Orientation to the Standards for Public Health in Washington State

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Orientation to the Standards for Public Health in
Washington State
Marni Mason MCPP Healthcare Consulting September
2006
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Orientation Objectives

• Participants can describe
• Performance Management concepts
• Context for and development of WA Standards
• Content and application of the Standards for
  Public Health
• Significant results of 2005 Assessment
• Whats Next for You?

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Performance Management Concepts
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Performance Management

• Performance measurement is not something done to
  you by someone else but something done together,
  in partnership, to improve your ability at every
  level local, state, regional, and national to
  achieve your common goals.

Former Assistant Secretary for Health, Philip R.
Lee (Guidebook for Performance Measurement )
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Performance Management

• The Guidebook for Performance Measurement
  produced in December 1999 by the Turning Point
  Project provides standard definitions of terms
• measure is the specific quantitative
  representation of capacity, process, or outcome
  deemed relevant to the assessment of
  performance
• Performance standard is a generally accepted,
  objective standard of measurement such as a rule
  or guideline against which an organizations
  level of performance can be compared
• Performance management is the use of performance
  measurement information to help set agreed-upon
  performance goals, allocate and prioritize
  resources, inform managers to either confirm or
  change current policy or program directions to
  meet those goals, and report on the success in
  meeting those goals and,
• Performance measurement is NOT punishment

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Context Development of WA Standards
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Standards for Public Health Legislative Mandate

• 1993 Law Set minimum standards, part of PH
  Improvement Partnership (PHIP)
• 1995 Law Accepted PHIP and required performance-
  based contracts
• 1998 PHIP Contained a model of Standards for
  Public Health, using a framework and level of
  detail that was used to develop the present
  Standards
• 2000 PHIP Reports on progress in establishing
  the Standards

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Standards for Public Health Why and Why Now?

• National processes underway regarding performance
  management
• CDC standards for the public health system
• Washington State is a national leader in
  collaborative state-local roles
• Accountability to Boards and citizens
• Integration in performance-based contracting

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Standards for Public Health Purpose and Goal

• The purpose for the Public Health Standards is
  to continue to build a strong public health
  system for the citizens of Washington State
• The goal is to define, measure, and facilitate
  the improvement of predictable level of public
  health protection throughout the state
• What every person has a right to expect

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Standards for Public Health What?

• Define a basic level of public health protection
• State what DOH overall and specific DOH programs
  need to do
• State what every jurisdiction needs to do
• Describes the collaboration needed between state
  and local levels

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Standards for Public Health How Developed?

• Collaborative state/local partnership in late
  1990s
• Workshops, on-line review, revisions
• 150 participantsgrass roots
• Test of standards in 2000
• Implement thoughtfully
• Take time to do it right
• Baseline Measurement in 2002 (72 local state
  sites)
• Remeasurement in 2005 all LHJs, 26 DOH sites
  and State Board of Health

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Application of the Standards to My Work
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Where Do Standards Fit in My Work?

• Standards are part of PHIP and QI work
• Standards are complementary to/consistent with
  DOH strategic planning work
• Standards are about how we do our work, Outcomes
  are about the results of our workthey are
  different and both are important
• All of this work is about leadership for the
  future of public health

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Where Do Standards Fit in My Work?

• Cross-walk to 3 Core Functions,10 Essential
  Services, and NACCHO definition
• They are a management toolfor you to use as you
  look at programs and initiatives
• They do not replace specific program
  requirementsboth are needed
• They are system-level and can help look at
  overall performance and where the system might do
  better

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The Plan-Do-Check-Act Cycle
Plan
Plan
Plan
Draft
Revised
Plan
Standards
Standards
Improvements
Act
Do
Act
Do
Act
Do
Evaluate
Committee
Performance
Recommend
Performance
Recommend
action
Work
Improvement
Improvement
Work
Check
Check
Check
Report/Recommend
Site visit Report
Site visit Report
Standards Development
Implementation of
Improvement cycle and
and Evaluation
Standards Baseline Site
Assessment cycle
Review Process
(2003 -2005)
(Fall 1999-Fall 2000)
(Winter 2001 Fall 2002)
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Program and System Standards
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Program and System Standards
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Applying Standards in Your Work

• Now is the time to learn about the standardsthe
  reassessment will occur in April-July 2008
• Measures are identified as applicable to all
  programs, or to entire agency, or to specific
  programs only
• You wont be able to meet all the measures that
  do applythese describe how public health ought
  to be

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The Content of the Standards
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State/Local Measures

• Single standard, different roles
• Unique approach nationally

Single Standard for the Public Health System
Local Measures
State Measures
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Standards Taxonomy

