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Priority Questionnaire

Local Public Health System Performance Assessment Instrument

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National Public Health Performance Standards Program
Local Public Health System Assessment Supplemental Questionnaire - Priority of Model Standards
OVERVIEW: This optional questionnaire is made available so that sites may consider the priority of each model standard to their
system. Sites choosing to complete this supplemental questionnaire will receive an additional component to their reports which
will depict their performance scores in relation to how they have prioritized model standards. This information may serve
to catalyze or strengthen the performance improvement activities resulting from the assessment process.
INSTRUCTIONS: Using a scale of 1 to 10 (with 1 being the lowest and 10 being the highest), please rate the priority of each
model standard without regard to performance scores or rank order. In considering this questionnaire, the following questions
may be helpful for participants. Example A: “On a scale of 1 to 10, what is the priority of this model standard to our public health
system?” Example B: “On a scale of 1 to 10, how important is it to improve our performance in this activity (e.g., through a quality
improvement process, increased emphasis or resources)?” Sites may complete this questionnaire in a single group, either at the
same time of the assessment or shortly thereafter, so that there is a consistent approach to responding to the questions across
the model standards.

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Local Public Health System Performance Assessment Instrument

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Model
Standard
Number

Response
(please circle)

Question

Essential Service #1 - Monitor health status to identify health problems
P1.1

On a scale of 1 to 10, what is the priority of this model standard - Populationbased Community Health Profile - to our local public health system?

1 2 3 4 5 6 7 8 9 10

P1.2

On a scale of 1 to 10, what is the priority of this model standard - Current
Technology to Manage and Communicate Population Health Data to our local public health system?

1 2 3 4 5 6 7 8 9 10

P1.3

On a scale of 1 to 10, what is the priority of this model standard - Maintenance of Population Health Registries - to our local public health system?

1 2 3 4 5 6 7 8 9 10

Essential Service #2 - Diagnose and investigate health problems and health hazards
P2.1

On a scale of 1 to 10, what is the priority of this model standard - Identification and Surveillance of Health Threats - to our local public health system?

1 2 3 4 5 6 7 8 9 10

P2.2

On a scale of 1 to 10, what is the priority of this model standard - Investigation and Response to Public Health Threats and Emergencies - to our local
public health system?

1 2 3 4 5 6 7 8 9 10

P2.3

On a scale of 1 to 10, what is the priority of this model standard - Laboratory
Support for Investigation of Health Threats - to our local public health system?

1 2 3 4 5 6 7 8 9 10

Essential Service #3 - Inform, educate and empower people about health issues
P3.1

On a scale of 1 to 10, what is the priority of this model standard Health Education and Promotion - to our local public health system?

1 2 3 4 5 6 7 8 9 10

P3.2

On a scale of 1 to 10, what is the priority of this model standard Health Communication - to our local public health system?

1 2 3 4 5 6 7 8 9 10

P3.3

On a scale of 1 to 10, what is the priority of this model standard Risk Communication - to our local public health system?

1 2 3 4 5 6 7 8 9 10

Essential Service #4 - Mobilize community partnerships to identify and solve health problems
P4.1

On a scale of 1 to 10, what is the priority of this model standard Constituency Development - to our local public health system?

1 2 3 4 5 6 7 8 9 10

P4.2

On a scale of 1 to 10, what is the priority of this model standard - Community
Partnerships - to our local public health system?

1 2 3 4 5 6 7 8 9 10

Essential Service #5 - Develop policies and plans that support individual and community health efforts
P5.1

On a scale of 1 to 10, what is the priority of this model standard - Governmental Presence at the Local Level - to our local public health system?

1 2 3 4 5 6 7 8 9 10

P5.2

On a scale of 1 to 10, what is the priority of this model standard - Public
Health Policy Development - to our local public health system?

1 2 3 4 5 6 7 8 9 10

P5.3

On a scale of 1 to 10, what is the priority of this model standard - Community
Health Improvement Process and Strategic Planning to our local public health system?

1 2 3 4 5 6 7 8 9 10

P5.4

On a scale of 1 to 10, what is the priority of this model standard - Plan for
Public Health Emergencies - to our local public health system?

1 2 3 4 5 6 7 8 9 10

Local Public Health System Performance Assessment Instrument

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Model
Standard
Number

Question

Response
(please circle)

Essential Service #6 - Enforce laws and regulations that protect health and ensure safety
P6.1

On a scale of 1 to 10, what is the priority of this model standard - Review and
Evaluation of Laws, Regulations and Ordinances - to our local public health
system?

1 2 3 4 5 6 7 8 9 10

P6.2

On a scale of 1 to 10, what is the priority of this model standard Involvement in the Improvement of Laws, Regulations, and Ordinances to our local public health system?

1 2 3 4 5 6 7 8 9 10

P6.3

On a scale of 1 to 10, what is the priority of this model standard Enforcement of Laws, Regulations, and Ordinances - to our local public
health system?

1 2 3 4 5 6 7 8 9 10

Essential Service #7 - Link people to needed personal health services and assure the provision of health care when otherwise unavailable
P7.1

On a scale of 1 to 10, what is the priority of this model standard Identification of Personal Health Service Needs of Populations - to our local
public health system?

1 2 3 4 5 6 7 8 9 10

P7.2

On a scale of 1 to 10, what is the priority of this model standard - Linkage
of People to Personal Health Services - to our local public health system?

1 2 3 4 5 6 7 8 9 10

Essential Service #8 - Assure a competent public health and personal health care workforce
P8.1

On a scale of 1 to 10, what is the priority of this model standard - Workforce
Assessment, Planning and Development - to our local public health system?

1 2 3 4 5 6 7 8 9 10

P8.2

On a scale of 1 to 10, what is the priority of this model standard Public Health Workforce Standards - to our local public health system?

1 2 3 4 5 6 7 8 9 10

P8.3

On a scale of 1 to 10, what is the priority of this model standard Life-Long Learning through Continuing Education, Training and Mentoring to our local public health system?

1 2 3 4 5 6 7 8 9 10

P8.4

On a scale of 1 to 10, what is the priority of this model standard Public Health Leadership Development - to our local public health system?

1 2 3 4 5 6 7 8 9 10

Essential Service #9 - Evaluate effectiveness, accessibility, and quality of personal and population-based health services
P9.1

On a scale of 1 to 10, what is the priority of this model standard - Evaluation
of Population-based Health Services - to our local public health system?

1 2 3 4 5 6 7 8 9 10

P9.2

On a scale of 1 to 10, what is the priority of this model standard Evaluation of Personal Health Services - to our local public health system?

1 2 3 4 5 6 7 8 9 10

P9.3

On a scale of 1 to 10, what is the priority of this model standard - Evaluation
of the Local Public Health System - to our local public health system?

1 2 3 4 5 6 7 8 9 10

Essential Service #10 - Research for new insights and innovative solutions to health problems

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P10.1

On a scale of 1 to 10, what is the priority of this model standard Fostering Innovation - to our local public health system?

1 2 3 4 5 6 7 8 9 10

P10.2

On a scale of 1 to 10, what is the priority of this model standard Linkage with Institutions of Higher Learning and/or Research to our local public health system?

1 2 3 4 5 6 7 8 9 10

P10.3

On a scale of 1 to 10, what is the priority of this model standard - Capacity to
Initiate or Participate in Research - to our local public health system?

1 2 3 4 5 6 7 8 9 10

Local Public Health System Performance Assessment Instrument