1. Hot Topics in Preparedness Casey Milne & Tom Milne Milne & Associates, LLC January 20th, 2005 Improving Public Health Preparedness

2.  Milne & Associates, LLC Objectives for today’s session Explain how improvement is a natural part of public health preparedness (not an extra) Identify an improvement process Apply improvement principles to emergency preparedness Describe resources (including colleagues) that could help you in improving your community’s preparedness Identify your next step

3.  Milne & Associates, LLC Question… A) formal, active and effective B) non-existent C) informal, sporadic and somewhat effective D) formal, inactive and ineffective Within my PH agency/system our quality improvement efforts can be best described as:

4.  Milne & Associates, LLC State-Local PHS LPHA LPHS Management Leadership Practice National PHS National PHS Global PHS Global PHS Outcome StructureProcess Model for Improvement

5.  Milne & Associates, LLC Question… A) differences between standards and actual practice B) examples of best practices C) examples of lower cost/more productive programs D) all of the above Which of the following help give focus to improvement efforts:

6.  Milne & Associates, LLC Areas to focus improvement efforts Where there are differences between standards, science and practice Identified recommendations from performance assessment (e.g. NPHPSP) Gaps in current practice from evidence-based and/or scientific knowledge Published evidence (3-4 articles) Where examples of better performance exist At least one “sentinel” organization Where others are achieving lower costs and/or improved outcomes

7.  Milne & Associates, LLC Getting Started Identify & describe the problems! Ask users, partners & providers for feedback, review competencies and essential services Draft “Charter” to guide and lead improvement work Secure & use mentors/experts/facilitators Find colleagues interested in improvement; identify team Day-to-day leadership Technical expertise (clinical & measurement) System leadership

8.  Milne & Associates, LLC Charter The Charter guides and leads improvement efforts for an individual, a team, a county, a state, a nation or globally Vision Mission Operational principles Description of the problem Stretch goals Targeted & measurable objectives Matrix of changes & related key measures

9.  Milne & Associates, LLC Starting the cycle of improvement Set an objective or aim Select 1-2 simple measures & measure consistently Begin with easy/small actions/changes most apt to meet objective (improve practice) Begin, start small, measure and grow Secure support of senior leadership- keep them updated of progress, results and lessons learned Cycle of Improvement

10.  Milne & Associates, LLC Using Data for Quality Improvement “There must be a better way to make decisions.”

11.  Milne & Associates, LLC Examples of Measurable Objectives All communities within the jurisdiction are covered with a BT plan and are included in exercises on a prescriptive basis. 100% of LPHA in the state are certified as Public Health Ready. All community players are involved in BT preparedness practices, elected officials are present and involved.

12.  Milne & Associates, LLC Question… A) measurement should become a daily routine B) all change leads to improvement C) improvement occurs as a result of change D) measures need to reflect improvement Which of the following statements about measurement in improvement efforts is NOT TRUE?

13.  Milne & Associates, LLC Tips on Measurement Measures should monitor an outcome that benefits those receiving service, contributes to health status, public health competencies, essential services, etc. Include measurement into daily routines Improvement occurs as a result of change All change does not lead to improvement Measures need to reflect the improvement Measures are used to guide improvement Not judgment Not research

14.  Milne & Associates, LLC What gets MEASURED Remember gets DONE !

15.  Milne & Associates, LLC Steps in Performance Improvement 1. Organize participation for performance improvement Identify improvement team Develop Charter and identify structure Ensure leadership support and accountability 2. Identify gaps between actual and desired performance Gaps in “doing it” and “doing it well” For example:  Low scores on EPHS 2 (Diagnose & Investigate), 2.2.2.4 Identify community assets that can be mobilized to respond to an emergency  Low score on CDC performance goals, measure 13, timeliness of response to disease reports

16.  Milne & Associates, LLC 3. Prioritize areas for action Low hanging fruit (what’s working elsewhere?) Factored in size of the gap, resource potential, political interest, workforce proficiency, and current intentions to improve 4. Summarize challenges and opportunities (analyze root causes of performance problems in system) Information, including expectations and feedback Materials and resources Methods (processes) Knowledge and skill Incentives, consequences Steps in Performance Improvement

17.  Milne & Associates, LLC 5. Develop improvement plans Specific targets Strategies that address root causes Define accountabilities 6. Implement and manage results Carry out change on small scale Report & analyze effects of change Act on what was learned Keep at it ACTPLAN DOStudy Steps in Performance Improvement

18.  Milne & Associates, LLC Identifying changes that improve practice Consider innovation from sentinel practices Use existing successes and knowledge Get feedback from users, partners & providers Look for and adapt to local needs and conditions Listen for and consider building on lessons learned from other colleagues and partners Be strategic: prioritize changes and action based on the objectives, known problems, and what’s possible Stay in alignment with the over arching goals of the organization and community

19.  Milne & Associates, LLC PD SA PD SA Site Visits & Coaching PD SA * * Monthly 1 page reports Distance Learning & Learning Sessions * * Web Conferencing, Email & Support PD SA PD SA PD SA Plan > Do > Study > Act * * * * ** PD SA

20.  Milne & Associates, LLC Inspiring & Leading Improvement 34% Early Adopters 16%2.5% Innovators 00 + sd 0 - sd0 - 2sd 13.5% Early Majority Late Majority Laggards What can we do to create more innovation & change leading to improvement in public health practice?

21.  Milne & Associates, LLC Question… A) innovator B) early adopter C) early majority D) late majority When it comes to creating innovation and change, I would describe myself as a:

22.  Milne & Associates, LLC You’re not on the road to improvement when you… Study the problem too long Wait for everyone’s buy-in (or permission) Educate without changing expectations or systems Measure everything Measure nothing Don’t build support for change and improvement Settle for the status quo

23.  Milne & Associates, LLC Turning Point Performance Management National Excellence Collaborative Source: Turning Point Performance Management Collaborative, From Silos to Systems: Using Performance Management to Improve the Public’s Health, March 2003. Model of a performance management system

24.  Milne & Associates, LLC Question… Where would you start if you wanted to begin an improvement effort for your system’s public health preparedness? What is your next step?

25.  Milne & Associates, LLC

26. For additional details contact: Milne & Associates, LLC Casey Milne, Tom Milne 262 NW Royal Blvd Portland, OR 97210 503 203-1025 (Phone) 503 203-1026 (Fax) casey.milne@comcast.net tom.milne@comcast.net