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1. WELCOME!NPHPSP User Teleconference Please mute your line by pressing *6 You can un-mute your line by pressing *7 Do not put your phone on hold. May 18, 2010Call in Information: 1-800-504-8071, code 8422006

2. The Indiana Public Health System Quality Improvement Program Partnering for the Public’s HealthOne County At a Time Presented on Behalf of the Indiana State Department of Health Deb Koester, DNP, MSN, RN, WHNP Program Manager, Population Health Initiatives Healthcare Technical Assistance Program Purdue University

3. The Charge..… Create Something Flexible…. and Standardize It ….For All 92 LHDs ….Using the 10 ES of PH To Strengthen All Public Health Systems and Prepare Indiana for National Accreditation Dr. Judith Monroe

4. Benton County Local Public Health SystemPopulation 9,421

5. Vanderburgh CountyLocal Public Health SystemPopulation 171,922

6. ? The Charge..… Create Something Flexible ….and Standardize It ….For All 92 LHDs

7. The Foundation of PHSQIPCDC’s National Public Health Performance Standards Program (NPHPSP) Early user of Version 2.0 Local, Governance, and State Instruments. Collaboration with partners is critical to developing clear, measurable standards and optimal performance in our local and state public health systems. Provides a means of evaluating local system-wide and state-wide performance Provide a foundation for quality improvement processes and accreditation readiness.

8. Public Health System Research institutions Philanthropist Churches Community Centers Nursing Homes Home Health Doctors Employers Economic Development Police EMS Corrections MCOs Health Department Parks Schools Elected Officials Hospitals Mass Transit Environmental Health Civic Groups CHCs Fire Tribal Health Laboratory Facilities Drug Treatment Mental Health

9. Indiana Public Health System Quality Improvement Program 2007-2010 PHSQIP 1 2007-2008 • 21 Local Public Health System Assessments • State Public Health System Assessment • 4 Governance Assessments • 4-Day Training for 14 counties and 10 ISDH teams • 14 Local Public Health System Assessments • 5 Governance Assessments (4 local/1 State) • 20 Local Public Health System Assessments • 5 Governance Assessments • State Public Health Lab System Assessment • 4-Day Training – Lean Six Sigma Yellow Belt in Public Health • Community Health Assessments, SHIP and CHIPs PHSQIP 2 2008-2009 (The Year of H1N1) PHSQIP3 2009-2010

10. Toward Accreditation in Indiana: Building From the NPHPSP LPHS Participation Map • 57 of 92 counties • Over 650 county assessment hours • Over 1,000 people, representing • public health and healthcare • organizations have invested over • 10,000 individual hours in assessments • Over 750 hours of QI training • have been delivered following • assessments for performance • improvement planning Indiana’s Talking About Public Health!!

11. Strengthening the System Strengthens the Agency Building Public Health Infrastructure with the NPHPSP Regular Assessment Core Planning Team Meetings (6 to 8 weeks) Pre-Assessment Phase • Resource Binder • Logistics • Invitation Assessment Phase • Participant Materials • Orientation to 10 ES • Facilitation Process • Visioning • Defining the System Post Assessment Phase • PH Summit • Review of Findings • Prioritization Send out invitations Assessment Day #1 Assessment Day #2 Assessment Day #3 Public Health Summit (4 to 6 weeks)

12. CDC National Public Health Performance Standards ProgramLocal Public Health System Assessment May 7, 2009 12:00 pm to 3:00 pm Sponsored by the Harrison County Health Department SAMPLE DAY 1 AGENDA* 10:00 Welcome & Introductions Tony Combs 10:10 Introduction to the Assessment Process: Carolyn Snyder Using the Assessment Instruments Pat Delph 10:30 Essential Service 1 Pat Delph 11:30 Break 11:45 Essential Service 2 (with working lunch) Pat Delph 12:45 Break 1:00 Essential Service 4 Pat Delph 2:00 Concluding Remarks Tony Combs Please keep in mind as you complete the assessment process that your participation and the information you share is critical to the outcome and findings for your county.  The goal of the assessment is to reach consensus through discussion to determine the most appropriate response for each question.  It is the perspectives and sharing of information from each person that makes the assessment most valuable and accurate.  *All times are approximate and are subject to change based on the length of time to complete the assessment process for each Essential Service.

