Accreditation – A Driver for Change Elissa J. Bassler, CEO Illinois Public Health Institute MLC Grantee Meeting February 3, 2010

Illinois Certification Illinois Dept. Public Health certifies LHDs –8 practice standards Deliverables: Community Health Assessment, Community Health Plan, Organizational Assessment/Strategic Plan Certain state funding contingent upon achieving certification

From Certification to Accreditation Overlap in foundational elements: assessment, planning, and strategy Overlap in vision: health, wellness, efficiency, accountability, and best practices Illinois LHDs’ experiences with certification pave the way for a LHDs to seek and obtain accreditation

Key Principals In Illinois Accreditation (either Illinois program or PHAB) is voluntary; LHDs have state certification option: Choices Strengthen infrastructure/contribute to QI Minimize economic burden/provide adequate financial resources Achievable regardless of size (w/ high standards) Stakeholder/participant driven 4

MLC – Testing Accreditation In Illinois Illinois Accred. standards measures and process – using Illinois certification standards & operational definition Pilot, evaluation, revision of measures –Certification standards PHAB Domains –Crosswalk to PHAB measures Illinois “equivalent” to PHAB?

Decision Point – Illinois or PHAB State action/direction needed “Deeming” of accredited LHDs – –Illinois program? PHAB? –One or the other or either? 6

Decision Point – Illinois or PHAB Deemed certification foundational for uptake (LHDs: “only one process”) Certification = assurance Accreditation – Rigorous, includes Cert. components State review of accreditation; decision on deeming Keep Illinois at the forefront of PH practice 7

Decision Point – Illinois Program or PHAB Assuming: PHAB recognition; deeming: Decision criteria -- 3 categories –Cost/resources: To LHDs; at state level –Leadership/will: Administration buy-in and promotion; energy & effort; “slippery slope” concerns; local voice; state-level analog –Best uptake: Labor/effort & costs, value to external customers, QI results; relevance 8

Illinois – Poised for Accreditation Illinois state and locals: poised for accreditation/could be national leader –State health assessments & State Health Improvement Plan; strategic plan? –Certification: IPLAN = community health assessment; community health plan; org. assessment or strategic plan Years of learning through MLC – accreditation and QI 9

10 Step UP to the OSDH Performance Management System: Accreditation is Driving Change in Oklahoma Step UP “Strategies toward excellent performance----Unlimited Potential” Oklahoma State Department of Health Performance Management System

11 Goals Of Step UP  Comprehensive, sustainable performance management system  Periodic and uniform measure of those indicators most important to success  Alignment of strategic initiatives  Trained staff in key public health/QI concepts  Accountability to stakeholders  Data –driven decision making  Institutionalization of quality improvement  Preparation for Accreditation

12 Development of StepUP Poor Health Outcomes/ Inconsistent Monitoring Expert Meeting Develop Framework & Changes Pilot 1 Pilot 2 Pilot 3 Implementation, Spread and Sustainability Step UP DesignElectronic Form Test Online Pilot Holding the Gains

13 The Step UP Performance Management System is a web-based application that will centralize data collection.

14 Nat’l & OK Framework Overview Strategic Plan Action Plan Annual Review Five Stages of Step UP Application * 5 Stages * 3 Templates

15 Public Health Alignment & Overview Template  Alignment to Oklahoma & Nat’l Framework  County Demographic Information or Service Target Population Information  Customer Satisfaction  Community Assessment  Mandates  Funding Sources  FTE

16 Strategic Plan Template  2-5 Goals  2-5 Objectives  1-5 Performance Measures  Baseline  Target and Trend Information  Data Sources and Formulas  Alignment to Strategic Map

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18 Sample Action Plan

19 Annual Review Template  Report Actual Data to Target  Scorecard  Barriers/Lessons Learned  Success Factors

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21 Step UP: a cycle of Plan-Do-Check-Act (PDCA) Set Standards Quality Improvement Reporting Measure Performance Plan Do Check Act Set action plans and begin implementation How did it go? Adopt/modify/drop based upon data & report results

22 Accreditation: A Driver for Change  Redesign of Step UP system elements  Tie improvement planning, assessment, and strategic planning through Step UP  Standardized improvement planning and assessment for CHDs/service areas

23 Accreditation: A Driver for Change  Tie to core measures throughout state services and county health departments  Cross-cutting STAT teams  Senior Leadership & Board involvement

