partnering for systems improvement: the role of public health institutes in quality improvement and...
TRANSCRIPT
Partnering for Systems Improvement: Partnering for Systems Improvement: The Role of Public Health Institutes The Role of Public Health Institutes
in Quality Improvement and in Quality Improvement and AccreditationAccreditation
December 4, 2008December 4, 2008
Call in Number: (800) 504-8071 Call in Number: (800) 504-8071 Code: 3019823Code: 3019823
Please mute your line by pressing *6
You can un-mute your line by pressing *7
Do not put your phone on hold.
Partnering for Systems Improvement: Partnering for Systems Improvement: The Role of Public Health Institutes The Role of Public Health Institutes
in Quality Improvement and in Quality Improvement and AccreditationAccreditation
December 4, 2008December 4, 2008
Background on NNPHI
Established in 2001 to enhance the capacity of the nation’s public health institutes
Vision: Fostering Innovations in Health Mission: To promote multi-sector
activities resulting in measurable improvements of public health structures, systems and outcomes
NNPHI Membersvisit www.nnphi.org for links to members’ websites
Statewide Nonprofit
University-Affiliated
Municipal / Sub-State
Provisional Member
Affiliate member
Attributes of PHIs
• Complement governmental public health system
• Convene multi-sector partners• Support health systems change and
improvement• Source of reliable health information• Nimble - able to leverage new resources• Rework boundaries and form creative
alliances
Competencies of Public Health Institutes
Population-based health programs Health policy development Training/Technical assistance Research and evaluation Health informatics Fiscal/administrative management Social marketing / health
communications
NNPHI Programs
Member Services Fostering Emerging Institutes National Programs (PHLS and NPHPSP) Multi-State Projects
BT Collaborative Preparedness Modeling Collaborative Multi-State Learning Collaborative: Lead
States in Public Health Quality Improvement
Brief History of Accreditation and QI in Public Health
2003 IOM Report: called for a national committee to examine the benefits of accrediting public health departments
2005 - 2006 Exploring Accreditation Project
2007 Public Health Accreditation Board established
2011 Projected launch of National Voluntary Accreditation Program
What is NNPHI doing to support accreditation & QI?
Co-coordinate NPHPSP partnership and promote use of NPHPSP
Manage the Multi-State Learning Collaborative: Lead States in Public Health Quality Improvement Project
Recently supported Public Health System Research Grants on Accreditation
Why is NNPHI involved in QI and Accreditation?
Session at 2005 NNPHI Conference and additional collaboration with PHIs identified that PHIs are working in partnership with state and local public health agencies to support their efforts to: Assess performance Prepare for accreditation Create a culture of quality improvement
How are the institutes partnering and collaborating with local, state and national partners to prepare
for accreditation and conduct quality improvement?
Supporting Use of NPHPSP
Institutes in New Hampshire, Maine, Texas and Illinois have supported the completion of state and local NPHPSP instruments by providing the following types of support: Orientation to public health and the assessment
process Facilitation of assessment and priority setting
sessions Analysis and presentation support Assistance in writing public health improvement plans
Supporting Accreditation Related Efforts Illinois Kansas Florida Michigan Missouri New Hampshire North Carolina Oklahoma Wisconsin
Convening stakeholders and building momentum for accreditation Illinois Public Health Institute staffs the Illinois
Accreditation Task Force (IATF) Goal: improve the performance of local
health departments in Illinois through accreditation strategies and quality improvement activities.
