Mobilizing for Action through Planning and Partnerships (MAPP)assets.thehcn.net/content/sites/nashville/LPHSA_REPORT... · 2013. 8. 14. · Services in Nashville?" Assessment results

Local Public Health System Assessment Report | 1

Mobilizing for Action through

Planning and Partnerships (MAPP)

Local Public Health System Assessment National Public Health Performance Standards Program

Version 2

Final Report

Retreat Date: August 14, 2013

Report Date: November 27, 2013

“A healthy Nashville has a culture of well-being, where all people

have the opportunity and support to thrive and prosper.”

MAPP Vision Statement

2013


Acknowledgements

Healthy Nashville Leadership Council,

MAPP Advisory Body

Dr. Alicia Batson

Jeff Blum

Rev. Theo Bryson

Ted Cornelius (Chair)

John Harkey

Dr. Arthur Lee

Nancy Lim

Councilwoman Sandra Moore (Vice-Chair)

Brenda Morrow

Vice-Mayor Diane Neighbors

Dr. Freida Outlaw

Janie Parmley

Dr. William S. Paul

Dr. Marybeth Shinn

Dr. Susanne Tropez-Sims

Councilwoman Sheri Weiner

Ex-Officio Members

Captain Mike Hagar

Laura Hansen

Tommy Lynch

Leslie Meehan

Renee Pratt Metro Public Health Department Core Support

Dr. William S. Paul, Director of Health

Dr. Sanmi Areola

Tracy Buck

Dr. Celia Larson-Pearce

Keri Kozlowski

Stan Romine

Thomas Sharp

Chris Taylor

Brian Todd

Dr. Sandra Thomas-Trudo

Dr. Kimberlee Wyche

Local Public Health System Assessment

Committee

Dr. William S. Paul (Committee Chair)

Dr. Sanmi Areola

Dr. Celia Larson-Pearce

Dr. Freida Outlaw

Thomas Sharp

Jason Stamm

Chris Taylor

Dr. Sandra Thomas-Trudo

Dr. Kimberlee Wyche

LPHSA Facilitators, Scorers and Note-Takers

Facilitators

Group 1 Joe Pinilla

Group 2 Lillian Maddox-Whitehead

Group 3 Jason Stamm

Group 4 Julie Fitzgerald

Scorers

Group 1 Thereasa Howse

Group 2 Rebecca Morris

Group 3 Angie Thompson

Group 4 Chris Michie

Note Takers

Group 1 Phyllis Raines

Group 2 Nyoka Rodgers

Group 3 Rhonda Brooks

Group 4 Jaleesa Johnson


Table of Contents

Executive Summary ……………………………………………………………………………………………… p 3

Background: Mobilizing for Action through Planning and Partnerships and the Local Public Health System

Assessment (LPHSA) ..................................................................................................................................... p 5

Implementation of the LPHSA ……………………………………………………………………………………… p 11

Assessment Results........................................................................................................................................ p 14

LPHSA Follow-Up: Root Cause Analyis …………………………………………………………………………... p 65

Bibliography ………………………………………………………………………………………………………….. p 72

Appendices ......................................................................................................................................... pp 73 - 104

A HNLC Executive Order

B Agenda

C NPHPSP Data Limitations

D Comments from Voting Process

E LPHSA Evaluation Summary

F Fishbone Instructions


Executive Summary

Nashville is using the Mobilizing for Action through Planning and Partnerships (MAPP) community health

assessment process as the framework for convening a large variety of organizations, groups, and individuals

that comprise the local public health system in order to create and implement a community health improvement

plan. MAPP utilizes four assessments, which serve as the foundation for achieving improved community

health. They are:

Community Health Status Assessment

Community Themes and Strengths Assessment

Forces of Change Assessment, and


The Local Public Health System Assessment (LPHSA) utilizes the National Public Health Performance

Standards Program (NPHPSP) assessment of the Local Public Health System. Fifty-seven of Nashville’s key

public health system partners, representing multiple government agencies, non-profit organizations, hospitals,

and others, convened on August 14, 2013 to help answer the assessment questions: "What are the activities

and capacities of our public health system?" and "How well are we providing the 10 Essential Public Health

Services in Nashville?" Assessment results represent the collective performance of all entities in the local

public health system and not any one organization.

There are three NPHPSP assessment instruments, which are used to assess state public health systems, local

public health systems, and local governance. The NPHPSP assessment instruments are constructed using the

10 Essential Public Health Services (EPHS) as the framework. Nashville used Version 2 of the NPHPSP Local

Instrument. Within the Local Instrument, each EPHS includes between 2-4 model standards that describe the

key aspects of an optimally performing public health system. Each model standard is followed by assessment

questions that serve as measures of performance. The dialogue that occurred in answering these questions

identified strengths, weaknesses and recommendations for performance improvement for each of the 30 Model

Standards discussed. The results, including the strengths, weaknesses and recommendations, are provided in

the full report.

Scoring

The scoring for each question used in voting on each model standard, as well as the overall scores for the

model standards and Essential Services are provided in the full report.

NPHPSP Local Instrument Scoring


None of the Essential Services received a score of No or Minimal, which is calculated using the scores from all

of the questions asked within each model standard for the Essential Service. Essential Services 3 and 7 were

scored as Moderate, meaning that on average, the local public health systems was performing more than 25%

but no more than 50% of the activity within the questions asked.

Essential Services 1, 4, 5, 8, 9 and 10 all were scored as Significant, meaning that on average, the local

public health system was performing more than 50% but not more than 75% of the activity within the questions

asked.

Essential Services 2 and 6 received the score of Optimal, meaning that on average, the local public health

system was performing more than 75% of the activity within the questions asked.

The table below provides the overall score for each of the 10 Essential Public Health Services. Also included is

the overall score for the Local Public Health System Assessment for Nashville-Davidson County 2013.


