HMA Handbook and Guiding Principles

Alliance Handbook and Guiding Principles

Healthy Monadnock Alliance is the Public Health Advisory Council for the Greater Monadnock Public Health Network Region

The principal supporter of Healthy Monadnock Alliance is: Center for Population Health at Cheshire Medical Center

For more information about HMA please visit: https://healthymonadnockalliance.org/

General Information

Healthy Monadnock Alliance Vision

Our vision is for better health and well-being for all.

Healthy Monadnock Alliance Overview

Healthy Monadnock Alliance (HMA) is a group of community-minded individuals, who are committed to improving community health and wellness. The members of HMA, representing multiple sectors of the region, are responsible for establishing the vision and carrying out the work of HMA.

HMA strives to:

 Empower people and groups to take greater responsibility for individual and population level health

 Support the adoption and/or development of evidence-based strategies

 Direct plans and actions at the population level

 Promote quality of life

 Promote health equity

HMA serves as the advisory council for the Greater Monadnock Public Health Network and is guided by the Greater Monadnock Community Health Improvement Plan (CHIP).

New Hampshire has public health networks in lieu of county health departments. Our regional public health network is Greater Monadnock Public Health Network (GMPHN). All networks have their own Public Health Advisory Council (PHAC); however, we use Health Monadnock Alliance instead of the state terminology.

History of Healthy Monadnock Alliance

Healthy Monadnock Alliance (HMA) was established in 1994 (as the Council for a Healthy Community) to provide community oversight and guidance to address population health needs in the community. In 2008, it adopted the vision to make the Monadnock region the healthiest community in the nation and launched Healthy Monadnock (then Vision 2020) community health improvement initiative. In 2012, HMA became one of 13 State of New Hampshire Public Health Advisory Councils for the 33 towns of the Monadnock region. HMA consists of community members representing multiple sectors and towns/cities throughout this Public Health region. The aim is to engage the community in the development and implementation of a comprehensive approach to improving population health outcomes.

Our Approach

Our work starts with listening to our community.

HMA’s strategic goals are based on the Greater Monadnock Community Health Improvement Plan (CHIP). This plan, rooted in findings of our region’s community health needs assessment, is drafted by HMA and CHIP workgroup members with support from Cheshire Medical Center. The CHIP includes input from numerous public health partners and community members, who

Adopted 10/26/10; Revised 4/5/12, 6/26/14, 8/25/16, 8/7/18, 8/14/2019, 8/2/22; 3/24

work together to create a roadmap for regional health priority areas. This roadmap inspires all our health and wellness partnerships, programs, policies, system and environmental changes.

In all of our priority areas, we are focused on a number of key factors that affect health outcomes. However, we know that these factors do not impact each area equally. We approach each of our goals with the following in mind.

 Social Drivers of Health: Studies are clear: the conditions where you live, learn, work, and play seriously affect your health. In fact, 50% of health outcomes are connected to a person’s physical environment and socio-economic status.

 Equity: Equity means ensuring that every individual has what they need to thrive. One size does not fit all. Solutions to health and well-being challenges must account for these individual differences.

 Trauma: We know many adverse behaviors or beliefs people exhibit towards their health and well-being are often rooted in a traumatic event or set of circumstances they experienced. Our work is informed by the role trauma plays in health, to prevent further harm and promote better outcomes.

Healthy Monadnock Alliance Governance

Governance

We understand governance as the establishment of policies and continuous monitoring of their proper implementation. It includes the mechanisms required to balance the powers of the members (with the associated accountability), and their primary duty of improving health outcomes for the populations we serve and the best possible cost.

We adopt the principles of good governance as enunciated by The United Nations Development Program (UNDP) (see Appendix A). As stated by the Institute on Governance by grouping them under five broad themes (legitimacy and voice, direction, performance, accountability, and fairness), we recognize that these principles often overlap or are conflicting at some point, that they play out in practice according to the actual social context, that applying such principles is complex and that they are all about not only the results of power and authority but how well it is exercised.

Assumptions

1. HMA is created as a voluntary organization of community minded institutions and individuals, interested in advancing health outcomes for the population of the region.