24 Accreditation: A Driver for Change  Alignment of resources  Tie to individual performance appraisals  Institutionalize QI

25 Transitioning to Accreditation in Washington State February 2010 Rita Schmidt, DOH

26 Local Health Agencies/Population Served Adams Benton- Franklin Health District Chelan- Douglas Health District Clallam Clark Columbia Cowlitz Garfield Grant Island Jefferson Kitsap Kittitas Klickitat Lewis Lincoln Mason Northeast Tri- County Health District Okanogan Pacific San Juan Skagit Skamania Snohomis h Spokane Pierce Thurston Wahkiakum Walla Whatcom Whitman Yakima Grays Harbor Asotin Chelan Douglas Ferry Stevens Pend Oreille Benton Franklin 18,000 21, ,300 72,600 69, ,200 4,100 99,600 37,600 7,800 72,700 2,250 86,100 71,200 29,000 King 39,900 20,200 75,200 10,450 40,500 21,800 12, , ,900 10, , ,000 44,000 4,100 16,300 59, ,100 43, ,400 Washington State Total Population as of June 2009 – 6,668,200 Office of Financial Management Official 2009 Population Estimate 249,800 56,800 80, ,600 1,909,300 Washington State Local Health Jurisdictions 1

27 3 Washington State Standards Process Developed collaboratively by local and state public health agencies in 1999 Used every three years to review the performance of the public health system in Washington Baseline measurement in 2002 Re-measurements in 2005 and 2008 Public Health Improvement Leadership-1993

28 4 Benefits of Washington’s Process Provides a system-wide snapshot Common language Create common expectations o What every person has a right to expect Capacity measures Site performance measureable over time

29 5 Standards for Public Health in Washington

System-wide Review Overall system report Individual site and special reports What we learned o Relationship of budget and FTEs to overall performance is nearing random (little or no correlation) Significant improvement over time

31 9 Comparison to Accreditation Washington System System-wide snapshot Specific QI recommendations Full participation Full disclosure of scores Accreditation County by county Pass or fail Confidential scores

32 10 Washington Challenge Transition to accreditation Maintain our statewide results Maintain participation Make the process useful for Washington

33 11 Decision Making Tools Assessment of Washington process – comparison to accreditation Crosswalk of Washington standards with PHAB standards Communication plan o PHAB standards o Our options

34 12 Our Options Continue our process without adjustments End the Washington process Develop an accreditation process Blend of PHAB and Washington process to prepare for accreditation

35 13 Discussions about Accreditation Presentations to Washington State Association of Local Public Health Officials Health Officers and Administrators Nursing and Environmental Health Directors State Board of Health Review and vet the PHAB standards PHAB Director, Kaye Bender, invited for special session

36 16 Participation in Beta Test All sites in Washington encouraged to participate State health agency and several local health agencies submitted applications State health agency selected Site visit in June of 2010

37 14 Revisions to the Public Health Improvement Partnership (PHIP) Structure Focus on governmental health agencies Smaller more focused committees and structure Change Public Health Improvement Plan focus o Public Health Assessment Improvement Plan Performance Management Committee o Standards and measures o Accreditation support

38 15 Revisions to the Standards Permission from PHAB to use the PHAB standards for Washington review o 80% of Washington measures align Include the Washington standards and measures that were not part of the PHAB standards Optional standards – those PHAB standards that were not part of the Washington reviews in the past

39 17 Revisions to the Process Results of the DOH Beta Test as the Washington review for DOH o All PHAB standards plus Washington standards and measures Schedule local health reviews for Spring of 2011 o Optional PHAB standards and measures Use all results to prepare for accreditation

40 18 State Agency Preparation for Beta Test Agency preparation assigned to Performance and Accountability Manager, Susan Ramsey Training with key staff Standards team o Every division represented o Work session monthly o Mock reviews Use electronic collection of documentation o Mind Manager

41 19 The New Washington Standards Process for Use trained staff as reviewers for local health in 2011 Sites will have the information to prepare for accreditation Results will give sites information for next cycle, or for accreditation preparation Washington will have state-wide results – “snapshot” of the state Washington will have recommendations for the public health system

42 Additional Changes Sites required to submit materials ahead of time 60% of Measures must have documentation to get a site visit Much of the review will be done offsite DOH is rethinking the Public Health Improvement Plan

43 20 Our Goal A predictable level of public health protection throughout the state “What every person has a right to expect.”

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