Greater than the sum of its parts: Challenges and growth of alliances in the Land of Oz MLC-3 kick off meeting August 2008 Gianfranco Pezzino, M.D., M.P.H. Kansas Health Institute

Do you agree with this statement? “Everyone, no matter where they live, should reasonably expect the local health department to meet certain standards”

Kansas Local Health Departments: Population Served 4% 7% 26% 63% of Pop. Served by 10 LHDS 37% of Pop. Served by 90 LHDs

Information and Resource Sharing Alliance 1 –Regional Cooperation

Regional Cooperation: Rules of Engagement At Least 3 Contiguous Counties You Pick Partners Inter-local Agreement  Approved by County Commissions  Approved by Office of Attorney General Governance  Each County has One Member on Board

Alliance 1 – Functional Regionalization Political Considerations Functional Regionalization- Not Consolidation Involvement of Local Elected Officials Planning Team Formal Inter-local Agreements Regionalization summit (2008) On-going Governance of Region Funding Considerations Voluntary Financial Incentive

15 Regions, 103/105 counties

Regionalization Standardization of Business Practices through technical assistance projects Alignment of Technology Performance Management National PH Performance Standards

Can a performance management system and an accreditation system for state and LHDs support each other? Performance management system forms the foundation for establishing accreditation process Accreditation system can stimulate improved performance, indicators, assessment process  Can be a “natural” evolution from performance management system KS will be well positioned and ready (remember, that train is coming……)

Alliance 2 – The broader Public Health System KS Association of LHDs KS Dept. of Health and Environment KS Health Institute

Alliance 2 – The broader Public Health System KS Association of LHDs KS Dept. of Health and Environment KS Health Institute University of Kansas Medical Center

The mini-collaborative projects 2 cycles, address two previously identified priorities:  MCH (prenatal care)  Information management (community health assessment) Based on regional projects  3 regional teams  1 “state” team  Each team = 3 to 5 people Nine months, 3 face-to-face sessions, one final learning congress Incentives  CE offered at all sessions  $7,000/region for each project

Mini-collaborative projects team selection  Interest and commitment to apply QI principles and methods  Potential for contribution to the statewide team efforts  Quality of the design of the specific activities proposed for the region  Strength of collaboration and commitment of regional partners  Meaningful evaluation plans for the regional activities  Development of a logical budget  Demonstrated ability to engage all the local health departments in the region

Communication Strategies KHI news website (check it out! Storyboards  Team specific  Mini-collaborative specific KALHD MLC web page Regionalization Summit, July and September 2008 Learning Congress sessions KALHD Mid-Year Meeting

Performance Management in Kansas – Related Projects MLC NACCHO PROPHIT

NACCHO Regionalization Project Regional Assessments Regional Planning Lessons Learned Legal Technical Assistance Financial Modeling Communications Sharing Experience Other local health departments Local Elected Officials/Boards of Health

PROPHIT Project Goals  To promote the adoption of a common performance management system among different programmatic areas, both at the local and at the state levels.  To expand the existing performance management system (“Track and Trend”) to include more services and state performance indicators.  To facilitate Kansas’ regional approach to building public health capacity and performance management and enhance the readiness for a voluntary accreditation process.  To promote the integration of measurable performance indicators for essential public health services into the design of state-wide public health information systems.

What makes us feel good? Potential for building a QI culture in the state’s Public Health System Regional approach could serve as demonstration of value of regions Regional and state teams working side by side Potential for workforce development  Academic involvement important for current project and future sustainability

What keeps us awake at night Unchartered territories  Functional regionalization  QI in public health Resources  Cost of project expected to exceed $600,000 + local and regional in-kind contributions Sustainability