 2 displays the ten items which resulted in the Department s highest percent negative responses. These were determined by combining the percent who responded either disagree or strongly disagree for each survey item. These items present opportunities for improvement for the Department. Challenges were primarily in the areas of advancement opportunities; equity and performance measurement; and appreciation, recognition, and empowerment of employees. Table 2. Overall Department Challenges 35. Advancement depends on how well employees perform their jobs. Percent Negative Responses 47 22. Advancement in my program is based on merit. 23. In my program, s teps are taken to deal with a poor performer who cannot or will not improve. 24. In my program, differences in performance are recognized in a meaningful way. 38 41 43 34. Creativity and innovation are rewarded. 34 70. How satisfied are you with your opportunity to get a better job in your Department? 33. Employees are recognized for providing high quality products and services. 25. Recognition in my program depends on how well employees perform their jobs. 77. I am satisfied with the amount of flexibility in my schedule. 73. Considering everything, how satisfied are you with your pa y? 34 33 32 28 25 7

INDICES Workforce Investment Assessment and Accountability Framework (WIAAF) The WIAAF indices provide consistent metrics for measuring progress towards WIAAF objectives. Figure 2 shows the department results for the four WIAAF Indices. The four indices are: Leadership and Knowledge Management Index, Results-Oriented Performance Culture Index, Talent Management Index, and Job Satisfaction Index. There are a total of 39 items that make up the indices. These indices were based directly on those created for the 2011 Federal Employee Viewpoint Survey. FIGURE 2 WIAAF Indices Percent Positive Responses The LEADERSHIP & KNOWLEDGE MANAGEMENT INDEX indicates the extent to which employees hold their leadership in high regard, both overall and on specific facets of leadership. It is made up of items 10, 37, 38, 53, 54, 55, 58, 59, 60, 63, 67, and 69. The Department had a 66% positive response for this measure. LEADERSHIP & KNOWLEDGE MANAGEMENT 66 The RESULTS-ORIENTED PERFORMANCE CULTURE INDEX indicates the extent to which employees believe their organizational culture promotes improvement in processes, products and services, and organizational outcomes. It is made up of items 12, 14, 15, 20, 22, 23, 24, 32, 34, 35, 45, 47, and 68. The Department had a 49% positive response for this measure. RESULTS-ORIENTED PERFORMANCE CULTURE 49 The TALENT MANAGEMENT INDEX indicates the extent to which employees think the organization has the talent necessary to achieve organizational goals. It is made up of items 1, 11, 18, 21, 31, 49, and 71. The Department had a 64% positive response for this measure. TALENT MANAGEMENT 64 The JOB SATISFACTION INDEX indicates the extent to which employees are satisfied with their jobs and various aspects thereof. It is made up of items 4, 5, 13, 66, 70, 72, and 73. The Department had a 67% positive response for this measure. JOB SATISFACTION 67 8

Employee Engagement The Health Department 2012 Employee Survey does not contain direct measurements of employee feelings of engagement such as passion, commitment, and involvement. However, it does include questions that cover most, if not all, of the conditions likely to lead to employee engagement. The Federal Office of Personnel Management developed an index that uses these conditions to assess employee engagement. The overall employee engagement score is calculated based on responses in three key areas: leadership, supervisors and intrinsic work experiences. The scores were calculated by combining the strongly agree and agree responses for each item. Figure 3 shows the Department s scores on the Employee Engagement Index, and its component indices: Leaders Lead, Supervisors, and Intrinsic Work Experiences. FIGURE 3 Conditions for Employee Engagement Index Percent Positive Responses For overall employee engagement, the Department had 71% positive responses. EMPLOYEE ENGAGEMENT 71 LEADERS LEAD reflects the employees perceptions of the integrity of leadership, as well as leadership behaviors such as communication and workforce motivation. It is made up of items 55, 56, 59, 63, and 65. The Department had a 63% positive response for this measure. LEADERS LEAD 63 SUPERVISORS reflects the interpersonal relationship between worker and supervisor, including trust, respect and support. It is made up of items 49, 50, 51, 53, and 54. The Department had a 73% positive response for this measure. SUPERVISORS 73 INTRINSIC WORK EXPERIENCES reflects the employees feelings of motivation and competency relating to their role in the workplace. It is made up of items 3, 4, 6, 11, and 12. The Department had a 76% positive response for this measure. INTRINSIC WORK EXPERIENCES 76 9

Responses to Quantitative Items DECISION AID Moving from Results to Action Table 3 displays the Department s percent positive, neutral, and negative responses*, presented in item order, to help inform decisions on where to focus action planning efforts. Positive responses include strongly agree and agree. Neutral responses include neither agree nor disagree. Negative responses include disagree and strongly disagree. The results are displayed in different colors: GREEN SHADED CELL: The item is 65 percent positive or higher. This is an area of strength. BLUE SHADED CELL: The item is 30 percent neutral or higher. This is an area for more communication. RED SHADED CELL: The item is 35 percent negative or higher. This is an area of challenge. Table 3. Onondaga County Health Department Positive Neutral Negative Work Experience 1. I am given a real opportunity to improve my skills in the Department. 63 23 13 2. I have enough information to do my job well. 81 10 9 3. I feel encouraged to come up with new and better ways of doing things. 65 17 18 4. My work gives me a feeling of personal accomplishment. 78 15 8 5. I like the kind of work I do. 84 11 5 6. I know what is expected of me on the job. 88 7 5 7. When needed I am willing to put in the extra effort to get a job done. 95 2 3 8. I am constantly looking for ways to do my job better. 86 11 4 9. I have sufficient resources (for example, people, materials, budget) to get my job done. 59 21 20 10. My workload is reasonable. 66 18 16 11. My talents are used well in the workplace. 64 20 17 12. I know how my work relates to the agency's goals and priorities. 83 12 4 13. The work I do is important. 91 5 4 14. Physical conditions (for example, noise level, temperature, lighting, cleanliness in the workplace) allow employees to perform their jobs well. 57 20 23 15. My performance appraisal is a fair reflection of my performance. 68 22 9 16. I am held accountable for achieving results. 81 15 4 17. I can disclose a suspected violation of any law, rule or regulation without fear of reprisal. 65 19 16 18. My training needs are assessed. 56 27 17 19. In my most recent performance appraisal, I understood what I had to do to be rated at different performance levels. 65 25 11 10

