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 132nd Annual MeetingSession 3247

Washington, DC

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

Structuring a Performance Standards Process

Liza Corso, MPA

Centers for Disease Control and Prevention

NPHPSP Partners

CDC, APHA, ASTHO, NACCHO, NALBOH, NNPHI, PHF

Assessment Instruments State public health system Local public health system Local governance International

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

Indicator

ModelStandard

Measures

Essential Service

Instrument Format

Measures

SummaryQuestions

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

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

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.

Structuring Participation:Different Approaches

Retreat (1 – 2 days)

Small Group Activities

Series of Meetings

Retreat Generally 1-2 days Advantages:

Short timeframe Maintains momentum

Drawbacks: Requires time commitment Can be overwhelming

Small Group Activities Advantages:

Allows for expertise, as needed Less overwhelming

Drawbacks: Less cross-learning Less consistency in response

development

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”

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

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

Statewide Activities

Pilot / Field Test States Currently using or planning for use statewide

Lessons Learned through the Use of the NPHPSP Performance

AssessmentEvelyn A. Knight

F. Douglas ScutchfieldAnn V. Kelly

Michelyn W. BhandariMiriam Fordham

University of Kentucky College of Public Health

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

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

Results Why complete the assessment? Planning the assessment Planning for facilitation Recruiting system partners Planning assessment sessions Planning for performance

improvement Benefits of assessment

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

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

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

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

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

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

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

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

The National Public Health Performance Standards

Resources to Assist Users

Chris KinabrewNational Network of Public Health Institutes

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

NPHPSP Activities

Training Workshops Statewide Kickoffs User Teleconferences Ongoing technical assistance

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

Statewide Kickoffs

Colorado New Mexico Florida

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

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?

Exercise

“The Local Public Health System and the Essential

Services”

Scott Fisher, MPHNational Association of County and City Health Officials

Questions?

Please stay tuned for additional info re 3rd Annual Training Workshop in

Spring 2005