2. HMA members will have no fiduciary responsibility toward the organization.

3. HMA is accountable to the community.

4. HMA embraces and adopts the following principles for action (created by HMA for Healthy Monadnock in 2010):

a. Empower people and groups to take greater responsibility for individual and population level health.

b. Support for adoption and/or development of evidence based strategies.

c. Plans and actions will be directed to the population level.

Adopted 10/26/10; Revised 4/5/12, 6/26/14, 8/25/16, 8/7/18, 8/14/2019, 8/2/22; 3/24 4

d. Promote quality of life.

e. Promote health equity.

Guiding Principles

HMA and its governing structures will be guided by the following principles:

1. Inclusivity: diversity of the region is represented with membership and activities

2. Transparency: with all activities and between members; assumption of the well-meaning of all activities and members

3. Intentionality: taking action with shared purpose

4. Efficiency: making progress in a timely manner

5. Data driven: decisions to promote health equity are made using reliable, factual data

6. Collaboration: working together in trustful relationships; leveraging networks and resources

7. Community Minded: whole population/all communities are at the forethought of all work

8. Consensus: striving for agreement with members on activities that are representative of the whole population/communities of HMA

Structure

The governance composition for HMA will include a diverse and complementary set of structures with different levels of authority and differentiated, but complementary, tasks and accountabilities.

The core components include, but are not limited to:

1. General membership

2. Executive committee

3. Ad hoc committees

4. Workgroups aligned with the Community Health Improvement Plan

5. Principal support (entity holding the grant)

Healthy Monadnock Alliance Principal Support

The Center for Population Health at Cheshire Medical Center holds the Greater Monadnock Public Health Network grant and coordinates all activities related to Healthy Monadnock Alliance (HMA). This includes all components of development, data collection and management, and all of activities related to the Community Health Improvement Plan (CHIP). The Center for Population Health provides ongoing support to the work of HMA, including the full HMA, committees and workgroups.

The principal support staff assumes the following responsibilities to help move the work forward:

 Guiding vision and strategy.

 Supporting aligned activity and a coordination of services.

 Establishing shared measurement for topic area.

 Building public will.

Adopted 10/26/10; Revised 4/5/12, 6/26/14, 8/25/16, 8/7/18, 8/14/2019, 8/2/22; 3/24 5

 Advancing policy in support of strategy.

 Coordinating funding requests with appropriate entities and for activities supported by HMA.

 Developing written agenda and meeting minutes.

 Outreaching to encourage new membership.

 Documenting/defining HMA activities, systems, processes.

 Utilizing existing resources within the community to assist with some of these tasks.

 Assuring effective communication and coordination with and between HMA and other committees and coalitions in the region.

Healthy Monadnock Alliance Membership

General Membership Overview

The intent of membership is to ensure diverse representation for support and guidance to the community related to the CHIP in areas including: strategic direction, on-going action planning, needs assessment, evaluation, partner engagement, community education and awareness, advocacy, strategy implementation and resource development. It is advisory in nature. HMA general members are committed advisors, ambassadors and advocates who are inspired and energized to engage the community in achieving the vision.

Member Expectations and Responsibilities

Members are expected to:

 Regularly attend HMA meetings or stay informed of HMA activities.

 Advise and make recommendations as appropriate, regarding programs, policies, and funding opportunities that support improvement of the health of the region.

 Leverage resources to support implementation of strategies to improve the health of the region.

 Elect members of the executive committee

HMA members responsibilities include:

 Connecting: Educate, advocate, and promote collaboration for the community health improvement needs for the region.

 Advancing: Members shall actively advance one of the five priority areas, identified in the Greater Monadnock Community Health Improvement Plan (CHIP).

 Assessing: Members shall continually collect data, evaluate, and report on progress and barriers.

Member Composition

Membership is open to representatives from all institutions and organizations. It will include unaffiliated individuals, to allow for independent voices and real grass roots engagement. No limit will be held on the number of general members, nor the amount of time that any member serves. Each organization will have no more than one official representative for voting purposes

Adopted 10/26/10; Revised 4/5/12, 6/26/14, 8/25/16, 8/7/18, 8/14/2019, 8/2/22; 3/24

and that institutional representation is encouraged to be consistent and at the highest level possible. When institutional representatives are no longer affiliated with their organization, they will provide notice to the chair of HMA and whenever possible help identify a replacement.