IATF Members includes the Departments of Public Health and Human Services, SACCHOs, IL Association of Boards of Health, UIC, IPHA
Careful process of building will for accreditation at the local and state level
Conducting research and evaluation of accreditation and quality improvement Missouri Institute of Community Health
Annual evaluation of Missouri’s voluntary accreditation program for local health departments
Michigan Public Health Institute Research Examining the Costs of Preparing and
Applying for Accreditation: Developing Cost Measures North Carolina Institute of Public Health
Evaluation of NC Local Public Health Accreditation Research on Incentives for Public Health Accreditation Research on Public Health Quality Improvement
Initiatives
Participating in PHAB Workgroups
Assessment Process Janet Canavese (Missouri) David Stone (North Carolina)
Equivalency Rachel Stevens (North Carolina)
Research and Evaluation Mary Davis (North Carolina) Laura Landrum (Illinois)
Creating tools and resources to help agencies prepare and conduct QI
NC Roadmap
Michigan QI Guidebook
Creating a quality improvement culture and field of practice
Organizing large and small group QI training sessions
Managing and providing technical assistance for QI projects
Communicating and Spreading QI Findings
MPHI and KHI created storyboards that describe each step of the QI process
KHI worked with local partners to share QI project findings with policy makers
Why is NNPHI involved in QI and Accreditation? Revisited Fits with our strategy to collaborate with
members and systems partners in effort to advance public health
Feedback/Recommendations for the Exploring Accreditation Steering Committee:
“NNPHI supports a national voluntary accreditation system it the system is able to incorporate a strong focus on technical assistance supporting continuous quality / performance improvement efforts”
Commitment to innovation in health
Roles of PHIs in QI and Accreditation
Examples from the Field: New Hampshire North Carolina Kansas Michigan
Improving the Public’s Health in New Hampshire
A Partnership of the Community Health Institute and
the NH Division of Public Health Services
December 4, 2008
Our Partnership- DPHS/CHI
Community Health Institute (CHI) Established in 1995 by JSI Research and Training
Institute (JSI), in partnership with the NH Department of HHS RWJ Foundation
Provide community-based providers with expertise and resources to strengthen New Hampshire's health care system
Works with health departments, health care providers and organizations, community organizations, and foundations
Work with DPHS as contractor, partner, fiscal agent
Performance Based
Contracting
Technical Assistance to local
networks for performance
assessment and improvement
National Public Health
Performance Standards
Assessment and Planning
MLC preparing for accreditation,
measuring performance,
learning
collaboratives
PerformanceImprovement
Public Health Improvement Team
CHI
DPHSDPHS
DPHS
CHI
And now, a brief word about local assessment: the NH
Context Each of New Hampshire’s 234 cities and towns are
statutorily required to have a health officer
Together with the local administrative body, the health officer constitutes the local health board
Approximately 25% of New Hampshire towns rely on volunteer health officers; many others utilize code enforcement officers
Only five New Hampshire communities maintain public health departments (2 comprehensive); no county health departments
We have been working slowly to strengthen our local public health infrastructure
Strengthening the Public Health System-Locally
In 2001, NH began funding 4 local public health demonstration programs through the RWJF Turning Point Program.
The Community Health Institute assisted communities in the measurement of system capacity and performance built into the demonstration effort from the beginning as part of the local evaluation; adapted Turnock-Miller 20 questions instrument.
By 2005, the initiative grew to include 14 local public health partnerships covering 70% of the NH population.
Assessment activities continued to be a fundamental program expectation; graduated to use of NPHPS local performance assessment instrument and the creation of community public health performance improvement plans
Assessment of the National Public Health Performance Standards - 2005 led by DPHS
110 public health stakeholders participated attendance Led to the development of 6 strategic priority areas with
work groups and action plans combined into a statewide action plan for the public health system
DPHS staffs the legislatively created Public Health Services Improvement Council – CHI is a council member
CHI leads one workgroup –Mobilizing Community Partnerships – sits on other work groups
Strengthening the Public Health System-Statewide
2007 Quality Improvement Activities
for MLC-2 Articulate measures to monitor improvement
for New Hampshire’s performance on our 6 strategic priorities – and others
Develop automated data collection, storage and reporting processes for the 6 strategic priorities and other performance measures
Improve the quality of public health practice using existing standards to create a tiered approach to credentialing/ accreditation of local public health professionals
MLC-3:Lead States in Public Health
Quality Improvement
To bring state and local stakeholders to together in a community of practice to
Prepare local and state health departments for national accreditation & contribute to the development of national voluntary accreditation
Advance application of QI methods that result in specific measurable improvements, and institutionalization of QI practice in public health
MLC-3 Goals
1. Facilitate development and improvement of local public health agencies and systems through application of collaborative, evidence-based quality improvement processes
2. Prepare the State Health Department for voluntary accreditation by piloting national accreditation standards and institutionalizing enhanced quality improvement processes
3. Incorporate national accreditation standards and assessment activities within the cycle of performance management and quality improvement at the local level
4. Create quality improvement mini-collaboratives working toward linking public health capacity to population health outcomes
5. Share best practices and lessons learned, and disseminate findings across the larger public health community
Focus on MLC-3 Goal #3
Incorporate national accreditation standards and assessment activities within the cycle of performance management and quality improvement at the local level
builds directly upon the work of MLC-2 advances the process of regionalization and
developing regional public health infrastructure
Public Health Capacity Assessment
Working with 6 Public Health Regions to capture the capacity of regional public health systems
Requires information about the contributions of diverse partners with formal as well as informal linkages.