Essential Service Performance Scores

Essential Service Number

Essential Service Overall Score Rating

ES #1 Monitor Health Status To Identify Community Health Problems

60 Significant

ES #2 Diagnose And Investigate Health Problems and Health Hazards

86 Optimal

ES #3 Inform, Educate, And Empower People about Health Issues 48 Moderate

ES #4 Mobilize Community Partnerships to Identify and Solve Health Problems

57 Significant

ES #5 Develop Policies and Plans that Support Individual and Community Health Efforts

72 Significant

ES #6 Enforce Laws and Regulations that Protect Health and Ensure Safety

93 Optimal

ES #7 Link People to Needed Personal Health Services and Assure the Provision of Health Care when Otherwise Unavailable

47 Moderate

ES #8 Assure a Competent Public and Personal Health Care Workforce

67 Significant

ES #9 Evaluate Effectiveness, Accessibility, and Quality of Personal and Population-Based Health Services

51 Significant

ES #10 Research for New Insights and Innovative Solutions to Health Problems

61 Significant

Overall Performance Score: 64 (Significant)

The table on the page below shows the rank ordered performance scores, from lowest performance to highest,

for the 10 Essential Services. The line segments show the range of performance scores for each of the model

standards within the 10 Essential Services.


Essential Public Health Services Results with Ranges

Of the two optional questionnaires, which are supplemental to the NPHPSP assessment instrument, Nashville

utilized the Priority Questionnaire, which asks system partners to rate the priority of each model standard on a

scale from 1 to 10, with 1 being the lowest priority and 10 being the highest priority.

The 30 models standards did not show great variation in average rating of priority. Table 2 below shows the 30

model standards, from lowest priority to highest.

Model Standard Priority Low to High

9.13 9.07 9.06

8.85 8.76 8.69 8.64 8.62 8.57 8.54 8.53 8.53 8.50 8.43 8.41 8.41 8.35 8.31 8.23 8.23

8.08 8.07 8.07 8.00 7.92

7.79 7.73 7.69 7.60

7.25

0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00 9.00 10.00

2.1 Identification and Surveillance of Health Threats

2.2 Investigation and Response to Public Health…

5.4 Plan for Public Health Emergencies

9.3 Evaluation of the Local Public Health System

3.3 Risk Communication

3.2 Health Communication

8.1 Workforce Assessment, Planning, and…

6.2 Involvement in the Improvment of Laws,…

8.4 Public Health Leadership Development

9.1 Evaluation of Population-Based Health Services

3.1 Health Education and Promotion

5.2 Public Health Policy Development

6.3 Enforcement of Laws, Regulations, and…

4.2 Community Partnerships

1.2 Current Technology to Manage and…

5.3 Community Health Improvement Process and…

1.1 Population-Based Community Health Profile

7.2 Assuring the Linkage of People to Personal…

2.3 Laboratory Support for Investigation of Health…

8.2 Public Health Workforce Standards

8.3 Life-Long Learning Through Continuing…

5.1 Governmental Presence at the Local Level

6.1 Review and Evaluation of Laws, Regulations,…

7.1 Identification of Personal Health Service Needs…

10.1 Fostering Innovation

1.3 Maintenance of Population Health Registries

10.2 Linkage with Institutions of Higher Learning…

4.1 Constituency Development

10.3 Capacity to Initiate or Participate in Research

9.2 Evaluation of Personal Health Services

RatingAverage


Background

Mobilizing for Action through Planning and Partnerships

Identifying Nashville’s public health issues and improving the community’s health and quality of life requires the

knowledge and experiences of all of those who live and work in Nashville. Nashville is using the Mobilizing for

Action through Planning and Partnerships (MAPP) community health assessment process as the framework

for convening a large variety of organizations, groups, and individuals that comprise the local public health

system in order to create and implement a community health improvement plan. As a community-based and

inclusive process, MAPP provides an opportunity to build and maintain relationships with community partners

and Nashville residents. Community involvement throughout the process creates community ownership of

public health concerns and solutions.

Fig 1: MAPP Process Roadmap to Improved Health

From 1997 through 2001, the National Association of County and City Health Officials (NACCHO), in

collaboration with the Centers for Disease Control and Prevention (CDC), developed MAPP. Prior to MAPP’s

inception, public health practitioners did not have structured guidance on creating and implementing

community-based strategic plans. In response, NACCHO and CDC created a process based on substantive

input from public health practitioners and public health research and theory. As a result, MAPP is a process

that is both theoretically sound and relevant to public health practice. (National Association of County and City

Health Officials, 2008).

Nashville has used many public health assessment tools in the past and was one of the first communities to

use the MAPP process for community health assessment and planning. Nashville was selected by NACCHO

as a MAPP demo site from 2001 until 2003, during which time the Healthy Nashville Leadership Council

(HNLC) was created as an overseeing body to help guide the MAPP process and prioritize strategic issues.

The HNLC is a mayoral appointed council, comprised of strategic thinkers and community leaders that is

convened by the Metro Public Health Department (MPHD) to serve as the steering committee for the MAPP

process. MPHD serves as the lead agency for conducting the MAPP assessments and has established a core

support team, comprised of 11 members, diversely representative of the health department and its initiatives,


who will serve as leadership for the MAPP assessment teams. See Appendix A for the Executive Order

establishing the Healthy Nashville Leadership Council.

Fig 2: MAPP Organizational Structure (2013-2014)

MAPP utilizes four assessments, which serve as the foundation for achieving improved community health. As

reflected in the organizational structure above, for this iteration of MAPP, Nashville has partnered with the

Nashville Food Policy Council to utilize information from their Food System Assessment to inform the strategic

issues in addition to the traditional four MAPP assessments. These four assessments are:

Community Themes and Strengths Assessment: Provides community perceptions of their health and quality of life, as well as their knowledge of community resources and assets.