My Program / Work Unit Positive Neutral Negative 20. The people I work with cooperate to get the job done. 74 14 12 21. My program is able to recruit people with the right skills. 51 35 13 22. Advancement in my program is based on merit. 18 39 43 23. In my program, steps are taken to deal with a poor performer who cannot or will not improve. 27 32 41 24. In my program, differences in performance are recognized in a meaningful way. 24 38 38 25. Recognition in my program depends on how well employees perform their jobs. 34 34 32 26. Employees in my program share job knowledge with each other. 76 11 13 27. The skill level of employees in my program has improved in the past year. 48 42 10 28. My program works well with other programs in the Department. 68 23 9 29. Other programs give my program the support it needs. 55 30 15 30. How would you rate the overall quality of work done by your program? 91 9 0 My Department 31. The workforce has the job-relevant knowledge and skills necessary to accomplish organizational goals. 82 15 3 32. Employees have a feeling of personal empowerment with respect to work processes. 44 31 25 33. Employees are recognized for providing high quality products and services. 40 27 33 34. Creativity and innovation are rewarded. 31 35 34 35. Advancement depends on how well employees perform their jobs. 17 36 47 36. Policies and programs promote diversity in the workplace (for example, recruiting minorities and women, training in awareness of diversity issues, mentoring). 40 49 11 37. Employees are protected from health and safety hazards on the job. 77 11 12 38. The Department has prepared employees for potential security threats. 76 14 11 39. Arbitrary action, personal favoritism and coercion for partisan political purposes are not tolerated. 41 34 25 40. Prohibited Personnel Practices (for example, illegally discriminating for or against any employee/applicant, obstructing a person's right to compete for employment, knowingly violating veterans' preference requirements) are not tolerated. 67 26 7 41. The mission of the Onondaga County Health Department is "to protect and improve the health of all residents of Onondaga County." I believe the Department is successful at accomplishing its mission. 83 14 3 42. The Department operates in a way that is consistent with the REACH values (Respect, Excellence, Accountability, Collaboration and Health Equity). 63 29 8 43. I recommend the Department as a good place to work. 72 21 7 44. I believe the results of this survey will be used to make the Department a better place to work. 53 33 14 11

My Supervisor Positive Neutral Negative 45. My supervisor supports my need to balance work and other life issues. 80 10 10 46. My supervisor provides me with opportunities to demonstrate my leadership skills. 61 26 13 47. Discussions with my supervisor about my performance are worthwhile. 67 22 11 48. My supervisor provides me with constructive suggestions to improve my job performance. 64 23 12 49. Supervisors in my program support employee development. 65 24 12 50. My supervisor listens to what I have to say. 78 14 8 51. My supervisor treats me with respect. 83 10 7 52. In the last twelve months, my supervisor has talked with me about my performance. 76 12 12 53. I have trust and confidence in my supervisor. 72 17 11 54. Overall, how good a job do you feel is being done by your immediate supervisor? 69 20 11 Leadership 55. In this Department, leaders generate high levels of motivation and commitment in the workforce. 49 31 20 56. Leaders maintain high standards of honesty and integrity. 63 23 14 57. Leaders are committed to a workforce representative of all segments of society. 53 40 7 58. Leaders work well with employees of different backgrounds. 66 26 8 59. Leaders communicate the goals and priorities of the Department. 70 20 9 60. Leaders review and evaluate the Department's progress toward meeting its goals and objectives. 61. Leaders promote communication among different programs (for example, about projects, goals, needed resources). 67 26 7 59 26 15 62. Leaders support collaboration across programs/work units to accomplish work objectives. 63 29 8 63. I have a high level of respect for the Department's administrative leaders. 65 25 11 64. Administrative leaders demonstrate support for work/life balance. 63 23 14 65. Overall, how good a job do you feel is being done by the supervisor directly above your immediate supervisor? 66 23 11 12

My Satisfaction 66. How satisfied are you with your involvement in decisions that affect your work? 67. How satisfied are you with the information you receive from leadership on what's going on in the Department? Positive Neutral Negative 57 24 19 56 25 20 68. How satisfied are you with the recognition you receive for doing a good job? 49 26 25 69. How satisfied are you with the policies and practices of the Department? 61 26 13 70. How satisfied are you with your opportunity to get a better job in your Department? 24 42 34 71. How satisfied are you with the training you receive for your present job? 64 24 12 72. Considering everything, how satisfied are you with your job? 77 15 8 73. Considering everything, how satisfied are you with your pay? 57 18 25 74. Considering everything, how satisfied are you with the Department? 68 24 8 Work/Life 75. The environment in this Department supports a balance between work and personal life. 67 20 13 76. I am able to satisfy both my job and family responsibilities. 78 15 7 77. I am satisfied with the amount of flexibility in my schedule. 58 14 28 This table format was adapted from the 2012 Federal Employee Viewpoint Survey for the U.S. Agency for International Development. *Percents may not add up to 100 due to rounding. 13

Responses to Open-ended Questions Five questions in the survey were designed to obtain open-ended responses from employees. The responses for each question were reviewed and analyzed by identifying overarching themes to the responses and then quantifying the number of times each major theme and subtheme were encountered in the responses. These themes and subthemes, along with the frequency with which they occurred in the responses are presented in Tables 4 through 8. The analysis of the responses to open-end questions was performed using Atlas.Ti software. The responses were read by a team of Maxwell researchers to identify apparent themes in the feedback. These themes were then used as initial codes in Atlas.Ti and were applied to the responses by the research team. This method allowed the analysis to focus on the data rather than beginning with a pre-determined set of assumptions. The coding process included an initial assessment that was then checked by a different team member to assess completeness and consistency. Table 4 presents a summary of all the responses to the statement, The one best thing about working for the Health Department is. The most frequent responses focused on the following themes/sub-themes: The Work helping others, significance of the work and enjoyment The People specifically co-workers Compensation specifically benefits Table 5 presents a summary of all the responses to the question, My one greatest frustration with working at the Health Department is. The most frequent responses addressed the following themes: The Organizational Culture bureaucracy, lack of fairness and equity, lack of accountability, poor communication Resources staffing shortages Personnel systems limited opportunities for promotion and advancement and the use of the Kronos time clock Table 6 presents a summary of the responses to the statement, Other than a pay increase, what else would improve your job satisfaction? The most frequent responses addressed the following themes/ sub-themes: Organizational Culture appreciation and respect for efforts, fairness and equity, and communication Personnel Systems schedule flexibility The People supervisory support and understanding Table 7 presents a summary of all responses to the question, What work/life options would improve your ability to balance your work and personal life? In this case most responses centered on one theme: Personnel Systems flexible scheduling, time off, and the opportunity to telecommute 14