→ Modification of NACCHO Self-Assessment Tool to capture essential characteristics unique to NH’s regional public health systems
Why participate in these assessments?
The findings from these assessments will provide the evidence that drives public health
policy in NH.
This is a unique and valuable opportunity to register assets, document need, and learn from one another about the public health services and functions that exist in your
region.
Assessment Process
Identify a lead organization [or organizations for regions in more formative stages of evolution]
Capture perceived contributions of the lead organization to the greater region
Validate perceived contributions of the lead organization with regional partners
Capture additional contributions of regional partners
Capture contributions of the state (Division of Public health Services, Division of Environmental Services, Department of Education, etc.)
Process: Part I
Completed by lead organization Occurs at the operational indicators
level for each standard of each Essential Service.
Process: Part II
Completed by a convened group of regional public health system partners
Occurs at the standards level for each Essential Service
Entails answering 3 questions: Does the group concur with the self-assessment of
the lead organization? Are there additional expertise or services within the
regional public health system (regional partners)? How does the State of NH contribute to regional
public health capacity?
STANDARD I-B Develop relationships with local providers and others in the community who have information on reportable diseases and other conditions of public health interest and facilitate information exchange.
FOCUS: DISEASE REPORTING RELATIONSHIPS; MAKE DATA AND INFORMATION FLOW ROUTINE
Operational Definition Indicators
Operational Definition Indicators Score - Lead organization(s)
TopicDocuments and/or
Activities That Demonstrate Indicators Have Been Met
1. LHD staff can be contacted at all times.
Preparedness
A written policy/procedure exists that describes that assures LHD staff can be contacted at all times.
1. Providers and other appropriate health care system partners are educated and trained in collecting and reporting data to the LHD.
Data Record of presentations, evidence of meetings held, conferences organized (e.g. agenda), and/or educational materials distributed to promote provider and other public health system partner to promote knowledge and disease reporting procedures.
1. LHD uses a quality improvement process between LHD and providers to make it easy for providers to report.
Quality Improve
ment
Written quality improvement process available for evaluation of disease reporting between providers and the LHD. Results of evaluation shared and documentation that the process was improved, if needed, based on a quality improvement process.
1. Health care providers and other public health system partners receive reports and feedback on disease trends and clusters.
Communication
Has process for organizing data to determine trends and clusters and for providing the information to health care providers and other public health partners.
Log of distribution of reports, topics, to whom and any feedback.
Comments regarding regional partners providing services for this focus area:
Using the same criteria as the lead organization, score the existence/availability of the regional contribution to local public health capacity for this standard.
Please rate the adequacy of state planning, staffing, or other resources applied directly at the regional level for this standard:
0 = insufficient information to rate the contribution 1 = insufficient contribution 2 = sufficient contribution
ESSENTIAL SERVICE I: Monitor health status and understand health issues facing the
community
Staff can be contacted at all times.
Providers & other health care system partners are educated and trained in collecting and sharing data among PH system partners.
Uses a QI process between to make it easy for providers to report.
Health care providers & other PH system partners receive reports and feedback on disease trends and clusters. community
health institute
STANDARD I-B Develop relationships with local providers and others in the community who have information on reportable diseases and other conditions of public health interest and facilitate information exchange.
FOCUS: DISEASE REPORTING RELATIONSHIPS
Scoring Matrices- Lead organization and regional partners
Scoring Matrices-State Contribution
How does the State of NH contribute to regional public health capacity?
Continuous Quality ImprovementNACCHO Local Health Department Self-Assessment Tool (Rev.) - Regional Partners Evaluation Tool
