Transcript Slide 1

APHA
Session 3008
November 8, 2010
Jennifer Jimenez, ASTHO

Association of State and Territorial Health
Officials

57 members – state, territorial and DC


Mission: To transform public health within
states and territories to help members
dramatically improve health and wellness
Support development of public policy and
promote public health programs.

January 2010 Letter of Invitation

8 states self-identified areas of need

ASTHO staff/consultant model

Facilitation, Planning Sessions, Virtual Meetings,
and Site-Visits

Outcomes/Projects
◦ Accreditation preparation and quality improvement
ASTHO’s technical assistance project was funded by the Centers for Disease
Control and Prevention
Joan H. Ascheim
Senior Deputy
Bureau Chief, Bureau of Public Health Systems, Policy and
Planning
NH Division of Public Health Services
Kerre L. Fisher
Deputy Director
Alaska Division of Public Health
Alaska Department of Health and Social Services
Valerie Ricker
Director, Family Health Division
Maine CDC
Moving Towards a Healthier
State
Preparing for Accreditation
New Hampshire’s Approach
Presented at APHA
November 8, 2010
Annual Meeting April8, 2009
What Does Public Health Look Like
in NH?
•Each
of New Hampshire’s 234 cities and towns are required by law to have
a health officer
•Only
five New Hampshire communities maintain public health
departments of various size; no county health departments
•At the state level, DHHS is the lead public health agency. The Department
of Environmental Services, Department of Education, and Department of
Safety also play key roles
• In almost all New Hampshire communities, non-governmental
organizations provide a significant sub-set of public health services
Public Health Regions
• Organized to plan for and
respond to public health
emergencies
• 15 Regions
• Looking to expand the
scope to broader public
health areas
Regionalization Goal
• Overall Goal – A performance-based public
health delivery system, which provides all 10
essential public health services throughout New
Hampshire
• Provide high quality public health based on
national standards (PHAB)
What are we learning?
At the Regional Level
Assessments to Help Us Determine, Resources,
Costs, Needs and Approach
•
Financial analysis of all state/local/private public health
funding with consideration of efficiencies from
regionalization – Patrick Bernet, FAU
•
Assessment of local/regional public health system capacity
to deliver the 10 essential services - with a gaps analysis
•
Assessment of what the link to government could look like
Moving Towards Accreditation
at the State Level
• 2005 Conducted the
NPHPS
• Developed Strategic
Priorities
• Workgroups
• Public Health
Improvement Services
Council
Purpose of the Council
•To monitor the
implementation of
existing public
health
improvement plans
and to develop a
public health
improvement plan
PUBLIC HEALTH SYSTEM
STRATEGIC PRIORITIES
2006–2009 NEW HAMPSHIRE
1 Inform, educate and empower people about
health issues
2 Monitor health status to identify and solve community health
problems
3 Mobilize community partnerships and actions to
identify and solve health problems
4 Develop policies and plans that support individual
and community health efforts
5 Develop a communication plan to convey the
importance and value of public health
6 Develop a plan to assure a competent public
health workforce
Develop a communication plan to convey
the
importance and value of public health
• Researched and developed a communication
plan
• Launched public health campaign and tagline
• NH Public Health Improving health, preventing
disease, decreasing costs for all
• Evaluated reach and use of materials and will
determine future efforts
Multi-State Learning Collaborative
• Working towards accreditation
• Asked our MLC site visitors
– What next? - repeat NPHPS
– Prepare for accreditation through
• Prerequisites –
– Strategic plan
– State health assessment
– State health plan
New Hampshire Division of Public Health Services
Strategic Map: 2011-2013
Demonstrate
Measurable Improvements
in Health and Well Being
A
B
Strengthen
Approaches to
Population Health
Implement Cross-
1
Program Integration
to Increase Population
Health Impact
Integrate
2
3
Data Systems to
Monitor Population
Health Status
Position DPHS as
Expert on Approaches
to Population Health:
Policy, Data, Practices
Make Strategic Use of
4
Partnerships to
Implement Population
Health Approaches
Strengthen
Public Health
Infrastructure
Develop and
Implement a
Health Messaging
Strategy
Ensure Access
to Healthcare and
Public Health Services
Build an Internal
Social Marketing
Capacity
Develop the Capacity
to Meet the Future
Health Workforce
Needs
Focus on Chronic
Disease Prevention,
Diagnosis, Treatment
and Intervention
Continue to
