Transcript Medical Errors & Information Systems

Ned E. Baker Lecture:
New Rules for Strengthening
the Public Health System
Leslie M. Beitsch
Florida State University
College of Medicine
Center for Medicine and Public Health
March 30, 2007
Landscape
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3000 counties in the US
20,000 cities and towns
50 states
7 territories
Federally recognized tribes
Landscape
• 3000 LHDs
• 75% have BOHs
• Home rule (Ohio), decentralization,
centralization, city/county/district, urban,
rural, tribal, state
Climate
• Provision of “unique” set of services
• Kindly back up the Brinks’ truck to the
loading dock
• Give us the $$$$$, and we will do good
(things)
Climate
• Deming and variance
Punctuation
• The emphasis on differences and
avoidance of accountability has not served
us well in the present competitive
marketplace
• We are more alike than we are diffferent
New Rule: We Are What We Eat
• A steady PH diet of
– QI/PM
– NPHPS
– Turning Point
– Exploring Accreditation Project
– Multi-State Learning Collaborative
• And so are our organizations
New Rule: Mutual funds and PH
Operate on Different Principles
• For mutual funds past performance does
not guarantee future results
• For PH, past performance is a very good
indicator of future performance
– Preparedness drills and exercises
A Challenge for Leadership
• How do you take dedicated PH workers
struggling in the gulag and lead them to
the promised land of improved health
outcomes?
• Reflect back a decade or so: Isn’t that why
we came to work everyday, day after day
after day?
New Rule: Empower the Public
Health Workforce
• Enhance confidence through training and
skills acquisition
• Models:
– state and regional leadership institutes
– Preparedness Centers (CDC)
– Training Centers (HRSA)
– State and local financed MPH sponsorship
A Challenge for Leadership
• We know what to do to enable our WF to
perform better
• But what about our organizations????
A Challenge for Leadership
• How do you know when your agency is
performing well???
• How do you know when it is improving???
• Or perhaps more importantly, when efforts
are deteriorating
Some Qualitative Data Points
to Consider
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Your staff tell you
Your BOH tells you
The Mayor is happy
The Governor remembers your first name
The press write positive stories about the
health department
• You have a devoted cult following
Some Quantitative Data Points to
Consider
• You benchmark your health department
against others nationally
• Your agency is accredited (maybe I am
getting ahead of the story)
Research Has Found Four Barriers to Strategic Implementation
The Vision Barrier
Only 5% of the work force
understand the strategy
The People Barrier
Only 25% of managers have
incentives linked to strategy
The Management Barrier
9 of 10
companies fail to
execute strategy
85% of executive teams spend
less than one hour/ month
discussing strategy
60% of organizations don’t link
budgets to strategy
The Resource Barrier
Today’s Management Systems Were Designed to Meet The Needs of
Stable Industrial Organizations That Were Changing Incrementally
You Can’t Manage Strategy With a System Designed for Tactics
A Challenge for Leadership
• A high priority among your numerous and
competing responsibilities is to assess
organizational capacity so you can outline
a trajectory for future directions that may
lead to better health outcomes
– What is our baseline
– What are our organizational needs
– What are our strengths
New Rule: It is every citizens
right to receive quality PH
services wherever in the U.S.
they may reside
• 10 Essential Services of PH as key
building blocks
New Rule: PH systems should be
accountable for the services they
provide (or fail to provide)
New Rule: PH systems should be
accountable for the services
they provide (or fail to provide)
• Accountable to citizens
• Accountable to BOHs
• Accountable to other funders
New Rule: Accreditation and
Standards Are Not Just for
Everyone Else
• Why is it that PH thinks it doesn’t need
standards or accreditation, but everyone
else should have them?
New Rule: Standards Actually
Mean Something, like a Standard
New Rule:
Quid Pro Quo Applies
• Local
• State
• Federal!!!!!!
A Challenge for Leadership
• All kidding aside (well maybe not ALL)
• The NPHPS can assist you and your
leadership team with:
– Establishing a baseline
– Prioritization
– With establishing performance goals
– Allocating scarce resources
Federal, State and Local Program Silos
Public
Health
Emergency
Law
Enforcement Management
Medical
Services
Agriculture
A Challenge for Leadership
• The NPHPS can assist you and your
leadership team with:
– Permeating and infusing program knowledge
broadly across silos
– Communicating performance progress to staff
– Improving performance
– Benchmarking
A Challenge for Leadership
• Is this beginning to sound like a case for a
performance management system?