Local Public Health System Assessment: Measures how well public health system partners collaborate to provide public health services based on a nationally recognized set of performance standards. The Local Public Health System Assessment is completed using the local instrument of the National Public Health Performance Standards Program (NPHPSP).

Community Health Status Assessment: Measures the health status using a broad array of health indicators, including quality of life, behavioral risk factors, and other measures that reflect a broad definition of health.

Forces of Change Assessment: Provides an analysis of the positive and negative external forces that impact the promotion and protection of the public’s health.


Fig 3: MAPP Process

Once strategic issues are identified, the HNLC will formulate goals, strategies and an action plan for

implementing the strategies.

This approach leads to the following:

o Measurable improvements in the community’s health and quality of life;

o Increased visibility of public health within the community;

o Community advocates for public health and the local public health system;

o Ability to anticipate and manage change effectively; and

o Stronger public health infrastructure, partnerships, and leadership.


The Local Public Health System Assessment (LPHSA) process for MAPP utilizes the National Public Health

Performance Standards Program (NPHPSP) assessment of the Local Public Health System. The LPHSA is

intended to help users answer questions such as "What are the activities and capacities of our public health

system?" and "How well are we providing the Essential Public Health Services in our jurisdiction?" The

dialogue that occurs in answering these questions can help to identify strengths and weaknesses and

determine recommendations for improvement.

The NPHPSP is a collaborative effort of seven national partners:

Centers for Disease Control and Prevention, Office of Chief of Public Health Practice (CDC/OCPHP)

American Public Health Association (APHA)

Association of State and Territorial Health Officials (ASTHO)

National Association of County and City Health Officials (NACCHO)

National Association of Local Boards of Health (NALBOH)

National Network of Public Health Institutes (NNPHI)

Public Health Foundation (PHF)

The NPHPSP is a partnership effort to improve the practice of public health and the performance of public

health systems. The NPHPSP assessment instruments guide state and local jurisdictions in evaluating their

current performance against a set of optimal standards. Through these assessments, responding sites

consider the activities of all public health system partners, thus addressing the activities of all public, private

and voluntary entities that contribute to public health within the community.


Three assessment instruments have been designed to assist state and local partners in assessing and

improving their public health systems or boards of health. These instruments are the:

State Public Health System Performance Assessment Instrument,

Local Public Health System Performance Assessment Instrument, and

Local Public Health Governance Performance Assessment Instrument.

The NPHPSP assessment instruments are constructed using the Essential Public Health Services (EPHS) as

a framework. Within the Local Instrument, each EPHS includes between 2-4 model standards that describe the

key aspects of an optimally performing public health system. Each model standard is followed by assessment

questions that serve as measures of performance. Each site's responses to these questions should indicate

how well the model standard - which portrays the highest level of performance or "gold standard" - is being

met.

The Local Public Health System Assessment measures the performance of the public health system as a

whole, and the scores reflect the whole system’s performance, not any one agency’s. The diagram below

shows a representation of the key groups that comprise the local public health system by delivering one or

more of the 10 Essential Public Health Services in Nashville.

Fig 4: Local Public Health System Web 1

Sites responded to assessment questions using the following response options below. These same categories

are used in this report to characterize levels of activity for Essential Services and model standards.


Fig 5: Voting Responses for LPHSA

Using the responses to all of the assessment questions, a scoring process generates scores for each first-tier

or "stem" question, model standard, Essential Service, and one overall score. The scoring methodology is

available from CDC or can be accessed on-line at http://www.cdc.gov/nphpsp/conducting.html.

For Nashville’s LPSHA, only first tier “stem questions” were used in voting. This is an acceptable use of the

tool, but in scoring the assessment, all sub-questions were also scored in the same manner as the first tier

“stem questions,” which presents a limitation to the findings of the assessment. For a full list of limitations, see

Appendix B.

Of the two optional questionnaires, which are supplemental to the NPHPSP assessment, Nashville utilized the

one which asks about priority of each model standard. The second optional questionnaire, which assesses the

local health department's contribution to achieving the model standard, was not used for this iteration of the

MAPP process.


Implementation of the LPHSA

Assessment Committee

The LPHSA Committee was made up of HNLC and MPHD Core support team members. This committee made

key decisions in the assessment planning process.

Assessment Structure

The LPHSA was conducted from 8:30 AM until 3:30 PM on August 14, 2013 at Martin Professional

Development Center in Nashville. Prior to the assessment, participants received notification of their breakout

group assignment with the description of the Essential Services and model standards in their group. An

Orientation to the assessment process was provided by LPHSA Committee Chair and the Director of Health for

Davidson County, Dr. William S. Paul. After the whole-group orientation, participants were dismissed to

participate in one of four breakout-groups. Membership of these breakout groups were determined by the

LPHSA Assessment Committee. The four breakout groups were comprised of the following Essential Services:

Group 1: Essential Services 1, 2 & 6

There were 17 participants in Group 1 representing the local health department,

Davidson County Sherriff’s Office, local hospitals, Metro Water Department, Metro Legal,

the Tennessee Department of Health, and emergency management organizations.

Group 2: Essential Services 3, 4 & 7

There were 16 participants in Group 2 representing the local health department,

behavioral health organizations, safety net organizations and local non-profit

organizations.

Group 3: Essential Services 5 & 9

There were 13 participants in Group 3 representing the local health department, local

hospitals, Metro Council, the Tennessee Department of Health, local foundations, and

emergency management groups.

Group 4: Essential Services 8 &10

There were 11 participants in Group 8 representing the local health department, local

hospitals, local universities, research organizations and the Tennessee Department of

Health.

A Closeout Session was facilitated by MAPP Project Director, Tracy Buck, where each group reported out on

their prioritized Strengths, Weaknesses, and Recommendations for each of the Essential Services. See

Appendix C for the full assessment Agenda.