13. Lessons Learned Assessment Planning and Implementation • LHD system leadership is a key priority • Requires a multi-disciplinary core planning team • Data is as accurate as the partners around the table • Self Assessment – the partners Know their system best • Audience Response System • Generates new data • Discovery of new data among partners • Promotes new and stronger relationships among partners • Standardized, yet flexible

14. Defining Indiana Public Health Systems

15. Benton County Public Health System

16. Vanderburgh CountyPublic Health System

17. Benton County Public Health SystemWhat’s Missing?

18. PARTNER: Program to Analyze, record and track networks To enhance relationships Local Public Health System Performance Improvement Using PARTNER to measure, analyze, and monitor relationships within Indiana’s local public health systems supports the delivery of essential services in the following manner: • Essential Service 1: PARTNER serves as a needs/resource assessment to create local data • Essential Service 4: PARTNER establishes a quantitative baseline to mobilize partnerships • Essential Service 9: PARTNER enables measurement and analysis for evaluation Ultimately, integration of PARTNER in the Indiana PHSQIP Program will support not only measurement of partner performance through the NPHPSP LPHS Assessment process, but will enable measurement and optimization of the relationships that exist between partners to improve population health.

19. Partner Survey Questions Please select your organization/program from the list: (most identifiable) Please type your job title: How long have you been in this position (in months)? Please indicate what your organization/program contributes to the collaborative (choose as many as apply). Which describes your organizations most important contribution to the collaborative. Please indicate which of the following outcomes have been achieved to the work of the collaborative (choose as many as apply). Which of the above describes the most successful outcome of the collaborative? How Successful has the collaborative been at reaching its goals? What aspects of collaboration contribute to this success? Select organizations/partners that you recognize from the list: How frequently does your organization work with this organization/person on issues related to...? What kinds of activities does your relationship with this person/organization entail? How valuable is this organization/person to achieving the overall mission of the collaborative in terms of Power/Influence? How valuable is this organization/person to achieving the overall mission of the collaborative in terms of Level if Involvement? How valuable is this organization/person to achieving the overall mission of the collaborative in terms of Resource Contribution? To what extent is the organization/person Reliable? To what extent is the organization/person In Support of Mission? To what extent is the organization/person Open to Discussion?

20. Post-PHSQIP Pre-PHSQIP PARTNER: Program to Analyze, record and track networks To enhance relationships

21. Visioning for the Future

24. Building Momentum with the NPHPSPUsing Performance Standards Results For Performance ImprovementDoing What We Do, Better Than Before

25. Creating A Culture for Accreditationwith the NPHPSP The 10 Essential Services “The Way We Do Business”

26. The Condition of Your Customer ES1 Monitor health status to identify community health problems. What’s going on in my community? How healthy are we? ES2    Diagnose and investigate health problems, health hazards in the community. Are we ready to respond to health problems or threats in my county? ES3   Inform, educate, and empower people about health issues. How well do we keep all segments of our community informed about health issues?

27. Your System Infrastructure 4.      Mobilize community partnerships to identify and solve health problems. How well do we really get people engaged in local health issues? 5.      Develop policies and plans that support individual and community health efforts. What local policies in both government and the private sector promote health in my community? How effective are we in setting local health policies? 6.      Enforce laws and regulations that protect health and ensure safety. When we enforce health regulations, are we technically competent, fair and effective?

