Partnering for Systems Improvement: The Role of Public Health Institutes

1. Partnering for Systems Improvement: The Role of Public Health Institutes in Quality Improvement and Accreditation Call in Number: (800) 504-8071 Code: 3019823 December 4, 2008

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3. Partnering for Systems Improvement: The Role of Public Health Institutes in Quality Improvement and Accreditation December 4, 2008

4. 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

5. NNPHI Members Statewide Nonprofit University-Affiliated Municipal / Sub-State Provisional Member Affiliate member visit www.nnphi.org for links to members’ websites

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. How are the institutes partnering and collaborating with local, state and national partners to prepare for accreditation and conduct quality improvement?

13. 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

14. Supporting Accreditation Related Efforts • Illinois • Kansas • Florida • Michigan • Missouri • New Hampshire • North Carolina • Oklahoma • Wisconsin

15. 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

16. 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

17. 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)

18. Creating tools and resources to help agencies prepare and conduct QI NC Roadmap Michigan QI Guidebook

19. 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

20. 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

21. 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

22. Roles of PHIs in QI and Accreditation • Examples from the Field: • New Hampshire • North Carolina • Kansas • Michigan

23. 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

24. 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

25. MLC preparing for accreditation, measuring performance, learning collaboratives CHI Technical Assistance to local networks for performance assessment and improvement Performance Based Contracting Performance Improvement CHI DPHS National Public Health Performance Standards Assessment and Planning Public Health Improvement Team DPHS DPHS

26. 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

27. 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

28. Strengthening the Public Health System-Statewide • 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

29. 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

31. 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

32. MLC-3 Goals • Facilitate development and improvement of local public health agencies and systems through application of collaborative, evidence-based quality improvement processes • Prepare the State Health Department for voluntary accreditation by piloting national accreditation standards and institutionalizing enhanced quality improvement processes • Incorporate national accreditation standards and assessment activities within the cycle of performance management and quality improvement at the local level • Create quality improvement mini-collaboratives working toward linking public health capacity to population health outcomes • Share best practices and lessons learned, and disseminate findings across the larger public health community

33. 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

34. 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

35. 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.

36. 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.)

37. Process: Part I • Completed by lead organization • Occurs at the operational indicators level for each standard of each Essential Service.

38. 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?

40. 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. ESSENTIAL SERVICE I: Monitor health status and understand health issues facing the community 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 community health institute

41. Scoring Matrices- Lead organization and regional partners

42. How does the State of NH contribute to regional public health capacity? Scoring Matrices-State Contribution

43. Continuous Quality Improvement

44. 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

45. 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)

46. 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

47. Questions Jascheim@dhhs.state.nh.us Joan Ascheim Bureau Chief NH Division of Public Health Services Bureau of Policy and Performance Management (603)271-4110 http://www.dhhs.state.nh.us/DHHS/DPHS/iphnh.htm Lea Ayers LaFave NH Community Health Institute/JSI (603)573-3335 Lea_ayers-lafave@jsi.com

48. NC Local Health Department Accreditation and the Role of the NC Institute for Public Health

49. NCLHDA Program Components Self-Assessment by the Agency Site Visit Board Adjudication

50. 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