The National Public Health Performance Standards 101 Jennifer McKeever Trina Pyron.
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Transcript of The National Public Health Performance Standards 101 Jennifer McKeever Trina Pyron.
The National Public Health Performance Standards
101Jennifer McKeever
Trina Pyron
This session will help you. . .• Describe the NPHPS and how it can be
used to drive performance improvement at state and local levels;
• Discuss how NPHPS and PHAB accreditation complement each other; and
• Discuss the opportunities and plans for the NPHPS in the future.
History of the NPHPS• Key Dates
– Began in 1998– Version 1 instruments released in 2002– 2002-2007 – Version 1 instruments used in more
than 30 states– Development of Version 2 instruments – 2005-2007– Release of Version 2 instruments – Fall 2007-
present– Re-engineering efforts underway – 2011
• CDC – Overall lead for coordination• ASTHO – Develop and support state
instrument; SHIP• NACCHO – Develop and support local
instrument; MAPP• NALBOH – Develop and support governance
instrument• APHA – Marketing and communications• PHF – Performance improvement; data
collection and reporting system• NNPHI – Co-coordination of partnership,
support through institutes, training workshop and bi-monthly webinars
NPHPS National Partnership
NPHPS Vision
A partnership effort to improve the
quality of public health practice
and performance of
public health systems
Four Concepts Applied in NPHPS1. Based on the ten Essential Public
Health Services
2. Focus on the overall public health system
3. Describe an optimal level of performance
4. Support a process of quality improvement
Assessment Instruments• State public health system• Local public health system• Local public health governance
NPHPS
Comprehensive Development of Instruments
• Practice-driven development by CDC and ASTHO, NACCHO and NALBOH Work Groups
• Field testing• Validation studies
Based on Ten Essential Services
NPHPS State Instrument Use (Through April 2012, n = 29 states + DC)
*Also includes sites using field test versions of the NPHPS State Public Health System Performance Assessment.
NH
WA
OR
NV
CA
ID
MT
AK
UT
AZ
WY
CO
NM
ND
SD
NE
KS
TX
OK
LA
AR
MO
IA
MN
MS
OH
WI
INIL
MI
ME
KY
NY
PA
WVVA
NC
GA
TN
AL
FL
SC
VT
MA
RI
CT
HI
NJ
DE
MD
NH
MA
RI
CT
NPHPS Local Instrument Use (Through April 2012)
Moderate Use(33% - 66%)
Significant Use (67% or greater)
Limited Use(1% - 32%)
*Also includes sites using field test versions of the NPHPS Local Public Health System Performance Assessment.
WA
OR
NV
CA
ID
MT
AK
UT
AZ
WY
CO
NM
ND
SD
NE
KS
TX
OK
LA
AR
MO
IA
MN
MS
OH
WI
INIL
MI
ME
KY
NY
PA
WVVA
NC
GA
TN
AL
FL
SC
VT
NJ
DE
MD
NH
MA
RI
CT
HI
NPHPS Governance Instrument Use (Through April 2012)
No Boards of Health
*Also includes sites using field test versions of the NPHPS Local Public Health Governance Performance Assessment.
WA
OR
NV
CA
ID
MT
AK
UT
AZ
WY
CO
NM
ND
SD
NE
KS
TX
OK
LA
AR
MO
IA
MN
MS
OH
WI
INIL
MI
ME
KY
NY
PA
WVVA
NC
GA
TN
AL
FL
SC
VT
NJ
DE
MD
NH
MA
RI
CT
HI
Moderate Use(33% - 66%)
Significant Use (67% or greater)
Limited Use(1% - 32%)
NPHPS Vision and GoalsTo improve the quality of public health practice
and performance of public health systems by:
1. Providing performance standards for public health systems and encouraging their widespread use;
2. Engaging and leveraging national, state, and local partnerships to build a stronger foundation for public health preparedness;
3. Promoting continuous quality improvement of public health systems; and
4. Strengthening the science base for public health practice improvement.
NPHPS Use in the Field(What the evaluation data tell us)
• Reasons for Using NPHPS – State and Local– Establish a baseline measure of performance– Wanted a nationally developed & recognized assessment
tool to help improve performance – NPHPS the best tool available for improving public health
system effectiveness– Was part of the MAPP process (local users only)
State evaluation data gathered through ASTHO survey 10/05-1/06 – 80% response rate (9 respondents reporting completion of State NPHPS). Local evaluation data gathered through NACCHO survey to known NPHPS and MAPP users in 01/06 – 05/06; 212 total respondents (149 respondents reporting completion of Local NPHPS).