1. The pace of the assessment was: Too slow Just right Too fast1 2 2.6 3 4 5 Improved over time
2. The process was:Painfully inefficient Extremely efficient Painfully efficient 1 2 3 3.2 4
3. How well did the poster boards keep the process moving?
Useless
Essential 1 2 3 3.4 4
4. How well did the PowerPoint slides keep the process moving?
Useless
Essential 1 2 3 3.3 4
6. The scoring methodology was: Muddy Crystal
Clear
1 2 3 3.3 4
7. Please share which aspect or aspects of this assessment process were most beneficial. Open discussion that was generated , group interaction Clear directions and process support Working the scores out together Slow process Negotiating to consensus PowerPoint, posterboards, and people who came to the meeting
8. Please share your ideas for improving the process. Use survey monkey More diverse/representative group- more participation from region
Other Important Details
Collaboration between CHI and NH Division of Public Health Services
Tool modification Shared facilitation of Regional Partner Process
Supporting Resources Modified NACCHO Tool PowerPoint Poster boards Evaluation tool
Estimated Time to complete Lead Organization - 2-4 hours Regional Partners – 4-6 hours
Other collaborative activities…
MLC-3 Quality Improvement Learning teams
addressing nutrition and activity, links to Healthy Eating Active Living Initiative
Development of integrated Division of Public Health outcome measures [Reduction of tobacco-related chronic disease]
Re-Assessment of the National Public Health Performance Standards (2009-2010)
Next steps…
Continue to assess regional public health capacity improving the process based on feedback
Phase 1 will be completed by March 2009 Synthesis of financial and governance assessments
data to inform further progression of regionalized public health system
Eventually, each of the 15 public health regions will complete this capacity assessment, as well as the financial and governance assessments
Data will be analyzed to provide a complete picture of our public health capacity in each region, gaps and needs
Questions
[email protected] AscheimBureau ChiefNH Division of Public Health ServicesBureau of Policy and Performance Management(603)271-4110http://www.dhhs.state.nh.us/DHHS/DPHS/iphnh.htm
Lea Ayers LaFave NH Community Health Institute/JSI(603)[email protected]
NC Local Health Department Accreditation
and the Role of the NC Institute for Public Health
NCLHDA Program Components
• Self-Assessment by the Agency• Site Visit• Board Adjudication
• The Accreditation Administrator notifies health departments
• 90 days to submit the Health Department Self-Assessment Instrument
• The Site Visit Team reviews the Self -Assessment, visits the health department and completes report
• The Accreditation Board meets and hears the report, granting a status of Accredited or Conditionally Accredited
Accreditation Process
Standard #1: Agency Core Functions and Essential Services (CF&ES)
Standard #2: Facilities and Administrative Services (F&AS)
Standard #3: Board of Health / Governance
41 benchmarks and 148 related activities
Health Department Self-Assessment Instrument
Role of the NCIPH
• Serves as the Administrator of the NCLHDA program– Direct and Oversee the Program
• By Statute, the Accreditation Board is “housed” within the NCIPH
Accreditation Partners
• NC Institute for Public Health• NC Division of Public Health• NC Association of Local Health Directors
• Partnerships continue with Board membership
History - Where have we been?• Work began on Accreditation in 2001-2002 with a joint NCALHD,
DPH, NCIPH committee• First standards were piloted in 6 local health departments• Revised tool - pilot II with 4 local health departments• Legislation to make system mandatory with 8 years for all to be
accredited• Commission for Health Services to adopt rules• Temporary Rules adopted in December, 2006 • Rules final in August, 2007
Where are we now?
• 40 Accredited Local Health Departments as of October 24, 2008
• 4 more will go before Board on December 19, 2008
http://nciph.sph.unc.edu/accred/
Health Departments participating in FY 2009
Health Departments participating in FY 2010
Health Departments participating in FY 2011
Health Departments proposed for FY 2012
Health Departments proposed for FY 2013
Accredited Health Departments
Other Support from NCIPH• Technical Assistance
• Program Evaluation• Consultation – Agency Assessment• Strategic Planning• Workforce Development – Training
• Maintain Firewall Between Accreditation & Other Services
NCIPH Support for National Accreditation
• Accreditation Road Map
• Research on incentives to encourage participation
• ASTHO toolkit
• PHAB Workgroups
Institute Opportunities
Questions?
Mute line: *6Unmute line: *7
Greater than the sum of its parts: Challenges and growth of
alliances in the Land of Oz
Greater than the sum of its parts: Challenges and growth of
alliances in the Land of Oz
Gianfranco Pezzino, M.D., M.P.H.
Kansas Health Institute
OutlineOutline
Who we (KHI) are What is the KS environment like? What about accreditation? “Lessons learned”
KHI BasicsKHI Basics
Private, non-profit, 501(c)(3) Annual operating budget of $2.4 million Kansas Health Foundation core funding Additional $4+ million in grants since
1999 Half of grant revenue flows through to
other research partners 20 full-time positions Use of experts/consultants ad hoc
Kansas Local Health Departments:Population Served
Kansas Local Health Departments:Population Served
90 LHDs w/ <50,000(37% of pop.)
<
50,00010 LHDs w/ >50,000 people (63% of pop.)
15 Regions, 103/105 counties15 Regions, 103/105 counties
Alliances – The broader Public Health System
KS Association of LHDs
KS Dept. of Health and
EnvironmentKS Health Institute
University of Kansas Medical
Center
Alliances – The MLC-3 project
KS Association of LHDs
KS Dept. of Health and
Environment KS Health Institute
University of Kansas Medical
Center
• Solicit proposal for QI projects• Contract with regions
Provide teams for mini-collaboratives
• Administer grant • T.A.