Invitations to Participate

100 individuals were identified and invited to participate in the LPHSA from various sectors in the Local Public

Health System; additional considerations included representativeness of age, gender, and race/ethnicity. Of

those invited, 57 participated in the assessment.

Facilitation

Each breakout group was facilitated by a Metro Public Health Department staff member trained in the

NACCHO recommended Technology of Participation (ToP) facilitation methods. Using information from the

NPHPSP stem questions, the NPHPSP User Guide and from the Model Standards, the facilitators led focused

conversations, using Objective, Reflective, Interpretive and Decisional questioning to inform voting. Strengths,

Weaknesses and Recommendations were discussed for each model standard. At the end of each Essential

Service, facilitators asked attendees to prioritize their Strengths, Weaknesses and Recommendations for the

report out.


In addition to the facilitator, each breakout session included a Scorer/Peer Evaluator, whose role was to record

all of the final scores and to provide feedback to the facilitator on her/his performance. There was also a skilled

note-taker in each room to capture the discussion on each model standard and vote. Each room also was

audio recorded..

Voting Process

In each room, participants were reminded of several considerations to use when voting. These included:

Use the conversation on the model standard to inform their vote

Consider the entire Local Public Health System in their vote, not only their organization (see Figure 4,

p. 9)

Awareness, Accessibility and Usability: If one system partner indicates that his or her organization

provides a particular public health service, but no one else in the system is aware of the activity, is that

service accessible and/or usable?

Involvement: Is the service provided in one sector of the public health system and not in others (e.g.

provided in hospitals, but not by governmental public health agencies)?

Dispersion: Is the activity in question disseminated/dispersed across the locality geographically, or

does it exist in only one area? Is the activity dispersed among programs or only addressed in one area

of public health? For example, health promotion activities might occur in maternal and child health

programs, but not in areas of chronic disease, infectious disease, or injury prevention.

Frequency: Is the activity in question done routinely or on an ad hoc basis? Does it occur frequently

enough to meet the needs of the population?

Quality and Comprehensiveness: Is the activity in question done in a high quality manner? Perhaps

it is a new activity that still needs quality improvement.

Only the Tier One questions were used to vote on performance of the assessment. In the full report below, the

vote for each model standard is included in the tables.

Participants used colored voting cards to indicate their vote. Cards were counted and noted by the Note Taker

in each group. If the participants did not reach consensus on their first vote, there was additional discussion

and a second vote. Consensus was defined as “overwhelming agreement,” which meant both a super-majority

of participants voting the same way and no great discrepancy in the votes (for example if the majority voted

significant, but one person voted minimal, a discussion and second vote would take place). If a second vote

was necessary, the results from that vote were recorded as the final score. Full voting results, including key

comments from voting discussions, as applicable, can be found in Appendix D.

Supplemental Questionnaires

The LPHSA Committee decided that the Priority Questionnaire, which asks participants to vote on the priority

level on a scale of 1 to 10 for each model standard, would provide useful information in addition to the

assessment. The Agency Contribution Questionnaire, which determines what percentage of Essential Service

delivery is provided by the Local Health Department, was not used. The final report includes the results from

the Priority Questionnaire.

Evaluation


An evaluation survey was sent out to all of the participants one week following the assessment. Participants

were given one week to respond to the evaluation survey. 30 participants responded to the evaluation survey.

See Appendix E for the results.


Assessment Results

Full results from the Local Public Health System Assessment are provided in the following report. The scoring

for each question used in voting on each model standard, as well as the overall scores for the model standards

and Essential Services are provided.

None of the Essential Services received a score of No or Minimal, which is calculated using the scores from all

of the questions asked within each model standard for the Essential Service. Essential Services 3 and 7 were

scored as Moderate, meaning that on average, the local public health systems was performing more than 25%

but no more than 50% of the activity within the questions asked.

Essential Services 1, 4, 5, 8, 9 and 10 all were scored as Significant, meaning that on average, the local

public health system was performing more than 50% but not more than 75% of the activity within the questions

asked.

Essential Services 2 and 6 received the score of Optimal, meaning that on average, the local public health

system was performing more than 75% of the activity within the questions asked.

The table below provides the overall score for each of the 10 Essential Public Health Services. Also included is

the overall score for the Local Public Health System Assessment for Nashville-Davidson County 2013.

Local Public Health System Assessment Essential Service Performance Scores

Essential Service Number

Essential Service Overall Score Rating

ES #1 Monitor Health Status To Identify Community Health Problems

60 Significant

ES #2 Diagnose And Investigate Health Problems and Health Hazards

86 Optimal

ES #3 Inform, Educate, And Empower People about Health Issues 48 Moderate

ES #4 Mobilize Community Partnerships to Identify and Solve Health Problems

57 Significant

ES #5 Develop Policies and Plans that Support Individual and Community Health Efforts

72 Significant

ES #6 Enforce Laws and Regulations that Protect Health and Ensure Safety

93 Optimal

ES #7 Link People to Needed Personal Health Services and Assure the Provision of Health Care when Otherwise Unavailable

47 Moderate

ES #8 Assure a Competent Public and Personal Health Care Workforce

67 Significant

ES #9 Evaluate Effectiveness, Accessibility, and Quality of Personal and Population-Based Health Services

51 Significant

ES #10 Research for New Insights and Innovative Solutions to Health Problems

61 Significant

Overall Performance Score: 64 (Significant)


Reading the Report Results

An overall score for each Essential Service is provided along with a description of the Essential Service.

Following the description of the Essential Service is a description and the results from all of the voting on the

model standards, as well as the discussion points on each model standards’ strengths, weaknesses and

recommendations provided by the participants in the breakout groups. At the end of each Essential Service,

the Prioritization of each model standard is provided, by priority rating determined by participants using the

optional priority questionnaire and the performance level of each model standard.

