Applying for National Public Health Accreditation: A Comprehensive Approach

1. Applying for National Public Health Accreditation: A Comprehensive Approach Karen Hagos, MPH PritiIrani, MSPH New York State Department of Health

2. Today’s Session… • National Public Health Improvement Initiative • PHAB Accreditation Overview • Building Accreditation Readiness Infrastructure • Development of Pre-Requisites and Prevention Agenda • Using a Quality Improvement Approach • Tracking Progress & E-PHAB

3. CDC National Public Health Improvement InitiativePerformance Management Initiative to Improve Health Outcomes “The initiative is intended to strengthen public health infrastructure and systematically increase performance management capacity so that public health goals are effectively and efficiently met.” - CDC • The Performance Management Group (PMG) focuses on building, institutionalizing, and implementing performance management and improvement capacity within the agency. Acknowledgement: This presentation was supported by funds made available from the Centers for Disease Control and Prevention, Office for State, Tribal, Local and Territorial Support, under CDC-RFA-CD10-101101PPHF12 Disclaimer: The content, findings and conclusions of this presentation are those of the authors and do not necessarily represent the official position of or endorsement by the Centers for Disease Control and Prevention. http://www.cdc.gov/stltpublichealth/nphii/about.html

4. Public Health Accreditation • Public Health Accreditation Board (PHAB) • Improve service, value and accountability to stakeholders • Identify improvement opportunities, develop leadership • Gain recognition as high quality, high performing agency • 11 Health Departments Accredited in March 2013 • Accreditation: Advancing PH Performance • https://www.youtube.com/watch?v=WgwSivfASM0 Accreditation Domains • Domain 1: Community Health Assessment • Domain 2: Investigate • Domain 3: Inform and Educate • Domain 4: Engagement with Community • Domain 5: Public Health Policies • Domain 6: Enforce Public Health Laws • Domain 7: Access to Health Care Services • Domain 8: Competent Public Health Workforce • Domain 9: Performance Management and Quality Improvement • Domain 10: Evidence-Based Public Health • Domain 11: Administrative and Management Capacity • Domain 12: Engage Public Health Governing Entity

5. Seven Steps to Accreditation • Pre-Application • Online orientation • Submit Statement of Intent • Application • Submit Pre-Requisites: Community Health Assessment, Community Health Improvement Plan, Strategic Plan • Submit form, fee • Attend Training • Document Selection and Submission • Site Visit • Accreditation Decision • Reports • Re-accreditation

6. Prevention Agenda 2013-2017Five Statewide Priorities Prevent Chronic Diseases Promote a Healthy and Safe Environment Promote Healthy Women, Infants and Children Promote Mental Health and Prevent Substance Abuse Prevent HIV, STDs, Vaccine Preventable Diseases and Healthcare Associated Infections

7. Prevention Agenda 2013-2017 For each priority, action plans contain: • Goals (at least one per priority) • Measurable objectives including some on disparities • 3-5 measures per priority: at least one impact/outcome measure and at least two process measures • Evidence based and promising practices sorted by sector and by health impact pyramid. http://www.health.ny.gov/prevention/prevention_agenda/2013-2017/

8. Pre-Requisite - CHA Community Health Assessment (CHA): Part of a strategic plan that describes the health of the community by collecting, analyzing and using data to educate and mobilize communities, develop priorities, garner resources, and plan actions to improve public health. Mandated for local health departments as per New York State Public Health Law §6. -Working Definition, New York State Department of Health Assessment : the process of regularly and systematically collecting, assembling, analyzing, and making available information on the health needs of the community, including statistics on health status, community health needs, and epidemiologic and other studies of health problems. Source: http://www.health.ny.gov/statistics/chac/glossary.htm#C • Lessons learned from our processes – good and bad (?) • Time it took for completion, parties involved

9. Pre-Requisites - CHIP • Priorities aligned with assessment findings and clearly articulated • Specific, measurable goals/objectives • Evidence-based or best practice strategies • Explanation of the process in assessment, priority-setting, and action plan, and the roles of community partners • Measures to track process and outcomes and reporting of lessons learned

10. Local Health Department CHA-CHIP Blue = new Community Health Assessment • Description of Community (i.e. Demographics, Health issues) • Identification of major health challenges • Succinct summary of assets and resources • Documentation of collaborative process and methods Community Health Improvement Plan • Identification of at least two community priorities. At least one must address a disparity. 2,4,5 For each priority – goals, objectives, strategies and practices, performance measures (process, outcome) 3. Community stakeholder roles and responsibilities 6. Process used to sustain engagement

11. Hospital CSP • Mission Statement • Definition of community served • Public Participation (i.e. participants, dates, process) • Assessment and selection of at least two community priorities. At least one must address a disparity. • 3-year plan of action • Dissemination of plan to the public • Process to sustain engagement

12. Key Points • Purpose statement aligned with defined priorities • Specific, measurable goals/objectives • Tracking measures at implementation and building on lessons learned • Use of best practice and/or evidence-based strategies • Brief explanation of the collaborative process: assessment, prioritization, criteria for selecting priorities, strategies • Description of roles of community partners

13. Selected Resources State Prevention Agenda http://www.health.ny.gov/prevention/prevention_agenda/2013-2017/index.htm Community Health Assessment Improvement Cath. Health Assc. Assessing/Addressing Community Health Needs http://www.chausa.org/Pages/Our_Work/Community_Benefit/Assessing_and_Addressing_Community_Health_Needs/ NACCHO Community Health Assessment and Improvement Planning http://www.naccho.org/topics/infrastructure/CHAIP/index.cfm Data Resources NYSDOH Community Health Indicator Reports http://www.health.ny.gov/statistics/chac/indicators/ County Health Rankings www.countyhealthrankings.org/ Evidence-Based /Promising Practices Resources Guide to Community Preventive Services http://www.thecommunityguide.org/index.html

14. Community Health Assessment and Improvement Process

15. Community Health Assessment and Improvement Process

16. CHA Review - Strengths • Local health departments have been submitting periodic reports on collaborative community health assessment for years • Existing strong relationships with hospitals and community partners • Access to county-level health status, behavior risk data • Data interpretation

17. CHA Review - Challenges • Tracking and evaluation of interventions • Balancing process and outcome measures • Adapting evidence-based or best-practice interventions to local context • Identify tangible roles for partners

18. Accreditation Self-Assessment • Project Management Tools • Project Charter • Work Plan • Timeline • Team Membership • Team Structure per Domain • Cross-Cutting Teams • Over 100 internal staff involved in accreditation self-assessment

19. Documentation Selection • Quality Improvement Tools Brainstorming “A method for a group to generate a large number of ideas around an issue of interest.” Nominal Group Technique “A process that helps teams prioritize by consensus.” Improved participation, efficiency, and sense of ownership over the process.

20. Documentation Storage & E-PHAB • SharePoint and Shared Drives for Documentation Storage • E-PHAB

21. Lessons Learned • Planning within each phase is important • Use tools available to you to structure and organize (Project charter, QI Tools, SharePoint) • Involve others to create buy-in and support

22. References Bialek, Ron et al. “The Public Health Quality Improvement Handbook.” (2009): 162, 175. National Public Health Improvement Initiative. (2010): http://www.cdc.gov/stltpublichealth/nphii/about.html