• If so (hum quietly to yourself…), the
NPHPS are an integral component…
• Consider…
Quid Pro Quo
• Turning Point PMC findings
– Most PM activities are local
– When present at state level, tendency for silo
orientation
• Local buy-in fostered by state participation
• NPHPS are excellent means to initiate
state PM
How do NPHPS relate to QI/PI/PM?
• NPHPS are capacity and performance
standards
• Standards are the first quadrant in the
Turning Point model
• QI program in FL and other states focus on
outcomes and systems processes
• These activities are complementary
• Successful QI/PI/PM may/should include both
How do the NPHPS Fit into the
National Scene?
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PH Preparedness (CDC and HRSA CA)
Accreditation Movement
HP 2010/ HP 2020
Nat’l PH Performance Improvement
Institute (PHF’s AARO)
A Challenge for Leadership
• This data can be utilized as a starting point
for a strategic plan
• It can be a major foundational
underpinning for constructing a quality
improvement system
• Compare this approach with what you may
be using now…
Accreditation Movement
• No longer a controversial topic for CDC, funders,
and PH organizations
• PH unique among health disciplines in lacking
national accreditation mechanism
• States have been the laboratory thus far
• Focus has been limited largely to locals; no
consensus approach
• State agency accreditation vision lacking
• Could NPHPS be an integrating factor (NC)?
• Role for Governance bodies????
RWJF/CDC
• Convened nat’l public health stakeholders
meeting December ’04
• Consensus from gathering
– Valuable to investigate feasibility of
establishing voluntary nat’l accreditation sys
– Sys defined as development of
• Set of standards
• Process for validation
• Recognition and/or incentives
Exploring Accreditation Project
• CDC/RWJF financed
• An APHA, ASTHO, NACCHO and
NALBOH collaboration to:
• A nat’l steering committee was established
to make definitive recommendations
regarding the feasibility and desirability of
a voluntary nat’l accreditation system
• Final recommendations recently released
The Nat’l Steering Committee
Utilized 4 Workgroups
• Governance and Implementation:
– Consideration of overall system structure
• Single point of entry
• Network of states meeting nat’l standard
• Other alternatives
– Relationship among levels of PH practice
(fed/state/local)
– Leadership and implementation of accreditation sys
– Remediation
• Standards Development:
– Identify principles for standard setting
– Role of NPHPS?
The Nat’l Steering Committee
Utilized 4 Workgroups
• Financing and Incentives:
– How is system to be financed?
– Appropriate incentives (avoiding unintended
consequences)
– Study business case for nat’l accreditation sys
• Research and Evaluation:
– Establish research agenda to promote evidencebased approach to accreditation methodology
– Evaluate NACCHO/ASTHO collaborative process
MLC 1
• Concurrently, through a grant from RWJF,
NNPHI/PHLS led a multi-state learning
collaborative to explore and advance
accreditation-like programs already in
implementation
• IL, MI, MO, NC, WA:
• Selected states received up to $150,000 to
enhance existing accreditation/assess. systems
for 12 months
– Variety of TA resources and eval available
– Influenced EAP recommendations
MLC 2
• MLC 2 currently underway
• Focus is on QI within contest of
accreditation
• Ohio one of 10 participating states
• FL, IL, KS, MN, NH, MI, MO, NC, WA
• MLC operates on 3 levels
Four components
of a performance
management
system
Source: Turning Point Performance Management Collaborative,
From Silos to Systems: Performance Management in Public Health
(in press).
In a performance
management
system...
• All components should
be driven by the public
health mission and
organizational strategy
• Activities should be
integrated into routine
public health practices
• The goal is continuous
performance and quality
improvement
Source: Turning Point Performance Management Collaborative.
Baldrige Criteria For Organizational
Performance Excellence
2
Strategic
Planning
5
Human
Resource Focus
7
Business
Results
1
Leadership
3
Customer &
Market Focus
6
Process
Management
4
Information and Analysis
New Rule: Peggy Lee Was Right
• EAP Steering Committee has drafted a
work plan and recommendations
• Although ultimate outcome remains to be
seen…
• the need for QI/PI/PM non-controversial
New Rule: Peggy Lee Was Right
• Potential organizational outcomes from an
accreditation process:
– Great organization
– Organization has transformed from good to
great
– Organization is good, but not great
– Organization is neither good nor great!
