2010 Public Health Standards Assessment Orientation

1. 2010 Public HealthStandards AssessmentOrientation Kris Kernan Pam Lovinger Trainers: Susan Ramsey Jennifer Tebaldi Rita Schmidt 1

2. Agenda • Welcome and introductions. • Public Health Improvement Plan/Partnership. • Cycles of Review. • 2010-2011 Washington Standards. • Preparation for Beta Test.

3. Training Objectives • Understand why we are measuring the standards. • Background and history. • How to show performance in the standards. • How to prepare for the “Beta” test.

4. They Are All Linked Employee Survey Data Health of Washington Budget Customer Survey Data Public Health Standards Results Implementation of Strategies, Operational Activities and Process Improvements Management Review and Analysis of Performance Tools Creation of GMAP Dashboard* Strategic Plan GMAP HealthMAP Legislative Agenda Data Analysis Data Collection POG / Activity Inventory Annual Self Assessment Ask yourself questions such as, how well are we doing? How do we collect data? What do we do with it? Is our strategic plan working? Who is involved? Use the Baldrige framework of Leadership, Strategic Planning, Customer Focus, Information & Analysis, Human Resource, Process Management and Performance Results to guide the assessment. WSQA Assessment Results 1 or 2 opportunities for improvements * = performance measurement tools

5. Public Health Improvement Partnership • Goal: To guide and strengthen the governmental public health system. • Partnership: DOH, Local Health Dept., Tribal entities, Others • Strategies for improvement. • Set standards to measure all governmental public health . • Identify health outcomes for populations. • Local public health indicators • Identify capacity needs. • Office of Public Health Planning and Development.

7. WA Standards- Background • Developed collaboratively by local and state public health agencies. • Used every three years to review the performance of the public health system in Washington. • Baseline measurement in 2002 and re-measurements in 2005 and 2008. • WA Cycle established : Every three years.

8. What Are the Standards? • Define a basic level of public health capacity. • Function as stretch standards – describe how public health ought to be. • State what Department of Health (DOH) and specific DOH programs need to do. • Describe the collaboration needed between state and local health. “What every person has a right to expect.”

9. Benefits of Washington’s Process • Provides a public health system-wide snapshot. • Common language. • Create common expectations. • What every person has a right to expect. • Capacity measures. • Site performance measureable over time.

10. Public Health Accreditation Board (PHAB) Voluntary Accreditation Goal: The goal of a voluntary national accreditation program is to improve and protect the health of the public by advancing the quality and performance of state and local public health departments. Exploring Accreditation Final Report, p.4

11. Comparison to Accreditation • Washington System. • System-wide snapshot. • Specific QI recommendations. • Full participation. • Full disclosure of scores. • Accreditation • County by county. • Pass or fail. • Confidential scores.

12. Washington Challenge • Transition to accreditation. • Maintain our statewide results. • Maintain participation. • Make the process useful for Washington.

13. WA Selected - PHAB Beta Test • One of eight states. • Evaluate the process. • No accreditation. • Site visit will be MAY/JUNE. • Documents due March 1, 2010.

14. WA Adopts PHAB Standards • Permission from PHAB to use the PHAB standards for Washington review. • 80% of Washington measures align. • Include the Washington standards and measures that were not part of the PHAB standards. • Optional standards – those PHAB standards that were not part of the Washington reviews in the past.

15. 2010/ 2011 WA Standards (Domains) Part A: Administrative Capacity and Governance. Part B: Domains • 1: Assessments focused on population health status and public health issues. • 2: Investigate health problems and environmental public health hazards. • 3: Inform and educate about public health. • 4: Engage with the community. • 5: Public health policies and plans. • 6: Public health laws. • 7: Access to healthcare services. • 8: Public health workforce. • 9: Improve processes, programs, and interventions. • 10: Evidence base of public health. standards domains

16. The New Washington Standards Process for 2010-2011 • Use trained staff as reviewers for local health in 2011. • Sites will have the information to prepare for accreditation. • Results will give sites information for next cycle, or for accreditation preparation. • Washington will have state-wide results – “snapshot” of the state. • Washington will have recommendations for the public health system.

17. National Standards Documentation Guidance • Required Documentation is a description of the topics and issues that the documentation must contain to demonstrate the measure, and • Examples of Documentation describes some examples of the types of documentation that could be presented.

18. DOH - Agency vs. Program Measures Agency : • Applies at the department level-Is demonstrated once at a central point in the agency (an example is human resources), or • May require the participation of many programs/activities within the organization. Program : • Applies at the program or activity level and a sample of programs must show individual demonstration. • Tobacco • Communicable Disease • Nutrition and Physical Activity • Immunizations • Food Safety • On-site Sewage Systems

19. Standards Documentation Guidance • Many types of documentation can be used to demonstrate performance. • Description of policies and processes • Documentation of reporting activities, data, decisions • Examples of materials to show distribution and other activities.

20. National Guide to Standards and Measures “Interpretation” Credibility and consistency in accreditation result from sharing the same interpretation. Clarify the intent of the standard and measure. Timeframes. Type of Measure. Type of Review. Interpretation and Guidance. Includes state, local, and tribal. 20

21. Washington State Standards Guidelines(8 Washington State specific measures) • Describes all requirements to meet each measure. • Suggests types of documents that demonstrate performance. • Gives specific time-frames for documentation. • Provides links to exemplary practices documentationfor your reference.

22. Crosswalk from Washington to National Standards • The crosswalk is a tool used to compare 2008 Washington state standards to the PHAB national standards. • Not all measures crosswalk to one measure. • Not all text within a measure is exactly the same as the old measure. • 80% of the 2008 Washington state standards are in the PHAB national standards.