• 12 Standards
• Standard 1 - Community Health Assessment
• Each Standard has one or more measures
• 1.4 A process is in place to assure that local
  health data are shared with appropriate local,
  state and regional organizations.
• State or Local level S or L shown as 1.4 L

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Five Important Aspects of PH

• Understanding Health Issues Public Health
  Assessment
• Protecting People from Disease Communicable
  Disease and Other Health Risks
• Assuring a Safe, Healthy Environment for People
  Environmental Health
• Prevention is BestPromoting Healthy Living
  Prevention and Community Health Promotion
• Helping People Get the Services They Need Access
  to Critical Health Services
• The previous set of Standards was structured in
  these five Topic Areas and they are reflected in
  the numbering sequence and 2005 reports.

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1.Community Health Assessment
Data about community health, environmental
health risks, health disparities and access to
critical health services are collected, tracked,
analyzed and utilized along with review of
evidence-based practices to support health policy
and program decisions.

• Measures regarding health data, including a set
  of core indicators, are collected, analyzed, used
  for decision making and shared with partners and
  community
• LHJs 7 measures and State level 9 measures

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2. Communication to the Public and Key
Stakeholders
Public information is a planned component of all
public health programs and activities. Urgent
public health messages are communicated quickly
and clearly.

• Measures regarding communicating PH mission,
  public contact information, working with the
  media and public health alerts, materials and
  educational materials availability, and
  referral/resources lists
• LHJ 11 measures and State level 10 measures

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3. Community Involvement
Active involvement of community members and
development of collaborative partnerships address
community health risks and issues, prevention
priorities, health disparities and gaps in
healthcare resources/critical health services.

• Measures regarding community and stakeholder
  involvement in the process of reviewing health
  data and set of core indicators, program
  evaluation results and analysis of gaps
• LHJ 2 measures and State level 3 measures

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4. Monitoring and Reporting Threats to the
Publics Health
A monitoring and reporting process is maintained
to identify emerging threats to the publics
health. Investigation and control procedures are
in place and actions documented. Compliance with
regulations is sought through education,
information, investigation, permit/license
conditions and appropriate enforcement actions.

• Measures regarding information to providers and
  labs, protocols for disease and environmental
  investigation and compliance, including legal
  authority reporting, response, tracking and
  evaluation of cases and outbreaks
• LHJ 11 measures and State level 12 measures

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5. Planning for and Responding to Public Health
Emergencies
Emergency preparedness and response plans and
efforts delineate roles and responsibilities in
regard to preparation, response, and restoration
activities as well as services available in the
event of communicable disease outbreaks,
environmental health risks, natural disasters and
other events that threaten the health of people.

• Measures regarding planning for emergency
  preparedness and response with plans (EPRP) that
  describe the specific roles and responsibilities,
  staff orientation to EPRP
• LHJ and State level 5 measures each

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6. Prevention and Education
Prevention and education is a planned component
of all public health programs and activities.
Examples include wellness/healthy behaviors
promotion, healthy child and family development,
as well as primary, secondary and tertiary
prevention of chronic disease/disability,
communicable disease (food/water/air/waste/vector
borne) and injuries. Prevention, health
promotion, health education, early intervention
and outreach services are provided.

• Measures regarding establishing priorities for
  programs/activities and program goals, objectives
  and performance measures updating and
  availability of educational materials and
  technical assistance
• LHJ 4 measures and State level 8 measures

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7. Helping Communities Address Gaps in Critical
Health Services
Public health organizations convene, facilitate
and provide support for state and local
partnerships intended to reduce health
disparities and specific gaps in access to
critical health services. Analysis of state and
local health data is a central role for public
health in this partnership process.

• Measures regarding access to critical health
  services (CHS), monitoring, analyzing, tracking
  and reporting access performance measures,
  identifying Gaps in access and coordination of
  health service delivery among health care
  providers
• LHJ 4 measures and State level 8 measures

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8. Program Planning and Evaluation
Public health programs and activities identify
specific goals, objectives and performance
measures and establish mechanisms for regular
tracking, reporting, and use of results.

• Measures regarding a planned, systematic process
  in which every program and activity has written
  goals, objectives, and performance measures that
  are monitored, tracked, analyzed and used to
  change and improve program activities and
  services, the use of best practices and customer
  service standards, the internal audit of cases,
  and workshop and after-action evaluations are
  used for process improvement
• LHJ 9 measures and State level 12 measures

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9. Financial and Management Systems
Effective financial and management systems are in
place in all public health organizations.