Table 8 presents a summary of the responses to the statement: Please offer up to three ideas or suggestions that would help the Department achieve our Vision. The most frequent responses addressed the following themes/sub-themes: Organizational Culture increased communication, appreciation and respect for efforts, reduction in bureaucracy, increased teamwork, and fairness and equity Community Support increased partnerships with the community People support from supervisors Table 4. Responses to Open ended Questions The one best thing about working at the Onondaga County Health Department is: Theme: The Work (113 Responses) Sub Theme Frequency Representative Quote Helping Others 44 Significance 34 Enjoyable 28 Quality 7 Helping people get to the services they need, good working relationship with co workers in the department. The knowledge that we are providing valuable services to our community. It is with a sense of pride that I know I contribute to the overall mission of the health department. The work that I do. I enjoy managing resources, supporting staff and finding ways to help staff get their work done effectively and efficiently. We have high standards and they are reflected in the quality of the work that we do, in particular as compared to other organizations in the community as well as other health departments.

Theme: People (78 Responses) Sub Theme Frequency Representative Quote Co workers 50 The people... most are professionals and have that needed internal desire to help others. Supervisor 12 Clients 11 Commissioner 5 I feel very comfortable going to my supervisor with any issue. Feel free to vent, even when things don't go my way. I feel "heard. I love the people we serve. Most people are truly appreciative of our services, which make this job rewarding. Working in a collaborative, team work atmosphere that is fostered from the top (Dr. Morrow) down. Theme: Organizational Culture (43 responses) Sub Theme Frequency Representative Quote Autonomy 12 The independence I am given to supervise my program. Sense of Team 12 Professional Development 6 Working in a collaborative, team work atmosphere that is fostered from the top (Dr. Morrow) down. The plentiful opportunities we as employees are given to attend continuing education and training events/workshops/speaking events/etc. I feel strongly encouraged to take advantage of these opportunities. Communication 4 I have full administrative support and can rely on expressing my opinions openly. Learning 4 Gives me the opportunity to better myself, and learn more about the clients I come across every day. Teaches me how to better my customer service skills. Integrity 3 I feel the Health Department has a high level of integrity. Community 2 The best thing about working at the Health Department is the sense of community I feel.

Theme: Compensation (40 Responses) Sub Theme Frequency Representative Quote Benefits 28 The benefits, which include pension and health insurance. Job Security 8 Employment at the health department is very stable in comparison to other jobs. Pay 4 Pay and benefits are good. Theme: Work Life Balance (14 Responses) Sub Theme Frequency Representative Quote Schedule 9 The work schedule. Flexibility 3 The flexibility in allowing time off to deal with health and personal issues. Low Stress 1 Low stress level, good for balance with life outside of work. Work Hours 1 Work hours and schedule. Theme: Miscellaneous (62 Responses) Sub Theme Frequency Representative Quote No Comment 51 No comment. None (or negative) 2 Other 9 There is no one best thing about working for the OCHD. Resources to do mailings and place advertisements that reach large groups. Totals: 350

Table 5. Response to Open ended Question My one greatest frustration with working at the Onondaga County Health Department is: Theme: Organizational Culture (160 Responses) Sub Theme Frequency Representative Quote Bureaucracy 36 Lack of Fairness and Equity 35 Lack of Accountability 24 Poor Communication 18 Lack of Appreciation 14 The extraordinary layer of bureaucracy added to the system that just slows everything to a snail s pace. Rules that don't always apply to everyone MC vs. CSEA. Example: Some staff being able to flex their hours, while others can't. Watching other people not doing their job and nothing being said. Important information does not always make it down the chain of command leaving lower level people not informed on certain issues. The lack of consideration for what people do. No one ever says "Thank you" or shows any appreciation when you go above and beyond. People need encouragement not more micro management. No one says anything if you find a way to save money, they just ask you to work with less. I hear constantly that people just want to hear thank you once in a while. The common comments are if no one cares, why should I? Limited Autonomy/Flexibility 13 Not being able to do my job independently. Lack of Teamwork 6 The time taken to confer with peers is discouraged. This is usually seen as people standing around talking and not working. Limited Professional Development 5 Professional growth in the County system is difficult. At times I do feel like there is not an opportunity for forward movement or to expand out and learn new skills. Politics 4 Dealing with Conflict 3 Negative Work Environment 2 The politics of it. No one is reprimanded individually. You get a memo that something has changed if only one person screwed up. The way conflict between employees is dealt with is more than lacking. No one ever wants to deal with conflict. I'm tired of people being afraid to do their jobs. I believe a course in conflict resolution would be advantageous because at this point it is virtually non existent. Lack of positive reinforcement. Very negative place to work.

