Evolving the Mindset: Public Health Data Management at the Local Level

1. Evolving the Mindset: Public Health Data Management at the Local Level LISA SWANSON, ENVIRONMENTAL HEALTH OFFICER BLACK HAWK COUNTY HEALTH DEPARTMENT WATERLOO, IOWA COHORT IV GRADUATION FEBRUARY 24th, 2009

2. Project Background Black Hawk County, Iowa Population ~128,000 Health Department, recently reorganized Enforcement, Surveillance & Preparedness Schools, Outreach and Clinic Health Promotion, Planning & Development Environmental Health Department 9 County region 9 Health officers

3. Project Background • Transitionfrom paper based to digital record keeping • Focus on daily workflow, not “big picture” • Each department manages data pertaining to their programs in isolation from the other departments and agency

4. Problem Statement & Focusing Questions Focusing Questions:   Why don’t we have a system in place for management of public health data that can effectively respond to our questions in a timely and flexible manner? Problem Statement No system is in place to ensure that public health data is managed to most effectively support the Department’s functional decision-making and future data.

5. Key Variables • recognition of need • amount of data generated • number of events that require data management • willingness to collaborate • number of decisions that are based on real data • funding opportunities that require measurability • number of programs that require data sharing/coordination • complexity of generating necessary statistics • security/protection issues with sensitive information • current level of inefficiency • duplication of effort • timeliness and ease of accessibility • ability/flexibility to update

6. Behavior Over Time

7. Quick fix: Put together stand alone database and tables to address specific data needs as they arise. Step 2 B Fragmented data - program silos of information Complexity of data manageability (impacts adapting) R Pressure to access data needed for decision making. Step 1 B PLANNING Step 3 Effort required making changes in the system Same Direction Causal Relationship Long term: Commitment/investment in data management planning. Opposite Direction Causal Relationship Causal Loop Diagram

8. Breaking out of “Business as Usual” PATH OF LEAST RESISTENCE • Breaking down old mind-sets • we don’t have time for this…. • what is wrong with how we always do it? • we need a solution fast! • there are no resources to change now… • this data is only important to my program • Recognize the Consequences of Inaction • fragmented silos of information • system complexity becomes a barrier to flexibility/accessibility

9. Logic Model

10. Project Plan • Event: Stakeholder Involvement • MIS committee • Division, program and project managers involved in data decisions • Event: Inventory of Current Datasets • Event: Alignment with Future Data Needs • Quality assurance, (agency) • ESAWP indicators (local) • Community Health Needs Assessment and Health Improvement Plan (CHNA & HIP) measures (state) • Healthy People 2010 indicators, Accreditation (national) • Event: Development of Templates

11. Department Goals Essential Services Annual Work Plan (ESAWP) Match essential services with measurable indicators Standardized to public health standards Customized tracking for showing outcomes Community Health Needs Assessment 2010 is a re-evaluation year Ability to query database Focus on the agency level rather than small program data

12. Essential Public Health Services

13. Health Protection Goals Integrate and enhance the existing surveillance systems at the local, state, national, and international levels to detect, monitor, report, and evaluate public health threats. Support and strengthen human and technological epidemiologic resources to prevent, investigate, mitigate, and control current, emerging, and new public health threats and to conduct research and development that lead to interventions for such threats. Enhance and sustain nationwide and international laboratory capacity to gather, ship, screen, and test samples for public health threats and to conduct research and development that lead to interventions for such threats. Assure an integrated, sustainable, nationwide response and recovery capacity to limit morbidity and mortality from public health threats. Expand and strengthen integrated, sustained, national foundational and surge capacities capable of reaching all individuals with effective assistance to address public health threats.

14. Environmental Competency Project Data Analysis and Interpretation: The capacity to analyze data, recognize meaningful test results, interpret results, and present the results in a meaningful way to different types of audiences. Evaluation: The capacity to evaluate the effectiveness or performance of procedures, interventions, and programs. Managing Work: The capacity to plan, implement, and maintain fiscally responsible programs/projects using appropriate skills, and prioritize projects across the employee's entire workload. Computer/Information Technology (IT): The capacity to utilize information technology as needed to produce work products. Reporting, Documentation, and Record-Keeping: The capacity to produce reports to document actions, keep records, and inform appropriate parties.  Communication: The capacity to effectively communicate risk and exchange information with colleagues, other practitioners, clients, policy-makers, interest groups, media, and the public through public speaking, print and electronic media, and interpersonal relations.

15. Next Steps… Complete and continue dataset inventory Integrate database systems Continuous stakeholder involvement Data management needs to become a natural part of strategic planning Prove mindset change by responding to data needs with a deliberate strategy

16. Acknowledgements Kristi Campbell and Russell Hadan, my supportive team Joy Harris, my wonderful mentor Bruce, Tom and Eileen…Black Hawk County Managers Michael Goodman, our personal systems thinking expert .....staff from the Heartland Center for PH Leadership National Center for Environmental Health at the Center for Disease Control and Prevention for making this opportunity possible.