Essential Service #1- Monitor Health Status to Identify Community Health Problems

Overall Score: 60 (Significant)

This service includes:

• Accurate, periodic assessment of the community’s health status, including:

- Identification of health risks, determinants of health, and determination of health service needs;

- Attention to the vital statistics and health status indicators of groups that are at higher risk than the total

population; and

- Identification of community assets that support the local public health system (LPHS) in promoting health

and improving quality of life.

• Utilization of appropriate methods and technology, such as geographic information systems (GIS), to

interpret and communicate data to diverse audiences.

• Collaboration among all LPHS components, including private providers and health benefit plans, to

establish and use population health registries, such as disease or immunization registries.

Essential Public Health Service 1, Monitor Health Status for Community Health Problems, includes 3 model

standards for local public health systems. These are:

Model Standard 1.1: Population-Based Community Health Profile

Model Standard 1.2: Current Technology to Manage and Communicate Population Health Data

Model Standard 1.3: Maintenance of Population Health Registries

A total of 8 questions were voted on for the 3 model standards to reach the score of 60 for the overall score for

Essential Service 1.

The table below shows the scores for each model standard, including the range of scores from each of the

questions in the model standard.


Model Standard 1.1: Population-Based Community Health Profile (CHP)

The community health profile (CHP) is a common set of measures for the community to prioritize the health

issues that will be addressed through strategic planning and action, to allocate and align resources, and to

monitor population-based health status improvement over time.

The CHP includes broad-based surveillance data and measures related to health status and health risk at

individual and community levels including: demographic and socioeconomic characteristics; health resource

availability; quality of life; behavioral risk factors; environmental health indicators; social and mental health;

maternal and child health; death, illness, and injury; communicable disease; and sentinel events. The CHP

displays information about trends in health status, along with associated risk factors and health resources.

Local measures are compared with peer, state, and national benchmarks. Data and information are displayed

in multiple formats for diverse audiences, such as the media and community-based organizations. Data

included in the community health profile are accurate, reliable, and consistently interpreted according to the

science and evidence-base for public health practice.

To accomplish this, the local public health system (LPHS):

Conducts regular community health assessments to monitor progress towards health-related

objectives.

Compiles and periodically updates a community health profile using community health assessment

data.

Promotes community-wide use of the community health profile and/or assessment data and assures

that this information can be easily accessed by the community.

Model Standard 1.1 Population-Based Community Health Profile

Overall Score 33 (Moderate)

1.1.1 Community health assessment 50

1.1.2 Community health profile (CHP) 25

1.1.3 Community-wide use of community health assessment or CHP data 25

In addition to the voting process, sub-group members had an opportunity to provide strengths, weaknesses

and recommendations during their discussion of each model standard. The strengths, weaknesses and

recommendations of Model Standard 1.1 are show in the table below.

Model Standard 1.1 Strengths, Weaknesses and Recommendations

Strengths Weaknesses

Lots of data available.

Performing LPHSA – good for partners.

HealthyNashville.org.

Collaboration between participating organizations.

It’s mainly the poor that have issues – those with money can, if desired, take care of their health and have housing. The poor have few advocates.

Our data may not be easily accessible for everyone else in the community.

There is a lack of coordination between agencies.

There are missing pieces - such as an assessment of dental and mental health.

Agencies are not working together.


Lack of funds available to keep programs running.

There is not a specified organization that can assist with problems such as sub-standard funding, housing issues, crime, rape, domestic violence, , community of immigrants, and an understanding about unmet needs.

Recommendations

Find a way to close gaps in assessments.

Create a clearinghouse of resources.

Disseminate the health assessment when completed.

Develop public health agency of advocacy.

The LPHSA needs to be a recurring community assessment every 3 years.

LPHS Model Standard 1.2: Current Technology to Manage and Communicate Population Health Data

Population health data are presented in formats that allow for clear communication and interpretation by end

users. Such formats include graphed trend data that allow for comparisons over time by relevant variables

such as gender, race, and geographic designation.

Tools such as geographic information systems (GIS) are used to combine geography, data, and computer

mapping to support the exploration of spatial relationships, patterns, and trends in health data. Use of

geocoded data (matching of street address to a corresponding latitude and longitude) is promoted, while

maintaining appropriate safeguards for confidentiality. Increased public access to GIS information provides

new insights to develop strategies that are appropriate for specific geographic areas and to align health status

indicators with health resources.

While the information in the Community Health Profile (CHP) is available in paper format, this information

is also available in a web-based version that is accessible to individuals, community groups, and other

organizations in a timely manner. Links to other sources of related information are provided.

To accomplish this, the LPHS:

Uses state-of-the-art technology to collect, manage, integrate, and display health profile databases.

Has access to geocoded data for geographic analysis.

Uses computer-generated graphics to identify trends and/or compare data by relevant categories (i.e.,

race, gender, age group).

Model Standard 1.2 Access to and Utilization of Current Technology to Manage, Display, Analyze and Communicate Population Health Data

Overall Score 58 (Significant)

1.2.1 State-of-the-art technology to support health profile databases 50

1.2.2 Access to geocoded health data 75







More people are using GIS.

Planning Department’s GIS tools are great.

Other departments have access to GIS.

Training available (free to limited cost) for anyone interested in GIS.

State also has GIS.

Cannot use GIS without training.

Recourses need to be devoted to GIS .

There is a lack of consensus as to the protection level offered in regard to confidentiality when sharing information.

Lack of updated definition in regards to race/ gender.

Recommendations

Make GIS more accessible..

Consider GIS when collecting data.

Determine what level of GIS data is needed most out in the community.

A uniform policy is needed regarding information confidentiality.

Better dissemination of GIS capability.

Conduct a needs Assessment for GIS

Extort ancillary data.

Share underlying raw data in addition to maps.