New Rule: Peggy Lee Was Right
• To successfully achieve accreditation,
some form of a QI/PI/PM system is a
prerequisite
• Both good and great organizations will
have successfully employed QI/PI/PM
techniques
• Remediating organizations will need to
build QI/PI/PM capacity
New Rule: Peggy Lee Was Right
• Bottom line:
– Acceptance of accreditation remains an open
question
– QI/PI/PM will be a centerpiece regardless
– NPHPS remain a cornerstone in the
evolutionary process
The Relationship Between
Accreditation and QI
Public Health Agency Accreditation System Implementation (Simplified)
Inputs
Accrediting Agency:
•Staff
•Resources
•Accrediting Standards
and support materials
PH agencies:
•Interest in
accreditation
•Readiness for
accreditation
•Perceived value of
accreditation
Broader Public:
•Local/State/Federal
public policy-maker
•General public
Strategies
Outputs
Research and
Evaluation of
Accreditation
Accrediting Process:
•Self-review
•Outside review
•Reaccreditation
PH Agencies Buy-into
Accreditation and
receive technical
Assistance for
pursuing Accreditation
PH Agencies meet
Accreditation Standards
and are Accredited
PH Sector as a whole
has a clear set of
benchmarks and
mechanism for
contextualizing
strengths and
weaknesses
Short-Term Outcomes
PH agencies more
effectively and
efficiently use
resources:
•Staff
•Other resources
•Funding
Improved PH Sector:
•Better and more
uniformly trained staff
•Increased ability to
collaborate
•Improved quality of
services
Long-Term Outcomes
Strengthened
public health
system
-Preparedness
-Infrastructure
-Capacity
-Results
Improved
community health
indicators
Increased public
recognition of
public health role
and value
PH agencies are better
ability to communicate
work and results to
public
Create incentives for
participation
July 21, 2006
More visibility of the
work of PH agencies
Legend
Accrediting Agency
Individual PH Agencies
PH Field
Public/Policy Makers
Multiple Groups
Achieving 9 HP 2010 Goals
• Would save 2 million lives by decade’s end
• Reductions in cancers, vascular disease,
and injury
• What are the fulcrums, leverage points to
enable these?
• How do we relate these ideas to the
ESPH? To accreditation?
Remember the 10 Great PH
Achievements?
• PH has an extraordinary track record
• Accreditation offers an opportunity and a
framework
• Envision extraordinary results, beginning
with very concrete steps
New Rule: Build Partnerships,
But Accept Credit (and Fault)
• Old Rule:
– There is no limit to what can be accomplished
if others receive the credit
• Old Rule amended:
– There is no limit to what can be accomplished
if others receive some of the credit
New Rule: PH must build
vocal constituencies
• NIH vs. CDC
• HIV/AIDS and MCHBG vs. PHBG
New Rule:
PH Whining is now extinct
• Although PH has developed whining into a
high art form, it has not served us well
• Others look to “can do” partners
– Relegating PH to the sidelines
New Rule: PH is A &W
• 101st anniversary of Jacobsen vs. Mass
• Preparedness remains at the forefront
• We have occasional hurricanes
• State Medicaid programs are broke
New Rule: Opportunities Abound
• Silver lining in the cloud of each new
disaster or calamity
• But PH has been invisible in Katrina and
Rita
• We must invite ourselves to the table,
even we have to bring our own chairs…
New Rule: All PH Staff Are
Empowered with the Courage to
Speak Out
• Esp. important when there is a vacuum in
leadership (at any level of tripartite
system)
• IF YOU DON’T SAY THE WORDS
“FAMILY PLANNING” OR
“ENVIRONMENTAL HEALTH,” NO ONE
ELSE WILL…
New Rule: Think boldly
• Adopt what Celestial Seasonings implores
– Edmund Spencer
– Dante
Questions/Comments/Diatribes
Leslie M. Beitsch
Director, Center for Medicine and Pub Hlth
Florida State University College of Medicine
1115 W. Call St
Tallahassee, FL 32306
(O) 850-645-1830
[email protected]