health assessment, improvement planning and strategic planning 101

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Health Assessment, Improvement Planning and Strategic Planning 101 Jessica Solomon Fisher, NACCHO Jim Pearsol, ASTHO May 8, 2012

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Page 1: Health Assessment, Improvement Planning and Strategic Planning 101

Health Assessment, Improvement Planning and Strategic Planning 101

Jessica Solomon Fisher, NACCHO

Jim Pearsol, ASTHOMay 8, 2012

Page 2: Health Assessment, Improvement Planning and Strategic Planning 101

Objectives

• Discuss the current landscape of health improvement planning

• Detail key components of accreditation prerequisites (health assessment, health improvement plan, agency strategic plan)

• Describe Community Benefit requirements and opportunities to partner

Page 3: Health Assessment, Improvement Planning and Strategic Planning 101

Current Landscape

• Demands are increasing while funds are decreasing

• Economic recession means increased need in population

• Categorical funding• Fragile and underfunded infrastructure• Aging workforce in need of training• Sustainable funding– Efforts to repeal ACA = uncertainty– Federal budgets = uncertainty + cuts– State and local budgets = cuts

Page 4: Health Assessment, Improvement Planning and Strategic Planning 101

Challenges in Public Health• Over 15,000 state health agency (SHA) and 39,000 local

health agency (LHA) jobs lost~20% of the workforce

• Over a third of SHAs have imposed furloughs– Almost 120,000 furlough days– Equivalent to another 500 workers

• Over 18,000 Jobs in LHAs affected by hours reduced or mandatory furlough

Page 5: Health Assessment, Improvement Planning and Strategic Planning 101

Opportunities

• Accreditation• Community Benefit• Foundation and federal investments– NPHII– COPPHI– Natl partner TA

Page 6: Health Assessment, Improvement Planning and Strategic Planning 101

PHAB Prerequisites

Page 7: Health Assessment, Improvement Planning and Strategic Planning 101

Why are the prerequisites, prerequisites?

Page 8: Health Assessment, Improvement Planning and Strategic Planning 101

AccreditationWhy Prerequisites?• Identifies community and health department needs

and assets• Good measure of capacity to address identified health

needs• Foundation for other documentation• Springboard to the future

Page 9: Health Assessment, Improvement Planning and Strategic Planning 101

Definition: Community/State/Tribal Health Assessment

What does this mean in your community?

Page 10: Health Assessment, Improvement Planning and Strategic Planning 101

Definition: Community Health Assessment

A community health assessment is a process that uses quantitative and qualitative methods to systematically collect and analyze health status data within a specific community. The process should involve active community engagement.

Health status data include information on risk factors, quality of life, mortality, morbidity, community assets, and other information that illustrates why health issues exist in a community.

Community health assessment data inform community decision-making, the prioritization of health problems, and the development and implementation of community health improvement plans.

(Issel 2004, Cibula et al 2003, Dever 1997)

Page 11: Health Assessment, Improvement Planning and Strategic Planning 101

State Health Assessment

• Common, core function of state health agencies

• Review existing assessment• Connect SHA and CHA where possible• Collect new data, as appropriate

Page 12: Health Assessment, Improvement Planning and Strategic Planning 101

Common Community Health Improvement Process Models/Frameworks

• PRECEDE-PROCEED (1970s)• Planned Approach to Community Health (PATCH) (1983)• Healthy Communities (1980s)• Assessment Protocol for Excellence in Public Health (APEX

PH) (1991)• Protocol for Assessing Community Excellence in

Environmental Health (PACE EH) (2000)• Mobilizing for Action through Planning and Partnerships

(MAPP) (2001)• Association for Community Health Improvement (ACHI)

