Transcript Using QI to Meet Accreditation Prerequisites

Presentation to the Open Forum
September 16, 2010
Lee Thielen, MPA
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Community/Statewide Health Assessment
Community/Statewide Health Improvement
Plan
Agency Strategic Plan
Supported by the Robert Wood Johnson Foundation
Community health assessment
Three
required
Three
components
required
components
Community health improvement plan
Agency strategic plan
As Mark Twain said,
“The secret to getting
ahead is getting
started.”
For public health, that
is assessment.
A Community or State Health Assessment is:
“collecting, analyzing and using data to
educate and mobilize communities, develop
priorities, garner resources, and plan actions
to improve public health.” (PHAB Newsletter April
2010)
Planning:
“You may be
disappointed if you
fail, but you are
doomed if you don’t
try.”
Beverly Sills
Definition: “A long-term systematic effort to
address issues identified by the assessment
and community health improvement
process. It is broader than the health
department agency and should include
partners…”
Source: PHAB Newsletter, May 2010
Definition:
A strategic plan is internal to the public health
agency and guides the health department in
fulfilling its obligations from the Health
Improvement Plan.
Sources:
Interviews with approximately 40 public health
individuals to date.
NACCHO Profile Data
2010 Tribal Public Health Profile
ASTHO Chartbook of State Public Health
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State health assessment – Not asked
24% have done a state health improvement
plan
75% have done a strategic plan
ASTHO Chartbook of State Public Health, 2010
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44% have done a community health
assessment
Not clear what percentage have done
community health improvement plan or
strategic plans
2010 Tribal Public Health Profile
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63% have done community health
assessments
49% have done community health
improvement plans
61% have done strategic plans
2008 NACCHO survey data
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10 states – 80% or more of LPHAs have
completed CHA
4 states - 80% or more LPHAs have
completed CHIP
3 states –80% or more LPHAs have done both
2008 NACCHO survey data
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Population size
Expenditures per capita
Type of governance
Staff: epidemiologist/health educator
Data sets available: BRFSS, hospital discharge
Partnerships with higher education
2008 NACCHO survey data
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Staff ---- epidemiologist/health educator
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Availability of data ---- BRFSS
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Partnership with academic institutions --Having had faculty/staff from an institution
conduct a program evaluation
1. Assessment vs Plan:
Agencies do not always see a sharp distinction
between the Community Health Assessment
process and documentation and the
Community Health Improvement Plan.
Instead it is a continuous process that needs
continuous investment.
2. Document or Information:
The concept of a “document” to be shown to PHAB does
not work for some agencies. Some agencies made it
very clear that they see little value in printing a
community health assessment.
The agencies with greatest capacity share their results
using on-line information with specific reports as
needed as the best approach.
Large agencies (over 1,000,000) do not find community
input useful, unless done at the neighborhood level.
3. Public Health Makes Do.
While specific ranges of costs can be noted for
an assessment, agencies also “make do”.
There are great examples of using faculty and
students from the schools of public health,
schools of nursing, etc. to obtain adequate
assessments for minimal costs.
“I’m going to make him an
offer he can’t refuse.”
- The Godfather, 1972
4. Incentives work.
Local Agencies respond to even modest
“incentive grants”, even though it doesn’t
include the full cost of producing an
assessment or a plan.
Examples:
$10,000
$20,000
$30,000
5. A Continuous Process:
The more experienced (sophisticated or wellresourced) agencies do not see assessment
and planning as something that is done as a
3 or 5 year obligation, but rather as a
continuous investment with dedicated staff
and dedicated systems.
6. The Role of the State Agency with Local Results:
The state agency can support local health
agencies, especially in data collection and
analysis, including rates and identifying outliers.
The state agency can provide incentive funding,
often using Preventive Health Block or sources
such as Tobacco Settlement funds.
The state agency can provide technical
assistance.
7. Costs of Assessments and Plans:
There is convergence on costs. Although it may be assessment only
or may include plan as well.
In a summary:
Less than 50,000: $20,000 to $50,000
(One agency with a population of 8700 did assessment for
$1000 plus 100 hours of director’s time, using graduate and
nursing students and faculty)
50,000-500,000: $69,000 to $130,000
(One 6 county region, population 80,000 did it for $32,000)
Over 500,000: $109,000 to $500,000
Agencies find it hard to break out costs of
assessment versus planning. They range from
62/28 to 80/20. Usually the assessment is
considered 75-80 of the cost.
