Lessons Learned (in the words of a famous Missourian)

1. Lessons Learned (in the words of a famous Missourian) Lieske Giese Wisconsin Division of Public Health, Western Region Director Nancy Young Executive Director, Institute for Wisconsin’s Health, Inc.

2. Wisconsin’s Public Health System • 92 local and 11 tribal health departments - home rule • Wisconsin Division of Public Health - Madison central and 5 regional offices • 24 LHD WIQI partners as of year two • Our goal - to create a sustainable community of practice around QI and accreditation

3. “How empty is theory in presence of fact!” - Mark Twain Lesson One: We shouldn’t assume that state or local staff or policy makers understand or embrace the public health essential services • Many were/are clueless about the essential services and how they apply to their work • Many local and state staff do not buy into essential services making a difference in health outcomes so…Why care? Why bother? • Many local and state staff do not know what other parts of their organizations do so they have difficulty looking at “the whole”

4. “Supposing is good, but finding out is better” Lesson Two: We need to start with basics of the 10 essential services and how a “siloed” agency can make that work  • Decided to not do accreditation prep & QI work with state health department as a whole • Piloted in regional offices & Bureau of Environmental & Occupational Health • Sorting out how to look at management buy-in & staff level engagement       • Challenge to make QI big (part of culture of organization), but also small (workable & meaningful)

5. “Often, the less there is to justify a traditional custom, the harder it is to get rid of it.” Lesson Three: The system must support our new community of practice - so change is required • State health plan for 2020 is required by statute and in draft form has infrastructure focus areas • One is Public Health Capacity and Quality. Its two new objectives are:  • Integration of QI processes into daily practice • Accreditation of local and state health departments • Beginning sense that this is critical to improving the health status of the population.

6. “When in doubt, tell the truth” Lesson Four: To build a community of practice around accreditation preparation and QI, we must encourage & celebrate honest evaluation • In WIQI parlance, “It’s OK to be a zero!” • Practical tools help - our experiment • Each LHD partner self-scores using Excel workbook based on draft PHAB standards • One way to generate discussion about readiness

7. Conversation

8. Conversation

9. “Let us make a special effort to stop communicating with each other, so we can have some conversation.” Lesson Five - To build a community of practice we must provide tools for conversation • It IS all local • How can we get key local people to talk about why this matters? • Our experiment - Essential services monograph

10. Conversation

11. Conversation

12. Contact Lieske Giese, Director, Western Region Office, Wisconsin Division of Public Health 715-836-5362 gieseea@dhfs.state.wi.us Nancy Young, Executive Director Institute for Wisconsin’s Health, Inc. Direct 715-884-2044 nyoung@instituteforwihealth.org