23. Timeframes • Documentation for compliance with the standards must be within the five years prior to the National Accreditation Survey date, unless the measure states a different timeframe. • Annual (within prior 14 months). • Current (within prior 24 months). • Biennially (at least every 24 monthsprior to accreditation survey date). • Regular (based on a pre-established schedule determined by the health department).

24. Glossary of Terms • Detailed sourced glossary for many of the terms used in the standards. • List of acronyms used in the standards.

25. 2010 National Beta Test and Washington State Site Visit • Assess how well our public health system is working overall. • Describe what every public health agency in Washington should be able to do regardless of size or location. • Build a stronger and better public health system. • Define, measure, and facilitate the improvement of public health protection throughout the state.

26. What is Expected? • The measurement process is rigorous. • Programs visited provide documentation to show they are able to perform the expected function. • The process requires planning, collection, and organization of documents. • This should be an “everyday” process and not a “wait until time for assessment” scurry. • Review and scoring of the documents is done by an independent entity.

27. Scoring National and State: There are three scores: (0) Does not demonstrate. • Partially demonstrates. • Fully demonstrates. 01 2

28. Who Does What?

29. Office of Performance and Accountability Coordinates quality Improvement efforts from assessment results. Hosts meetings. Acts as liaison between senior management, division/programs, & reviewers. Provides regular status updates to SMT. Provides information. OPA Makes agency decisions as needed. Conducts a pre-assessment survey. Serves as collection point for division’s final input. Makes training available.

30. Public Health Systems Planning and Development (PHSPD) Provides representation at statewide & department planning meetings. Maintains an up-to-date website. PHSPD Acts as liaison between local health jurisdictions and the Dept. of Health. Provides Standards expertise to local and state public health.

31. Programs Attend Standards trainings. Coordinate with division contact. Programs Collect and post documentation in MindManager.

32. Reviewers Serve as a resource. Provide feedback on strengths and opportunities. Done by an outside entity. Reviewers Perform on-site visits with DOH programs and local health jurisdictions. Complete a final report with scoring results.

33. How does it all fit and what do I need to do?

34. Establish Division Workgroup Leadership commitment – resources and communication. Assign coordinator for preparation project. Assign specific categories/standards to individuals (usually managers). Develop detailed work plan that addresses each standard. Establish meeting schedule for workgroup. Report progress and barriers to leadership team. 34

35. Progress and Coordination Workgroup meets regularly to review progress on work plan. Coordinate shared areas of documentation. Meet with increasing frequency as review gets closer; monthly, bi-weekly, weekly. Leadership involvement of progress and where help is still needed. Prepare for mock review. 35

36. Beta Test Site Standards Work Evaluation Monthly tracking log. Four web-based surveys. Written comments on process documents. Observation/discussion during site visit. How can the process be improved? Training Self-assessment Site visit Standards and Measures 36 36

37. Evaluation Questions What are the total costs? What standards and measures are confusing, challenging to meet, or difficult to document? How effective are PHAB-provided guidance documents and templates? Process Division/Program Coordinator will provide Office of Performance and Accountability monthly tracking information the 1st of every month. 37 37

38. Monthly Tracking Logs - Scope Accreditation includes only the tasks and activities that are required and/or directly related to preparing for and completing the accreditation process. Accreditation does not include activities to improve performance in order to be compliant with the accreditation measures, or activities required based on the 10 Essential Public Health Services 38 38

39. Tell Your Story . . . Reviewers will not be familiar with your area. Provide short summary or note that describes your processes for the topic being addressed (“Read Me”). Be “laser focused” on the specific requirement of that measure. Provide only the documentation that is needed to demonstrate performance. More is not better! 39

40. Organizing Your Documents Collect and organize all documents for reviewers to review. Online document library with folders for each standard and measure. Electronic submittal tool – MindManager. 40

41. How to Submit Documentation

42. Organizing Your Documents State page number and highlight with text box (“read me”) where specific information addressing the measure is located. Can use same document for multiple measures – just indicate all measures that are relevant and page of document. 42

43. Use Documentation From Daily Work Plan ahead. 43

44. Use Documentation From Daily Work Plan ahead. Build documentation into regular processes: Use summary formats for regular reporting documents. Minutes of working committees. Case write-ups, logs, and progress reports. Emphasize conclusions, actions and results. 44

45. Use Documentation From Daily Work Plan ahead. Build documentation into regular processes: Use summary formats for regular reporting documents. Minutes of working committees. Case write-up, logs, and progress reports. Emphasize conclusions, actions and results. Include required information e.g. data results, analysis, conclusions from analysis, opportunities for improvement and actions/ interventions taken. 45

46. Who is Responsible? Assignment sheets show who is responsible for what measures. Those responsible, for department level measures should reach out to other programs, if necessary, to assist meeting the performance measure.

47. Washington State Standards Exemplary Practices • Collected during the 2008 site-reviews. • Five criteria for a document to be considered: • Optimally demonstrates at least one of the requirements of a measure. • Timely and/or current. • Concise and easy-to-use. • Adaptable to other DOH programs or LHJ’s. • Available electronically. • 350+ documents available through a link on PHSPD website. (http://www.doh.wa.gov/phip/documents/PerfMgmt/08EP/EPcompendium.pdf) • Hyperlinks of two state examples, where programs received score of 2, available next to measures

48. How to Use the Exemplary Practice Compendium

49. Exemplary Practices Used for Improvement Efforts

50. Mock Review • Each program is reviewed by a team of peers that: • Performs an electronic review of program documentation. • Provides feedback on documentation review to program, division, and OPA.