Prepare for and
Respond to
Public Health Threats
Develop Key
Communications
Partnerships to
Increase Impact
Evaluate Message
Effectiveness and
Make Needed
Adjustments
5
6
7
C
Expand
Public Health
Education and
Messaging
Color boxes denote
priority tracks of work
for year one. Similar
colors are related
focus areas and
would be worked on
together.
Implement a
Regional
Public Health System
Prepare for
Accreditation
of the State
Health Department
Implement the
Technology Required
For Future
Effectiveness
Develop and Implement a Public Health Performance Management System
F
D
Improve the
Effectiveness
of Resource
Allocation
Align Internal
Resources to
Support
Strategic Goals
Allocate Resources
Externally to
Support
Strategic Goals
Build the Internal
Capacity to Support
Strategic Resource
Allocation
E
Strengthen
Organizational
Effectiveness and
Adaptability
Improve Intra-agency
Communication at
All Levels
Redesign Internal
Contracting Process
and Financial
Management Structure
Ensure Optimal
Workforce
Capacity
Strengthen
Organizational and
Staff Resilience
Optimize the
Performance of Key
Business Processes
Strategic Planning
•
•
•
•
Selected priorities for year one
Created work groups
Developed work plans
Assessing first quarter accomplishments
Next Step
State Health Assessment
ASTHO Project
• PHAB Definition
Regularly and systematically collecting, analyzing and
making available information on the health of a (state)
including :
– health status, state needs, other studies
– Assist in adapting and responding to health problems
and risks
– Moving towards strengths and resources
Looked at Other States
• MLC states – Oklahoma, Iowa, Washington
• Site visit to Oklahoma via MLC
• Applied to ASTHO for TA
– Provided other examples – Florida, Montana, Illinois
– Provided criteria for indicator selection
– Validated our plan and direction to meet PHAB
standards
State Health Assessment Aim
To provide health profiles that assist the state
and regions to set priorities to improve health
status.
Decisions/Challenges
• Audience – elected officials, public health
partners and stakeholders, public
• Approach- determinants of health (County Health
Rankings), by state and PHR
• Format – hard copy, web-based, report card- ata-glance
• Indicators- how many? How to choose?
• What now, what later?
• Time and resources
Indicators
• Used County Health Rankings indicators as a
base (we don’t have services based on counties)
• Added key indicators for NH as determined by
state epis, program managers
• Used an indicator sorting tool – adapted from OK
Selection of Indicators
• Impact on health (high,
medium, low – proportion
of population impacted)
• National benchmarks
available
• State benchmarks
available
• Perceived ability to affect
change – best practices
demonstrating that
change can be affected in
10 years (high, medium,
low)
• Emerging PH issue
• Meaningfully
measured(reliable, valid)
• Links to other measures
• Demographic availability
• Trend data
• Available at PHR
Indicators
• 60 total - Arranged by chapters
– Social/economics
– Health status/well-being
– Disease – cancer, heart disease, injury, perinatal,
obesity etc
– Health behaviors – seatbelts, smoking, alcohol,
physical activity
– Clinical care – sealants, colonoscopy, Pap,
immunizations
– Physical environment – radon, lead, air quality
Work in Progress
• Programs asked to write about each indicator
with support from epi
• Style guide provided (thanks to OK)
• Reviewed by three editors
• Final edit
• Layout and design
• 1st iteration – state only, second by region
• At a glance - national ranking, trend
• Intro and so what?
Next Steps
•
•
•
•
•
•
•
Regional assessments
Web based – links to in depth data
MAPP like process
?NPHPS?
State health plan
Revisit strategic plan
Begin self-assessment for accreditation
Questions?
• Joan H. Ascheim, MSN
Senior Deputy
Bureau Chief, Bureau of Public Health Systems, Policy
and Planning
NH Division of Public Health Services
[email protected]
603-271-4110
ASTHO Technical Assistance
for Accreditation in Alaska
Kerre L. Fisher
Deputy Director
Alaska Division of Public Health
Alaska’s Road to Accreditation
 How do we fit in?
 Where are we now?
 How far do we need to go?
 What do we need to do to get there?
 What help is available?
Same Scale Comparison:
Alaska Area to Lower 48 States
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ALASKA HIGHWAY SYSTEM
0
200
400
MILES
600
800
Gambell Health Clinic
Beaver General Store
Tyonek ‘Road’ System
Public Health Organization
Public Health System in Alaska
One local government health department with
limited services
 Three local grantee agencies – public health
nursing only
 537 state public health employees
 22 state public health centers
 38 Native health corporations