8. Strategic Plans can be done for a low cost:
Strategic Plans are in the range of $3,000 to
$30,000, depending on cost of facilitator and
if vetting in public meetings. Some
communities use volunteer facilitators and
have negligible costs.
9. State Agency Data:
States are investing 2.5 to 4 FTE for
assessment and planning.
One centralized state estimates that for
$500,000 to $800,000 all districts would
have assessments and plans.
Note: This is small sample.
10. Hospital Relationship Can Help.
Some agencies have received funding for
community health surveys. One LHA had a
$18,000 community survey supported.
Another received $120,000 to do a Health
Indicators Report. The hospitals satisfy their
community benefit requirements.
1.PHAB should rethink document versus
information availability of information and
engagement.
2.Assessments and improvement plans are
seen as a continual process with no
beginning and no end by some agencies.
3. Incentives matter. Public health continues to
“make do”.
[email protected]
Oklahoma QI Collaborative:
Stepping up and Preparing the
Way to Accreditation
Joyce Marshall, MPH
Director, Office of Performance Management
Oklahoma State Department of Health
September 16, 2010
31
Accreditation Prerequisites
Three
required
components
Health assessment
Health improvement plan
Agency strategic plan
32
The Way It Was . . .
We are They and They are We
State
• Oklahoma Health Improvement Plan
• State of the State’s Health Report
• OSDH Strategic Map/Plan
Agency
• Step UP Performance Management
System
Program
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County Pilot Site Selection
 Geography
 Size
 QI Knowledge/Experience
 Demonstrated Commitment/Resources
 Knowledge of MAPP Process
 Active Turning Point/Community Health
Improvement Coalition
 Accreditation Readiness Efforts
34
Oklahoma Quality Improvement Collaborative
Washington
County
Logan
County
Cleveland
County
Okfuskee
County
Comanche
County
35
Collaborative Overall Goal
 By March 2011, the county health department teams
involved in the Oklahoma Quality Improvement
Collaborative will improve community engagement
and the health improvement planning process in their
counties and make significant progress towards
completion of the three core components for
accreditation including a community health assessment, health improvement plan and strategic plan that
are aligned to the state strategic plan and health
improvement plan using proven quality improvement
tools and processes.
36
Learning Session Trainings
Quality
Improvement
Strategic/Health
Improvement
Planning
MAPP
Community
Engagement
Step UP
Meeting
Effectiveness
38
Collaborative Schedule
Item Description
Orientation & Pre-Planning Meeting
Kick-off Meeting & Learning Session 1
[MAPP & QI Training]
Videoconference Meeting
Learning Session 2
[Step UP, Strategic/Health Improvement
Planning & QI Training]
Date
July 2010
August 2010
September 2010
October 2010
Videoconference Meeting
November 2010
Videoconference Meeting
January 2011
Videoconference Meeting
February 2011
Closing Session
March 2011
39
Step UP: a cycle of
Plan-Do-Check-Act
(PDCA)
Plan
Do
Adopt, modify or drop
Set Standards
Act
Reporting
Implement the change
the change
Quality
Improvement
Measure Performance
Check
How did it go?
40
Performance Measures
 Pre/post test of community engagement
 Pre/post test of health improvement
planning process
 Progress towards completion of local
community assessment, health
improvement plan, and strategic plan
 Shared successful processes and tools
41
The Better Way . . . Tying It All Together
OSDH Performance Management &
Quality Improvement Model
National
State
Healthy People
2010/2020
Agency
Strategic Plan
Tool – Strategic
Map
Service
Area
& County
Health
Department
Program Area/CHD
Strategic Plans
Tool – Step Up
3 Core Functions
10 Essential Public
Health Functions
Oklahoma Health
Improvement Plan
Strategic Targeted
Action
Teams/Plans
Tool – Step Up
Accreditation
United Health
Foundation &
Commonwealth
Fund
Core Services
Document
Tool – Business
Plan
Individual
Employee
Community
Community Health
Improvement Plans
Tool – Mobilizing
for Action through
Planning and
Partnerships
(MAPP) Turning
Point & Step UP
Individual
Performance
Appraisal
Tool – Agency
Individual
Performance
Management
Process (PMP)
Evaluations
42
MLC Kansas – Paving the Road
for Accreditation
Gianfranco Pezzino, M.D., M.P.H.
Senior Fellow
Kansas Health Institute
Follow the
Yellow Brick
Road…?
