2010 public health standards assessment orientation

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2010 Public Health2010 Public HealthStandards AssessmentStandards Assessment

OrientationOrientation

Kris KernanKris Kernan

Pam LovingerPam Lovinger

Susan RamseySusan Ramsey

Jennifer TebaldiJennifer Tebaldi

Trainers:Trainers:

Rita SchmidtRita Schmidt

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Agenda

• Welcome and introductions.

• Public Health Improvement Plan/Partnership.

• Cycles of Review.

• 2010-2011 Washington Standards.

• Preparation for Beta Test.

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Training Objectives

• Understand why we are measuring the standards.

• Background and history.

• How to show performance in the standards.

• How to prepare for the “Beta” test.

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They Are All Linked

Employee Survey Data

Employee Survey Data

Customer Survey Data

Customer Survey Data

Public Health Standards

Results

Public Health Standards

Results

GMAP HealthMAP

GMAP HealthMAP

POG / Activity Inventory

POG / Activity Inventory

WSQA Assessment

Results

WSQA Assessment

Results

Strategic Plan

Strategic Plan

Creation of GMAP

Dashboard*

Creation of GMAP

Dashboard*

Legislative Agenda

Legislative Agenda

Implementation of Strategies, Operational

Activities and Process

Improvements

Implementation of Strategies, Operational

Activities and Process

Improvements

Data Analysis

Annual Self AssessmentAsk yourself questions such as, how well are we doing?

How do we collect data? What do we do with it? Is our strategic plan working? Who is involved?

Use the Baldrige framework of Leadership, Strategic Planning, Customer Focus, Information & Analysis, Human Resource, Process Management

and Performance Results to guide the assessment.

Annual Self AssessmentAsk yourself questions such as, how well are we doing?

How do we collect data? What do we do with it? Is our strategic plan working? Who is involved?

Use the Baldrige framework of Leadership, Strategic Planning, Customer Focus, Information & Analysis, Human Resource, Process Management

and Performance Results to guide the assessment.

Management Review and Analysis of

Performance Tools

Data Collection

BudgetBudget

1 or 2 opportunitiesfor improvements

* = performance measurement tools

Health of Washington

Health of Washington

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tPublic Health

Improvement Partnership• Goal: To guide and strengthen the

governmental public health system.

• Partnership: DOH, Local Health Dept., Tribal entities, Others

• Strategies for improvement.– Set standards to measure all governmental public health .

– Identify health outcomes for populations.

– Local public health indicators

– Identify capacity needs.

• Office of Public Health Planning and Development.

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JANUARY 2010

Purpose: The Partnership is directed by the legislature to guide and strengthen the governmental public health system in Washington State. To accomplish that, partners will take actions to ensure that the public health system is accountable and transparent, and continuously measures and improves health outcomes.

Performance ManagementWorkgroup

Partners Content experts Ex Officio members Other participants

Activities and ServicesWorkgroup


PartnershipState Board of HealthDepartment of Health

WA State Association of Local PH OfficialsLocal Health AgenciesLocal Boards of Health

Tribal NationsAmerican Indian Health Commission

CDC/ DHHS Region X

Ex Officio MembersWA Health Foundation

NW Center for PH PracticeWA State PH Association

Individuals/ organizations with expertise in IT,

communications, workforce development, finance,

legislative policy

Local Public Health I ndicatorsWorkgroup


Public Health I mprovement Partnership

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WA Standards- Background

• Developed collaboratively by local and state public health agencies.

• Used every three years to review the performance of the public health system in Washington.

• Baseline measurement in 2002 and re-measurements in 2005 and 2008.

• WA Cycle established : Every three years.

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What Are the Standards?

• Define a basic level of public health capacity.

• Function as stretch standards – describe how public health ought to be.

• State what Department of Health (DOH) and specific DOH programs need to do.

• Describe the collaboration needed between state and local health.

“What every person has a right to expect.”

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tBenefits of

Washington’s Process• Provides a public health system-wide

snapshot.

• Common language.

• Create common expectations.

• What every person has a right to expect.

• Capacity measures.

• Site performance measureable over time.

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tPublic Health Accreditation

Board (PHAB)Voluntary Accreditation Goal:

The goal of a voluntary national accreditation program is to improve and protect the health of the public by advancing the quality and performance of state and local public health departments.

Exploring Accreditation Final Report, p.4

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Comparison to Accreditation

• Washington System.• System-wide

snapshot.• Specific QI

recommendations.• Full participation.• Full disclosure of

scores.

• Accreditation• County by county.• Pass or fail.• Confidential scores.

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Washington Challenge

• Transition to accreditation.• Maintain our statewide results.• Maintain participation.• Make the process useful for Washington.

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WA Selected - PHAB Beta Test

• One of eight states.• Evaluate the process.

– No accreditation.• Site visit will be MAY/JUNE.• Documents due March 1, 2010.

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WA Adopts PHAB Standards

• Permission from PHAB to use the PHAB standards for Washington review.o 80% of Washington measures align.

• Include the Washington standards and measures that were not part of the PHAB standards.

