Contract Template Update and Contracting Process
In order to simplify and standardize its formal contracts (numbering over 200) with the seven local health districts in Idaho, which led to great frustration and wasted time by both local and state staff in processing multiple different forms for contracts, the Idaho Division of Public Health used QI to develop a standardized, shared template, resulting in reduced time to develop and complete contracts. As a result of this success, they are taking on additional QI projects on contract monitoring, fiscal reporting and other related administrative operations.
The Idaho Division of Public Health within the state Department of Health and Welfare has contracts with seven local public health districts to provide a variety of services. The contracts did not contain a standard language or structure. The Idaho Division of Public Health created a standardized contract template for all programs that resulted in a more efficient contracting process.
Organization that conducted the QI initiative:
Idaho Department of Health and Welfare, Division of Public Health
Ward, D. Public Health Quality Improvement Exchange. Contract Template Update and Contracting Process. Fri, 09/11/2015 - 14:08. Available at https://phqix.org/content/contract-template-update-and-contracting-process. Accessed May 28, 2023.
Background and Aim
Need For The QI Initiative:
The Division administrator, all bureau chiefs, the performance improvement manager (PIM), and a representative from the Contracts and Procurement Services Unit (CAPSU) were assembled with the goal of creating a standard, yet flexible contract template. As the team worked through the process, they realized there would be a need to update the overall contract process as well. In addition, a routine federal audit of the health preparedness program found that the Division needed to develop more rigorous and fiscal monitoring practices for its contracts. A second team, the Contract Process Team, was created to handle the task of updating the contract. This team consisted of representatives from Business Operations, Communicable Disease, Public Health Preparedness, Clinical Services, Community and Environmental Health, and CAPSU. The goal of this group was to update the contracting policy and procedures for the Division's contracts.
Area for Improvement:
The Division of Public Health contracts with seven local public health districts for delivery of public health services. Throughout the Division, there were more than 200 individual contracts with the public health districts. Depending on the program, the contracts looked different and contained varying forms of legal language. These variations made it difficult for the stakeholders. For CAPSU, the variation made it difficult to develop contracts. For districts, the variation made it difficult to interpret the contracts. For the Division, the variation made it difficult to evaluate contracts. The independent process of contract writing led to a dysfunctional and nonstandard process that would not fit with the Division's changing business needs.
Contract terms were negotiated in a highly decentralized process by four different bureaus in the Division. Staff had multiple versions on file and would build new contracts off varied old versions each time a contract needed to be renewed.
Planning and Execution Details
The first task was to identify how significant the variations were among contracts. The PIM examined samples from programs across the Division and documented the variations in language and layout. It was identified that very little was standard. The second task was to update and standardize the contracting policy and procedures. The PIM met with key staff from four separate bureaus to flowchart their current processes for updating contracts. Multiple versions of contracts placed them at risk of errors and outdated legal verbiage, and this created tension with CAPSU because language was updated on a per-contract basis. Depending on the version being used, the guidance from CAPSU varied. Additionally, this team learned that the current documented process was incomplete and inefficient. The most significant changes to the contracting process included the requirement that all program staff (1) create any new contracts using a standard agency-wide template, (2) involve CAPSU staff during initial contract negotiation conversations, and (3) use a boilerplate cover letter for each contract. Because little to no standardization existed in public health districts' contracts, a template became the only solution. Additionally, there were inconsistencies in the existing contracting policy and procedures. Accurate documentation of the policy and procedure was critical, as was training of staff to ensure compliance. Meetings were held between the two teams over a period spanning 1 year. The theory behind the creation of the template was that it would ease the process for creating or updating contracts from year to year, ease tension between Division staff and CAPSU because there would be standard language approved by CAPSU from the beginning, and ease the public health districts' ability to track contract requirements because of its uniform format. It would be important to include Division staff and CAPSU staff in documenting the contract process as a means of bridging communication and resolving many of the misunderstandings that had occurred over the years. The group would work side by side to figure out the business processes so both groups could see the whole picture and work more effectively. A centralized SharePoint site would be created to house all public health districts' contracting documents and policies. As needed changes to the template were identified, CAPSU and Business Operations would convene to discuss and approve. The template would be updated on the SharePoint site so staff could always access the latest template when creating or renewing contracts.
Between 12-18 months
Methods of evaluation:
The new template would be phased in as contracts expired. The first contracts to use the template served as the pilot. A focus group of the initial users was held, and adjustments were made to add flexibility and maintain the standard language that was needed. One-on-one technical assistance was provided to staff as they began to use the new template. In addition, training was provided to each bureau by the Business Operations bureau chief and the CAPSU supervisor to ensure a successful transition to the new processes.
Measurable QI Outcomes:
As part of the new workflow, programs send draft contracts to CAPSU for review during the negotiation process rather than after. This procedure saves significant time and frustration for programs renegotiating with the public health districts. Using the CAPSU boilerplate letter was an immediate success and reduced the contracting process by 2 days. The process led to more integrated work between CAPSU and the Division. Training on the new process is done jointly between them, which creates a unified voice.
Other QI Outcomes:
The contract template is located on a SharePoint site accessible to all staff. Updates and revisions are done as needed. Staff are notified when a change has been made.
Lessons Learned, Observations and Insights:
Within the Division of Public Health and within CAPSU, different legal terms and operational definitions were being used. With the newly created policies and procedures, the team created a list of working definitions of terms, ensuring consistency. Also, the Division learned to make sure all stakeholders are included in the flowcharting processes. This would have been a missed opportunity of not knowing that CAPSU had a boilerplate cover letter for the Division to use, resulting in a savings of 2 processing days.
Additional focus groups will be held to assess their effectiveness and identify any needed changes (continuous quality improvement). The contract template is now required for all contracts effective July 1, 2012. In addition, staff now have a formal written contract policy, process, and flowchart to guide them. This contracting project has blossomed into more quality work in the area of contract monitoring. Projects are under way to improve fiscal monitoring and will likely lead to more standardized programmatic monitoring as well.
Training and Preparation
QI Related Training Received:
Public Health Business Operations and CAPSU provided the training to Division staff.
Information about the Community
Information about the Health Department
State Health Department Governance:
Under a Larger Agency (Super Agency/Umbrella Agency)
PHAB Accreditation Status:
Planning to submit application for accreditation in the next year
Annual QI Initiative Frequency:
QI activity level:
QI Staff Information
Total number of Staff on QI Team:
QI team members:
Contact Information of the Submitter
Idaho Department of Health and Welfare
Hello Mr. Ward:
Hello Mr. Ward:
Would you mind sharing a blank example of your contract template that you used with me?
Oklahoma State Department of Health