Though not complete, member institutions and community organizations include:

 City/Town Representatives (selectmen, administrators, emergency management directors, or health officers)

 Law Enforcement (city/town police, county sheriff, or state police)

 Healthcare Industry (CMC, MCH, HCS, community-based service providers)

 Business Community (chamber of commerce, local business owners)

 Public School District (representatives from any of the SAUs in the region: SAU 1Peterborough, SAU 24-Stoddard Elementary, SAU 29-Keene, SAU 47-Jaffrey/Rindge, SAU 60-Fall Mountain, SAU 87-New Ipswich, SAU 92-Hinsdale, SAU 93-Moandnock, and SAU 94-Winchester). This could be the superintendent, principal, school nurse.

 Faith-based Community

 County government (Cheshire and Hillsboro)

 Social Service/Non-Profit organizations

 Colleges/Universities

 Unaffiliated Residents of the region

Meeting Schedule

HMA will meet on a regularly scheduled basis as set by the executive committee (EC). It is anticipated to occur up to five times per year, unless there is a need for additional meeting(s).

Meetings will provide opportunities for networking, updates, specific organizational or programmatic issues, etc. HMA meetings will allow for an informal flow of conversation necessary to generate information, identify challenges and opportunities, and discuss solutions.

Meeting agendas will be developed by the EC; and any member may suggest items to be reviewed at one of HMA meetings.

Workgroups

As necessary to develop, monitor and evaluate the implementation of action plans that respond to the priorities identified by HMA, the executive committee (EC) will recognize existing work groups or charter as many workgroups as it deems necessary. Every workgroup will have an EC member liaison, who is responsible for bringing information to EC meetings. Workgroups will present periodic reports to HMA.

Decision Making Process

The Greater Monadnock Community Health Improvement Plan (CHIP) is used by Healthy Monadnock Alliance (HMA) as the guide for the work. As described above, HMA and Executive Committee (EC) will strive for consensus when making decisions. Some decisions such as approval of new EC members, approval of specific plans or motions will require a vote.

Adopted 10/26/10; Revised 4/5/12, 6/26/14, 8/25/16, 8/7/18, 8/14/2019, 8/2/22; 3/24

Votes will be held at regularly scheduled meetings if at all possible and a simple majority will be required to approve or deny the item under vote. Items for vote will be carefully worded and read before the vote takes place. Documentation of the vote will be made by the secretary in the minutes of the meeting. If votes are held electronically, clear instructions for deadlines need to be included with the item under consideration. Simple majority of voters will make the decision.

Policy changes, priority selections, re-prioritization and election of EC members will only occur at regular meetings (unless special dispensation for that specific effect has been provided by HMA or the EC). Decisions requiring a vote at the EC will require a quorum to be present. A quorum will constitute 50% plus one of the EC membership.

Executive Committee

The executive committee (EC) is responsible for setting direction, identifying priorities, establishing processes, and making recommendations on behalf of HMA.

Executive Committee Composition

Paramount to HMA’s efforts, the Executive Committee EC) must remain diverse and representative of the members. EC membership shall include the officers of HMA, who will retain the same functions, and 17 representatives distributed across the following sectors:

 Business/Worksite

 Hospital representation

 Other healthcare representation

 Education & Childcare

 Community Organization & Support

 Community Member (adult or youth)

 Municipal & County Government

 Faith-based

 Basic Needs (food, shelter, transportation)

It is the responsibility of the nominating committee to ensure diverse representation is maintained.

Executive Committee Member Expectations and Responsibilities

Executive Committee (EC) members are expected to:

 Be familiar with the purpose and responsibilities of HMA.

 Engage and recruit new members to HMA and EC.

 Attend EC meetings and HMA meetings as scheduled.

 Sit on one workgroup and bring workgroup information back to EC.

 State conflict of interest and abstain from voting where applicable.

Additionally, EC members assume the following responsibilities:

Adopted 10/26/10; Revised 4/5/12, 6/26/14, 8/25/16, 8/7/18, 8/14/2019, 8/2/22; 3/24

1. Following regular membership expectations as outlined here

2. Supporting the governance of HMA by:

a. Assisting in developing and maintaining structure and procedures to assure efficient HMA functions and communication (i.e. action planning process, charters for committees and workgroups, member and partner agreements, etc.).

b. Creating ad hoc committees and workgroups to operationalize its functions.

