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Building a high performing health department

Mel Kohn, M.D., M.P.H , Director and State Health Officer, Oregon Division of Public Health Lillian Shirley, BSN, MPH, MPA , Director, Multnomah County Health Department. Building a high performing health department. Welcome to Oregon!. Mel Kohn, MD MPH

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Building a high performing health department

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  1. Mel Kohn, M.D., M.P.H, Director and State Health Officer, Oregon Division of Public Health Lillian Shirley, BSN, MPH, MPA, Director, Multnomah County Health Department Building a high performing health department

  2. Welcome to Oregon! Mel Kohn, MD MPH State Public Health Officer and Public Health Director Oregon Health Authority Open Forum Meeting on Accreditation and Quality Improvement in Public Health Portland, June 19, 2012

  3. Act Like an Oregonian • Oregon = “AW-re-gun” • Willamette River = “will-AM-et” • Smile, make eye contact, be friendly

  4. Some Oregon Facts • 3.8 million people (in 2010) • We’re growing • 12% population growth from 2000 to 2010, compared with 9.7% for US • We’re still largely white, but becoming more diverse • 1.8% African-American, 11.7% Hispanic compared to 12.6% and 16.3% for US • We are the leading provider of lumber and hazelnuts in US, and you’re probably eating our peppermint and berries too • We have a few large companies: Intel, Nike • Tourism increasingly important

  5. Some Odd Oregon Facts • State Beverage: Milk (Tillamook cheese) • State Crustacean: Dungeness Crab • State Fish: Chinook Salmon • State Dance: Square Dance (at least in 1977)

  6. Spend Lots of Money While You’re Here • Think of the lack of sales tax as a permanent sale, compared to what you would pay at home.

  7. Official Oregon Attire

  8. Oregonians Worry About Being “Californicated” “Come visit us again and again. This is a State of excitement. But for heaven’s sake, don’t move here to live” • Governor Tom McCall to a CBS reporter, 1971 “I am simply saying that Oregon is demure and lovely, and it ought to play a little hard to get. And I think you'll all be just as sick as I am if you find it is nothing but a hungry hussy, throwing herself at every stinking smokestack that's offered“ • Governor Tom McCall explaining his 1971 remark in 1982

  9. Oregon Governor John Kitzhaber Audio Clip

  10. We Love Bikes! • Portland has the highest share of bicycle commuters of any US city (6-8%) • Portland is the only large city to earn The League of American Bicyclists’ platinum status as a bicycle-friendly city • Portland has 324 miles of bikeways

  11. Accreditation and Quality Improvement in Oregon

  12. Oregon Aggressively Pursuing Health Reform • Current Governor played key role in creation of the Oregon Health Plan in 1980s • Currently health reform is one of his top two priorities • Current efforts focused on Coordinated Care Organizations for Medicaid clients • Global budget • Accountable for health outcomes • Community-driven • 11 covering 70% of Medicaid population to begin functioning in August • Expansion to public employees and private sector?

  13. Oregon Health Authority • New agency created last July • Includes Public Health, Mental Health and Addictions, Medical Assistance Programs • Focus on Better Health, Better Care, Lower Costs • Leverage state purchasing of health care • State purchases about 25% of health care bought in the state

  14. Public Health Needs Reform Too • Financial sustainability of current business model in question especially as health insurance coverage increases • Need to refocus on key drivers of health and health care costs and where public health can add value • Better communicate to a public skeptical about government what we do and that we are efficient and effective

  15. Transforming Public Health • CDC’s National Public Health Infrastructure Initiative (NPHII) grant • In Oregon, we have used NPHII to— • Establish a vision for the future • Create a strategic plan for Oregon Public Health • Reorganize our Division to meet our goals • Fund our accreditation prerequisites • Support accreditation of county health departments • Carry out quality improvement activities • Begin to develop a public health policy capability

  16. Public Health Division VISION: Lifelong health for all people in Oregon. MISSION: Promoting health and preventing the leading causes of death, disease and injury in Oregon. Transforming the public health system through public health accreditation Preventing tobacco use Decreasing obesity/overweight Supporting CCOs in achieving community health goals Reducing suicide Increasing the use of health impact assessments as a tool in communities Preventing or reducing heart disease and stroke, increasing survivability Maintaining excellence in epidemiology and surveillance Preventing family violence Establishing mechanisms that ensure health in all policies Increasing community resilience to emergencies