Theme: Resources (60 Responses) Sub Theme Frequency Representative Quote Staffing 21 Technology 11 We DO NOT have the manpower to completely do our jobs well. For instance, when one staff person leaves their position, we are clearly told that there will be no filling that position. There is increasing stress in our work environment. Computer issues. It seems when you fix one problem another occurs. Physical Environment 10 Lack of space and cleanliness of workplace. Funding 7 General Scarcity 5 Underutilization 4 I feel like the answer to every question is "we don't have the money to do that." Lack of resources to ensure that I have the ability to devote enough time to planning and improvement rather than immediate issues and problems. Not using my skills, talents and intelligence to its full potential in the job duties I now have. Service Quotas 2 Not being able to help some of the people. Theme: Personnel Systems (37 Responses) Sub Theme Frequency Representative Quote Limited Promotion/ Advancement 14 Professional growth in the County system is difficult. At times I do feel like there is not an opportunity for forward movement or to expand out and learn new skills. Time Clock 12 Civil Service 8 The Kronos time clock system. It is extremely insulting, being a professional, and having to be held accountable for punching in 1 or 3 minutes late, yet it doesn't matter if we punch out 5 minutes later than our day ends. Sometimes it is a weather issue, sometimes traffic, but usually out of our control. Not only do we have to punch in and out, but we have to fill out time sheets! It is a tedious process, and has only made more work for the employees. Seems punitive. CSEA rules around hiring and firing. The tests do not match the jobs. I could see testing for entry, but promotion should be based on merit. Union 3 Though I respect the union, I feel its protection also keeps people who do not care about their work from being held accountable or having any reason to improve their attitude or workload.

Theme: People (32 responses) Sub Theme Frequency Representative Quote Supervisor 27 The supervisors are not supportive. Co workers 5 Some bitterness of co workers negatively impacts my morale. Theme: Miscellaneous (62 responses) Sub Theme Frequency Representative Quote No Comment 42 No comment. Other 13 Constant changes that aren't necessary. None (or positive) 7 I don't really have any frustrations working for the OCHD. Totals: 351

Table 6. Responses to Open ended Questions Other than a pay increase, what else would improve your job satisfaction: Theme: Organizational Culture (180 Responses) Sub Theme Frequency Representative Quote Appreciation/Respect 31 Fairness/Equity 28 Communication 24 Accountability 18 Professional Development 17 Autonomy/Flexibility 15 Bureaucracy 15 Attitude/Morale 15 Recognition for dedication to job responsibilities and public health. See to it that people are all held accountable for their work and when they are not working to the same standards that they are reprimanded. More communication within the department not just on a need to know basis. Making everyone accountable for their job performance. I would like to have educational in services, seminars, or conferences. I don t remember when we have had in services for job related topics. More direct involvement in the decisions that affect my work. Re implementing the Total Quality Management (TQM) approach in the Department. Streamlined administrative processes. Clear expectations that do not change without notice. A system to remove / demote supervisors who consistently demonstrate inappropriate / ineffective managerial skills. Co workers dissatisfaction affects everyone s attitude and morale. Teamwork 11 More teamwork and cooperation at all levels. Dealing with Conflict 6 The ability for supervisors to deal with conflict.

Theme: Personnel Systems (93 Responses) Sub Theme Frequency Representative Quote Schedule Flexibility 63 Benefits 13 Promotion/advancement 13 Just the ability to flex without jumping through hoops. Currently I give more time to my job than required, so would like the ability to flex when necessary and not use time. Work covering some expense of gym memberships to promote physical and mental well being. Opportunity for advancement and job diversification. Comp Time/Overtime 4 Being able to have a choice between earning comp time and getting paid for overtime. Theme: Resources (35 Responses) Sub Theme Frequency Representative Quote Staffing/Workload Balance 12 Need more people to adequately address workload. Physical Environment 12 Workplace very dumpy program does not have budget to better itself or its atmosphere. Technology 11 Better computer equipment and support. Theme: People (22 Responses) Sub Theme Frequency Representative Quote Supervisor 19 More support, encouragement, and mentoring toward improvement and advancement, from my supervisors. Co workers 3 Co workers dissatisfaction affects everyone s attitude and morale.

Theme: The Work Itself (19 Responses) Sub Theme Frequency Representative Quote Diversification 12 Improve Quality 7 To not be so limited in the type of work I am allowed to do. To have the ability to have more time for planning, evaluation and program improvement. Theme: Miscellaneous (66 Responses) Sub Theme Frequency Representative Quote No Comment 53 No comment. None (or positive) 8 Other 5 I m very satisfied; we have it pretty good here with the County. To be able to dress so that clients do not feel that we are above them. Totals: 415

Table 7. Responses to Open ended Questions What work/life options would improve your ability to balance your work and personal life? Theme: Personnel Systems (141 Responses) Sub Theme Frequency Representative Quote Work Hours/Flextime 104 Time Off 12 Telecommuting 10 Lunch 6 More flexibility in my work schedule. Flex time within a day and within a week would be nice. Being able to take time off. Department so short staffed, feel guilty or get denied time off if other people are taking the time as well. Having the option of working from home would greatly improve my ability to balance work and personal life. Accessing my Ongov email from home and being able to access my personal email account from work would be very helpful as well. 30 minute lunches would improve my ability to balance work and personal life. Full time/part time 6 The possibility of part time or job sharing. Evenings/Weekends 3 Not that I have a heavy workload and that I m doing some work not related to my position, even if I m doing work that my supervisor should be doing. Sometimes I have to stay late to get it done and unfortunately nobody recognizes that. I m taking from my family time to complete a task because I am a responsible employee and I don t think my leaders care.

Theme: Organizational Culture (24 Responses) Sub Theme Frequency Representative Quote Fairness/Equity 9 Attitude/Morale 6 Equal treatment for all employees within the Department. Giving employees more control over their time may improve morale and productivity. Autonomy/Flexibility in Performing Work Understanding Family Commitments 5 5 Greater flexibility in managing my own schedule. A strictly 8 4 type schedule is not always necessary alternating scheduling such as 4 10 hour days, earlier or later start times, etc. would be preferable. Be a little more understanding when we have issues with children. Professional Development 3 A fully trained and staffed section would take a burden off those of us in the section. Bureaucracy 1 More leeway should be given to employees who have been working long term, allow for modifications in work duty when an injury precludes an employee from doing their regular duties for a prescribed period of time. Theme: People (10 responses) Sub Theme Frequency Representative Quote Supervisor 8 Co workers 2 Having a supervisor that makes you feel bad for taking sick time is not helpful. Tasks that could be assigned to others with less work loads would free up time.

