The PHABulous Journey

1. The PHABulous Journey Susan Ramsey Washington State Department of Health Torney Smith Spokane Regional Health District January 8, 2013

2. Learning Objectives Describe what public health accreditation is Understand the purpose of a site visit by PHAB Identify tools to prepare for your site visit Understand the strengths and weaknesses of those who have had their site visit Know what to do with your site visit report

3. Accreditation 3

4. What is Public Health Accreditation? • The measurement of health department performance against a set of nationally recognized, practice-focused and evidenced-based standards • The issuance of recognition of achievement of accreditation within a specified time frame by a nationally recognized entity • The continual development, revision, and distribution of public health standards

5. National Accreditation Goal The goal of the voluntary national accreditation program is to improve and protect the health of the public by advancing the quality and performance of state, local, Tribal and territorial public health departments.

6. Preparing For The Site Visit 6

7. Where Do You Start? • Your work begins years before you consider a PHAB site visit • Fortunately Washington State public health has worked with standards and QI since 2000 • Agency culture change occurs that can prepare you for PHAB review

8. Where Do You Start? (cont.) • Work with your PHAB coordinator to finalize the site visit agenda • Share with staff and partners the agenda as soon as possible • Identify who will interview with the site visit team for each Domain area • Determine how the governing entity and partners will engage with the site visit team

9. What Tools Do You Use? Applicability Matrix – Who Is Assigned What Measures (have back-up identified) Excel Share folder – Mind Manager maps Outlook appointment notices FAQ for partners and staff 4 meeting rooms (a room for each reviewer and a home room)

11. Selecting Documentation Reflects the work of the health department Representative of the entire range of programs and services (sources of documentation) Most applicable to what the measure requires Talk with peers when stuck

12. Using the PHAB Guidance • Read the statement of the specific measure you are scoring, including the “Intent” • Read each requirement carefully. You will need to validate that each of these requirements are present in the documentation to score the measure as “Demonstrates” • Review the Guidance section in detail and highlight every “active” verb statement • Review the PHAB Acronyms and Glossary and use to clarify definition of terms and how they are used in the PHAB Standards

14. Keeping Staff Engaged Involve them in the agenda times Ensure they know the documentation they will be speaking about Provide training on the do’s and don’ts during the site visit Keep them informed in all steps of the process Celebrate all the hard work

15. Site Visit 15

16. What Is The Purpose of a Site Visit?Reviewing Documentation for Conformity • A process of assessing the department’s conformity with the standards and measures • Review documentation • Clarify through discussions • Supplement with additional information • Interview others (e.g., governance) • Assess conformity • Develop written report

17. Putting it all together The role as a reviewer is to determine the level of conformity of the supplied documents (along with what is learned on-site) to affirm or deny the truth of the department’s assertion of demonstrating the measure.

18. Tell Your Story…. • Site reviewers will not be familiar with your HD or even your state • Provide short summary or note that describes your processes for the topic addressed by the measure • Be laser-focused on the specific requirement of that measure • State page number (or highlight with text box) where specific information addressing the measure is located if document more than 3 pages long • Provide only the documentation that is needed to demonstrate performance. More is not better!

19. PHAB’s Description Box Use the Description Box to help provide the link between the Measure and the uploaded document for the Site Reviewers • Character Limit: 150 words • Optional • Describe how document demonstrates conformity • Identify specific location within the document • Provide context if upload is part of a larger document • State the author, if not a health department document

20. What Are the Roles of Partners? Formal partners provide specific services, develop materials, and coordinate services Be aware of accreditation effort Review standards and measures Contribute documentation Partner on QI Meet with Site Visit Team

21. What Qualities Should Your Accreditation Coordinator Have? Ability to build relationships Manage projects and teams Knowledge of the Department activities Lead the Accreditation Team Good facilitation skills Manage the selection of documentation Maintain a document management process Coordinate and support the PHAB site visit

22. The Site Visit Report 22

23. DOH – Successes Culture of Quality Improvement and Performance Management Commitment to technical assistant to LHJ given we are a decentralized state Execution of regulatory authority