3. Supporting HMA strategic planning by:

a. Approving and maintaining the Greater Monadnock Community Health Improvement Plan (CHIP).

b. Making recommendations to HMA members and to the State of NH regarding priorities for service delivery based on needs assessments and data collection.

c. Making recommendations to HMA regarding priorities for population health improvement in the region.

d. Lending expertise and experience to the action planning, assessment, and prioritization of public health needs for HMA’s catchment area.

e. Advising and making timely recommendations, as appropriate, HMA members and critical stakeholders on funding opportunities.

f. Making decisions and recommendations for funding opportunities.

4. Supporting the implementation of HMA’s work by:

a. Representing HMA in and to the community by sharing information regarding roles, responsibilities, actions, and priorities.

b. Acting as liaison for one HMA workgroup, providing updates on progress, challenges, and needs of the workgroup at EC meetings.

c. Providing information and support to the workgroup chair to facilitate advancement of the work and reduce duplication of efforts between workgroups.

Executive Committee Member Election Process

Every year, by July, the nominating committee will confirm with current Executive Committee (EC) members whose terms are to expire of their intent to remain on the EC.

 Based on the results, HMA will be informed of any opening on the EC and communicate sector needs.

 An outgoing EC member may present his/her replacement to the nominating committee. In addition, other members of the EC or HMA may also present nominations to the nominating committee.

 EC members must have attended at least 50% of EC meetings in the past year.

 Nominees for EC, new or re-appointed, will be presented by the nominating committee at HMA meeting in September for voting.

 Voting methodology will be at the discretion of the chair (e.g. hands, paper-ballot, etc.).

Executive Committee Member Term-Limits

Executive Committee (EC) members agree to the following:

Adopted 10/26/10; Revised 4/5/12, 6/26/14, 8/25/16, 8/7/18, 8/14/2019, 8/2/22; 3/24

 Three-year cycle with the ability to renew for an additional three-year cycle.

 No maximum term limit.

 Staggered terms will allow for a rolling three-year cycle that ensures consistent representation on the EC.

 Failure to attend 50% of EC meetings in a calendar year may result in termination from the EC.

 Vacant positions will be filled based on sector representation and recommendation to the EC by the nominating committee.

Executive Committee Officer Positions

Officer Positions

The chair, vice chair, and past chair shall be the elected officers of HMA’s executive committee (EC). The secretary and the Public Health Network Coordinator will be an appointed officer. The officers of chair and secretary may not be held by the same person.

Nomination and Election of Officers

The EC will elect the officers annually before the September full HMA meeting.

Elected Officer Qualifications

Only members of HMA who are currently serving on the EC are eligible for election as officers.

Terms of Office

 Chair: The person installed as chair will serve a two-year term of office as chair, followed by a two-year term as immediate past chair.

 Vice Chair: The vice-chair shall be elected to a two-year term of office, and then be installed as chair at the end of the second year following his or her election.

 Past Chair: Past chair will serve for two years before rolling off as an officer.

Officer Duties

 Chair: It shall be the duty of the chair to:

o Serve as an official representative of HMA in its contacts with governmental, and other public and private agencies for the purpose of advancing the vision, goals, objectives and policies of HMA.

o Preside at the meetings of HMA and to be chair of and preside at meetings of the EC.

 Vice-chair: It shall be the duty of the vice-chair to:

o Assist the chair as requested.

o Serve as a member of the EC.

o Preside at meetings in the absence of the chair.

o Succeed the chair if a vacancy is realized.

Adopted 10/26/10; Revised 4/5/12, 6/26/14, 8/25/16, 8/7/18, 8/14/2019, 8/2/22; 3/24

 Past chair: It shall be the duty of the immediate past chair to:

o Assist the chair as requested.

o Serve as a member of the EC.

o Serve as chair of the nominating committee or appoint a designee.

 Secretary: It shall be the duty of the secretary to:

o Record, or provide for the recording of, the minutes of all meetings of HMA and the EC; maintain such minutes in one or more books provided for such purpose.

o See that meeting agendas and other necessary notices for meetings are provided to members in advance of the meeting.

o Have charge of the correspondence and keep a record of the acts and proceedings of HMA and EC.

o Preside at meetings in the absence of the chair and vice chair.

o Perform the general duties of the secretary and such other duties as are prescribed by the EC.

o All duties of the secretary may be delegated to the principal support staff.