Theme: Resources (10 Responses) Sub Theme Frequency Representative Quote Staffing 7 Technology 1 Physical Environment 1 Money/Salary 1 Being able to take time off. Department so short staffed, feel guilty or get denied time off if other people are taking time as well. Please, please, please find a way to allow us to synch personal calendars, ipads, telephones with calendars and other information. Having duplicate everything is really challenging. The office can be a very distracting environment, making it hard to focus on accomplishing my best work. Unfortunately, making more money so that I didn t have to work more than one job! Theme: The Work Itself (9 Responses) Sub Theme Frequency Representative Quote Too Stressful 5 Being able to share some of the responsibilities that I am solely responsible for now. Maybe create a position in between the supervisor and the staff that would have more responsibility and a little more pay. Retire 2 Retirement. Too Much Responsibility 2 If there were less responsibility to my job. Theme: Miscellaneous (133 Responses) Sub Theme Frequency Representative Quote No Comment 101 No comment. None (or positive) 27 Other 5 There have never been any issues with balancing work and personal life while working at the Health Dept. I think the Health Department does try to extend some flexibility to its employees. Totals: 332

Table 8. Responses to Open ended Questions Please offer up to three ideas or suggestions that would help the Department achieve our Vision. Theme: Organizational Culture (210 Responses) Sub Theme Frequency Representative Quote Communication 54 Appreciation/Respect 31 Communication should be more timely or in advance. There needs to be recognition when employees are meeting and exceeding job standards. Bureaucracy 29 Teamwork 27 Fairness/Equity 26 Attitude/Morale 14 Reduce bureaucracy involved in accomplishing basic work activities (receiving blue sheet approval, talking with the media, completing print shop orders, accounting for hours worked, etc.). All departments work together to get the job done. Equal treatment among staff in different departments. Some rules of the Health Department are so strict that it affects the emotional and social well being of the employees. If the rules were less strict, it would help morale. Professional Development 13 More funds for training and equipment; support advanced degrees. Accountability 12 Diversity 3 Dealing with Conflict 1 There needs to be accountability for all employees to perform up to acceptable standards. Greater and more effective recruitment of African American, Latino, and Asian staff. Again, ability for supervisors to deal with employee conflict.

Theme: Programs (48 Responses) Sub Theme Frequency Representative Quote Quality 15 Access 12 Processes 10 Empowerment 6 Consider the needs of the public when developing programs instead of just doing what is convenient for OCHD. Many County programs are only for residents of the City of Syracuse. All programs should be extended to the entire County, as long as it s financially feasible. Re implement a Total Quality Management (TQM) approach in the way business is done within the Department and in the community. Be open to new ideas even if they may be radically different than the way things are done now. Holistic Approach 5 Have a clinic where all programs could offer services with enough space, parking and staff to serve the public more efficiently in a one stop shopping concept. Theme: Community (45 Responses) Sub Theme Frequency Representative Quote Partnerships 24 Continued collaborations with community partners with ongoing periodic meetings centered around key topics, i.e., mental health in children, pregnant adolescents, etc. Public Education 17 Greater community understanding re: services, goals, opportunities available through OCHD. Advocacy 4 Recognizing how big an impact this can have, I think as an organization, we need to do more to advocate on the macro level.

Theme: Resources (32 Responses) Sub Theme Frequency Representative Quote Staffing 14 Increase staffing so there is more time to adequately serve the community not just push papers and meet deadlines. Physical Environment/ Facilities 7 Go above and beyond to create a comfortable environment for the employees. General 5 Technology 4 Parking 2 More resources for education and for the dayto day operation of our program. Ability to handle paperwork and documentation more efficiently, by increased use of technology. Negotiate with Upstate for some parking spaces for employees who are unable to park in or lot for the month. Theme: People (24 Responses) Sub Theme Frequency Representative Quote Supervisors 21 Commissioner 2 Co workers 1 I would like to suggest mandatory supervisor training for anyone who is a supervisor so that they can communicate with their employees much better and understand how to motivate their employees to get the most out of them. An occasional visit by the Commissioner or Deputy Commissioner, i.e., Commissioner s Breakfast at the division level. Could be a good morale booster. Finally, I think that there should be ZERO TOLERANCE FOR NEGATIVITY and bad behavior.

Theme: Personnel Systems (24 Responses) Sub Theme Frequency Representative Quote Scheduling 16 Pay and Benefits 6 More flexible hours (4 day work week) so people have time to take care of personal business when places are open for business. Make supervisor pay increase more in line with regular employees the catch up step increases do not do anything to help incoming supervisors. Respect in Time Off 2 Less intrusive questioning when asking for comp time, medical time and personal time. Theme: Miscellaneous (145 Responses) Sub Theme Frequency Representative Quote No Comment 122 No comment. None (or positive) 5 No comment. Think we run like a well oiled machine. Other 16 Opportunities for employees to volunteer in community. Nothing will Change 2 No comment. I don t actually think anything is going to change. Totals: 528

Bringing It Together Quantitative and Open-ended Questions Several common views emerge when we compare the responses to the quantitative survey items and the open-ended questions. First, employees value the work of the department- its importance, quality, and its significance in helping others. Further, employees see how their individual work is connected to a larger mission and feel accountable for successful achievement of the mission. Second, the people in the Department make the organization successful. Employees describe co-workers as skilled, committed, and supportive. Supervisors are often seen as treating employees with respect and encouraging performance. The employees also see issues to be addressed. They point to specific practices (the time clock, limits to advancement, lack of flex time systems) as affecting not only their morale but also their ability to perform more effectively. Equally important, employees perceive that some are not treated equally, that efforts are not recognized and appreciated, and that there is little support for creativity and innovation. For example, The Department does the right things for the right reasons. I love what I do for the Health Department. I think that we really do make a difference for children and families. I love my co-workers. But... The Kronos time system is very insulting. Too much bureaucracy. There seems to be favoritism. The Department is not always consistent in how rules are applied to everyone. 31