State Public Health Services
Vital Statistics
 Chronic Disease Prevention & Health Promotion
 Certification & Licensing
 Emergency Programs
 Epidemiology
 Laboratories
 Public Health Nursing
 State Medical Examiner
 Women’s, Children’s and Family Health

Getting the Job Done –
Alaska Style
Elaine Clement, Alaska PHN, 1956
Jane Conard, Alaska PHN, 2003
Public Health Strategic Plan
Goals







Prevent and Control Epidemics and the Spread of Infectious
Disease
Ensure the Public Benefits from Reductions in Suffering, Death
and Disability Due to Injuries
Prevent and Control Chronic Disease and Disabilities
Minimize the Loss of Life and Suffering Resulting from Public
Health Emergencies, Disasters and Terrorist Attacks
Assure Access to Early Preventive Services and Quality Health
Care
Protect Against Environmental Hazards Impacting Human
Health
Ensure Effective and Efficient Management and Administration
of Public Health
PHAB Standards Meet Alaska
Env
Health
Alaska Department of
Alaska &Division
of
Health
Social
PHAB Health
State Standards
Public
Services
Tribal
Health
ASTHO Technical Assistance
 Stakeholders
 Expert
briefing
advice
 Workgroup / teleconferences
 Peer support – Washington and Florida
 Tools for assessing and organizing
 Site Visit - workshop
 Plans for moving forward
Assignment of Standards Tool
Measures
DO
BVS
CDPHP
CL
EMERG
EPI
LABS
PHN
SME
EH
WCFH
ALL
Other
Part A: Administrative Capacity and Governance
Provide Infrastructure for Public Health Services
Standard A1 B: Develop and maintain an operational infrastructure to support the performance of public health functions.
A1.1 B: Maintain policies and procedures regarding agency
operations, review policies regularly and make them accessible to
X
staff
A1.2 B: Demonstrate written policies regarding confidentiality,
X
including applicable HIPAA requirements
A1.3 B: Maintain socially, culturally, and linguistically relevant
approaches in agency processes, programs, and interventions
A1.4 B: Maintain a Human Resources system
A1.5 B: Maintain information systems that support the agency’s
mission and workforce by providing infrastructure for data
X
collection/analysis, program management, and communication
A1.6 B: Maintain facilities that are clean, safe, accessible, and
X
X
secure
Provide Financial Management Systems
Standard A2 B: Establish effective financial management systems.
A2.1 B: Comply with requirements for externally funded programs
X
X
X
X
X
X
A2.2 B: Maintain written agreements with entities providing
processes, programs and/or interventions delegated or purchased by
the public health agency
A2.3 B: Maintain financial management systems
X
A2.4 B: Seek resources to support agency infrastructure and
processes, programs and interventions
Define Public Health Authority
Standard A3 B: Maintain current operational definitions and statements of the public health roles and responsibilities of specific authorities.
A3.1B: Provide mandated public health operations and services
A3.2B: Demonstrate that the governing entity complies with
regulations regarding governing entities
A3.3 B: Demonstrate evaluation of the agency director by the
X
governing entity
Provide Orientation / Information for the Governing Entity
Standard A4 B: Provide orientation and regular information to members of the governing entity regarding their responsibilities and those of the public health agency.
A4.1 B: Provide orientation and regular information to the governing
X
entity regarding the responsibilities of the public health agency
A4.2 B: Provide orientation and regular information to the governing
X
entity regarding their responsibilities
X
X
ITS
X
X
HR
X
ITS
X
FMS
X
X
FMS
X
X
FMS / DOA
X
CO
X
X
GOV / CO /
AG
X
GOV / CO
X
CO
X
CO
State Assessment Tool
Measures
Conformity of Measure
Demonstrated
Quality Improvement Assessment
of Measure
Partially
Not
Evidence of
QI
No QI
Demonstrated Demonstrated Improvement Assessment Assessment
Present
Present
Classification
of Measures
(S, PS, PO, O)
Part A: Administrative Capacity and Governance
Provide Infrastructure for Public Health Services
Standard A1 B: Develop and maintain an operational infrastructure to support the performance of public health functions.
A1.1 B: Maintain policies and procedures regarding agency
operations, review policies regularly and make them accessible to
X
staff
A1.2 B: Demonstrate written policies regarding confidentiality,
X
including applicable HIPAA requirements
A1.3 B: Maintain socially, culturally, and linguistically relevant
X
approaches in agency processes, programs, and interventions
A1.4 B: Maintain a Human Resources system
X
A1.5 B: Maintain information systems that support the agency’s
mission and workforce by providing infrastructure for data
X
collection/analysis, program management, and communication
A1.6 B: Maintain facilities that are clean, safe, accessible, and
X
secure
Provide Financial Management Systems
Standard A2 B: Establish effective financial management systems.
A2.1 B: Comply with requirements for externally funded programs
X
A2.2 B: Maintain written agreements with entities providing
processes, programs and/or interventions delegated or purchased by
X
the public health agency
A2.3 B: Maintain financial management systems
X
A2.4 B: Seek resources to support agency infrastructure and
X
processes, programs and interventions
Define Public Health Authority
Standard A3 B: Maintain current operational definitions and statements of the public health roles and responsibilities of specific authorities.
A3.1B: Provide mandated public health operations and services
X
A3.2B: Demonstrate that the governing entity complies with
X
regulations regarding governing entities
A3.3 B: Demonstrate evaluation of the agency director by the
X
governing entity
Provide Orientation / Information for the Governing Entity
Standard A4 B: Provide orientation and regular information to members of the governing entity regarding their responsibilities and those of the public health agency.
A4.1 B: Provide orientation and regular information to the governing
entity regarding the responsibilities of the public health agency
X
A4.2 B: Provide orientation and regular information to the governing
entity regarding their responsibilities
X
Next Steps
 Leadership
briefings, recommendations,
buy-in
 Complete state health assessment

