Tribal Accreditation Readiness Guidebook and Roadmap June 12, 2013 NNPHI Open Forum Aleena M. Hernandez, MPH Apryl Krause, ND, MPH

TARGET Project: Tribal Accreditation Readiness through Guidance, Education and Technical Assistance Red Star Innovations Inter Tribal Council of Arizona, Inc. California Rural Indian Health Board Tribal Epidemiology Center Institute for Wisconsin’s Health, Inc. Support for this project was provided by a grant from the Robert Wood Johnson Foundation

Objectives Have a basic understanding of accreditation and its benefits Provide an overview of the Tribal Public Health Accreditation Guidebook and Roadmap – Including its development Discuss the early stages of readiness for accreditation

Workshop Participants We recommend that participants be: Familiar with public health accreditation – Eligibility requirements – Accreditation Process – PHAB standards and measures If accreditation is new, we recommend you view the PHAB Online Orientation in addition to this webinar at This webinar will be recorded and available online at

What is Public Health Accreditation? Measurement of Tribal, state and local health department performance based on a set of national standards Issuance of recognition of achievement by a nationally recognized entity Supports continuous quality improvement in public health performance

Public Health Accreditation Board PHAB: Non-profit, non-governmental organization dedicated to advancing continuous quality improvement of Tribal, state, local and territorial public health departments. Accrediting body for national public health accreditation. Vision: a high performing governmental public health system that will make us a healthier nation.

10 Essential Public Health Services (

The Essential Public Health Services 1.Monitor health status 2.Diagnose and investigate health problems 3.Inform, educate and empower people 4.Mobilize communities to address health problems 5.Develop policies and plans 6.Enforce laws and regulations 7.Link people to needed health services 8.Assure a competent workforce 9.Evaluate health services 10.Conduct research for new innovations

PHAB Standards and Measures v1.0 Based on the public health functions set forth in the 10 Essential Public Health Services and Core Functions ( 12 Domains – Each domain has a set of standards and measures Required documentation for each measure

TRIBAL PUBLIC HEALTH SYSTEMS Community Health Tribal Government Tribal Health Dept. Federal agencies Private Industry Local/ State Health Dept. Tribal Colleges Community ITCs/Tribal EpiCenters

Tribal Public Health Infrastructure Community Health Tribal Gov Tribal Health Dept/Clini c Federal agencies Private Industry Local/ State Health Depart Tribal Colleges Communi ty Leaders ITC’s/Epi Centers

Benefits and Opportunities Strengthen self-determination Identify and act upon improvement opportunities High performance and quality improvement Strengthen leadership and employee performance Build stronger partnerships and increase communication and collaboration Recognition, validation and accountability Potential increased access to resources It’s about communities

PHAB Resource Documents Seven Steps to Accreditation Guide to Accreditation Standards and Measures 1.0 Other Accreditation Materials – Glossary 1.0 – Readiness Checklists – Statement of Intent and Application information

Readiness Checklists: Preparation Planning and Process

Readiness Checklists Readiness Checklists are divided into four sections: 1.Initial Checklist – eligibility and support 2.Prerequisite Checklist – 3 prerequisites are current and complete 3.Process Readiness Checklist – recommended processes in place to support accreditation 4.Organizational Checklist – accreditation preparation tasks

Initial Checklist Is the health department eligible? – Statutory authority to promote and protect health Do you have support from: – Health Department Director? – Appointing Authority of the Health Department Director? – Board of Health or other governing entity? Has the Director considered the cost of apply and budget implications? Have HD staff reviewed the 10 Essential Public Health Services and determined the HD is providing all 10?

THD Eligibility A Tribal health department is defined, for the purposes of PHAB accreditation, as a federally recognized Tribal government 1, Tribal organization or inter-Tribal consortium, as defined in the Indian Self- Determination and Education Assistance Act, as amended. Such departments have jurisdictional authority to provide public health services, as evidenced by constitution, resolution, ordinance, executive order or other legal means, intended to promote and protect the Tribeʼs overall health, wellness and safety; prevent disease; and respond to issues and events. Federally recognized Tribal governments may carry out the above public health functions in a cooperative manner through formal agreement, formal partnership or formal collaboration. 1 As evidenced by inclusion on the list of recognized Tribes mandated under 25 U.S.C. § 479a-1. Publication of List of Recognized Tribes.

Process Readiness Checklist Accreditation Coordinator (AC) designated Online orientation completed by AC, HD Director and Accreditation Team Appointing authority and Board of Health engaged in process Electronic capability to produce documentation Capability to establish internal electronic filing system Process to systematically review and revise policies and procedures Evidence of collaboration with key stakeholders

Organizational Readiness Checklist Work plan to discuss and complete tasks; timeframes to gather documentation Process for identifying appropriate documentation Review of standards and measures and PHAB materials (Guide to Nat’l PH Dept Accreditation) Self-Study or initial review of standards and measures Identified areas for technical assistance Identified a target for submitting Statement of Intent

Prerequisite Checklist Prerequisites must be complete and current (within the past 5 years): 1.Community Health Assessment 2.Community Health Improvement Plan 3.Department Strategic plan

Purpose of the Guide Simplify a complex process Tool to plan, organize and prepare for accreditation Create connections among various readiness and preparation activities Provide additional references, resources and tools for specific readiness activities Provide a “roadmap” or “scorecard” to monitor progress and success!

