Management Academy for Public Health: Creating Entrepreneurial Managers

Abstract

The Management Academy for Public Health develops public health managers’ management skills. Ultimately, the program aims to develop civic entrepreneurs who can improve the efficiency and the effectiveness of their organizations. With help from a coach, teams write public health business plans to meet needs in their communities.

An external evaluation found that 119 teams trained during the first 3 years of the program generated more than $6 million in enhanced revenue—including grants, contracts, and fees through their business plans—from $2 million in program funding. Approximately 38% of the teams expected to generate revenue from an academy business plan or a spin-off plan.

Action-learning methods can help midcareer managers transfer their training to the workplace and build entrepreneurial skills.

PUBLIC HEALTH WORKFORCE assessments have prompted many institutions to develop “Public Health 101” courses, but many public health managers and leaders—including those with public health degrees—lack formal training in management. In 1999, the Centers for Disease Control and Prevention (CDC), the Health Resources Services Administration, the W.K. Kellogg Foundation, and the Robert Wood Johnson Foundation pooled $4 million through the CDC Foundation to establish and evaluate the Management Academy of Public Health as a national demonstration project that would develop skills for managing people, data, and money.

Two partner schools at the University of North Carolina (UNC), Chapel Hill, were selected to develop the program: the School of Public Health and the Kenan-Flagler Business School. These partners have since collaborated on the National Public Health Leadership Institute1 and the W.K. Kellogg–funded Emerging Leaders in Public Health program. The Management Academy of Public Health design incorporates 3 residential sessions that total 10 days over a 9-month period. Faculty from the 2 partner schools jointly developed most of the courses. Individuals receive a multirater assessment to help them develop individual goals,2 and course credits are available for purchase. Between residential sessions, teams work on a business plan with guidance from a coach. Since 1999, more than 850 managers have enrolled, and 96% of the teams have completed the program. Each team presents their business plan during the closing session.

KEY FINDINGS.

• From an initial $2 million training investment in the Management Academy of Public Health, graduates have generated $4 million in actual revenue and an additional $2 million in forecasted revenue for team business plans.

• This collaboration between the School of Public Health at the University of North Carolina, Chapel Hill, and the Kenan-Flagler Business School has served as the foundation for additional training programs.

• State and city public health organizations will pay for an effective management training program that generates concrete projects.

• Public health managers can build their skills and confidence to become civic entrepreneurs.

• Action-learning methods help midcareer public health managers transfer their training to the workplace.

CIVIC ENTREPRENEURSHIP THROUGH ACTION LEARNING

The goal of the Management Academy of Public Health is to create civic entrepreneurs who can improve the efficiency and the effectiveness of organizations.3^–8 In the public health context, competency in civic entrepreneurship is the ability to combine skills, including assessing needs, marshalling human and other resources, building strategic alliances, using evidence-based planning processes, attracting start-up funds, identifying revenue streams, and planning, for post-grant sustainability. To improve the likelihood of organizational impact, the program trains teams of managers who apply together; most teams are based in local public health agencies. To underscore the importance of intersectoral collaboration in public health, the program encourages teams to include community partners.9^,10

To ensure training transfers to the workplace, the design includes an action-learning project that requires teams to practice and apply what they have learned.11^,12 Each team develops a public health business plan that describes a sustainable new program, with intersectoral partners,13 for addressing an important community health issue within their purview. To fit the model, plans must have a revenue-generating component, although grants and in-kind (e.g., noncash contributions such as space or materials) and government funds are often included in start-up. The business plan is primarily a learning tool that makes teams integrate and synthesize their new skills and knowledge in areas such as budgeting, making financial assumptions, managing a team, assessing or creating data, planning, analyzing markets for public health programs, writing, and making presentations. At the same time, teams use their business plans to address real health issues in their communities, within real organizational contexts. As alumni teams began to use their business plans to attract start-up funding and to implement new programs, funders and state partners asked the evaluation team to track enhanced revenue as a measure of success: how much money did locally implemented business plans generate from grants, contracts, and fees?

MEASURING SUCCESS

Generation of Business Plan Revenue

The pilot program was evaluated internally by UNC staff and externally by the Lewin Group, a consulting firm (Figure 1 ▶); both evaluations measured individual change and organizational change. The internal evaluation focused on short-term measures of program quality. Individual participants answered formative questions about course relevance, quality of the instructors, and support for applying course concepts in their jobs. The internal evaluation also measured changes in skills, knowledge, beliefs, and behaviors with pretests and posttests, interviews, and artifacts of organizational change immediately after the 9-month training period. On the individual level, both internal and external evaluation results from the pilot program showed significant knowledge, belief, and skill improvement on the dimensions of managing money, data, and people. Preliminary results have been reported elsewhere14^–16; a special issue of the Journal of Public Health Management and Practice provided further details on program implementation and internal evaluation results.8^,17^,18

FIGURE 1—

Management Academy of Public Health (MAPH) Program and Evaluation Model.