24. DOH – Opportunities for Improvement Succession planning Increase use of technology Board of Health – formalizing the relationship

25. Spokane Strengths • Long-term trusted relationships with community partners • Three prerequisites very strong • BOH does not overreach • HO role • Workforce planning • Strong technology • Higher education connections • Population based services • Community reaches out to us • Collection and use of data • Management and leadership • Good integration of CHA and CHIP • Saw us as strategic, innovative, adaptive, leadership stays the course, synergistic

26. Spokane Challenges • Decreased resources and increased demand • Transition stretches us as we move to what we will be • Categorical funding application to integrated programs • Helping staff with transitions

27. Spokane – Successes XX XX XX

28. Spokane –Opportunities for Improvement XX XX XX

29. How Does Quality Improvement Fit? After you have the results of your Self-Assessment • Have we described the gaps in our performance against the Standards? • How can our team select what items to improve? • Can we find good examples of documentation to adapt or adopt? • What’s next?

30. Choosing an Approach Factors to Consider: • Connection to health and strategic priorities • Influence on other standards or measures • Feasibility of success • Amount of effort to improve performance

31. Some Activities Do Not Need QI • Policy or procedure needs to be written and implemented • A different agency, division or program may have documentation, just need to identify and collect it • Documentation needs to be approved, updated, reviewed or revised (is not timely or is in draft form) • Other examples?

32. Some Gaps Can Benefit From QI • More systemic or wide spread gap; e.g. need for quantifiable outcome measures in all programs • New work process needed • Staff evaluation or training processes need improvement • Consistent application of activity needed across programs, e.g. review of data analysis and making conclusions from the data

33. Gap Analysis – PHAB Standard 5.2

34. Individual Standard or Measure Focus on specific standards with low capacity…and high importance.

35. Radar Chart Example

36. Broader Impact Issue Begin with a high level view of weaknesses and cross-cutting themes vs. individual standards or indicators. • For example: “Establish measurable outcomes with time-frames and targets as part of QI work” • Addressing this area for improvement could impact scoring in Domain 1, Domain 5 and Domain 9.

37. Interrelationship Digraph (ID) Tool Benefits • Finds potential drivers of improvement in many areas • Simple and fast (30-45 min.) • Know what to work on first • Achieves team commitment • Surfaces assumptions, documents reasoning • Generates hypotheses about relationships between areas that can be tested • Creates ideas for potential measures of improvement

38. What We Know Now That We Wish We Knew When We Started 38

39. Key Lessons Learned • Be flexible • Organize Documentation and staff • Displaying Your Documents • Include title page, highlight, date • Use only what you need • More is not better • Site visit is conversation not presentation

40. Technical Assistance • Washington’s Performance Management Centers: http://www.doh.wa.gov/PublicHealthandHealthcareProviders/PublicHealthSystemResourcesandServices/PerformanceManagementCentersforExcellence.aspx • Association of State and Territorial Health Officials (ASTHO): www.astho.org • National Association of County and City Health Officials (NACCHO): www.naccho.org • National Association of Local Boards of Health (NALBOH): www.nalboh.org • National Indian Health Board (NIHB): www.nihb.org • National Network of Public Health Institutes (NNPHI): www.nnphi.org • Public Health Foundation (PHF): www.phf.org

41. PHAB Resources www.phaboard.org PHAB Guide to National Public Health Department Accreditation Version 1.0 PHAB Standards and Measures Version 1.0 PHAB Acronyms and Glossary of Terms version 1.0 PHAB Fee Schedule (2011-12) Fact Sheet PHAB National Public Health Department Accreditation Documentation Guidance Version 1.0 PHAB National Public Health Department Accreditation Readiness Checklists Version 1.0 PHAB Standards and Measures Documentation Selection Spreadsheet Version 1.0 (Excel) e-PHAB SOI Information e-PHAB Application Information Video Instructions for Site Visits at www.cecentral.com/phab Version 1.0 Errata released 12/22/11

42. What comments and questions do you have? Torney Smith (509) 324-1518 tsmith@srhd.org Susan Ramsey 360-236-4013 Susan.ramsey@doh.wa.gov