QUANTITATIVE RESPONSE ITEMS DIVISIONAL COMPARISONS Table 11 presents a breakdown of the percent positive responses for each question by Bureau or Division, as well as for the Department as a whole. The percent positive response was calculated by combining scores from the strongly agree and agree categories. Table 11. Quantitative Responses: Divisional Comparisons Admin Disease Control Env Health Forensic Laboratories Health Promo Healthy Families MEO Surv & Stats Departmentwide 1. I am given a real opportunity to improve my skills in the Department. 66 48 55 70 62 64 91 33 63 2. I have enough information to do my job well. 3. I feel encouraged to come up with new and better ways of doing things. 4. My work gives me a feeling of personal accomplishment. 80 86 76 80 69 84 91 67 81 73 67 74 57 58 60 82 56 65 80 76 79 73 69 82 82 44 78 5. I like the kind of work I do. 90 95 76 77 77 87 86 67 84 6. I know what is expected of me on the job. 90 100 84 73 92 89 91 100 88 7. When needed I am willing to put in the extra effort to get a job done. 100 95 95 90 96 96 91 100 95 8. I am constantly looking for ways to do my job better. 88 95 89 77 88 83 91 67 86 9. I have sufficient resources (for example, people, materials, budget) to get my job done. 71 43 55 60 65 58 68 33 59 10. My workload is reasonable. 85 52 68 60 69 63 64 33 66 11. My talents are used well in the workplace. 83 57 55 50 54 64 82 56 64 12. I know how my work relates to the agency's goals and priorities. 83 95 79 77 81 85 95 56 83 13. The work I do is important. 85 100 92 90 85 93 91 89 91

14. Physical conditions allow employees to perform their jobs well. 15. My performance appraisal is a fair reflection of my performance. Admin Disease Control Env Health Forensic Laboratories Health Promo Healthy Families MEO Surv & Stats Departmentwide 71 43 53 77 54 49 73 22 57 71 71 82 73 62 67 64 22 68 16. I am held accountable for achieving results. 90 90 87 80 65 81 77 56 81 17. I can disclose a suspected violation of any law, rule or regulation without fear of reprisal. 80 67 63 63 58 62 59 67 65 18. My training needs are assessed. 49 48 53 57 62 61 68 22 56 19. In my most recent performance appraisal, I understood what I had to do to be rated at different performance levels. 63 62 76 73 62 66 55 22 65 20. The people I work with cooperate to get the job done. 88 57 76 73 81 76 45 78 74 21. My program is able to recruit people with the right skills. 46 52 42 73 46 51 68 22 51 22. Advancement in my program is based on merit. 15 24 32 27 4 17 14 0 18 23. In my program, steps are taken to deal with a poor performer who cannot or will not improve. 15 43 16 27 23 38 14 33 27 24. In my program, differences in performance are recognized in a meaningful way. 25. Recognition in my program depends on how well employees perform their jobs. 22 19 24 23 19 29 18 22 24 24 38 32 43 15 39 36 33 34 26. Employees in my program share job knowledge with each other. 78 71 61 80 81 83 59 89 76 27. The skill level of employees in my program has improved in the past year. 28. My program works well with other programs in the Department. 41 43 34 63 65 45 59 44 48 85 67 71 60 62 69 55 56 68

Admin Disease Control Env Health Forensic Laboratories Health Promo Healthy Families MEO Surv & Stats Departmentwide 29. Other programs give my program the support it needs. 66 52 53 60 46 56 50 22 55 30. How would you rate the overall quality of work done by your program? 90 100 92 100 85 85 95 100 91 31. The workforce has the jobrelevant knowledge and skills necessary to accomplish organizational goals. 80 81 84 80 88 81 82 67 81 32. Employees have a feeling of personal empowerment with respect to work processes. 46 38 45 50 38 44 55 22 44 33. Employees are recognized for providing high quality products and services. 49 48 29 43 42 39 36 11 39 34. Creativity and innovation are rewarded. 39 43 26 33 27 29 27 11 29 35. Advancement depends on how well employees perform their jobs. 7 29 26 20 12 21 5 0 21 36. Policies and programs promote diversity in the workplace. 37 62 34 30 35 55 9 11 40 37. Employees are protected from health and safety hazards on the job. 93 76 68 87 77 73 82 44 77 38. The Department has prepared employees for potential security threats. 88 86 79 70 73 74 59 67 76 39. Arbitrary action, personal favoritism and coercion for partisan political purposes are not tolerated. 56 33 37 40 38 40 36 33 41 40. Prohibited Personnel Practices are not tolerated. 83 67 63 63 62 70 64 33 67 41. I believe the Department is successful at accomplishing its mission. 93 86 82 70 88 84 86 56 83 42. The Department operates in a way that is consistent with the REACH values (Respect, Excellence, Accountability, Collaboration and Health Equity). 73 67 63 60 58 66 45 56 63

Admin Disease Control Env Health Forensic Laboratories Health Promo Healthy Families MEO Surv & Stats Departmentwide 43. I recommend the Department as a good place to work. 80 67 84 73 62 70 68 56 72 44. I believe the results of this survey will be used to make the Department a better place to work. 71 57 50 57 50 49 50 11 53 45. My supervisor supports my need to balance work and other life issues. 85 67 92 73 65 83 73 78 80 46. My supervisor provides me with opportunities to demonstrate my leadership skills. 63 57 63 63 62 58 73 44 61 47. Discussions with my supervisor about my performance are worthwhile. 68 57 66 63 62 73 64 56 67 48. My supervisor provides me with constructive suggestions to improve my job performance. 68 43 66 63 62 70 64 56 64 49. Supervisors in my program support employee development. 63 57 58 70 65 69 73 44 65 50. My supervisor listens to what I have to say. 83 62 87 70 77 81 77 67 78 51. My supervisor treats me with respect. 85 67 87 77 88 87 77 78 83 52. In the last twelve months, my supervisor has talked with me about my performance. 68 76 84 87 85 78 64 33 76 53. I have trust and confidence in my supervisor. 76 52 84 60 54 79 73 67 72 54. Overall, how good a job do you feel is being done by your immediate supervisor? 71 62 71 67 58 74 73 56 69 55. In this Department, leaders generate high levels of motivation and commitment in the workforce. 61 43 39 43 46 52 50 33 49 56. Leaders maintain high standards of honesty and integrity. 78 52 55 67 62 60 77 44 63

