ADVERSITY, QI, AND ACCREDITATION: 18 MONTHS AFTER A PUBLIC HEALTH “TOTAL MAKE-OVER”Paul Khuenert, MS, RN, Public Health Team Director, Robert Wood Johnson Foundation

Adversity, QI and Accreditation: 18 months after a Public Health

‘Total Make-Over'

Paul Kuehnert MS, RNPaul Kuehnert MS, RN

(Former) County Health Officer & Executive Director(Former) County Health Officer & Executive Director

Kane County, IllinoisKane County, Illinois

Public Health Team DirectorPublic Health Team Director

Robert Wood Johnson FoundationRobert Wood Johnson Foundation

“Sweet are the uses of adversity,Which, like the toad, ugly and venomous,Wears yet a precious jewel in his head.”

-Wm Shakespeare

Today’s Presentation

• Background and Context

• Recession of 2008

• Impact on Kane County Health Department

• Strategic Response: 2010 ‘Total Makeover’

• Transfer MCH personal health services

• 50% RIF, Re-organization

• Results to date

• Fiscal

• MCH Services

• Population health

• QI & Accreditation

Kane County, Illinois

• 515,000 residents

• 2nd & 5th largest IL cities

• 70% urban/suburban, 30% rural

• 1/3 of residents are Hispanic

• Second youngest county in Illinois

• Fastest growing segment: 45-64 year olds

Kane County Health Department

• Established by resolution in 1985

• Governance: County Board of 24 & County Chairman

• Annual Budget: $6 Million 62 FTEs

The Problem

The current recession has reduced tax revenue while increasing service demands for

governmental public health

KCHD at Crossroads: June 2010

• Illinois has both cut grants and set a policy of late payment to vendors, including local government

• KCHD has lost $1m in state grant revenue & experienced payment delays up to 200 days

The Opportunity

The recession and the state fiscal crisis demand a strategic organizational response from the Kane

County Health Department

The Strategy

Transform the Kane County Health Department to completely focus on population health:

• Transfer direct client services to 3 FQHCs

• Reduction in workforce by 50%

• Re-organization using PHAB standards as framework

2010 Agency Reorganization

THEN:

•120 FTEs

•50% grant-funded

•Budget: $10 million

•Focus: Mixed, individual-level programs and services &

• population

• focused

NOW:

•60 FTEs

•20% grant-funded

•Budget: $6 million

•Focus: Population-focused health, 10 essential services

•All job descriptions include: QI, population focus, essential services, preparedness & response

New Capacity

New Job Descriptions & Capacity

Re-org Results So Far…

1. Financial sustainability

2. Impact on MCH services

3. Population focused practice

4. QI & Accreditation

1. Financial Sustainability

Financial Sustainability

KCHD CFY 2010 Revenue: $8,882,749

Expend.: $9,536,488

($653,739)

(~50% from Grants)31 total grants26 state grants

122 FTES

KCHD CFY 2011:Revenue: $6,683,413 Expend.: $6,272,263

$411,150

(~20% from Grants)21 total grants17 state grants

60 FTEs

Financial Sustainability

Our FY12 budget:

•Slight increase to revenues

•Added 2.0 FTES

•Projected 2% positive margin

2. Impact on MCH Services

Quarterly Reports: www.Kanehealth.com

Quarterly Reports: www.Kanehealth.com

3. Population Focused Practice

New capacity led to new community assessment and planning process in Kane in 2011-12:

1.Formal partnership with 5 hospitals, mental health board, 2 United Ways~~~additional $$ resources

2.Integrated planning and policy development with County Development and Transportation Departments

3.Alignment: policy, systems & environmental change

2011 Community Health Assessment &Improvement Planning

Why?•Efficient resource use: 9 Kane County agency partnership•KCHD reorganization>>>capacity•Alignment around health needs & priorities

What?•Comprehensive two-part report

• Assessment• Improvement Plan

•9 customized reports•Health integrated in Kane 2040 Plan•Web-based data and source reports

Why?•Efficient resource use: 9 Kane County agency partnership•KCHD reorganization>>>capacity•Alignment around health needs & priorities

What?•Comprehensive two-part report

• Assessment• Improvement Plan

•9 customized reports•Health integrated in Kane 2040 Plan•Web-based data and source reports

Population Focused Practice

4. QI & Accreditation

QI Training Needs

Use of QI Tools

Staff Interest/Engagement

2010-2011 QI Projects

Division/Team Project

OCHR, CHR Section Improve response rates of employee call-down drills.

DP, PHN Section Improve rates of initial high risk infant follow-up visits within compliance levels.

OCHR, Admin Section Improve structured spending of grant funds.

HP, Environmental Health Section

Decrease critical food inspection violations (to decrease instances of FBI).

HP, Community Health Section

Improve pre & post meeting communication in Community Health

DP, Communicable Disease Section

Improve collection & reporting of immunization data

DP, Immunization Section Improve rate of immunization competence for PHNs

KCHD Leadership Team Improve KCHD financial management

Project Results (So Far!)

• Employee call-down drill rates increased from 36% to 88%.

• Vaccine accountability increased from 92% to 100%, decreased from 3 data systems to 1.

• PHNs “competent” (Benner) in delivering immunizations increased from 25% to 100%.

• Awareness of CH meetings and of partnership increased from ~60% to ~90%.

Accreditation Committee & Workgroups

• COMMITTEE

• 16 Leadership Team Members

• 8 CHS-III staff

• CHS-I & CHS-II staff as support, as needed

• WORKGROUPS

• 1 per domain

• Lead: Leadership staff expert (in that area)

• Support: CHS-III staff, Leadership team

– CHS-III: No more than 2-3 domains

PHAB Application Accepted: May, 2012

“Sweet are the uses of adversity,Which, like the toad, ugly and venomous,Wears yet a precious jewel in his head.”

-Wm Shakespeare

Robert Wood Johnson Foundation

Route 1 and College Road East,

P.O. Box 2316,

Princeton, NJ 08543

pkuehnert@rwjf.org

Phone: 609-627-6319

Paul Kuehnert Senior Program Officer & Team Director, Public Health Team

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