Improving Public Health Preparedness

1. ImprovingPublic Health Preparedness Hot Topics in Preparedness Casey Milne & Tom Milne Milne & Associates, LLC January 20th, 2005

2. Objectives for today’s session • Explain how improvement is a natural part of public health preparedness (not an extra) • Identify an improvement process • Apply improvement principles to emergency preparedness • Describe resources (including colleagues) that could help you in improving your community’s preparedness • Identify your next step

3. Question… Within my PH agency/system our quality improvement efforts can be best described as: A) formal, active and effective B) non-existent C) informal, sporadic and somewhat effective D) formal, inactive and ineffective

4. Model for Improvement Outcome Global PHS National PHS Practice Management State-Local PHS LPHS LPHA Process Structure Leadership

5. Question… Which of the following help give focus to improvement efforts: A) differences between standards and actual practice B) examples of best practices C) examples of lower cost/more productive programs D) all of the above

6. Areas to focus improvement efforts • Where there are differences between standards, science and practice • Identified recommendations from performance assessment (e.g. NPHPSP) • Gaps in current practice from evidence-based and/or scientific knowledge • Published evidence (3-4 articles) • Where examples of better performance exist • At least one “sentinel” organization • Where others are achieving lower costs and/or improved outcomes

7. Getting Started • Identify & describe the problems! • Ask users, partners & providers for feedback, review competencies and essential services • Draft “Charter” to guide and lead improvement work • Secure & use mentors/experts/facilitators • Find colleagues interested in improvement; identify team • Day-to-day leadership • Technical expertise (clinical & measurement) • System leadership

8. The Charter guides and leads improvement efforts for an individual, a team, a county, a state, a nation or globally Vision Mission Operational principles Description of the problem Stretch goals Targeted & measurable objectives Matrix of changes & related key measures Charter

9. Starting the cycle of improvement • Set an objective or aim • Select 1-2 simple measures & measure consistently • Begin with easy/small actions/changes most apt to meet objective (improve practice) • Begin, start small, measure and grow • Secure support of senior leadership-keep them updated of progress, results and lessons learned Cycle of Improvement

10. Using Data for Quality Improvement “There must be a better way to make decisions.”

11. Examples ofMeasurableObjectives • All communities within the jurisdiction are covered with a BT plan and are included in exercises on a prescriptive basis. • 100% of LPHA in the state are certified as Public Health Ready. • All community players are involved in BT preparedness practices, elected officials are present and involved.

12. Question… Which of the following statements about measurement in improvement efforts is NOT TRUE? A) measurement should become a daily routine B) all change leads to improvement C) improvement occurs as a result of change D) measures need to reflect improvement

13. Measures should monitor an outcome that benefits those receiving service, contributes to health status, public health competencies, essential services, etc. Include measurement into daily routines Improvement occurs as a result of change All change does not lead to improvement Measures need to reflect the improvement Measures are used to guide improvement Not judgment Not research Tips onMeasurement

14. Remember What gets MEASURED gets DONE !

15. Steps in Performance Improvement • Organize participation for performance improvement • Identify improvement team • Develop Charter and identify structure • Ensure leadership support and accountability • Identify gaps between actual and desired performance • Gaps in “doing it” and “doing it well” • For example: • Low scores on EPHS 2 (Diagnose & Investigate), 2.2.2.4 Identify community assets that can be mobilized to respond to an emergency • Low score on CDC performance goals, measure 13, timeliness of response to disease reports

16. Steps in Performance Improvement • Prioritize areas for action • Low hanging fruit (what’s working elsewhere?) • Factored in size of the gap, resource potential,political interest, workforce proficiency, and current intentions to improve • Summarize challenges and opportunities (analyze root causes of performance problems in system) • Information, including expectations and feedback • Materials and resources • Methods (processes) • Knowledge and skill • Incentives, consequences

17. ACT PLAN Study DO Steps in Performance Improvement 5. Develop improvement plans • Specific targets • Strategies that address root causes • Define accountabilities 6. Implement and manage results • Carry out change on small scale • Report & analyze effects of change • Act on what was learned • Keep at it

18. Identifying changes that improve practice • Consider innovation from sentinel practices • Use existing successes and knowledge • Get feedback from users, partners & providers • Look for and adapt to local needs and conditions • Listen for and consider building on lessons learned from other colleagues and partners • Be strategic: prioritize changes and action based on the objectives, known problems, and what’s possible • Stay in alignment with the over arching goals of the organization and community

19. Learning Community Site Visits & Coaching Communicate Learning * Successes * Barriers * Hunches * Lessons Learned Distance Learning & Learning Sessions Web Conferencing, Email & Support PD SA PD SA PD SA PD SA PD SA PD SA PD SA * * Plan > Do > Study > Act * * Measure & Plot Over Time * * * * * * Monthly 1 page reports

20. Inspiring & Leading Improvement What can we do to create more innovation & change leading to improvement in public health practice? Early Adopters Laggards Early Majority Late Majority Innovators 2.5% 13.5% 34% 34% 16% 0 0 + sd 0 - 2sd 0 - sd

21. Question… When it comes to creating innovation and change, I would describe myself as a: A) innovator B) early adopter C) early majority D) late majority

22. You’re not on the road to improvement when you… • Study the problem too long • Wait for everyone’s buy-in (or permission) • Educate without changing expectations or systems • Measure everything • Measure nothing • Don’t build support for change and improvement • Settle for the status quo

23. Model of a performance management system Turning PointPerformance Management National Excellence Collaborative Source: Turning Point Performance Management Collaborative,From Silos to Systems: Using Performance Management to Improve the Public’s Health , March 2003.

24. Question… Where would you start if you wanted to begin an improvement effort for your system’s public health preparedness? What is your next step?

25. Questions? Comments?

26. For additional details contact: Milne & Associates, LLC Casey Milne, Tom Milne 262 NW Royal Blvd Portland, OR 97210 503 203-1025 (Phone) 503 203-1026 (Fax) casey.milne@comcast.net tom.milne@comcast.net