NPHPS Outcomes Achieved
0 20 40 60 80 100
ID strengths / weaknesses of PHS
Awareness of interconnectedness of PH
HD plan to make improvements
Better understanding of health issues
Stronger system collaboration
Tangible commitments for improving
PI processes that engage system partners
Initiate a MAPP process
State Local
Percentage of respondents indicating achievement of these outcomes was partial/medium or high
Data based on evaluation conducted by ASTHO and NACCHO in 2005-06. Findings are consistent with Respondent Information Form data, August 2007 – present.
Health Department
+PH System
+Community
Partners+
Workforce
OperationalCapacity
(infrastructure)
EveryCommunity
Program and Public Health
Activity
(Chronic Disease, Inf Disease, EH)
Builds Impacts
Whichleads
to
Investments here Pay big dividends here
Better HealthOutcomes
Reduced Disparities
Better Preparedness
Framework for Improving Performance
NPHPS: Strengthening systemsThe value of strengthening systems • Diminishing resources• Increasing service demands• Complex problems • Collaborative service delivery systems• Policy development • New opportunities (e.g., health reform)• Accountability
Considerations:• Important to strengthen both the agency and the
system
NPHPS and Public Health Agency Accreditation:complementary tools for strengthening public healthNPHPS• Based on the ten Essential
Public Health Services
• Focus on the overall public health system (but acknowledges agency as hub / convener)
• Describe an optimal level of performance
• 4. Support a process of quality improvement
Accreditation•Same – also includes domains about admin / governance
•Focus on agency (but acknowledges importance of the system and agency in building the system)
•Standards / measures that can be met, but also have “stretch” opportunities.
•Support a process of quality improvement
Future Directions
Re-engineering the NPHPS
Reengineering will sustain and continue to enhance the NPHPS as a tool for systems building, assessment and improvement activities
Reengineering guided by. . .• Program evaluation data• User feedback• Opportunities in the field
The Re-engineered NPHPS
• Goal: To sustain and enhance the NPHPS as a tool for systems building, assessment and improvement activities
• Re-engineering priorities:– Streamline assessment tools – Enhance systems building aspects of assessment
process– Strengthen linkages with accreditation– Promote quality and performance improvement
activities
The Re-engineered NPHPS
The Re-engineered NPHPS • Current and more community-
friendly standards • Streamlined assessments • Comprehensive and seamless
package of tools that most effectively promote systems engagement and performance improvement
Re-engineering Timeline Date Activity
Fall 2010 State, Local, and Governance Instrument Update workgroups convened
Jan – May 2011 Draft field test instruments
Jun – Sept 2011 Finalize field test instruments; Identify and confirm field test sites
Sept – Dec 2011 Conduct field test; desktop review; follow up interviews
Jan 2012 – May 2012 Complete final revisions to instruments; revise supporting documents
Summer 2012 Develop new instrument layout/design; revise online materials
Fall 2012 Launch new instruments!
Phases
Four Re-engineering Priorities• Streamline the assessment tools• Enhance systems building aspects of
the assessment process• Strengthen linkages with
accreditation• Promote quality and performance
improvement activities
Streamline Assessment Tools
• Fewer scored questions– Scoring at stem question level only
• Emphasize use of plain language
Enhance Systems Building • Implementation Guide highlights
techniques to build system connections
• List of potential system partners included at Essential Service level in State and Local Instruments
• Revised stem question language to reinforce system orientation– “At what level does the system. . .”
Strengthen Linkages with Accreditation
• Draft cross-walk between accreditation standards and NPHPS– Two potential supplemental
components: 1. Recommendations for ways to
document/act upon NPHPS work for accreditation purposes and
2. Questionnaire/note-taking format for accreditation coordinators.
Promote Quality and Performance Improvement
• Implementation Guide emphasizes improvement orientation throughout the assessment process (pre-, during, and post-assessment)
• Assessment includes a framework to identify improvement opportunities within each Essential Service
• Revised template and guidance for identifying priorities
THANK YOU!