LPHS Model Standard 1.3: Maintenance of Population Health Registries

Population health registries track health-related events such as disease patterns and preventive health

services delivery (i.e., cancer registries facilitate tracking of cancer incidence, cancer stage at diagnosis,

treatment patterns, and survival probability; vaccine registries provide the real time status of vaccine coverage

for specified age groups in the community). The LPHS creates and supports systems to assure accurate and

timely reporting by providers.

Data are collected for registries in accordance with standards that assure comparability of data from public,

private, local, state, regional, and national sources. Collaboration among multiple partners facilitates the

aggregation of individual data to compile a population health registry used to inform policy decisions, program

implementation, and population research.


Maintains and regularly contributes to population health registries using established criteria to report

identified health events.

Uses information from one or more population health registries

Model Standard 1.3 Maintenance of Population Health Registries

Overall Score 88 (Optimal)

1.3.1 Maintenance of and/or contribution to population health registries 75

1.3.2 Use of information from population health registries 100







The legal mandated registers are well adhered to.

Information is widely disseminated – it moves up to federal levels and then, it is disseminated back to the local level.

Lack of local support to maintain registry database.

Confidentially around mental health or HIV issues is so paramount that the fear is information won’t stay confidential.

Stigma around certain issues that prevent collection.

Recommendations

Need to create a better system for entering data into registries to maintain confidentiality.

Define process for responding and reporting events.

Less manual / more technical

Having a conversation about how information is collected and what it’s used for may relieve some of the stigma.

Need better public education about values or benefits of maintaining registry.

Priority Ratings for Essential Service #1

LPHSA participants were asked to rate their priority level for each of the 30 model standards – rating what the

priority level should be, not what it currently is. Using a scale from 1 to 10, with 10 being the highest priority

and one being the lowest, participants provided their ratings. The table below shows the priority ratings and

performance scores for each of the model standards.

Quadrant 1 - High Priority/Low Performance 1.1 Population-Based Community Health Profile (CHP) 1.2 Access to and Utilization of Current Technology to Manage, Display, Analyze and Communicate Population Health Data

Quadrant 2 - High Priority/High Performance 1.3 Maintenance of Population Health Registries

Quadrant 3 - Low Priority/High Performance Quadrant 4 - Low Priority/Low Performance

The priority data are calculated based on the percentage standard deviation from the mean. Performance

scores above the median value are displayed in the "high" performance quadrants. All other levels are

displayed in the "low" performance quadrants. All of the model standards for Essential Service 1 were rated as

a high priority and either high or low performance. Scores in Quadrant 1 indicate that some increased attention


is necessary in order to perform at higher level, per the prioritization of this model standard; using public health

practices and resource allocation are two ways to improve Quadrant 1 scores. See the recommendations

included for each of the model standards for additional ideas for improvement. Scores in Quadrant 2 indicate

that it is important to maintain the current level of performance through utilization of public health best practices

and allocation of resources.

Essential Public Health Service 2 includes 3 model standards for local public health systems. These are:

Model Standard 2.1 Identification and Surveillance of Health Threats

Model Standard 2.2 Investigation and Response to Public Health Threats and Emergencies

Model Standard 2.3 Laboratory Support for Investigation of Health Threats

A total of 12 questions were voted on for the 3 model standards to reach the score of 86 for the overall score

for Essential Service 2.



LPHS Model Standard 2.1: Identification and Surveillance of Health Threats

Surveillance systems are designed and maintained to monitor health events, to identify changes or patterns,

and to investigate underlying causes or factors. Epidemiological and behavioral science techniques are used to

collect data to identify risk factors for health threats. Local public health surveillance systems are integrated

with national and state surveillance systems to provide comprehensive monitoring of health events using

consistent collection and reporting procedures. Surveillance data are used to assess and analyze health

problems and hazards. Surveillance data are also used to examine the impact of health hazards, behaviors,

and risk factors on disease and mortality. Surveillance efforts also alert the local public health system (LPHS)

Essential Service #2- Diagnose and Investigate Health Problems and Health Hazards in the Community

Overall Score: 86 (Optimal) This service includes:

Epidemiological investigations of disease outbreaks and patterns of infectious and chronic diseases and injuries, environmental hazards, and other health threats.

Active infectious disease epidemiology programs.

Access to a public health laboratory capable of conducting rapid screening and high volume testing.


to community and health indicators that may signal public health emergencies (e.g., natural and intentional

disasters including biological and chemical incidents).


Participates in integrated state, local and national surveillance system(s) that identify and analyze

health problems and threats.

Collects timely reportable disease information from community health professionals who submit

information on possible disease outbreaks.

Utilizes human and technological resources to support surveillance and investigation activities,

including state-of-the-art information technology and communication systems, as well as Masters

and/or

Doctoral level statistical and epidemiological expertise to assess, investigate, and analyze health

threats and health hazards.



2.1.1 Surveillance system(s) to monitor health problems and identify health threats 75

2.1.2 Submission of reportable disease information in a timely manner 75

2.1.3 Resources to support surveillance and investigation activities 50



recommendations for Model Standard 2.1 are shown in the table below.



Access to laboratories and hospital.

Solid partnerships have been established.

Human capital – lots of expertise among us.

Rapid response to disease investigation.

Some surveillance systems are not utilizing all resources available.

We are not as technically advanced as we could be.

Need more syndrome surveillance,

Underutilization of local cancer database.

Technology used not always the most current.

Inability to monitor homelessness as they rotate through the jails, homeless centers, community.

Recommendations

Increase surveillance capacity and use in schools.

Improve technology.

Create a data sharing agreement.

LPHS Model Standard 2.2: Investigation and Response to Public Health Threats and Emergencies

Local public health systems must have capacity to respond rapidly and effectively to investigate public health

threats and emergencies which involve communicable disease outbreaks or chemical, biological, radiological,


nuclear, explosive or environmental incidents. With the occurrence of an adverse public health event or

potential threat, a collaborative team of LPHS professionals participates in the collection and analysis of

relevant data. A network of support and communication relationships exists in the LPHS, which includes

health-related organizations, public safety and rapid response teams, the media, and the general public.

