1. Using the NPHPSP for Performance Improvement
Stacy Baker, MSEd
Director of Performance Improvement
Public Health Foundation
Session , Nov. 5, 2007, 2:30 – 4:00 PM

2. Let’s Focus on Results Learning Results of the Assessment
Achieving Results ─ Next Steps for Performance Improvement

3. NPHPSP Reports for “Version 2”
Jurisdiction Name
Date
Obtain User ID
Enter data online
Generate report

4. Obtain User ID

5. Enter Data Online

6. Generate Report www.nphpsp-results.org Visit “Report Center Check
Status of modules
Name
Generate report (RTF)
Download raw data (CSV)

7. NPHPSP Reports for “Version 2”
Jurisdiction Name
Date
Types of Reports
State PH System
Local PH System
Local Governance
Aggregate reports for statewide users
All locals or boards in state
State-local comparison

8. NPHPSP Reports for “Version 2”
Performance Assessment Instrument Results
All reports answer three questions:
I. How well did the (public health system/board) perform the ten Essential Public Health Services (EPHS)?
II. How well did the (public health system/board) perform on specific areas of each Essential Service?
III. Overall, how well is the (public health system/board) achieving optimal activity levels?

9. NPHPSP Reports (Example) I. How well did the board perform the ten EPHS?
Figure 3: Rank ordered performance scores for each Essential Service, by level of activity

10. NPHPSP Reports (Example) II
NPHPSP Reports (Example) II. How well did the board perform on specific areas?
Figure 4: Performance scores for questions within each model standard/ Essential Service
Users receive one bar chart for each Essential Service/model standard. For the governance report, each bar represents a stem question. For the state and local assessments, each bar represents a model standard within the EPHS.

11. NPHPSP Reports (Example) III
NPHPSP Reports (Example) III. Overall, how well is the board achieving optimal activity levels?
Figure 6: Percentage of all questions scored in each level of activity

12. NPHPSP Reports – Optional Modules
Optional Priority Rating Results:
What are potential areas for attention, based on the priority ratings and performance scores?
Optional Agency Contribution Results (State or Local):
How much does the (Local Health Department/State Public Health Agency) contribute to the system’s performance, as perceived by assessment participants?
Jurisdiction Name
Date

13. Priority Rating vs. Performance
Quadrant I ─ May need increased attention
Quadrant II ─ May be important to maintain efforts
Quadrant III ─ May shift or reduce some resources or attention to focus on higher priority activities
Quadrant IV ─ May need little or no attention at this time
Perceived
Priority
(1-10)
High I
High Priority
Low Performance II
High Performance
Low IV
Low Priority
III
Current Level of Performance
(1 – 100)
Source: NPHPSP User Guide

14. Priority Rating Results (Example)
Quadrant I (High Priority/Low Performance) ─ May need increased attention
Quadrant II (High Priority/High Performance) ─ May be important to maintain efforts
Quadrant III (Low Priority/High Performance) ─ May shift or reduce some resources or attention to focus on higher priority activities
Quadrant IV (Low Priority/Low Performance) ─ May need little or no attention at this time
Figure 8: Scatter plot of Essential Service scores and priority ratings

15. Priority Rating Results (Example)
Table 4: Model Standard by priority and performance score, with areas for attention
Essential Service
Priority Rating
Performance Score (Level of Activity)
Quadrant I (High Priority/Low Performance)
These important activities may need increased attention.
5.2 Public Health Policy Development 9
25 (Minimal)
5.3 Community Health Improvement Process 10
Quadrant II (High Priority/High Performance)
These activities are being done well, and it is important to maintain efforts.
1.3 Maintenance of Population Health Registries
100 (Optimal)
6.3 Enforce Laws, Regulations and Ordinances
Quadrant III (Low Priority/High Performance)
These activities are being done well, but the system can shift or reduce some resources or attention to focus on higher priority activities.
3.1 Health Education and Promotion 7
3.3 Risk Communication 6
Quadrant IV (Low Priority/Low Performance)
These activities could be improved, but are of low priority. They may need little or no attention at this time.
8.1 Workforce Assessment, Planning, & Development 4
8.2 Public Health Workforce Standards

16. Building Systems to Achieve Health
How can we “find the gold” among the standards & results? Which could be drivers of our health outcomes?
What’s the shortest path…
FROM THIS TO THIS ?