Toolkit• State-specific models/frameworks

Page 13: Health Assessment, Improvement Planning and Strategic Planning 101

Common Elements in Health Improvement Process Models

1) Prepare and plan2) Engage the community 3) Develop a goal or vision* 4) Conduct community health assessment(s)5) Prioritize health issues 6) Develop community health improvement plan7) Implement community health improvement plan8) Evaluate and monitor outcomes

*Not a PHAB requirement

Page 14: Health Assessment, Improvement Planning and Strategic Planning 101

Common Steps in Conducting a Health Assessment

1. Develop an assessment plan2. Engage the community and local public health system partners3. Define the population4. Identify community health indicators that align with your

Community’s vision* or goals for the assessment5. Collect data on identified indicators6. Analyze data7. Summarize key findings8. Report results back to community and partners

*not a PHAB requirement and in some cases visioning may come before the CHA

conduct

Page 15: Health Assessment, Improvement Planning and Strategic Planning 101

PHAB CHA Standards and Measures Version 1.0• Standard 1.1: PARTICIPATE IN OR CONDUCT A COLLABORATIVE

PROCESS RESULTING IN A • COMPREHENSIVE COMMUNITY HEALTH ASSESSMENT.

• Measure 1.1.1 S: Participate in or conduct a state partnership that develops a comprehensive community health assessment of the population of the state

• Measure 1.1.2 S: Complete a state level community health assessment

• Measure: 1.1.1T/L: Participate in or conduct a local partnership for the development of a

• comprehensive community health assessment• Measure 1.1.2T/L: Complete a local community health assessment• Measure 1.1.3 A: Ensure that the community health assessment is

accessible to agencies, • organizations and the general public

Page 16: Health Assessment, Improvement Planning and Strategic Planning 101

PHAB CHA Process (Standard 1.1 Measure 1.1.1 T/L)

1. Participation of representatives of various sectors of local community

• The collaboration could include hospitals and healthcare providers, academic institutions, local schools, other departments of government, community non-profits, and the state health department.

2. Regular Meetings

3. Description of the process used to identify health issues and assets

• Provide documentation of the collaborative process to identify and collect data and information, identify health issues, and identify existing state assets and resources to address health issues.

• The process used may be an accepted state or national model; a model from the public, private, or business sector; or other participatory process model.

Page 17: Health Assessment, Improvement Planning and Strategic Planning 101

PHAB SHA Components (Standard 1.1 Measure 1.1.1 S)

1. Participation of representatives of various state-level sectors

• The collaboration could include hospitals and healthcare associations, provider associations, academic institutions, other departments of state government, state-wide non-profits, and local health department representation.

2. Regular Meetings

3. Description of the process used to identify health issues and assets

1. Provide documentation of the collaborative process to identify and collect data and information, identify health issues, and identify existing state assets and resources to address health issues.

2. The process used may be an accepted state or national model; a model from the public, private, or business sector; or other participatory process model.

Page 18: Health Assessment, Improvement Planning and Strategic Planning 101

PHAB CHA Components (Standard 1.1 Measure 1.1.2 T/L)

1. Dated within the last five years2. Documentation that data and information from various sources contributed to

the CHA and how data were obtained• Must include primary and secondary data

3. Description of the demographics of the population of the jurisdiction served4. General description of health issues and specific descriptions of population

groups with particular health issues• Narrative description of health issues and distribution of health issues• Should include health issues of the uninsured/low income and minority

populations5. Description of contributing causes of community health issues

• Including behavioral risk factors, environmental, socio-economic factors, morbidity/mortality, injury, maternal and child health, communicable and chronic disease, and other unique characteristics

• Must include health status disparities, health equity and high health-risk populations

6. Description of existing community assets or resources to address health issues7. Documentation that the local community at large has had an opportunity to

review and contribute to the assessment

Page 19: Health Assessment, Improvement Planning and Strategic Planning 101

PHAB SHA Components (Standard 1.1 Measure 1.1.2 S)