Timely investigation of public health emergencies is coordinated through an Emergency Response

Coordinator, who leads the local effort in collaboration with LPHS partners in the event of a public health

emergency (e.g., health officer, environmental health director).

In order to have the capacity to investigate and respond to public health emergencies, the LPHS:

Maintains written protocols to implement a program of case finding, contact tracing and source

identification and containment for communicable diseases or toxic exposures.

Develops written protocols for the immediate investigation of public health threats and emergencies,

including natural and intentional disasters.

Designates an Emergency Response Coordinator.

Identifies personnel with the technical expertise to rapidly respond to potential biological, chemical, or

radiological public health emergencies.

Evaluates incidents for effectiveness and opportunities for improvement.

Model Standard 2.2 Investigation and Response to Public Health Threats and Emergencies


2.2.1 Written protocols for case finding, contact tracing, source identification, and containment

75

2.2.2 Current epidemiological case investigation protocols 100

2.2.3 Designated Emergency Response Coordinator 100

2.2.4 Rapid response of personnel in emergency / disasters 100

2.2.5 Evaluation of public health emergency response 75






Worksite Point of Dispensing (POD) program.

Written protocols are in place.

Lots of communication and training taking place.

Collaboration with the Tennessee Department of Health.

Davidson County’s food safety program one of the best in the country.

There are a lot of written protocols resulting in protocol non-compliance.

There are also gaps in written protocols – differences between local, state, and federal agencies when they work together.

Over dispersal of local resources – this is a structural issue.

Not enough cross-training among staff.

Recommendations

Broaden training to include cross training that can be applied to different scenarios.

Provide more updates between training – especially if training is yearly.

Let public health make decisions as to when public health needs to be involved.


Make sure that the Emergency Operations Center (EOC) is involved in the process.

LPHS Model Standard 2.3: Laboratory Support for Investigation of Health Threats

Laboratory support is defined as the ability to produce timely and accurate laboratory results for diagnostic and

investigative public health concerns. The actual testing may be performed outside the traditional public health

system, however, public health retains the responsibility for ensuring that proper testing and timely results are

available to the community.


Maintains ready access to laboratories capable of meeting routine diagnostic and surveillance needs.

Maintains ready access (24 hours-per-day/7 days-per-week) to laboratories capable of supporting

investigations of public health threats, hazards, and emergencies.

Confirms that laboratories are in compliance with regulations and standards through credentialing and

licensing agencies.

Maintains guidelines or protocols to address the handling of laboratory samples, which describe

procedures for storing, collecting, labeling, transporting, and delivering laboratory samples, and for

determining the chain of custody regarding the handling of these samples, as well as reporting findings.

Model Standard 2.3 Laboratory Support for Investigation of Health Threats


2.3.1 Ready access to laboratories for routine diagnostic and surveillance needs 100

2.3.2 Ready access to laboratories for public health threats, hazards, and emergencies 100

2.3.3 Licenses and/or credentialed laboratories 100

2.3.4 Maintenance of guidelines or protocols for handling laboratory samples 100






Asset rich community - there are commercial and state labs available, also contracts with environmental agencies.

The Health Department has a lab on site.

Availability of Metro resources for investigations.

The system is flexible and diverse.

System in transit while it is updating its technology.

The labs’ budgets are receiving cuts.

Recommendations

Maintain quality of current system while budgets are being cut.

Increase awareness of the vast resources available.







Quadrant 1 - High Priority/Low Performance

Quadrant 2 - High Priority/High Performance 2.1 Identification and Surveillance of Health Threats 2.2 Investigation and Response to Public 2.3 Laboratory Support for Investigation of Health Threats





a high priority and high performance. Scores in Quadrant 2 indicate that it is important to maintain the current

level of performance through utilization of public health best practices and allocation of resources.


Model Standard 3.1 Health Education and Promotion

Model Standard 3.2 Health Communication

Model Standard 3.3 Risk Communication

Essential Service #3 Inform, Educate, and Empower Individuals and Communities about Health Issues

Overall Score: 48 (Moderate)


Health information, health education, and health promotion activities designed to reduce health risk and promote better health.

Health education and health promotion program partnerships with schools, faith communities, work sites, personal care providers, and others to implement and reinforce health promotion programs and messages that are accessible to all populations.

Health communication plans and activities such as media advocacy and social marketing.

Accessible health information and educational resources.

Risk communication processes designed to inform and mobilize the community in time of crisis.






LPHS Model Standard 3.1: Health Education and Promotion

The local public health system (LPHS) actively creates, communicates, and delivers health information and

health interventions using customer-centered and science-based strategies to protect and promote the health

of diverse populations. The LPHS supports its health improvement objectives and responds to public health

issues with health education and health promotion initiatives that are based on the best available scientific

evidence of effectiveness in helping people make healthy choices throughout their lives. Strong working

relations include numerous agencies that are actively engaged in promoting and implementing these activities.

The LPHS designs and implements a wide range of health education and health promotion activities. Health

promotion activities include any combination of educational and environmental supports that give individuals,

groups, or communities greater control over conditions affecting their health. Health education is the process

by which the LPHS conveys information and facilitates the development of health-enhancing skills among

individuals and groups in the community. Health education serves to reinforce health promotion messages

within the community, ultimately helping to reduce health risk and improve health status.


Provides the public, policymakers, and stakeholders with information on community health status and

health needs in the community, as well as information on policies and programs that can improve

community health.

Plans, conducts, and evaluates targeted health education and health promotion activities to develop

and enhance knowledge and attitudes and assist in lowering risk or changing negative behaviors.

Works with other entities within the system on health education and health promotion activities that

facilitate healthy living in healthy communities.


