Ask A Researcher

July 2024

ND SHIP - Guiding Public Health Strategies in North Dakota

Grace N. Njau, PhD MPH – Dr. Grace N. Njau is the director of the Division of Special Projects and Health Analytics at the North Dakota Department of Health. She also serves as community faculty at the University of North Dakota School of Medicine and Health Sciences and at North Dakota State University (NDSU). Dr. Njau received her master’s from the University of Colorado and her doctorate in comparative and experimental medicine at the University of Tennessee, Knoxville. Dr. Njau is passionate about all-things-data, and especially rapid and targeted data communication and dissemination to inform positive behavioral changes, health policy and program planning.

The State Health Improvement Plan (SHIP) for North Dakota represents a strategic initiative designed through extensive evaluation of data and collaboration with a wide range of partners throughout the state. Anchored by a commitment to data-driven decision-making, this comprehensive plan is the cornerstone for guiding public health strategies in the state. It sets forth a vision for enhancing the health and well-being of all North Dakotans by identifying health priorities that will inform the development of associated goals, objectives and activities. Within the framework of North Dakota's SHIP, dedicated workgroups and strategy teams support each data-informed priority area. Each team will execute strategic initiatives and continuously evaluate and adapt strategies to meet emerging health needs. This collaborative and adaptive approach ensures that North Dakota's health improvement efforts are effective and responsive, aiming to achieve the overarching goal of making North Dakota the healthiest state in the nation.

SHIP and Public Health Accreditation

The Public Health Accreditation Board (PHAB) Standards & Measures include domains that align public health's core functions and essential services. These domains serve as a framework for health departments to structure their activities and policies, including developing and implementing a SHIP. The North Dakota Public Health Division (Division) was awarded a five-year reaccreditation status by PHAB in 2022. The Division continues to fulfill the PHAB requirement and this five-year plan lays out an intentional framework designed to be adaptable to individual communities while providing guidance on state-level goals for health improvement.

Benefits of SHIP

1. Use of Data to Inform Strategy: Priorities are identified using multiple state and community-level data sources and validating data with key informant feedback.
2. Setting Upstream Priorities for Health Outcomes: Priorities are intentionally upstream, broad categories that encompass health outcome goals in various ways and are not limited to public health division activities.
3. Providing Guidance for Strategic Plan Alignment: The SHIP's priorities are comprehensive. Internal and external partners can use the priorities and data in their strategic planning, creating synergy statewide in our work toward improved health outcomes.
4. Tracking Progress: Dashboards provide insight on goals and outcomes related to priorities and focus areas allowing leaders to identify quality improvement opportunities more often than every five years.

The SHIP Process

The development of the ND SHIP occurs in a five-year cycle. The first step of the cycle is to conduct a State Health Assessment (SHA). A timeline of activities and accountabilities in developing and activating the 2024-2029 SHIP is included below.

The SHA was last conducted in 2021 and included a comprehensive review of statewide data and focus groups. The SHA is conducted every 3-5 years and is a very comprehensive review of all health-related data available to the public health division, looking at the quantity and quality of life in ND.

Developing the SHA

The HHS Health Statistics & Performance section analyzed vital records, survey data, census data, hospital discharge information, health care utilization, health care access, etc.
Focus groups were conducted to gain stakeholder input.
North Dakota State University Center for Social Research (NDSU CSR) assisted in data analysis and wrote the final report summary, which was last completed in 2021.

The Division determined to update the data and conduct additional quantitative and qualitative analysis in 2023 to account for the various impacts of the COVID-19 pandemic when determining priority areas for the SHIP. Data is published on the HHS website as a dashboard for public knowledge and use.

In addition to reviewing primary data sources, the following secondary assessments were considered in the analysis:

America’s Health Rankings 2023 – ND
UND School of Medicine & Health Sciences Seventh Biennial Report on Health Issues for the State of North Dakota
UND Center for Rural Health Community Health Needs Assessments
BCBS Caring Foundation Report on Health and Well-Being of North Dakota

Building on the results from this meta-analysis, NDSU CSR conducted qualitative surveys of key informants (n=150). Survey respondents included representatives from every county, rural and urban areas, and a wide range of individuals, including:

Local government officials
School board members
Economic development professionals
Non-profits
Industry representatives
Tribal health
Healthcare
Public health professionals

The goal of the survey was to understand if the priorities that emerged from the data were aligned with the needs identified at the community level and to learn more about current work or interest in work happening in the state around those priority areas. A summary of findings was prepared and submitted to the Division’s executive leadership.