  17. Oregon Public Health Division New Organizational Structureas of July 1, 2012

  18. Quality Improvement Activities • Using a variety of tools to improve our programs • Plan-Do-Check-Act • LEAN and Six Sigma • Rapid Process Improvements (RPI) • Balanced Scorecard measures • Program Reviews

  19. Quality Improvement Activities • Success Story: • Senior Farm Direct Nutrition Program (SFDNP) certification and benefits moved to a lottery system • Allows seniors to know much sooner if they are eligible • New process will save 360+ hours of staff time, or $13,000 annually

  20. Emerging Focus: Policy Development • Using NPHII grant funds to identify— • Partnership opportunities with other sectors, like transportation, housing, and education • Policy processes where the public health system should be playing a role • Creating a policy unit to— • Ensure policy capabilities in our public health system • Coordinate policy development across programs • Do policy analysis and development for our priorities • Sustain partnerships with other sectors • Use data to link health outcomes and policy change

  21. Our Journey to Building a High-Performing Public Health Department Lillian Shirley, BSN, MPH, MPA Director, Multnomah County Health Department Portland, Oregon NACCHO President June 19, 2012

  22. Health Reserve Corps/Medical Services Community Wellness Public Health & Community Initiative Emergency Preparedness Hospital Preparedness Training Grants Pharmacy Services Health Assessment/ Evaluation Corrections Health Vector Control Health Promotion/ Empowerment Facilities & Safety Dental Services Lead prevention Finance/Business Services Food handlers Communicable Disease Epidemiology WIC Immunization Health Equity Initiatives FQHC Clinics Emergency Medical Services Environmental Health-Asthma Inspections/Healthy Homes STD Prevention Early Childhood Services Community Health Council Human Resources/Workforce Development HIV/Hep C Patient Advisory Council SBHC Disease Control/Occupational Health Population Shift Public Health Workforce Eliminating Health Inequities Healthcare Reform Budget Crisis EHR Accreditation Meaningful Use

  23. High-Performing Public Health Department Our definition: • Self-improving system • Recruiting and retaining capable public health workforce • Commitment to build capability and capacity for continuous quality improvement culture • Focusing on outcomes

  24. High-Performing Public Health Department Our definition: • Strategically focusing on patients/clients and communities (epidemiology) • Managing the present and planning for the future • Public Health Accredited

  25. Our Metaphor “Pick a Pony and Stick with It” Commitment to build capability and capacity for continuous quality improvement through Lean techniques

  26. Our Journey/Approaches Whole Quality Culture Values & Beliefs Processes/Structures Patient/Client Leadership Strategic Values & Beliefs

  27. Strategic Approach • Build a culture of continuous improvement • Priorities (not everything at once 80- 20) • Deployment of various Kaizen events • Systemic redesign of Communicable Disease Services • EHR adoption-Examine system efficiencies for STD/HIV Community Programs • Telephone Improvement Project • Business Services

  28. Client/PatientApproach • Leverage Innovations • Engage through “voice” • Involve patients/clients/community in what you decided to improve or you tell us what we need to redesign • Medical/Health home/Team based • Redesigned our client engagement survey • Standardized Race/Ethnicity and Primary Language Data Collection process

  29. Leadership Approach • Living system=human community • Common and consistent goals/leaders • Clear accountability • Focus on quality and system performance • Performance management system/QI Plan • Implemented the use of Equity Lens • Learning community-reciprocity

  30. Process/Structure Approach-Systems≠ Programs(how to stay out of the weeds) • Focus on Systems • Prioritization • Standardization • Processes and people together • Benchmarks • Outcomes patients would care about

  31. Values and Beliefs • Conditions for people to be healthy • Honoring diversity • Partnership • Value leadership • Responsible stewards • Continuous quality improvement • Balancing science and experience • Prevention, health promotion, early intervention

  32. Lessons • Infrastructure • Leadership • Vision/Mission/Values • Promoting systems thinking • Improvements are led by people who do the work in collaboration with clients/community • Organizational priority

  33. For More Information Lillian Shirley Director, Multnomah County Health Department 426 SW Stark St, 8th floor Portland, Oregon 97204 Office: 503-988-3674 Email: Lillian.shirley@multco.us Website: http://web.multco.us/health

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