1. Public Health Performance Improvement: How National Performance Standards Make the Difference (Part II) Got Skills? How To Build Your Public Health System Performance Assessment APHA 132 nd Annual Meeting Session 3247 Washington, DC

2. Recap of Session I Session II Objectives  identifying the benefits of using the performance standards  learning different methods for structuring the assessment process  gaining knowledge on using assessment results for performance improvement

3. Structuring a Performance Standards Process Liza Corso, MPA Centers for Disease Control and Prevention

4. NPHPSP  Partners  CDC, APHA, ASTHO, NACCHO, NALBOH, NNPHI, PHF  Assessment Instruments  State public health system  Local public health system  Local governance  International

5. Four Concepts Applied in NPHPSP 1. Based on the ten Essential Public Health Services 2. Focus on the overall public health system 3. Describe the “gold standard” for performance 4. Results drive performance improvement

7. Indicator Model Standard Measures Essential Service Instrument Format

8. Measures Summary Questions

9. Key Steps in the Process  Identify, recruit and orient participants  Complete the instrument  Use facilitators and recorders  Gain consensus responses  Submit responses to CDC  Discuss CDC report with participants  Determine challenges and opportunities  Develop and implement improvement plans

10. Identifying Participants  Key questions:  Who plays a role in the public health system?  Who provides the Essential Services?  What broad, cross-sector participation is needed?  What consumers can be included?  Who else needs to be included (e.g., to assure expertise in certain areas)  How many people should participate?  Ensure consistency or a core group among respondents

11. The “Public Health System”  More than just the public health agency  “Public health system”  All public, private, and voluntary entities that contribute to public health in a given area.  A network of entities with differing roles, relationships, and interactions.  All entities contribute to the health and well-being of the community.

12. Structuring Participation: Different Approaches  Retreat (1 – 2 days)  Small Group Activities  Series of Meetings

13. Retreat  Generally 1-2 days  Advantages:  Short timeframe  Maintains momentum  Drawbacks:  Requires time commitment  Can be overwhelming

14. Small Group Activities  Advantages:  Allows for expertise, as needed  Less overwhelming  Drawbacks:  Less cross-learning  Less consistency in response development

15. Series of Meetings  Advantages:  Allows for expertise, as needed  Gets the work done in small pieces  Drawbacks:  Participation changes with meeting attendance  Process may seem to “drag on”

16. Approaches in Determining Responses  Walk through questions one by one  Discuss the model standard with facilitator/recorder judgment on responses  Discuss model standard with follow- up voting

17. Coordinated Statewide Process  Use of multiple NPHPSP instruments in a coordinated approach  Benefits:  Coordinated orientation, training, and technical assistance opportunities  Aggregate reports of assessment results  Coordinated improvement planning

18. Statewide Activities Pilot / Field Test States Currently using or planning for use statewide

19. Lessons Learned through the Use of the NPHPSP Performance Assessment Evelyn A. Knight F. Douglas Scutchfield Ann V. Kelly Michelyn W. Bhandari Miriam Fordham University of Kentucky College of Public Health

20. Method  First step in three phase project  1-1.5 hour interviews with state and local users selected to represent broad cross-section of users  10 state assessment users  12 state coordinators of local assessments  5 local assessment users  Incorporated results of earlier study of 9 local public health systems in Kentucky

21. Interviews with users  Description of public health system in state or local area  How performance assessment carried out  Benefits/barriers of carrying out the performance assessment

22. Results  Why complete the assessment?  Planning the assessment  Planning for facilitation  Recruiting system partners  Planning assessment sessions  Planning for performance improvement  Benefits of assessment

23. Why complete the assessment?  State and Local Assessment  Initiated coordinated quality improvement process for state and local levels  Local Assessment Only  Part of MAPP process; extension of Turning Point activities  Statewide effort to assess level of public health performance across all jurisdictions; justify need for full time staff in all jurisdictions  State Assessment  Initiate coordinated planning across the state  To educate state health department staff

24. Planning the Assessment  Allow for steep learning curve inside the sponsoring organization  Consider carrying out a trial assessment inside the sponsoring PH agency  Take advantage of training and technical assistance –Partners websites  Plan for training and orientation of assessment leaders and facilitators  Keep performance improvement in mind

25. Planning for facilitation  Professional facilitation can help, but not necessary if training available  Have a plan for coming to consensus  Capture key issues for later discussion  Facilitators and recorders MUST be neutral  Pacing is imperative, which can be difficult for less experienced facilitators

26. Recruiting System Partners  Build on existing relationships—establish a steering committee a la MAPP  If existing relationships are thin, allow more time and effort for recruitment  Help potential new partners see their public health role  Be selective

27. Planning assessment sessions  Carefully orchestrate assessment retreats  Single or multiple  If multiple sessions are used, do not extend out over too long a time period  Divide the group or not….both seem to work  If divided, assure good representation across EPHS groups  Provide some advance orientation as well as at the assessment itself

28. Planning for performance improvement  Consider how results will be used  How to share with partners  How to prioritize EPHS – develop importance ratings  How to gather supporting information  Revisit the model standards and the instrument  Know who will be responsible  PR

29. Benefits of Assessment for PH System Performance Improvement  Building knowledge and greater understanding of public health across the community/system  The conversation and system learning  Identifying system strengths and areas to be changed  Establishing new networks  Building system identity

30. Summary  Plan the assessment process to:  meet your system’s needs  transition into a performance improvement process  Greatest benefits include  Education about public health  Sharing and networking  Building the public health system

31. The National Public Health Performance Standards Resources to Assist Users Chris Kinabrew National Network of Public Health Institutes

32. Useful Products from NPHPSP Partners  Assessment Instruments (online, binder, standards only)  User Guide  Frequently Asked Questions  Reports with data  For each respondent  Aggregate statewide data  Tri-fold brochures  Posters  Performance Improvement Resources available at http://www.phf.org/Tools-Resources.htm#NPHPSP

33. NPHPSP Activities  Training Workshops  Statewide Kickoffs  User Teleconferences  Ongoing technical assistance

34. Training Workshops  Annual event  Topics covered include:  Orientation to 10 Essential Services  Using the Instruments  Coordination of Statewide Approach  Facilitation and Consensus Building  Data Submission and Reports  Developing and Implementing Improvement Plans  CD-ROM from April, 2004 workshop available  Sign up now for info re Spring, 2005 training workshop

35. Statewide Kickoffs  Colorado  New Mexico  Florida

36. NPHPS User Network  Monthly conference calls with:  Jurisdictions that have completed assessments  Interested Parties  Partner organizations  Sharing information about:  Implementation Strategies  Performance improvement processes  Tools  Resources

37. Questions to Consider  How does our state/local public health structure affect our planning?  Which tools do we want to use?  What leadership can sponsor the process and create buy-in?  What approaches will be most successful?  Should this connect with other current or past activities?  What resources exist to support the effort?

38. Exercise “The Local Public Health System and the Essential Services” Scott Fisher, MPH National Association of County and City Health Officials

39. Questions? Please stay tuned for additional info re 3 rd Annual Training Workshop in Spring 2005