• Optional standards – those PHAB standards that were not part of the Washington reviews in the past.

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t2010/ 2011 WA Standards

(Domains)Part A:

Administrative Capacity and Governance.

Part B: Domains

• 1: Assessments focused on population health status and public health issues.

• 2: Investigate health problems and environmental public health hazards.

• 3: Inform and educate about public health.

• 4: Engage with the community.

• 5: Public health policies and plans.

• 6: Public health laws.

• 7: Access to healthcare services.

• 8: Public health workforce.

• 9: Improve processes, programs, and interventions.

• 10: Evidence base of public health.

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tThe New Washington Standards

Process for 2010-2011

• Use trained staff as reviewers for local health in 2011.

• Sites will have the information to prepare for accreditation.

• Results will give sites information for next cycle, or for accreditation preparation.

• Washington will have state-wide results – “snapshot” of the state.

• Washington will have recommendations for the public health system.

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National Standards Documentation Guidance

• Required Documentation is a description of the topics and issues that the documentation must contain to demonstrate the measure, and

• Examples of Documentation describes some examples of the types of documentation that could be presented.

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tDOH - Agency vs. Program Measures

Agency : • Applies at the department level-Is demonstrated once at a

central point in the agency (an example is human resources), or

• May require the participation of many programs/activities within the organization.

Program : • Applies at the program or activity level and a sample of

programs must show individual demonstration. – Tobacco– Communicable Disease– Nutrition and Physical Activity– Immunizations– Food Safety– On-site Sewage Systems

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t Standards Documentation

Guidance• Many types of documentation can be used to

demonstrate performance.– Description of policies and

processes– Documentation

of reporting activities, data, decisions

– Examples of materials to show distribution and other activities.

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National Guide to Standards and Measures “Interpretation” • Credibility and consistency in accreditation

result from sharing the same interpretation.

• Clarify the intent of the standard and measure.

• Timeframes.

• Type of Measure.

• Type of Review.

• Interpretation and Guidance.

• Includes state, local, and tribal.

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tWashington State Standards Guidelines

(8 Washington State specific measures)

• Describes all requirements to meet each measure.

• Suggests types of documents that demonstrate performance.

• Gives specific time-frames for documentation.

• Provides links to exemplary practices documentationfor your reference.

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tCrosswalk from Washington

to National Standards• The crosswalk is a tool used to compare

2008 Washington state standards to the PHAB national standards.

• Not all measures crosswalk to one measure.

• Not all text within a measure is exactly the same as the old measure.

• 80% of the 2008 Washington state standards are in the PHAB national standards.

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Timeframes

• Documentation for compliance with the standards must be within the five years prior to the National Accreditation Survey date, unless the measure states a different timeframe.– Annual (within prior 14 months).– Current (within prior 24 months).– Biennially (at least every 24 months

prior to accreditation survey date).– Regular (based on a pre-established schedule

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Glossary of Terms

• Detailed sourced glossary for many of the terms used in the standards.

• List of acronyms used in the standards.

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t2010 National Beta Test and Washington State Site Visit

• Assess how well our public health system is working overall.

• Describe what every public health agency in Washington should be able to do regardless of size or location.

• Build a stronger and better public health system.

• Define, measure, and facilitate the improvement of public health protection throughout the state.

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What is Expected?

• The measurement process is rigorous. • Programs visited provide documentation to

show they are able to perform the expected function.

• The process requires planning, collection, and organization of documents.

• This should be an “everyday” process and not a “wait until time for assessment” scurry.

• Review and scoring of the documents is done by an independent entity.

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tScoring

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National and State:

There are three scores:

(0) Does not demonstrate.

(1) Partially demonstrates.

(2) Fully demonstrates.

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Who Does What?

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tOffice of

Performance and Accountability

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OPA

Provides information.

Hosts

meetings.

Makes agency decisions as needed.

Conducts a pre-assessment

survey. Serves as collection

point for division’s final input.

Makes training available.

Provides regular status updates to SMT.

Coordinates quality Improvement efforts

from assessment results.

Acts as liaison between senior

management, division/programs,

& reviewers.

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tPublic Health Systems Planning

and Development (PHSPD)

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PHSPD

Maintains an up-to-date website.

Provides representation at statewide & department

planning meetings.

Provides Standards expertise

to local and state public health.

Acts as liaison between

local health jurisdictions and the

Dept. of Health.

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Programs

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Coordinate with division

contact.

Attend Standards trainings.

Collect and post documentation in

MindManager.

Programs

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Reviewers

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Done by an outside entity.

Provide feedback on

strengths and opportunities.

Perform on-site visits with DOH programs

and local health jurisdictions.

Reviewers

Complete a final report with

scoring results.

Serve as a resource.

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How does it all fit and what do I need to do?

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Establish Division Workgroup

• Leadership commitment – resources and communication.

• Assign coordinator for preparation project.

• Assign specific categories/standards to individuals (usually managers).

• Develop detailed work plan that addresses each standard.

• Establish meeting schedule for workgroup.

• Report progress and barriers to leadership team.

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Progress and Coordination

• Workgroup meets regularly to review progress on work plan.

