LISA SWANSON, ENVIRONMENTAL HEALTH OFFICER

BLACK HAWK COUNTY HEALTH DEPARTMENT

WATERLOO, IOWA

COHORT IV GRADUATION FEBRUARY 24th, 2009

Evolving the Mindset: Public Health Data Management at

the Local Level

Project Background

Black Hawk County, Iowa Population ~128,000

Health Department, recently reorganized Enforcement, Surveillance & Preparedness Schools, Outreach and Clinic Health Promotion, Planning & Development

Environmental Health Department 9 County region 9 Health officers

Project Background

• Transition from paper based to digital record keeping• Focus on daily workflow, not “big picture”• Each department manages data pertaining to their programs in isolation from the other departments and agency

Problem Statement & Focusing Questions

Focusing Questions:   Why don’t we have a system in place for

management of public health data that can effectively respond to our questions in a timely and flexible manner?

  Problem Statement

No system is in place to ensure that public health data is managed to most effectively support the

Department’s functional decision-making and future data.

Key Variableso recognition of needo amount of data generatedo number of events that require data managemento willingness to collaborateo number of decisions that are based on real datao funding opportunities that require measurabilityo number of programs that require data

sharing/coordinationo complexity of generating necessary statisticso security/protection issues with sensitive

informationo current level of inefficiencyo duplication of efforto timeliness and ease of accessibilityo ability/flexibility to update

Behavior Over Time

Causal Loop Diagram

Long term: Commitment/investment in data management planning.

Step 2

Step 1

Step 3

Quick fix: Put together stand alone database and tables to address specific data needs as they arise.

Same Direction Causal Relationship

Opposite Direction Causal Relationship

B

B

RPressure to access data needed for

decision making.

PLANNING

Complexity of data manageability (impacts adapting)

Fragmented data - program silos of information

Effort required making changes in the system

Breaking out of “Business as Usual”

PATH OF LEAST

RESISTENCE

Breaking down old mind-setso we don’t have time for this….o what is wrong with how we always do it?o we need a solution fast!o there are no resources to change now…o this data is only important to my programRecognize the Consequences of Inaction

o fragmented silos of informationo system complexity becomes a barrier to flexibility/accessibility

Logic Model

Project Plan

Event: Stakeholder Involvement MIS committee Division, program and project managers involved in data

decisions

Event: Inventory of Current DatasetsEvent: Alignment with Future Data Needs

Quality assurance, (agency) ESAWP indicators (local) Community Health Needs Assessment and Health

Improvement Plan (CHNA & HIP) measures (state) Healthy People 2010 indicators, Accreditation (national)

Event: Development of Templates

Department Goals

Essential Services Annual Work Plan (ESAWP) Match essential services with measurable indicators Standardized to public health standards Customized tracking for showing outcomes

Community Health Needs Assessment 2010 is a re-evaluation year

Ability to query database Focus on the agency level rather than small program

data

Essential Public Health Services

ASSESSMENT• Monitor health status to identify community health problems• Diagnose and investigate health problems and health hazards in the community

The ability to compare, trend, aggregate and analyze data in our field is a very important way to get valuable insight into the work we do. All of the data we collect should be deliberate and in line with specific, meaningful goals. When this is accomplished, the data is more valuable to us and is a vehicle for answering questions and helping to truly monitor health indicators and understand the true status of the community.

POLICY DEVELOPMENT• Inform, educate, and empower people about health issues• Mobilize community partnerships to identify and solve health problems• Develop policies and plans that support individual and community health efforts• Enforce laws and regulations that protect health and ensure safety• Link people to needed personal health services and ensure the provision of health care when otherwise unavailable

Data is a fundamental basis for understanding health status in our community, an important part of being able to effectively match policies to target populations, study the effectiveness of policies and program efforts. Closely monitoring how data is managed will ensure that we will be able to take a more intelligent, informed look at services and outcomes with the flexibility to adapt the system to meet evaluation needs.

ASSURANCE• Ensure a competent public health and personal health care workforce• Evaluate effectiveness, accessibility, and quality of personal and population-based health services• Research for new insights and innovative solutions to problems

When a strategy is in place for effective data management, it is possible to gain a greater insight into how indicators and program information (and the “real world” indices that the data describes) relate to other datasets and how they change over time. This flexibility means that we will have a more accurate way to evaluate program effectiveness (Are we getting the expected outcome? Can we measure progress and success as a direct result of our use of resources?). Data is the backbone of being able to support evidence-based environmental health programs.

Health Protection Goals

Integrate and enhance the existing surveillance systems at the local, state, national, and international levels to detect, monitor, report, and evaluate public health threats.

Support and strengthen human and technological epidemiologic resources to prevent, investigate, mitigate, and control current, emerging, and new public health threats and to conduct research and development that lead to interventions for such threats.

Enhance and sustain nationwide and international laboratory capacity to gather, ship, screen, and test samples for public health threats and to conduct research and development that lead to interventions for such threats.

Assure an integrated, sustainable, nationwide response and recovery capacity to limit morbidity and mortality from public health threats.

Expand and strengthen integrated, sustained, national foundational and surge capacities capable of reaching all individuals with effective assistance to address public health threats.

Environmental Competency Project

Data Analysis and Interpretation: The capacity to analyze data, recognize meaningful test results, interpret results, and present the results in a meaningful way to different types of audiences.

Evaluation: The capacity to evaluate the effectiveness or performance of procedures, interventions, and programs.

Managing Work: The capacity to plan, implement, and maintain fiscally responsible programs/projects using appropriate skills, and prioritize projects across the employee's entire workload.

Computer/Information Technology (IT): The capacity to utilize information technology as needed to produce work products.

Reporting, Documentation, and Record-Keeping: The capacity to produce reports to document actions, keep records, and inform appropriate parties. 

Communication: The capacity to effectively communicate risk and exchange information with colleagues, other practitioners, clients, policy-makers, interest groups, media, and the public through public speaking, print and electronic media, and interpersonal relations.

Next Steps…

Complete and continue dataset inventoryIntegrate database systemsContinuous stakeholder involvementData management needs to become a natural part

of strategic planningProve mindset change by responding to data

needs with a deliberate strategy

Acknowledgements

Kristi Campbell and Russell Hadan, my supportive teamJoy Harris, my wonderful mentorBruce, Tom and Eileen…Black Hawk County ManagersMichael Goodman, our personal systems thinking

expert .....staff from the Heartland Center for PH

Leadership

National Center for Environmental Health at the Center for Disease Control and Prevention for making

this opportunity possible.