 Public Health Network (PHN) Coordinator: It shall be the duty of the PHN Coordinator to:

o Serve on behalf of the principal supporter of HMA.

o Direct and manage all activities of HMA under the policy guidance of the EC.

o Weigh-in and provide guidance on all requests for support.

o Serve as an ex-officio member of the EC and HMA without vote.

Committees

HMA has no standing committees. If a standing committee were needed, ad hoc committee procedures, outlined below, would be followed.

Ad hoc committees may be formed as needed to address short term needs of HMA. Other committees not having and exercising the authority of HMA or the executive committee (EC) may also be designated by HMA, upon suggestion and charter development by the EC. Expectations for an ad hoc committee will be communicated by the EC when the committee is formed.

The nominating committee is an ad hoc committee that meets at certain months of the year for the purpose of identifying suitable candidates for the EC and crafting the slate of officers on an annual basis. This committee consists of five active members of HMA with the immediate past chair serving as the chair for this committee or his/her designee. Four members are elected by the membership of the EC to serve.

Requests for Support

In the event that HMA is asked to support a policy, program, legislation, funding request, ordinance or comment on a public health or civic matter, the following process will be used:

Adopted 10/26/10; Revised 4/5/12, 6/26/14, 8/25/16, 8/7/18, 8/14/2019, 8/2/22; 3/24

1. A request for letters of support and/or funding will be sent to the chair.

2. The chair, vice chair, and principal support staff will review all letters of support or funding requests.

a. If all agree that the application is consistent with the goals and values of the Greater Monadnock Community Health Improvement Plan (CHIP) and HMA’s work, the chair will compose and submit a letter to notify the EC of the request, so that it may be reviewed at the next regularly scheduled meeting.

b. The chair will also inform requestors of the denial of the request or of the process for approval, which includes the review, discussion, and decision-making at the next regularly scheduled EC meeting. The chair will include the date of the next regularly scheduled EC meeting to provide a timeframe to the requestor.

3. If a request is made of HMA for written support or clarification of HMA’s position on a matter of public interest, the chair will present the request at the next regular EC meeting for discussion.

a. The chair will endeavor to present the EC with as many relevant facts as practicable to inform their decision.

b. The chair may or may not make a recommendation to the EC.

c. A vote of the EC will decide whether to support, reject or offer only relevant facts on the matter.

4. If a request for funding is made of HMA, then the principal supporter will provide the parameters of capacity for the request.

a. A vote of the EC will be to support or deny funding of the request.

5. The request and subsequent results will be communicated to HMA members at the next regular meeting.

Appendix A: Governance Principals from the United Nations Development Program

Legitimacy and Voice

Direction

Participation – all men and women should have a voice in decision-making, either directly or through legitimate intermediate institutions that represent their intention. Such broad participation is built on freedom of association and speech, as well as capacities to participate constructively.

Consensus orientation – good governance mediates differing interests to reach a broad consensus on what is in the best interest of the group and, where possible, on policies and procedures.

Strategic vision – leaders and the public have a broad and long-term perspective on good governance and human development, along with a sense of what is needed for such development. There is also an understanding of the historical, cultural and social complexities in which that perspective is grounded.

Performance

Accountability

Responsiveness – institutions and processes try to serve all stakeholders.

Effectiveness and efficiency – processes and institutions produce results that meet needs while making the best use of resources.

Accountability – decision-makers in government, the private sector and civil society organizations are accountable to the public, as well as to institutional stakeholders. This accountability differs depending on the organizations and whether the decision is internal or external.

Transparency – transparency is built on the free flow of information. Processes, institutions and information are directly accessible to those concerned with them, and enough information is provided to understand and monitor them.

Equity – all men and women have opportunities to improve or maintain their well- being.

Fairness

Rule of Law – legal frameworks should be fair and enforced impartially, particularly the laws on human rights.

Adopted 10/26/10; Revised 4/5/12, 6/26/14, 8/25/16, 8/7/18, 8/14/2019, 8/2/22; 3/24