1. Dated within the last five years2. Documentation that data and information from various sources contributed

to the SHA and how data were obtained• Must include primary and secondary data

3. Description of the demographics of the population of the jurisdiction served4. General description of health issues and specific descriptions of population

groups with particular health issues• Narrative description of health issues and distribution of health issues• Should include health issues of the uninsured/low income and minority

populations5. Description of contributing causes of health issues

• Including behavioral risk factors, environmental, socio-economic factors, morbidity/mortality, injury, maternal and child health, communicable and chronic disease, and other unique characteristics

• Must include health status disparities, health equity and high health-risk populations

6. Description of existing state assets or resources to address health issues7. Documentation that the public at large has had an opportunity to review

and contribute to the assessment

Page 20: Health Assessment, Improvement Planning and Strategic Planning 101

PHAB CHA Components (Standard 1.1 Measure 1.1.3A)

1. Documentation that the community health assessment has been distributed to partner organizations

• Must provide two examples

2. Documentation that the community health assessment and/or its findings have been made available to the population of the jurisdiction served by the health department

• Must provide two examples

Page 21: Health Assessment, Improvement Planning and Strategic Planning 101

Definition: Health Improvement Plan

What does this mean in your community?

Page 22: Health Assessment, Improvement Planning and Strategic Planning 101

Definition: Health Improvement Plan

■ A long-term systematic effort to address issues identified by the assessment and community health improvement process

■ Is broader than the health department and should include partners

■ Considered current by PHAB if developed or updated within a 5 year time period prior to application

■ Based on community health assessment ■ Relates directly to Domain 5

Page 23: Health Assessment, Improvement Planning and Strategic Planning 101

PHAB HIP Standards and Measures Version 1.0• Standard 5.2: CONDUCT A COMPREHENSIVE PLANNING PROCESS RESULTING IN

A TRIBAL/STATE/COMMUNITY HEALTH IMPROVEMENT PLAN

• Measure 5.2.1 S: Conduct a process to develop a state health improvement plan

• Measure 5.2.2 S: Produce a state health improvement plan as a result of the health improvement planning process

• Measure: 5.2.1 L: Conduct a process to develop a community health improvement plan

• Measure 5.2.2 L: Produce a community health improvement plan as a result of the community health improvement process

• Measure 5.2.1 T: Conduct a process to develop a Tribal community health improvement plan

• Measure 5.2.2 T: Produce a Tribal community health improvement plan as a result of the health improvement process

• Measure 5.2.3 A: Implement elements and strategies of the health improvement plan, in partnership with others

• Measure 5.2.4 A: Monitor progress on implementation of strategies in the community health improvement plan in collaboration with broad participation from stakeholders and partners

Page 24: Health Assessment, Improvement Planning and Strategic Planning 101

PHAB HIP Process (Standard 5.2 Measure 5.2.1 S, L, T)

1. Broad participation of public health system/community partners

2. Information from the SHA/CHAs3. Issues and themes identified by

stakeholders4. Identification of state/local/Tribal assets

and resources5. A process to set state/local/Tribal health

priorities

Page 25: Health Assessment, Improvement Planning and Strategic Planning 101

PHAB HIP Components (Standard 5.2 Measure 5.2.2 S, L, T)

1. Dated within last five years2. Health priorities, measurable objectives,

improvement strategies, and performance measures with measurable and time-framed targets

3. Policy changes needed to accomplish health objectives

4. Individuals and organizations that have accepted responsibility for implementing strategies

5. Measurable health outcomes or indicators to monitor progress

6. Alignment between state/local/national/Tribal priorities

Page 26: Health Assessment, Improvement Planning and Strategic Planning 101

The health department must provide:

a.Reports of actions taken related to implementing strategies to improve health

b.Examples of how the plan was implemented

5.2.3A Implement elements and strategies of the health improvement plan, in partnership with others