2024-2029 SHIP Priorities

After reviewing the available data and feedback from key informants and focus groups, four common themes emerged as public health priorities and have been adopted as priority areas for the 2024-2029 SHIP. These priorities broadly encompass the work of public health in our state and provide a framework for aligning internal and external efforts to improve the health of all individuals in North Dakota.

The SHIP Priorities

Strengthening Workforce
Cultivating Wellness
Expanding Access and Connection
Building Community Resilience

Within each identified priority area, there are several focus areas. These focus areas provide specific aims for collaborative work to improve the health and well-being of all. Objectives, goals, activities, and measurements will be developed collaboratively with internal and external partners.

Strengthening Workforce Focus Areas:
Implement effective recruitment, retention, and training strategies so we can ensure a strong and stable workforce ready to meet the needs of North Dakotans.

Cultivating Wellness Focus Areas:
Further the collective commitment to improving the health outcomes of all our communities by investing in developing strategies to:

Strengthen childhood opportunities and reduce adverse childhood experiences
Decrease occupational injuries
Curb tobacco and e-cigarette usage
Enhance the length and quality of life of tribal populations and older adults.

Expanding Access and Connection Focus Areas

Enhance well-being by expanding access to essential healthcare services, such as primary care, cardiac care, oral health care, cancer screening, and chronic disease management and prevention.
Additionally, support strategies to actively connect individuals to referrals for services and programs that support their holistic wellbeing, ensuring that everyone has the opportunity to receive the care and support they need.

Building Community Resilience Focus Areas

Build capacity and enhance readiness for infectious disease response, emergency preparedness, and response.
Strengthen overall community resilience, while being responsive to the challenges of rural communities.

Multi-Partner Health Collaborative

Background

In 2021, the Division implemented a Work As One (WAO) initiative designed to support data gathering for needs assessments. As part of this initiative, a WAO stakeholder group, composed of partners representing state populations and health challenges, was identified. The WAO group operated with a limited scope, focusing primarily on the process for needs assessments, such as the Maternal and Child Health Needs Assessment and the State Health and Equity Assessment, among others. As plans for activating the 2024-2029 SHIP were discussed, the Division Leadership considered ways to build upon the foundation of the WAO and expand connections for participation and collaboration beyond needs assessments. As a result of these discussions, the State Health Officer directed the establishment of a Multi-Partner Health Collaborative (MPHC).

About the Collaborative

The North Dakota MPHC is a coalition of diverse partners that fosters partnerships among government agencies, non-profit organizations, non-government organizations, and healthcare systems.
The State Health Officer is the executive authority establishing the MPHC.
The MPHC will consist of four Goal Groups aligned with the four priorities. These goal groups will serve as specialized task forces focusing on critical areas outlined within the SHIP.
Operating guidelines, milestones, and activities defining how the goal groups will operate are being developed in spring 2024, with recruitment of members beginning in summer 2024.
The MPHC will be convened by an external partner, the Foundation for a Healthy North Dakota, that will recruit participants to join the Collaborative, schedule meetings, and guide the process of setting goals and objectives. HHS team members will participate in goal groups, provide operational support and develop dashboards for tracking progress and outcomes.

Tracking Progress and Outcomes

As part of our commitment to enhancing public health outcomes and ensuring the well-being of our communities, the new SHIP introduces a comprehensive and collaborative approach to addressing critical health priorities. Central to this are the MPHC's goal groups, each dedicated to a specific priority area. These groups will collaborate to work on the focus areas within the four priorities. These groups are tasked with a critical mission: to establish clear objectives and strategies/activities that align with the SHIP.

The collaborative nature of this approach ensures that the expertise and resources across different sectors are harnessed, promoting a unified effort in tackling our most pressing health challenges. By working together, the goal groups aim to create a synergistic impact that transcends the sum of individual efforts, addressing complex public health issues with innovative and effective solutions.

The HHS Systems & Performance Section will support the MPHC by developing dashboards to track and report progress towards these shared objectives. These dashboards will serve as vital tools for stakeholders at all levels, providing real-time data and insights that inform decision-making and strategy adjustments. The use of dashboards will allow the MPHC members and the Public Health Division to monitor effectiveness and implement quality improvement practices.

By employing a data-driven approach, the Division aims to not only track our advancements but also identify areas requiring further attention or a strategic pivot. This iterative process ensures that our actions are continually refined and aligned with our goal of improving health outcomes across the state.

To access the document electronically, please visit: https://www.hhs.nd.gov/health/north-dakota-state-health-improvement-plan-ship