28. Your Product and Quality Assurance 7.      Link people to needed personal health services and assure the provision of health care when otherwise unavailable. Are people in my community receiving the medical care they need? 8.      Assure a competent public health and personal health care workforce. Do we have a competent public health staff? How can we be sure that our staff is current? 9.      Evaluate effectiveness, accessibility, and quality of personal and population-based health services. Are we doing any good? Are we doing things right? Are we doing the right things?

29. Continuous Improvement 10. Research for new insights and innovative solutions to health problems. Are we discovering and using new ways to get the job done?

30. The View From Ground Zero

31. The View From the District Level

32. The View From 30,000 Feet **Results shown were created for this presentation and do not represent findings of IN counties

33. **Results shown were created for this presentation and do not represent findings of IN counties

34. The View For Accreditation Readiness 4.2.1. Do partnerships exist in the community to maximize public health improvement activities? 4.1.1 B: Establish and actively participate in collaborative partnerships and coalitions to address public health issues. **Results shown were created for this presentation and do not represent findings of IN counties

35. 5.3.3 Does the local health department (LHD) conduct a strategic planning process? 5.2.1 B: Conduct a strategic planning process 5.2.2 B: Develop a strategic plan **Results shown were created for this presentation and do not represent findings of IN counties

36. Quality Improvement Training

37. PHSQIP3 Training for Community Health Improvement • 4-Day Training – Lean Six Sigma Yellow Belt • 32 hr course – didactic + project • Certification available • Requires multi-disciplinary team • Data for analysis • Assessment data is prioritized for improvement • Local data • PHS Diagram • Visioning Data • Evidence-based strategies are developed and documented in project charter and A3/A4’s.

38. Quality Improvement in Public Health • Improves both process and outcome measures in public health • Identifies actions and opportunities to improve performance • Evaluate whether or not achieved intended result • Facilitates collaboration and integration among partners • Breaks down the silos

39. What are Your Customer Expectations? • What does the public expect from it’s public health system? • What does the public health system expect from itself?

40. Three Sides of Quality Improvement • Customer focus • Understand customer requirements • Deliver services that meet requirements • Use effective processes and methods • Evidence based and process driven approach • Data drive action • Study, measure, analyze, improve the process • Teamwork • Understand ISDH vision and values • Have a shared commitment to satisfy customers

41. Organizational Lessons learned from working as a project team: • How to blend teamwork & scientific methods • Where Sponsors fit in • How to move decisions forward • Why making improvements are not easy • How to develop internal QI experts • How to expand the QI effort

42. The Quality Improvement Goal • Everyone in the Public Health System looking for answers to the continuous improvement question: How Can We Do a Better Job?

43. Good To Great for Public Health Systems Two Quotes to Consider: • “Good is the enemy of Great.” • Jim Collins, Good to Great • “Greatness is not a function of circumstance. Greatness, it turns out, is largely a matter of conscious choice, and discipline.” • Jim Collins, Good to Great and the Social Sectors

44. The Evolution of PHSQIPIndiana’s Building Blocks to Accreditation 2007 2010 • LPHS Assessment • 4-Day Training • LPHS Assessments • Enhancement with ARS • Public Health Summits • Visioning for the Future • Defining Public Health Systems • Application of PARTNER software • 32 hr Lean Six Sigma Yellow Belt course • County Health Rankings

45. Indiana’s Roadmap to Accreditation Starts With the NPHPSP • GOALS • Develop a vision and process for ISDH and 92 counties • Standardized, yet flexible • Identify opportunities to apply QI • CHA, CHIP, Agency Strategic Plans

46. Good To Great For the Social SectorDiscussion June 23, 2010 – 2 to 3 pm For more information or to join contact Deb Koester at dkoester@purdue.edu

47. The Indiana Public Health System Quality Improvement Program Partnering for the Public’s HealthOne County At a Time Presented on Behalf of the Indiana State Department of Health Deb Koester, DNP, MSN, RN, WHNP Program Manager, Population Health Initiatives Healthcare Technical Assistance Program Purdue University

48. QUESTIONS? Click on ‘Q/A’ above to type in your question.