Page 27: Health Assessment, Improvement Planning and Strategic Planning 101

Evaluation reports on progress made inimplementing SHIP strategies must

show:

a.Monitoring of performance measuresb.Progress related to health

improvement indicators

The health department must show that the health improvement plan has been revised based on the evaluation

5.2.4A Monitor progress on implementation of strategies in the HIP collaboration with broad participation from stakeholders and partners

Page 28: Health Assessment, Improvement Planning and Strategic Planning 101

Common Steps in Developing a HIP

1.Ongoing engagement of community and public health system partners

2.Review findings of HA3.Determine health priorities based on HA findings and

community and partner input and how these were chosen4.HIP implementation plan/ work plan: develop goals,

measurable objectives, strategies, timeline, and organization/persons responsible* to address each identified health priority [*not limited to HD responsibility-refer to PHAB CHIP standard/measure language].

5.Devise process for monitoring progress on work plan implementation and meeting goals and objectives

6.Distribute HIP throughout the community/state7.Action and monitoring action

Page 29: Health Assessment, Improvement Planning and Strategic Planning 101

Affordable Care Act: Community Benefit Requirements • CHNA every three years– Community engagement– Incorporation of public health expertise– Implementation strategy– Accessible to the community

Page 30: Health Assessment, Improvement Planning and Strategic Planning 101

Opportunity: IRS Community Benefit Requirement

Community Benefit• Program or activities that provide

treatment or promote health as a response to community needs and meet at least one community benefit objective:• Improve access to health

services• Enhance public health• Advance knowledge• Relieve government burden

Community Need• Community need can be

demonstrated through:

• Community health needs assessments

• Request from public agency or community group

• Partnership with government or other tax-exempt organizations

Source: PPACA, Sec. 9007 and AHA’s April 19, 2010 “Detailed Summary” of the legislation.

Page 31: Health Assessment, Improvement Planning and Strategic Planning 101

Reasons to Consider Partnering with Hospitals

• By and large, they serve the population you serve

• They are/will be conducting CHNAs in any case

• Lots of valuable data (and knowledge) complementary to public health’s own

• Potential economies of scale on assessment costs & effort

• Potential voluntary coordination on priority-setting

• Potential voluntary coordination on plans and actions

Page 32: Health Assessment, Improvement Planning and Strategic Planning 101

Discussion of opportunities to engage with hospitals at each step along the way.

Tailor your approach to meet each party’s needs in your case.

Opportunities to Partner: Points in the Process

Note: Six step process is from ACHI Community Health Assessment Toolkit.

Page 33: Health Assessment, Improvement Planning and Strategic Planning 101

Definition: Strategic Plan

What does this mean in your agency?

Page 34: Health Assessment, Improvement Planning and Strategic Planning 101

Department Strategic Plan

A strategic plan results from a deliberate decision-making process and defines where an organization is going. The plan sets the direction for the organization and, through a common understanding of the mission, vision, goals and objectives, provides a template for all employees and stakeholders to make decisions that move the organization forward.

• Internal to the health department• Sets what the health department plans to achieve and how it will

do that• Guide to:

• Making decisions• Allocating resources• Taking action

Page 35: Health Assessment, Improvement Planning and Strategic Planning 101

Agency Strategic Plan

Domain 5: Develop public health policies and plans

• Standard 5.3: Develop and implement a health department organizational strategic plan.

• Measure 5.3.1 A: Conduct a department strategic planning process• Measure 5.3.2 A: Adopt a department strategic plan• Measure 5.3.3 A: Implement the department strategic plan

Page 36: Health Assessment, Improvement Planning and Strategic Planning 101

PHAB Required Components for a Strategic Plan

• Mission, vision and guiding principles/values for the health department

• Strategic priorities• Goals and objectives with measurable and time-framed

targets • Identification of external trends, events, or other factors

that may impact community health or the health department

• Analysis of the HD’s weaknesses and strengths• Linkages with the HIP and QI plan• Members of the Governing Body involved in the process

Page 37: Health Assessment, Improvement Planning and Strategic Planning 101

What is the difference?