17. Coordination with MAPP
Use of NPHPSP within MAPP
Provides the context of health and priorities needed to interpret system results
Anchors system changes to strategic and measurable health improvement

18. 5 Steps for Performance Improvement
Organize participation for performance improvement.
Prioritize areas for action.
Explore “root causes” of performance.
Regularly monitor and report progress.
Develop and implement improvement plans.
Source: NPHPSP User Guide

19. Thinking about System Improvement
Every system is perfectly designed to achieve exactly the results it gets!
─Deming

20. Thinking about System Improvement
What kind of system do you need to achieve the results important to your state or community?

21. Why isn’t this done (or solved!) already?
The case for pausing to examine “root causes” of public health performance issues

22. Source: NPHPSP Users’ Guide, 2006
Why isn’t this done (or solved!) already?
Two Jurisdictions: Same Performance, Different Reasons
Low Score on “Essential Public Health Service 10”
(Research for New Insights and Solutions to Health Problems)
Jurisdiction A
Jurisdiction B
Reasons for Low Score
No university or research institution nearby
Don’t know how to link with research institutions, despite leader-ship interest
No leadership support for research with local universities
No incentives for organizations or staff to identify innovations
Source: NPHPSP Users’ Guide, 2006

23. Source: NPHPSP Users’ Guide, 2006
Why isn’t this done (or solved!) already?
Two Jurisdictions: Same Performance, Different Reasons
Low Score on “Essential Public Health Service 10”
(Research for New Insights and Solutions to Health Problems)
Jurisdiction A
Jurisdiction B
Potential Improvement Actions
Identify out-of-town research partners
Access sample academic-practice linkage agreements
Meet with leaders to show benefits to local priorities
Recognition and grant incentives for innovative solutions
FROM USERS’ GUIDE
Source: NPHPSP Users’ Guide, 2006

24. Successful Improvement Efforts Analyze and Address “Root Causes”
Why can’t we make progress on ______________?
Is it because of:
Methods / procedures
Motivation / incentives
Materials / equipment
People (personnel, partners, providers, or patients)
Information / feedback
Environment
Policy
One of the key concepts in QI is to examine and address root causes of problems
Value systems thinking
Pause to consider what is causing a problem in the first place
Before deciding what the solution will be
We simply don’t do this enough in public health.
Fill in the blank: Why can’t we make progress on _____________? (speeding up purchase orders, obesity, having a regular state health profile)
There are tools to examine these, as well as prioritize places to delve deeper.
What if you filled in the blank with “spreading QI practices?”

25. What it Takes to Improve
2005 Study: Characteristics of Public Health Systems Engaged in Performance Improvement
After NPHPSP Assessment
Leadership support
Ability to find, use, or hire expertise
Partnerships/involvement of community
Small steps toward system improvements
Experience with multiple, related efforts MAPP, accreditation program
Regular PI meetings with feedback
Data from PHF interviews in 2005 with NPHPSP users believed to engage in performance improvement efforts.
Source: Public Health Foundation, 2005.

26. NPHPSP Improvement Resources
User Guide
Post-Assessment Toolkit
Monthly User Calls
MAPP Clearinghouse
Personalized technical assistance
Searchable Online Resource Center

27. Tips Start with a vision for what’s next after assessment
Get started – action trumps nice write-ups
Set priorities – and put aside the rest
Ask why the system is this way
Find something to measure
Do we need to do it? Or do it well?
How do we know if it’s getting better?
Plan-Do-Check-Act

28. “When you come to a fork in the road, take it."
―Yogi Berra