MAPP process used in several communities
 Develop
State Health Improvement Plan
 Internal policies and documentation
 Accreditation application
Timeline for Moving Forward
Tasks
Preparation Phase
·
Designate a Point of Contact for Preparation Phase
·
Prepare a site visit summary for Director to include:
o accreditation self-assessment strengths and weaknesses
o fact sheet/summary of costs & benefits of accreditation
·
Set regular meeting schedule for accreditation workgroup (all Section Chiefs) to discuss to following:
o Identify others who aren’t at the table e.g. C&L, SME, BVS
o Identify available resources for the accreditation process
o Identify comprehensive list of the “carrots” and/ or “sticks” of accreditation
·
Present final recommendation to the Director
Implementation Phase
·
Identify Point of Contact for Implementation Phase
·
Set regular meeting schedule for accreditation workgroup (all Section Chiefs/appointee)
·
Develop a Social Marketing Campaign to assure
o Buy in from Commissioner
o Buy in from other SOA IT/FMS/DOA
o Buy in from partner agencies e.g. UA, ANTHC
o Buy in from the public on a statewide benefit/value
·
Define LHD for Alaska
·
Establish how to work with LHDs for accreditation
·
Get templates & samples from ASTHO
·
Get clarification on roles & responsibilities of each Section re: Measures
·
Identify a repository for documentation to be gathered and kept
·
Evaluate similar undertakings for overlap e.g. Healthy Alaskans 2020 planning/measures.
·
Inventory: current strategic plans & assessments & health improvement plans
·
DEC/EH and DPH/Sections assess their status of conformity with measures
o Assess what would be needed to move from ‘not demonstrated’ to ‘partial’ or ‘demonstrated’
o identify timeline to fill gaps of each domain responsible for
·
Identify the timeline to complete Statewide
1.
Community Assessment
2.
Community Health Improvement Plan
3.
Strategic Plan
Who
Start
End
Barriers to the Process
Contact Information
Kerre L. Fisher
Deputy Director
Alaska Division of Public Health
Alaska Department of Health and Social Services
3601 C Street, Suite 756
Anchorage, AK 99503
Phone – (907) 269-2042
Fax – (907) 269-2048
Email – [email protected]
Maine CDC :
Stepping
Forward into
Voluntary
Accreditation
American Public Health
Association
November 8, 2010
Stepping Forward into
Accreditation
• Maine and Public Health
– Geography
– Structure
– Why apply for voluntary accreditation
Stepping Forward into
Accreditation
• How Maine CDC got started
• Opportunity: ASTHO Technical
Assistance
– A gift of support
– The first giant step forward
Stepping Forward into
Accreditation
• First giant step
– State Public Health Systems Assessment
• Assessment meeting
• Initial summary report
• Full report back and prioritization
Stepping Forward into
Accreditation
• Steps preparing for accreditation
– Structures developed to support
achieving accreditation
– Leadership
– Implementation of support structures
– Integration with US CDC Public Health
Infrastructure grant
Stepping Forward into
Accreditation
• Challenges
– Placement of resources
– Managing expectations
– Implementing a system wide QI process
Stepping Forward into
Accreditation
• For more information as we move
forward through the journey
– Valerie Ricker
– Director, Family Health Division
– Maine CDC
– [email protected]
– 207-287-5396