Admin Disease Control Env Health Forensic Laboratories Health Promo Healthy Families MEO Surv & Stats Departmentwide 57. Leaders are committed to a workforce representative of all segments of society. 51 67 47 43 54 57 55 33 53 58. Leaders work well with employees of different backgrounds. 78 67 66 60 50 69 64 56 66 59. Leaders communicate the goals and priorities of the Department. 78 71 58 77 77 71 68 44 70 60. Leaders review and evaluate the Department's progress toward meeting its goals and objectives. 63 76 61 80 73 65 64 44 67 61. Leaders promote communication among different programs (for example, about projects, goals, needed resources). 66 76 58 63 54 57 50 22 59 62. Leaders support collaboration across programs/work units to accomplish work objectives. 66 71 66 63 58 63 55 44 63 63. I have a high level of respect for the Department's administrative leaders. 78 52 63 67 65 61 68 56 64 64. Administrative leaders demonstrate support for work/life balance. 78 71 71 60 38 60 64 44 63 65. Overall, how good a job do you feel is being done by the supervisor directly above your immediate supervisor? 80 76 55 70 62 61 68 78 66 66. How satisfied are you with your involvement in decisions that affect your work? 71 67 58 60 42 51 64 33 57 67. How satisfied are you with the information you receive from leadership on what's going on in the Department? 68 67 50 53 38 57 55 44 56 68. How satisfied are you with the recognition you receive for doing a good job? 59 57 50 53 38 46 45 44 49 69. How satisfied are you with the policies and practices of the Department? 68 71 55 73 46 62 55 33 61

Admin Disease Control Env Health Forensic Laboratories Health Promo Healthy Families MEO Surv & Stats Departmentwide 70. How satisfied are you with your opportunity to get a better job in your Department? 22 24 26 27 31 27 9 11 24 71. How satisfied are you with the training you receive for your present job? 54 71 55 53 65 72 82 44 64 72. Considering everything, how satisfied are you with your job? 83 81 79 60 81 79 82 56 77 73. Considering everything, how satisfied are you with your pay? 63 48 58 67 73 51 45 56 57 74. Considering everything, how satisfied are you with the Department? 73 67 68 60 69 66 82 44 68 75. The environment in this Department supports a balance between work and personal life. 68 71 89 60 42 67 64 67 67 76. I am able to satisfy both my job and family responsibilities. 73 76 84 83 69 80 77 78 78 77. I am satisfied with the amount of flexibility in my schedule. 46 71 76 63 35 60 64 11 58

Findings from 2011 Community Health Needs Assessment Forums: Syracuse, New York January, 2012 INTRODUCTION Title IX of the Patient Protection and Affordable Care Act of 2010 requires charitable hospitals to meet certain provisions related to community benefit in order to maintain their tax- exempt status. Among those requirements is that every three years they are to conduct a community health needs assessment (CHNA) that includes community and public health input. Local health departments in New York State are required to conduct periodic community health assessments (CHA) in order to ensure that their programming remains consistent with community needs. These two community planning processes run parallel and have similar attributes. The Central New York Masters in Public Health Program, run jointly by the State University of New York Upstate Medical Center and Syracuse University, initiated a process of community engagement that can support the hospital s CHNA and the Onondaga County Health Department s CHA. Students in the program s Public Health Administration course coordinated and facilitated five forums convened in October and November 2011 and analyzed data collected during those forums as their semester s project. The Lerner Center for Public Health Promotion at the Maxwell School for Citizenship and Public Affairs at Syracuse University provided logistical support and assistance with recruiting forum participants in collaboration with the Onondaga County Advisory Board of Health, the Syracuse City Schools, and Say YES to Education. The forums were held at the Central New York Community Foundation Philanthropy Center; the school- focused forum was held at the Say Yes to Education offices. Altogether, 92 people participated in the forums. APPROACH The forums were conducted using a small- table format that included five to seven participants per table as well as two students from the public health administration course a facilitator and a scribe (for transcribing ideas onto newsprint). Each table, regardless of the type of representatives present, was presented with a common set of core questions/topics. These consisted of an exercise in composing a picture of an ideal community; describing that community succinctly in narrative form; identifying strengths and weaknesses of the current public health situation in our community; issues needing attention in the domains of the public health system and the health status of individuals; and, based upon what they had identified in previous portions of the session, recommendations for local public health priorities. Each session was designed to last two hours. Lerner Center for Public Health Promotion Page 1 of 9 Community Health Needs Findings

The data used for the analysis presented in this report consist of responses given during the portion of the sessions devoted to identifying issues needing attention in the domains of the public health system and the health status of individuals. The analysis process, carried out by an independent researcher assigned to the project as well as public health experts from the Lerner Center, consisted of thematically coding the responses inductively into categories that are consistent with dimensions targeted by the public health field. The following presentation of findings is divided into those representing system- level needs and those representing health status issues. The report s final section attempts to draw conclusions regarding public health priorities for the next three years. System- Level Issues FINDINGS Chart 1 shows the distribution of responses among the four main categories that emerged from the data regarding system- level issues. Social conditions generally consists of responses in which people indicated that public health priorities should target community- level factors that are not directly related to the delivery of health, such as the economy, the school system, the public transportation system, and policies affecting safety. The remaining responses generally can be categorized as relating to the public health system s capacity to provide needed care, the difficulties many people have in accessing healthcare either due to problems with the availability of affordable health insurance or in obtaining clear, useful, and unbiased information about healthcare. Chart 1 Percent of Responses Related to Four Main Categories (N=141) 36.2 34.0 17.0 12.8 Social Conditions Access to Care: Capacity Access to Care: Financial Access to Care: Information Lerner Center for Public Health Promotion Page 2 of 9 Community Health Needs Findings

Based upon the number of responses that comprise the social conditions category (see Chart 2), forum participants apparently are concerned that the City and County are not favorable locations in which healthcare and health can thrive. Over half of the responses in this category indicate needs for stronger policies regarding safety (especially crime prevention), jobs, and access to healthy food. Chart 2 Percent of Responses Related to the Theme "Social Conditions" (N=51) 21.6 15.7 15.7 11.8 9.8 9.8 9.8 5.9 Charts 3, 4, and 5 present the distribution of responses within each of the Access to Care categories shown in Chart 1. Chart 3 shows that most (77%) of the responses are related to the healthcare system s inability to accommodate consumers healthcare needs, particularly primary and mental health care. Forum participants placed relatively little emphasis on dental care and options for eldercare. 41.7 Chart 3 Percent of Responses Related to the Theme "Access to Care: Capacity" (N=48) 35.4 14.6 8.3 Primary Care Mental Health and Substance Abuse Dental Eldercare Options Lerner Center for Public Health Promotion Page 3 of 9 Community Health Needs Findings