• Measures regarding alignment of budget with the
  organizations strategic plan, reflect
  organizational goals and is monitored on a
  regular basis, contracts are reviewed for legal
  requirements and monitored for compliance with
  performance requirements
• LHJ and State level 2 measures each

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10. Human Resource Systems
Human resource systems and services support the
public health workforce.

• Measures regarding personnel rules and policies
  for diversity and cultural competence, methods
  for compensation decisions job descriptions and
  performance evaluations, and employee licenses,
  credentials and experience, staff training in
  many topics, confidentiality and ADA compliance
  
• LHJ and State level 6 measures each

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11. Information Systems
Information systems support the public health
mission and staff by providing infrastructure for
data collection, analysis, and rapid
communication.

• Measures regarding assuring the protection of
  data and data systems, policies to address
  security redundancy, and appropriate use,
  availability of computer hardware and software,
  and strategies for future technologies, website
  content, and the confidential transfer of data
• LHJ and State level 5 measures each

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12. Leadership and Governance
Leadership and governance bodies set
organizational policies and direction and assure
accountability.

• Measures regarding Boards of Health operations,
  review of reports, and recommendations for
  action agency strategic planning, risk
  management, written quality improvement plan with
  annual evaluation of progress and demonstrated
  improvements
• LHJ 10 measures and State level 6 measures

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What questions do you have?
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What Did We Learn the Last Time They Were
Measured?2005 Performance Assessment Results
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2005 Assessment Major Themes

• Impressed with the skills and commitment of the
  staff, the scope and depth of work being done to
  improve health status of the public
• In LHJs, four topic areas above 50 demonstrated
  performance, AS, CD, EH, AC PP topic area
  below 50 demonstrated
• In DOH all five topic areas have more than 50
  demonstrated performance

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2005 Assessment Major Themes

• Budget of 7.5 million or more is predictive of
  demonstrating performance on more than 60 of the
  measures (all 8 LHJs gt 60)
• There is variability not connected to budget or
  size (64 LHJs had budgets higher than 7.5
  million / 36 had lower than 2.5 million)
• Five LHJs with budgets of 2.5 million or less
  had gt 60 performance (only 3 LHJs in 2002)
• Other drivers of high performance are local
  priority-setting leadership local funding
  staff skills, training and experience and
  documentation and data systems.

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Importance of Assessment
Analysis of the correlation between topic areas
of standards and overall demonstrated performance
showed the strongest correlation (0.92) between
performance on assessment and overall performance.
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Understanding Health Issues - Demonstration
Levels of LHJs and DOH Programs
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Measures with Significant Changes from 2002 to
2005

• Statistical analysis of 2005 results compared to
  2002 Baseline performance indicated statistically
  significant changes in
• Assessment use of data for decisions and in
  confidentiality (LHJs)
• Communicable Disease internal audits,
  identifying key performance measures, and
  outbreak response (both)
• Program evaluation training in community
  involvement (DOH)
• QI training (LHJs)

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Exemplary Practices Report

• Version 3.0
• Use for practice sites not demonstrating
  performance with standard for faster improvement
  and implementation
• Ideas for other sites to improve what they are
  currently doing to achieve better results
• Electronic release of a compendium of statewide
  exemplary practices

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Current Improvement Actions

• Conducting improvement consultations with local
  and state sites to improve site performance
• Identified 3 areas for system-wide improvement
• Established statewide Collaborative for system
  improvement of establishing and monitoring
  program performance measures

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Whats Next For You in Applying the Standards and
in Performance Management
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Use 2005 Site Specific Report
Use the 2005 Site Report to identify measures
needing improvement.
Topic 1. Understanding Health Issues Standard
5 Health data is handled so that confidentiality
is protected and health information systems are
secure
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2007-2008 Training Assessment

• Snapshot review of the Public Health systems
  performance (selected DOH programs all LHJs) -
  all within 4-5 months
• Reviewers visit site for document review and
  informal interviews to assess the sites ability
  to demonstrate performance in the Standards that
  are applicable to that site
• Statewide Health Indicators, reported at least
  every other year, are part of site performance
  report

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Guidelines for Assessment
The Guideline gives detailed information about
the applicability and requirements of every
standard and measure. Use the Guideline to
conduct a self-assessment and to prepare for an
assessment site visit.
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Attend Training Sessions

• Training for state and local PH managers and
  staff (various locations around the state)
• Interpretation of standards and measures
• Document organization, including electronic
• Mock site visit preparation exercise

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Summary

• Get more training in performance management and
  in interpretation of the Standards
• Implement the standards in your work
• Develop and collect documentation
• Prepare for the site visit
• Use the results to identify areas to improve

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What questions do you have?