Financing Public Health System
Improvement: Findings from the
Turning Point Initiative –
how did states leverage funds?
AcademyHealth
June 25, 2006
Catharine Riley, MPH, School of Public Health and Community Medicine,
University of Washington
Background
The National Turning Point Initiative
– Planning Phase
– Implementation Phase
Turning Point “Leveraging” Survey
– How much was leveraged by TP states
Betty Bekemeier, MPH, MSN, RN, Deputy Director, Turning Point National
Program Office, University of Washington
Bobbie Berkowitz, PhD, RN, FAAN, Alumni Endowed Professor of Nursing
& Director, Turning Point National Program Office, University of Washington
Significance
Secondary effects of grant funding are
largely unknown
Lack of research on factors that facilitate
leveraging resources
Research Objective
Examine and identify specific factors
associated with the effective leveraging of
resources toward financing public health
systems improvement.
Best practices in leveraging resources
have not been communicated
Methods
Methods
Data Collection
– IRB approval obtained
– Key informant interviews
Study Design
– Exploratory, descriptive
• Semi-structured interview schedule
• Key leaders from 17 states were interviewed at least once
Data analysis
Study Sample
– QSR N6 Qualitative Data Analysis software
– 17 of the 21 Turning Point States
– Iterative Coding
• identified themes and concepts
– interrater reliability maintained
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Sample Interview Questions
Limitations
–
Based on the survey we conducted with you and/or your
colleague(s), your state was able to leverage $______.
Please give an example of how you were able to
leverage some of this funding. Describe the background
and process of your efforts, tell us the story behind
these leveraged funds.
–
What approaches generally worked well in leveraging
hard dollars? What worked well in leveraging soft
dollars?
–
Describe the local and state conditions that have
positively or negatively influenced Turning Point’s
ability to leverage additional funding.
– Not all Turning Point states participated
– Potential recall bias
– National Program Office conducting the
interviews
Principle Findings
“the plan gave us something to partner around”
LEADERSHIP:
MONEY:
The Partnership AND The Plan
Internal & external
leadership – changes in
leadership
“its not just the state”
seed $ - new $
- lack of $
TIMING:
good or “right”
timing – having
enough time
“go-to document for organizing resource development”
EXTERNAL EVENTS:
catalytic - positive or
negative - serendipitous
events
Money - Leadership
Timing - External Events
“at the local level we have hoards of heroes”
LEADERSHIP:
MONEY:
Internal & external
leadership – changes in
leadership
seed $ - new $
- lack of $
“people on the inside working to
make this happen”
“here is the opportunity to do
some of these things”
TIMING:
good or “right”
timing – having
enough time
“That’s probably the most direct way that
we used the TP, work to obtain other funds”
EXTERNAL EVENTS:
catalytic - positive or
negative - serendipitous
events
“we were able to make the case because of the timing being right”
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Making the Case
LEADERSHIP:
MONEY:
Internal & external
leadership – changes in
leadership
“The 2000 Strategic Plan for Public Health
System Improvement set up a blue print”
seed $ - new $
- lack of $
LEADERSHIP:
MONEY:
Internal & external
leadership – changes in
leadership
seed $ - new $
- lack of $
TIMING:
good or “right”
timing – having
enough time
Leveraged Resources
TIMING:
EXTERNAL EVENTS:
catalytic - positive or
negative - serendipitous
events
good or “right”
timing – having
enough time
EXTERNAL EVENTS:
catalytic - positive or
negative - serendipitous
events
“We were able to leverage funding
because we made a case.”
“you have to do your homework, you have to make your case”
Conclusions
It was the combination of having a comprehensive
plan and inclusive partnership(s) that provided a
platform from which Turning Point Initiatives were
able to:
– seek out and create new resource opportunities (both hard
funding and in-kind support)
– capitalize on existing funding and new public health dollars as
they became available
– attract new partners beyond the “usual suspects.”
Acknowledgments
Funding Source:
Host Agency:
This platform allowed Turning Point Initiatives to
“make the case” for leveraging dollars for public
health infrastructure as opportunities were
presented.
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