The PHABulous Journey 1 Susan Ramsey Washington State Department of Health Torney Smith Spokane Regional Health District January 8, 2013

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative Learning Objectives Describe what public health accreditation is Understand the purpose of a site visit by PHAB Identify tools to prepare for your site visit Understand the strengths and weaknesses of those who have had their site visit Know what to do with your site visit report 2

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative Accreditation 3 3

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative What is Public Health Accreditation? The measurement of health department performance against a set of nationally recognized, practice-focused and evidenced- based standards The issuance of recognition of achievement of accreditation within a specified time frame by a nationally recognized entity The continual development, revision, and distribution of public health standards 4

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative National Accreditation Goal The goal of the voluntary national accreditation program is to improve and protect the health of the public by advancing the quality and performance of state, local, Tribal and territorial public health departments. 5

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative Preparing For The Site Visit 6 6

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative Where Do You Start? 7 Your work begins years before you consider a PHAB site visit Fortunately Washington State public health has worked with standards and QI since 2000 Agency culture change occurs that can prepare you for PHAB review

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative Where Do You Start? (cont.) 8 Work with your PHAB coordinator to finalize the site visit agenda Share with staff and partners the agenda as soon as possible Identify who will interview with the site visit team for each Domain area Determine how the governing entity and partners will engage with the site visit team

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative What Tools Do You Use? Applicability Matrix – Who Is Assigned What Measures (have back-up identified) Excel Share folder – Mind Manager maps Outlook appointment notices FAQ for partners and staff 4 meeting rooms (a room for each reviewer and a home room) 9

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Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative Selecting Documentation Reflects the work of the health department Representative of the entire range of programs and services (sources of documentation) Most applicable to what the measure requires Talk with peers when stuck 11

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative Using the PHAB Guidance 1.Read the statement of the specific measure you are scoring, including the “Intent” 2.Read each requirement carefully. You will need to validate that each of these requirements are present in the documentation to score the measure as “Demonstrates” 3.Review the Guidance section in detail and highlight every “active” verb statement 4.Review the PHAB Acronyms and Glossary and use to clarify definition of terms and how they are used in the PHAB Standards 12

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Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative 14 Keeping Staff Engaged Involve them in the agenda times Ensure they know the documentation they will be speaking about Provide training on the do’s and don’ts during the site visit Keep them informed in all steps of the process Celebrate all the hard work

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative Site Visit 15

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative What Is The Purpose of a Site Visit? Reviewing Documentation for Conformity 16 o A process of assessing the department’s conformity with the standards and measures Review documentation Clarify through discussions Supplement with additional information Interview others (e.g., governance) Assess conformity Develop written report

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative Putting it all together The role as a reviewer is to determine the level of conformity of the supplied documents (along with what is learned on-site) to affirm or deny the truth of the department’s assertion of demonstrating the measure. 17

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative Tell Your Story…. Site reviewers will not be familiar with your HD or even your state Provide short summary or note that describes your processes for the topic addressed by the measure Be laser-focused on the specific requirement of that measure State page number (or highlight with text box) where specific information addressing the measure is located if document more than 3 pages long Provide only the documentation that is needed to demonstrate performance. More is not better! 18

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative PHAB’s Description Box Use the Description Box to help provide the link between the Measure and the uploaded document for the Site Reviewers Character Limit: 150 words Optional – Describe how document demonstrates conformity – Identify specific location within the document – Provide context if upload is part of a larger document – State the author, if not a health department document 19

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative What Are the Roles of Partners? 20 Formal partners provide specific services, develop materials, and coordinate services Be aware of accreditation effort Review standards and measures Contribute documentation Partner on QI Meet with Site Visit Team

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative What Qualities Should Your Accreditation Coordinator Have? Ability to build relationships Manage projects and teams Knowledge of the Department activities Lead the Accreditation Team Good facilitation skills Manage the selection of documentation Maintain a document management process Coordinate and support the PHAB site visit 21

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative The Site Visit Report 22

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative DOH – Successes 1.Culture of Quality Improvement and Performance Management 2.Commitment to technical assistant to LHJ given we are a decentralized state 3.Execution of regulatory authority 23

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative DOH – Opportunities for Improvement 1.Succession planning 2.Increase use of technology 3.Board of Health – formalizing the relationship 24