Curriculum, faculty, C.E.
“What about accreditation?”
Some Issues Around Accreditation in a Rural State
Some Issues Around Accreditation in a Rural State
KS public health “universe” is very diverse
How to define common levels of standards for LHDs with diverse capacity: “Minimum” common denominator? Technical assistance to “weak” sites? Multiple tiers of accreditation?
Focus on Standards and Performance ManagementFocus on Standards and
Performance Management
“Everyone, no matter where they live, should reasonably expect the local health department to meet certain standards”
Define the standards, then discuss how each LHD can get there
Establish performance management system to monitor progress towards standards
Focus on Standards and Performance ManagementFocus on Standards and
Performance Management
“Everyone, no matter where they live, should reasonably expect the local health department to meet certain standards”
Define the standards, then discuss how each LHD can get there
Establish performance management system to monitor progress towards standards
READY FOR ACCREDITATION!
Performance Management in Kansas – Related Projects
Performance Management in Kansas – Related Projects
•MLC
1 2
3 4
•NACCHO
•PROPHIT
•PROPHIT
Role for KHIRole for KHI
Increase capacity in state for applied research, assessment, evaluation, technical assistance
Independent, authoritative entity Credible voice Mediate among competing needs and resources
of other partners
More flexible structure than government agencies Manage some projects on behalf of all partners
Lessons LearnedLessons Learned
The “Blessing”: K.H.I. is not “in charge”
The “Curse”: K.H.I. is not “in charge”
The Solution: It takes patience, time and consensus
building Personal relations are paramount
Healthier Kansans through informed decisionsHealthier Kansans through informed decisions
Embracing Quality in Local Public Health: Embracing Quality in Local Public Health: Michigan’s Quality Improvement GuidebookMichigan’s Quality Improvement Guidebook
Michigan Public Michigan Public Health InstituteHealth Institute
- - Kanchan Kanchan Lota, MPH Lota, MPH
- Julia Heany, - Julia Heany, PhD.PhD.
http://www.accreditation.localhealth.net/
Michigan Local Public Health Accreditation Program Partners
MDCH
LHDsMPHI
Accreditation Program
MDA MDEQ
Embracing Quality in Local Public Health: Embracing Quality in Local Public Health: Michigan’s Quality Improvement GuidebookMichigan’s Quality Improvement Guidebook
http://www.accreditation.localhealth.net/
Plan
DoStudy
Act
Guidebook: Content and StructureGuidebook: Content and Structure
Overview of the PDSA approach to Quality Overview of the PDSA approach to Quality Improvement (QI)Improvement (QI)
Sections on:Sections on: Customers & StakeholdersCustomers & Stakeholders The Importance of DataThe Importance of Data Writing an Aim StatementWriting an Aim Statement QI Tools & PH Measures of ImprovementQI Tools & PH Measures of Improvement PH Example of PDSAPH Example of PDSA Storyboards & Case Studies from the 4 MLC-2 QI Storyboards & Case Studies from the 4 MLC-2 QI
projects at the Local Health Departmentsprojects at the Local Health Departments Program Evaluation, QI Resources, & MoreProgram Evaluation, QI Resources, & More
Why Develop a QI Guidebook for Why Develop a QI Guidebook for Public Health?Public Health?
Addressing
an
ABSENCE
in
the
Marketplace!
Coordination Coordination Coordination Coordination Coordination! Coordination!
Managed entire Managed entire process from process from development to development to completioncompletion
Set up meetingsSet up meetings Tracked content Tracked content
developmentdevelopment Ensured deadlines were Ensured deadlines were
being metbeing met All graphicsAll graphics FormattingFormatting Final editsFinal edits Publishing Publishing
“The road to quality is never smooth, but
it’s the only one that leads to long-
term success.”-Author unknown
The Road to Quality
Embracing Quality in Local Public Health: Embracing Quality in Local Public Health: Michigan’s Quality Improvement GuidebookMichigan’s Quality Improvement Guidebook
Lessons LearnedLessons Learned
- Public health Public health applicationapplication
- Provide resourcesProvide resources- Build on Build on
relationshipsrelationships- Facilitate Facilitate
collaborationscollaborations- Share successesShare successes
http://www.accreditation.localhealth.net/
Questions?
Mute line: *6Unmute line: *7
Thank You!