Chart 4 shows that between the private insurance market and public coverage (largely Medicaid), it is the private market that caused the most concern to forum participants. Individual responses in the private category primarily focused on coverage and cost while those in the public category mainly focused on a lack of providers that accept Medicaid. Chart 4 Percent of Responses Relating to the Theme "Access to Care: Financial" (N=24) 66.7 33.3 Private Insurance System Public Insurance System Chart 5 shows that forum participants who mentioned problems with obtaining information about healthcare were mostly concerned about a general lack of consumer information. They mentioned information overload, a lack of communication about healthcare opportunities such as free screenings, and a general lack of consumer education. Political responses included mentions of public officials lack of knowledge about local health concerns, politics driving of healthcare decisions, and difficulties posed by the state regulatory environment. 44.4 Chart 5 Percent of Responses Related to the Theme "Access to Care: Information" (N=18) 22.2 22.2 11.1 Consumer Information Cultural Competency Less Political Easier- to- navigate Healthcare System Healthcare System Lerner Center for Public Health Promotion Page 4 of 9 Community Health Needs Findings

Health Status Issues Chart 6 presents the distribution of responses across four general categories impacting health status. Over half of the responses are captured in the chronic disease, mental health and substance abuse, and physical activity and nutrition categories. Chart 6 Percent of Individual- level Responses Included in Each Main Category (N=188) 21.8 18.6 17.6 15.4 13.8 12.8 Chronic Disease Mental Health Physical Activity and Substance and Nutrition Abuse Maternal and Child Health Social Determinants Other Conditions Chart 7 shows that the forum participants identified the need for prevention and treatment of chronic disease to be of importance to the local community. They particularly mentioned asthma as needing attention. 31.7 Chart 7 Percent of Responses Relating to Chronic Disease (N=41) 24.4 22.0 22.0 Respiratory Disease Diabetes Cancer Cardiovascular Disease Lerner Center for Public Health Promotion Page 5 of 9 Community Health Needs Findings

Chart 8 shows that forum participants identified obesity as the status in this category that is most in need of attention. They also are concerned about hunger and poor nutrition among people of all ages. The accessibility category consists of responses in which people identified difficulties people have in getting good food and exercise. Chart 8 Percent of Responses Related to Physical Activity and Nutrition (N=33) 51.5 24.2 15.2 9.1 Obesity Nutrition Accessibility Fitness Chart 9 shows that participants regard mental health for both children and adults as important issues. Substance abuse, including prescription drugs and smoking are also seen as problems. Chart 9 Percent of Responses Related to Mental Health and Substance Abuse (N=36) 60.0 28.6 11.4 Mental Health Substance Abuse Smoking Lerner Center for Public Health Promotion Page 6 of 9 Community Health Needs Findings

Chart 10 shows that almost all of the responses in the maternal and child health category consisted of infancy- related problems. Mentions of infant mortality and low birth weight predominated within this category. Chart 10 Percent of Responses Related to Maternal and Child 86.2 Health (N=29) 13.8 Infancy- related Teen/unplanned Pregnancy Chart 11 presents information about the distribution of other conditions that arose during the sessions. Other conditions mainly include infectious diseases (especially STDs), injuries (especially falls among elderly people), and general oral health. Other conditions within this overall category that were mentioned by forum participants were diseases of the eye, seasonal affective disorder, and allergies. Chart 11 Percent of Responses Related to Other Conditions (N=24) 25.0 20.8 16.7 12.5 12.5 12.5 Infectious Disease Injuries Dental Health Disability Aging Other Lerner Center for Public Health Promotion Page 7 of 9 Community Health Needs Findings

Chart 12 presents findings regarding social factors that are connected to health status. Most responses related to violence mentioned crime or domestic violence, including child abuse; most responses in the education category mentioned either the cost of education or low rates of achievement; all of the responses in the income category either mentioned the cost of health insurance or poverty; and lead poisoning was mentioned by three people. Chart 12 Percent of Responses Related to Social Determinants of Health Status (N=26) 38.5 26.9 23.1 11.5 Violence Education Income Lead Poisoning Overall Assessment of Public Health Issues When the health system and health status issues are considered together, social conditions is the set of factors that are most frequently cited as impacting overall health of the community. These social issues are wide ranging and clearly demonstrate the enormous effect of social and environmental conditions on health. Interventions to address these issues are also broad and would include economic development and expansion of educational opportunities. Access to health care is also a dominant theme. Access is defined broadly and includes financial access and capacity as well as the degree to which consumers are a partner in their health care. In particular, access to primary care and mental health care were identified as problematic. Health status was also negatively impacted by a number of variables including physical activity and nutrition which drives, in large measure, chronic disease, another area of concern frequently cited. Other health concerns relate to mental health and substance abuse as well as maternal and child health, problems exacerbated by limited access to care and poor social conditions. Lerner Center for Public Health Promotion Page 8 of 9 Community Health Needs Findings

CONTACT INFORMATION LERNER CENTER STAFF Faculty Director: Thomas Dennison Program Director: Rebecca Bostwick Evaluation Consultant: Elaine Wolf Phone: 315-443-4526 Email: lerner@syr.edu Website: lernercenter.syr.edu Community Health Needs Forums facilitated by thirty-five Master of Public Health Students at the Central New York Master of Public Health Program, a joint degree between SUNY Upstate and Syracuse University. upstate.edu/cnymph January 2012 Lerner Center for Public Health Promotion Page 9 of 9 Community Health Needs Findings

Onondaga County Health Department Strategic Plan 2015-2019 Photo: Wikimedia Commons Onondaga County Health Department John H. Mulroy Civic Center 421 Montgomery Street, 9 th Floor Syracuse, New York 13202 www.ongov.net/health www.facebook.com/ongovhealth