Accreditation Guidebook Organizational Readiness Public Health Performance Community Health Improvement Planning Based on PHAB Readiness Checklists

Corn: Organizational Readiness Accreditation Team Tribal Leadership Engagement Cost Electronic Filing System

Beans: Public Health Performance Self-Study (based on PHAB Standards and Measures) Tribal Administration and Department Engagement Quality Improvement

Squash: Community Health Improvement Planning Community Health Assessment Community Health Improvement Plan Organizational Strategic Plan

Phases of Readiness Early Phase – Information gathering, identifying models, training teams Planning Phase – Developing the plan of action, identifying benchmarks and timelines Implementation Phase – Plan into action! Monitoring progress, adjusting the plan Application Ready – Implementation has concluded and a PHAB application requirement has been met or completed.

Phases of Readiness Planning Phase Implementation Phase Early Phase Application Ready Harvest Planting the Seed Germination Growth

Roadmap Development Placed all items from the Readiness Checklists on small sticky notes Organized them by theme Organized them into chronological steps Identified additional steps based on experience and using the standards and measures Reviewed and refined Three sister analogy was born

Early Stage – Planting the Seed Organizational Readiness – Information Gathering Determine eligibility documentation THD Director support Identify the Accreditation Coordinator(s) Establish a multidisciplinary Accreditation Team Review PHAB online orientation and materials, especially Guide to Accreditation

Early Stage – Planting the Seed Organizational Readiness – Information Gathering Inform Tribal Leadership about the purpose, benefits, cost and requirements – Public health policy and laws – Formalize partnership – MOUs/MOAs – Engagement of other Tribal Departments – Governance domain – Budget requests/resource allocation

Early Stage – Planting the Seed Organizational Readiness – Information Gathering Cost – Accreditation application fees and associated costs – Technical assistance – consultants, others – Training – registration, travel – Infrastructure – IT system, communications meetings, software – Prerequisites – facilitators, consultants, meetings, travel, survey development

Early Stage – Planting the Seed Organizational Readiness – Information Gathering Electronic Filing System – Meeting with IT to discuss capacity – Electronic filing system to organize documentation by domain, standard and measure – Access to the filing system – Early discussions about what might be needed in the future – Capability to produce electronic documentation

Early Stage – Planting the Seed Public Health Performance – Information Gathering Self Study based on standards and measures – THD provides all 10 essential services – Identified a tool to conduct the self-study – Conduct preliminary self-study Identify who will participate in the self-study Tribal Administration and Departments Engage QI or Performance Improvement Manager for development of QI Plan

Tribal Self-Assessment Workbook Created by the Institute for Wisconsin’s Health through Wisconsin’s Public Health Quality Initiative

Early Stage – Planting the Seed Community Health Improvement Planning – Information Gathering Community Health Assessment Community Health Improvement Plan Strategic Plan

Community Health Assessment (CHA) A collaborative process that is conducted in partnership with other organizations Involves the systematic collection and analysis of data and information Provides a snapshot of information that can then be followed in the future Results in a report about community health status that is shared with the community at-large Basis for development of a community health improvement plan

Type of Data Collected Demographics Socioeconomic characteristics Quality of life Behavioral factors The environment (including the built environment) Morbidity and mortality Other social, Tribal, community, or state determinants of health status

Basis-Use-Benefits Data-based decision making and action Informs priority setting and action planning Provides a baseline to measure changes in health over time Engages stakeholder/community in defining its strengths and needs Increases collaboration/coordination among stakeholders to address identified needs

Systematic Process Develop an assessment plan Systematically engage the community Define the community/population Identify community health indicators Collect data Analyze the data Identify health priorities Report results

Community Health Improvement Plan (CHIP) A long-term, systematic plan to address issues identified in the community health assessment Describes how the health department and the community it serves will work together Must include participation of a broad set of stakeholders and partners Planning and implementation process is community- driven Addresses the needs of the population residing within the Tribe's jurisdiction

Elements of a CHIP Tribal health priorities, measurable objectives, strategies, performance measures, and time Policy changes needed to accomplish objectives Individuals and organizations responsible (does not have to be formal) Measureable health outcomes/indicators to monitor progress Alignment with state and national priorities (HP 2020) Plan implementation (reporting, monitoring, evaluating progress)

Department Strategic Plan Process for defining an organization's roles, priorities, and direction over 3-5 years What an organization plans to achieve, how it will achieve it, and how it will know if it has achieved it Guide for allocating resources and pursuing priorities Focus on the entire health department Program-specific strategic plans may complement and support the department strategic plan Links to CHIP and quality improvement plan

Performance and Health Improvement

Resources and Tools Inter Tribal Council of Arizona (CHA) Northwest Portland Area Indian Health Board (CHA) Mobilizing for Action through Planning and Partnerships (MAPP) – Covers CHA and CHIP; very comprehensive NACCHO – Local health department samples and tools ASTHO – State samples and tools

Questions/Comments

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