MLC-3
 Goal: To improve public health
services by implementing quality
improvement practices.
 Strong emphasis on:
 Quality Improvement (QI)
 Preparedness for accreditation
 Based on collaborative projects
 For Kansas: regional model
Functional Regionalization
 Since 2002
 Voluntary
 You pick your partners
 At least 3 contiguous counties
 Inter-local agreement
 Approved by County Commissions
 Filed with Attorney General
 Governance
 Each county has one member on Board
Functional Regionalization
Source: U.S. Census Bureau, Census 2000
MLC-3 Kansas Target Areas
Health Status
Immunizations
MCH- Infant Mortality
Capacity
Community Health
Profile
Culturally Appropriate
Services
Tobacco Related Illness
Health Improvement Planning
Chronic Disease
Competent Workforce
Alcohol Related Injuries
Customer Service
Want to Apply? First You Need
These Documents….
Community Health
Assessments in Kansas
 Last broad state health assessment
done in the ‘90s
 No action plan
 Not updated
 No legal requirements
 No standardized approach
 Little collective knowledge and
experience
Challenge #1
How to apply Breakthrough
Series and Quality
Improvement to a new
activity?
Challenge # 2
Region 1
Team
Region 7
Team
Region 2
Team
Region 3
Team
KDHE Team
Region 5
Team
Region 8
Team
Challenge # 3
Community or Regional
assessments?
Answer
Be creative! 
Be Flexible! 
Explore new models!

And Last but not Least…..
Steal without shame!
 Thanks to Kim McCoy (MN)
for supporting our stealing!
C.H.A. Collaborative Goals
1. To improve the level of readiness of
public health agencies in Kansas for
accreditation
2. To learn and practice basic concepts
on C.H.A. and improvement plan
3. To increase knowledge and skills on
Q.I. tools
C.H.A. Collaborative in a
Nutshell
 Based on teams and regional projects
 10 regional teams
• 62 LHDs, 64 counties
 1 “state” team
 About 10 months of activities
 3 face-to-face sessions, one final learning
congress
 Much work takes place between sessions
 CE offered at all sessions
 Travel costs paid
 Incentive $$ to each team
C.H.A. Collaborative Focus
1. Data issues:
a) Finding the right data
b) Compiling the data
c) Interpreting the data
2. Community engagement process and
tools
3. Q.I. tools and techniques used throughout
project
 We will NOT complete a C.H.A. during the
Collaborative
Phases of the Collaborative
 Pre-session activities
 Learning sessions
 1, 2 and 3
 Action periods
 Between learning sessions
 Learning congress
 Final event
 Sessions are “hands on”
 Teams lead
Community Health Assessment
Q.I. and Community Engagement Tools and Techniques
MLC-3 collaborative
Some of the Products
and Technical
Assistance
Example of Teams’ Charters
 What is the purpose of this team?
The purpose of the West Central Public Health
Initiative (WCPHI) MLC 3 Project Team is to
explore completing a regional community health
assessment (…) versus local community health
assessments.
What is the final product?
The final product of our team’s work will be
identifying regional partners to assist in the
regional community health assessment, including
the creation of a letter of commitment for the
partners to sign.
Examples of Teams’ Public
Health Issue Statements
• Binge drinking is high for all ages of adults due
to a shift in societal norms and increased
access to alcohol.
• Physical inactivity in our region exceeds the
state average.
• Women are at risk for poor birth outcomes due
to failure to receive adequate prenatal care
Monthly Conference Calls
 Teams present their progress on
scheduled tasks
 One topic selected for presentation
and discussion
Assigning Roles - Example
Strategy
LHD role
OTHERS - Role
Health education in
schools
Will support
School district will lead
Enhanced family
planning clinics
Will start service
Community Health Clinic
will expand service
Parental education: how Will support
to “talk” to your teen
Public library will conduct
sessions
Integration of family
planning and STD
services
Will do
Community Health Clinic
will do
Increase in bilingual
staff
Will expand
Community Health Clinic
and Hospital will expand
Conclusions
 We used opportunity of MLC-3
collaborative to enhance capacity to do
CHA/CIP
 We “learned by doing”
 We improved collective skills
 We explored balance between local-state-
regional approach to accreditation and
CHA
 We increased preparedness for
accreditation
Improved P.H. System
Accreditation
C.I.P.
C.H.A.
Skills+Q.I.
MLC-3
Kansas Health Institute
Healthier Kansans through
informed decisions