• Coordinate shared areas of documentation.• Meet with increasing frequency as review

gets closer; monthly, bi-weekly, weekly.• Leadership involvement of progress and

where help is still needed.• Prepare for mock review.

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Beta Test Site Standards Work Evaluation

• Monthly tracking log.• Four web-based surveys.• Written comments on process documents.• Observation/discussion during site visit.• How can the process be improved?

– Training– Self-assessment– Site visit– Standards and Measures

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Evaluation Questions

• What are the total costs?• What standards and measures are

confusing, challenging to meet, or difficult to document?

• How effective are PHAB-provided guidance documents and templates?

• Process– Division/Program Coordinator will provide Office

of Performance and Accountability monthly tracking information the 1st of every month.

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Monthly Tracking Logs - Scope

Accreditation includes only the tasks and activities that are required and/or directly related to preparing for and completing the accreditation process. Accreditation does not include activities to improve performance in order to be compliant with the accreditation measures, or activities required based on the 10 Essential Public Health Services

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Tell Your Story . . .

• Reviewers will not be familiar with your area.

• Provide short summary or note that describes your processes for the topic being addressed (“Read Me”).

• Be “laser focused” on the specific requirement of that measure.

• Provide only the documentation that is needed to demonstrate performance. More is not better!

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Organizing Your Documents

• Collect and organize all documents for reviewers to review.

• Online document library with folders for each standard and measure.

• Electronic submittal tool – MindManager.

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How to Submit Documentation

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Organizing Your Documents

• State page number and highlight with text box (“read me”) where specific information addressing the measure is located.

• Can use same document for multiple measures – just indicate all measures that are relevant and page of document.

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Use Documentation From Daily Work

• Plan ahead.

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• Plan ahead.

• Build documentation into regular processes:– Use summary formats for regular reporting

documents.– Minutes of working committees.– Case write-ups, logs, and progress reports.– Emphasize conclusions, actions and

results.

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• Plan ahead.

• Build documentation into regular processes:– Use summary formats for regular reporting documents.– Minutes of working committees.– Case write-up, logs, and progress reports.– Emphasize conclusions, actions and results.

• Include required information e.g. data results, analysis, conclusions from analysis, opportunities for improvement and actions/ interventions taken.

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Who is Responsible?• Assignment sheets show who is

responsible for what measures.

• Those responsible, for department level measures should reach out to other programs, if necessary, to assist meeting the performance measure.

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tWashington State

Standards Exemplary Practices• Collected during the 2008 site-reviews.• Five criteria for a document to be considered:

– Optimally demonstrates at least one of the requirements of a measure.

– Timely and/or current.– Concise and easy-to-use.– Adaptable to other DOH programs or LHJ’s.– Available electronically.

• 350+ documents available through a link on PHSPD website. (http://www.doh.wa.gov/phip/documents/PerfMgmt/08EP/EPcompendium.pdf)

• Hyperlinks of two state examples, where programs received score of 2, available next to measures

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How to Use the Exemplary Practice Compendium

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3.1

There is documentation of community and stakeholder involvement in the process of reviewing health data and the set of core indicators and recommending action such as:•Further investigation•New program efforts•Policy direction•Prevention priorities

ALL NPA/CD Prev: Make sure that we have, and document, a process of linking that review of data to taking input from stakeholders. It is likely this is happening but not documented.

http://www.doh.wa.gov/phip/documents/PerfMgmt/08EP/LHJ/3-1/PHSKC.pdf

STD: There should be an annual meeting of the IPP with the stakeholders.

http://www.doh.wa.gov/phip/documents/PerfMgmt/08EP/

LHJ/3-1/Mason.pdf

Radiation: Stakeholder group review of key data/indicators and recommendations. Staff will need to identify and work with Stakeholder groups who could review key data/indicators and recommendations.


LHJ/3-1/Yakima.ppt

HSQA: Include meeting date, presenter name, and name of group presenting to on all presentations. Obtain attendee list for meetings that include a presentation. Increase research of health data within the division and incorporate it in meeting discussions with stakeholders. This includes credential and renewal data. Document recommendations/ outcomes/ next steps identified at meetings with stakeholders.


LHJ/3-1/PHSKCwn.pdf

PHL: Documentation stakeholder (CLAC) review of health data.


LHJ/3-1/PHSKC.pdf

Exemplary Practices Used for Improvement Efforts

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Mock Review

• Each program is reviewed by a team of peers that:– Performs an electronic review of program

documentation.– Provides feedback on documentation review

to program, division, and OPA.

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Standards Training Schedule

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tResource Websites

• 2010 Assessment Web Site. http://dohweb/PaA/opa2010assessment.htm

• Public Health Improvement Plan. http://www.doh.wa.gov/PHIP/default.htm

• Washington Standards for Public Health.http://www.doh.wa.gov/PHIP/PerfMgmt/overview.htm

• Local Public Health Indicators.http://www.doh.wa.gov/PHIP/khi/product.htm

• National Standards for Public Health. http://www.phaboard.org/standards/

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Celebrate!!

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Be sure to celebrate your success in the

review!