Note. IDP = individual development plan. The thick black line indicates graduation. Internal evaluation components align vertically with corresponding program components.

^aBusiness plan portfolio.

The external evaluation focused on longer-term outcomes. Surveys and interviews with alumni were used to measure individual change. Organizational change attributable to training is difficult to measure directly; therefore, the ability to implement a business plan and generate revenue was used as a proxy measure for organizational change and entrepreneurship.

To measure business plan implementation, the evaluators conducted 60-minute semistructured telephone interviews19 with teams or team representatives (N=73 interviews) from the first 3 program years (2000–2002). For projects that had already begun the implementation process, the actual amount of start-up funding acquired from any source and a conservative estimate of forecasted revenue a project was likely to generate (i.e., enhanced revenue) was determined during the interview process.

Implementation Results

During the first 3 years of the pilot program, the academy expended roughly $2 million on training. The 119 teams that graduated during those 3 years—490 people from 4 states—generated more than $6 million in start-up funds and actual revenue plus forecasted revenue (Table 1 ▶). This revenue includes federal, state, and private grants and gifts toward start-up of a business plan in addition to revenue generated through fees or billable services.

TABLE 1—

Generation of Enhanced Revenue: Management Academy of Public Health, 2000–2002

No. of teams generating revenue (N = 73)	28 (38%)
Actual revenue generated	$3 988 000
Forecasted revenue generated	$2 057 000
Total enhanced revenue generated	$6 045 000

Approximately 38% of the teams interviewed expected to generate revenue from an academy business plan or a spin-off plan (Figure 2 ▶). Grant funding from governmental and nongovernmental sources represented approximately 85% of the total $6 million generated through enhanced revenue initiatives, and fee-based initiatives accounted for the balance.

FIGURE 2—

Management Academy of Public Health business plan implementation by year: 2000–2002.

BUSINESS PLAN EXAMPLE.

In 2002, a team from Dare County, NC, developed a business plan for providing dental care to underserved school-aged children in a double-operatory van, which can serve 2 patients at a time (http://www.maph.unc.edu/reports). The plan showed need, described operations, showed the commitment of partners (e.g., the dentist and school nurses), and determined staffing, the target market, and evaluation measures. The plan forecasted a break-even point for the mobile clinic on the basis of considerations such as payer mix (how many people would self-pay, use private insurance, use Medicaid, and so on), case mix (how many patients would need cavities filled, teeth pulled, and so on), and capacity (patients treated per day).

The team submitted the business plan to the Kate B. Reynolds Charitable Trust, which provided most of the $277 000 in start-up funds to purchase the van. Program revenue (primarily Medicaid billing) covered ongoing costs for personnel and supplies. During its first year, the dental van hosted 1600 appointments; 44% of the children treated received sealants. Moreover, the project filled an important gap: during year 1, more than 90% of patients had demonstrable financial need, and the majority did not have a routine dental provider.

Fewer than half of the teams surveyed reported having abandoned or postponed their plans. More than half continued to pursue implementation of their plans, with 22% reporting their business plans were fully implemented. Teams that graduated during the first year of the program reported a much higher implementation rate (42%) than did teams from the second and third years. Many graduates said in interviews that they had become more entrepreneurial in their approach to generating revenue for public health, including looking to nontraditional sources.

DISCUSSION AND NEXT STEPS

The enhanced revenue assessment is important for 2 reasons. First, it measures training results in terms of dollars, which policy-makers understand. In 2005, Management Academy of Public Health tuition was $4500 per person, not including travel and time away from the office; the enhanced revenue results make it easier for organizations to justify that training expense because graduates will return to their organizations better able to generate revenue. Second, this analysis measures training results expressed at the organizational level, not the individual level. Academy funders believed that individual knowledge change was a necessary but insufficient measure of success. Individual change for these learners has been documented. The ability of alumni teams to generate revenue from their business plans suggests that the individual change measured on tests and surveys actually transferred to the workplace.

Enhanced revenue does have limitations as a measure: it is a useful proxy for organizational change, but it clearly stops short of measuring health improvement. Business plans should be evaluated individually to determine health impacts. Next steps include following up with graduates to find out if their business plans were implemented and what the results were and to look for other evidence of entrepreneurial thinking and activity.

Overall, the Management Academy of Public Health has succeeded in achieving 3 key goals: individual change, organizational change, and sustainability. The program created a consistent training model grounded in action learning and built around civic entrepreneurship. The team business plan project in particular has been effective at integrating individual skills and ensuring that training transfers to the workplace.20^–24 The program has expanded with help from partners such as the National Association of City and County Health Officials, who continue to help market the program nationally: to date, the academy has served teams from 10 states. Management development programs like this one should be more broadly available as an important supplement to existing leadership programs.