Consultation Services to Assist the Aberdeen Area Office of the Indian Health Service to Develop a Strategic Plan, 2012–2017

Sundance Research Institute, in partnership with Econometrica, Inc., developed a Strategic Plan for the Aberdeen Area Indian Health Service (AAIHS) for the years 2012–2017. Strategic planning for the Indian Health Service is particularly complex due to:

  • The number of organizations and entities that comprise the complete Indian health care system—IHS Service Units, Tribal health programs, Urban Indian Health Programs (UIHPs)—each of which may have unique priorities, goals, and objectives determined by its local stakeholders and circumstances.
  • The importance of developing the Plan in partnership with Tribes to ensure that the priorities and issues of Tribal leaders and Tribal members are reflected and addressed in the Plan.
  • The need to ensure that the AAIHS Strategic Plan is coordinated and consistent with the goals and objectives of the national IHS Strategic Plan and with the U.S. Department of Health and Human Services (DHHS) Strategic Plan.
  • Limitations and uncertainties about the funding levels that will be available to AAIHS over the years 2012–2017 that would support initiatives to implement Strategic Plan goals and objectives.
  • Anticipated significant changes in the national health care system that will affect AAIHS, stakeholders, Tribal members, and all components of the local health care system, through expanded insurance coverage, increased revenue opportunities, changing reimbursement levels, expanded use of health information technologies, and a wide range of regulatory changes and reporting requirements.

The key activities conducted during this one-year project included:

  • Conduct Internal Indian Health Service/Tribal/Urban Indian Health Program (I/T/U) Environmental Scan: The internal I/T/U environmental scan documented current resources, types and quantities of services provided, characteristics of patients, performance measures and monitoring, existing initiatives (e.g., Improving Patient Care activities, electronic health records (EHRs), and other health information technology plans), identified needs for improvement, and challenges faced by the I/T/U system. The internal environmental scan was conducted through interviews with managers and key staff of the I/T/U system; focus groups with I/T/U patients; interviews with Contract Health Service providers; interviews with other individuals who coordinate and partner with AAIHS; and review of program statistics, internal documents, and other materials that provide insight into the strengths, weaknesses, and issues that guided development of the Strategic Plan.
  • Conduct External Environmental Scan: The external environmental scan documented the health care system within which AAIHS and the I/T/U system operates, including:
    • Documentation of available non-I/T/U health resources that provide services to American Indian/Alaska Native (AI/AN) people in the four-State AAIHS region.
    • Key informant interviews with a small number of managers of non-I/T/U health facilities to obtain information and perceptions of their role and contribution to Indian health.
    • Documentation of Medicaid/SCHIP programs in each AAIHS State and any special AI/AN health-related programs and initiatives in each State.
    • Review the Indian-specific provisions in the Affordable Care Act and identify those that will require AAIHS and the I/T/U system to make changes and/or present opportunities or threats.
    • Review provisions of the Indian Health Care Improvement Act and identify specific issues that may affect AAIHS and the I/T/U system.
    • Review U.S. DHHS Strategic Plans and national IHS Strategic Plans.
  • Prepare Environmental Scan Report: The Internal and External Environmental Scan Report summarized and documented strengths, weaknesses, opportunities, and threats that provided background for AAIHS, the Great Plains Tribal Chairmen’s Health Board (GPTCHB), and other stakeholders to assist them in identifying priorities and specific objectives that might be necessary and feasible. In addition, the Environmental Scan identified potential new partnerships and resources that can be useful in advancing and achieving elements of the Strategic Plan.
  • Gather Partner and Stakeholder Input: AAIHS partners with the Tribes it serves to establish priorities, address issues, and resolve problems that occur within the IHS system. AAIHS Area Office division leaders, individual Service Units, Tribally-operated health programs, and UIHPs are also stakeholders in the I/T/U system and collaborate and coordinate with the Area Office to ensure that services are available, accessible, of high quality, and are user friendly. Other possible stakeholders include Contract Health Service providers, State and local public health agencies, State Medicaid/SCHIP programs, and other non-governmental health-related organizations and programs that provide services and resources to AI/AN people in the Aberdeen Area. Input from all partners and stakeholders is an essential and critical component of the strategic planning process and was gathered throughout the project through multiple approaches, including:
    • Involvement of GPTCHB in all stages of the Work Plan and strategic planning process, through a joint process with AAIHS.
    • Meetings and key informant interviews with Area Office division managers and other key staff.
    • Design and analysis of a survey of stakeholders to identify issues they would like to have addressed in the Strategic Plan and their suggestions and recommendations.
    • Meetings with Aberdeen Area health care facility leadership to identify issues of concern, priorities in their individual strategic plans, and recommendations for integrating facility strategic goals and objectives into the Aberdeen Area Strategic Plan.
    • A broad process of sharing interim information and draft deliverables with all stakeholders identified by AAIHS.
  • Identify Priorities and Goals: Priorities and goals for the two Strategic Plans—Aberdeen Area Office Strategic Plan and Aberdeen Area Strategic Plan—were identified through an iterative process with AAIHS leadership, GPTCHB, Area Office division managers, and other stakeholders. Based on meetings and discussions with AAIHS and GPTCHB, the Environmental Scan findings, the Stakeholder Survey analyses and results, and input and feedback from stakeholders, the Econometrica/Sundance Research Institute team developed a preliminary outline of Mission and Values, Strategic Priorities, and Measurable Goals. This preliminary outline was circulated to AAIHS, GPTCHB, and appropriate stakeholders identified by AAIHS and GPTCHB, and a second draft of the Mission and Values, Strategic Priorities, and Measurable Goals was prepared and again disseminated to AAIHS, GPTCHB, and other stakeholders. Feedback and input on this second draft was then used to prepare the final version of these dimensions of the strategic planning process.
  • Identify Feasible Objectives Under Each Priority/Goal: Once a consensus was reached on Strategic Priorities, a similar process was used to obtain consensus on specific objectives under each Priority. These specific objectives are sub-priorities within the Strategic Priority—i.e., if Prevention is a Strategic Priority, there are many prevention targets that might be considered, such as preventing infant mortality, preventing cervical cancer, or preventing long-term consequences of tobacco use. Each preliminary specific objective identified was broadly assessed for feasibility and other considerations and ranked in terms of potential resources required and other factors that might affect feasibility.