Page 38: Health Assessment, Improvement Planning and Strategic Planning 101

FIVE-YEARSTRATEGIC PLAN

KITSAP COUNTY

COMMUNITY HEALTH

IMPROVEMENT PLAN

30,000 FT

10,000 FT

20,000 FT

SEA LEVEL

QUALITY

IMPROVEMENT PLAN

STRATEGIC IMPLEMENTATION

PLAN

PROGRAM WORK PLANS

INDIVIDUAL PERFORMANCE PLANS

MarMason Consulting

Health Assessment

Putting it all Together

Page 39: Health Assessment, Improvement Planning and Strategic Planning 101

CHA

CHIPSP

Prerequisites

Domains1, 2, 3, 4, 5, 6, 7, 8, 9, 10

Essential Service1, 2, 3, 4, 5, 6, 7,

8, 9 10

Essential service system performance measured using the NPHPSP instrument can inform health department PHAB domain performance. MAPP and NPHPSP can be deliberately designed to meet standards in domains 1, 3, 4, 5, 7, and 10. 39

Page 40: Health Assessment, Improvement Planning and Strategic Planning 101

Strategic Planning ResourcesNACCHO Resources

Strategic Planning• Example strategic

plans and guidance materials

• Strategic planning webinar, May 16th, 3 – 4:30 PM ET

• Developing a LHD Strategic Plan: a How-To Guide

• Pre-conference training at NACCHO Annual, July 11, 2012

• Virtual TA

CHA/CHIP and MAPP• Example CHA/CHIPs • CHA/CHIP Resource

Center• MAPP Clearinghouse

http://www.naccho.org/topics/infrastructure/mapp/framework/clearinghouse/

• Virtual TA• MAPP Network

Accreditation/QI

•Accred Coordinators Learning Community•QI Roadmap•Webinar series•Documentation repository and staff review•Virtual TA•accreditNATION e-newsletter

Page 41: Health Assessment, Improvement Planning and Strategic Planning 101

NACCHO Websites

Strategic Planninghttp://www.naccho.org/topics/infrastructure/accreditation/strategic-plan.cfm

CHA/CHIPwww.naccho.org/chachipgeneral

MAPPwww.naccho.org/mapp

Accreditation/QIwww.naccho.org/accreditation

Page 42: Health Assessment, Improvement Planning and Strategic Planning 101

Strategic Planning ResourcesASTHO Resources

Strategic Planning, SHA, and SHIP • Example strategic plans, SHAs

and SHIPs and guidance materials• Accreditation and Performance

Improvement Guide• Onsite and Virtual TA• PHAB prerequisites

http://www.astho.org/Programs/Accreditation-and-Performance/Accreditation/Preparing-for-Accreditation/

• SHA Accreditation Coordinators’ Network

• SHIP guidance and resourceshttp://www.astho.org/Display/AssetDisplay.aspx?id=6597

Page 43: Health Assessment, Improvement Planning and Strategic Planning 101

ASTHO Resources

• Custom-designed, “hands on” technical assistance– Staff, Peer to Peer connections, SME expertise, funding partners– On-site, teleconference, webinar, and/or email– State health agency workgroups, planning resources, templates,

tools , slide presentations, state examples• ASTHO Accreditation & Performance Website, Webinars (archived

webinars)• ASTHO Quality Connection newsletter• ASTHO, CDC, RWJF, and partner web pages and newsletters• Readiness assessment for PHAB prerequisites and across domains

(gap analysis and self-assessment) • Road mapping to accreditation• Quality Improvement Tools, Techniques and Strategies• http://www.astho.org/Programs/Accreditation-and-Performance/

Page 44: Health Assessment, Improvement Planning and Strategic Planning 101

Jessica Solomon Fisher Jim [email protected] [email protected] 202.371.9090

For more information