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative Spokane Strengths Long-term trusted relationships with community partners Three prerequisites very strong BOH does not overreach HO role Workforce planning Strong technology Higher education connections Population based services Community reaches out to us Collection and use of data Management and leadership Good integration of CHA and CHIP Saw us as strategic, innovative, adaptive, leadership stays the course, synergistic 25

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative Spokane Challenges Decreased resources and increased demand Transition stretches us as we move to what we will be Categorical funding application to integrated programs Helping staff with transitions 26

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative Spokane – Successes 1.XX 2.XX 3.XX 27

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative Spokane –Opportunities for Improvement 1.XX 2.XX 3.XX 28

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative After you have the results of your Self- Assessment How Does Quality Improvement Fit? 1.Have we described the gaps in our performance against the Standards? 2.How can our team select what items to improve? 3.Can we find good examples of documentation to adapt or adopt? 4.What’s next? 29

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative Factors to Consider: 1.Connection to health and strategic priorities 2.Influence on other standards or measures 3.Feasibility of success 4.Amount of effort to improve performance Choosing an Approach 30

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative Policy or procedure needs to be written and implemented A different agency, division or program may have documentation, just need to identify and collect it Documentation needs to be approved, updated, reviewed or revised (is not timely or is in draft form) Other examples? Some Activities Do Not Need QI 31

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative More systemic or wide spread gap; e.g. need for quantifiable outcome measures in all programs New work process needed Staff evaluation or training processes need improvement Consistent application of activity needed across programs, e.g. review of data analysis and making conclusions from the data Some Gaps Can Benefit From QI 32

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative Standard 5.2 Conduct a comprehensive planning process resulting in a Tribal/state/community health improvement plan. MeasureScoreCompliance Demonstration L3Demonstrated L2Largely Demonstrated A1Slightly Demonstrated A0Not Demonstrated Gap Analysis – PHAB Standard

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative Individual Standard or Measure Focus on specific standards with low capacity…and high importance. 34 High Priority Low Performance (Example: Domain 9 Standard 9.2 – QI Plan) High Priority High Performance Low Priority Low Performance Low Priority High Performance

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative Radar Chart Example 35

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative Begin with a high level view of weaknesses and cross-cutting themes vs. individual standards or indicators. For example: “Establish measurable outcomes with time-frames and targets as part of QI work” Addressing this area for improvement could impact scoring in Domain 1, Domain 5 and Domain 9. Broader Impact Issue 36

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative Interrelationship Digraph (ID) Tool Benefits Finds potential drivers of improvement in many areas Simple and fast (30-45 min.) Know what to work on first Achieves team commitment Surfaces assumptions, documents reasoning Generates hypotheses about relationships between areas that can be tested Creates ideas for potential measures of improvement 37

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative What We Know Now That We Wish We Knew When We Started 38

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative Key Lessons Learned Be flexible Organize Documentation and staff Displaying Your Documents – Include title page, highlight, date – Use only what you need – More is not better Site visit is conversation not presentation 39

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative Technical Assistance Washington’s Performance Management Centers: roviders/PublicHealthSystemResourcesandServices/Pe rformanceManagementCentersforExcellence.aspx roviders/PublicHealthSystemResourcesandServices/Pe rformanceManagementCentersforExcellence.aspx Association of State and Territorial Health Officials (ASTHO): National Association of County and City Health Officials (NACCHO): National Association of Local Boards of Health (NALBOH): National Indian Health Board (NIHB): National Network of Public Health Institutes (NNPHI): Public Health Foundation (PHF): 40

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative PHAB Resources PHAB Guide to National Public Health Department Accreditation Version 1.0 PHAB Standards and Measures Version 1.0 PHAB Acronyms and Glossary of Terms version 1.0 PHAB Fee Schedule ( ) Fact Sheet PHAB National Public Health Department Accreditation Documentation Guidance Version 1.0 PHAB National Public Health Department Accreditation Readiness Checklists Version 1.0 PHAB Standards and Measures Documentation Selection Spreadsheet Version 1.0 (Excel) e-PHAB SOI Information e-PHAB Application Information Video Instructions for Site Visits at Version 1.0 Errata released 12/22/11 41

Public Health Performance Management Centers for Excellence Funded by CDC’s National Public Health Improvement Initiative What comments and questions do you have? 42 Torney Smith (509) Susan Ramsey