Model Standard 3.1 Health Education and Promotion


3.1.1 Provision of community health information 50

3.1.2 Health education and/or health promotion campaigns 50

3.1.3 Collaboration on health communication plans 25






Try to meet needs of those coming in the door by learning how to take care of them, e.g., we perform diabetes training ourselves.

Partnering with entities to receive grant training, etc.

Tier one prevention

WIC mobile unit provides nutrition classes and issues vouchers. It meets the community by going to them. Strong initiation with task force to teach suicide prevention.

Tennessee Obesity Taskforce increases awareness with education.

There is a large car seat coalition which practices nonviolent safety risks.

Nashville Breastfeeding Collaboration collaborates with hospitals and health departments.

We don’t know who to contact or who the diverse population is - How can we meet their needs or deliver to them?

We should have professionals available that speak the client’s language.

Some clients are undocumented individuals and have been told they are not eligible for certain services.

Illegal individuals may hesitate to approach those in public health because of the way they were treated at another agency.

Misunderstanding among public health workers regarding accessibility and resources available.

Undocumented persons may not be eligible for financial assistance to pay for services.

Those lacking communication skills may perceive barriers that are not there.

Nashville General Hospital will treat undocumented individuals; however, a portion of the fee is required before services rendered – may not be financially feasible.

There is a service gap for those affected with HIV or suffering from behavioral health issues.

Connections are not made for those looking for a medical home within the safety net clinics; however, they do accept undocumented persons.

A lot of decision-makers don’t recognize patients’ barriers – doesn’t understand what they are going through.

Public health staff may not have enough community health educators.

Some of our materials do not meet literacy standards.

Recommendations

Resolve funding issues.

If were able to pay peer educators and community health workers, they would be more willing to do the work and have more stake in the conversation. This would also result in a more diverse, better trained workforce.


Stronger collaborations between organizations that address the community.

Identify what resources are available in community.

Educate ourselves on who our community is and who we serve.

Understand the culture of the community being served.

Identify stakeholders who can communicate to those in the community so that they can disseminate information.

Need individuals that offer education and can collaborate to offer services .

Efforts need to be about behavior change.

LPHS Model Standard 3.2: Health Communication

Health communication encompasses the use of multiple communication strategies to inform and influence

individual and community decisions that enhance health. Health communication includes activities related to

media campaigns, social marketing, entertainment education, and interactive health communication.

Health communication serves to raise awareness of health risks and solutions, support adoption of healthy

behavior, and create advocacy for health policies and programs that empower people to adopt healthy

lifestyles. The LPHS utilizes a variety of communication channels, such as interpersonal, small group,

organizational, community, and mass media, to reach people in a variety of settings, including home, school,

work, and community. The LPHS works collaboratively to identify the best contexts, channels, and content of

health messages in their community and to leverage resources for their implementation.


Develops health communication plans addressing media and public relations, as well as guidelines for

sharing information among stakeholders.

Utilizes relationships with media channels (e.g., print, radio, television, Internet) to share health

information with general and targeted audiences.

Identifies and trains spokespersons on public health issues.

Model Standard 3.2 Health Communication


3.2.1 Development of health communication plans 25

3.2.2 Relationships with media 25

3.2.3 Designation of public information officers 50






Some agencies have a positive working relationship with media.

Pockets of good face-to-face conversations .

Sub-populations have created avenues where information is communicated, e.g., newspapers, Facebook.

Less commentary and opinions -- more facts.

The bad stuff gets reported and the good ignored – need to be more proactive.

Collaborate and share one document instead of preparing numerous email blasts.

Use various kinds of social media – don’t rely on


just one (emails, Twitter).

Some of the community may still rely on radio, TV, or newspapers.

Do our media efforts reach the younger population?

How do we address the issue while respecting those of other cultures?

There are over 140 languages at Metro Nashville Public Schools – How do we reach them?

Recommendations

Keep the message consistent

Reach out to businesses for funding

Use social media in more constructive ways for target audiences.

Find and consolidate a list of subjects that experts and the media can focus on.

Examine mechanism tools to target audiences (for example, 70% of people have I-Phones).

Coordinating and leveraging resources around marketing.

Market consistently.

LPHS Model Standard 3.3: Risk Communication

Risk communication is the provision of information by public health professionals to allow individuals,

stakeholders, or an entire community to make the best possible decisions about their well-being in times of

crisis or emergency. Risk communication includes pre-event, event and post-event communication planning.

The LPHS identifies and analyzes potential risks in order to develop strategic plans for public, media, partner,

and stakeholder communication during public health emergencies, including terrorism.


Develops an emergency communications plan to effectively create and disseminate materials for each

stage of a crisis according to recognized theories and methods.

Ensures adequate resources to enable a rapid emergency communications response.

Provides crisis and emergency communications training for employees and establishes protocols for

the dissemination of public information and instructions during a public health emergency.

Maintains current, accurate 24 hours-per-day, 7 days-per-week contact information and collaborative

relations with news media, public information officers (PIOs), and partners.



3.3.1 Emergency communications plan(s) 75

3.3.2 Resources for rapid communications response 75

3.3.3 Crisis and emergency communications training 50

3.3.4 Policies and procedures for public information officer response 75







Pre-event planning and exercises are helpful, preparing for a real situation (contaminated water, flooding, etc.).

Collaborating between agencies.

Crisis communication before event.

We tend to be reactive instead of proactive.

Certain physical or medical situations have a stigma attached (HI Mental Health).

How do we get to the community that doesn’t speak English?

Media creates anxiety around crisis events (i.e. – snow).

Recommendations

Communicate that we are prepared for emergency and specify what our expectations are of the community.

Offer diversity while disseminating information with Smart phones, sirens, media.

Could there be more of a role for the neighborhood associations?

Churches are available to disseminate information.

Involve stakeholders within community.

Create more visible and stronger collaboration between agencies.

People get tired of being in a constant crisis mode - we need to continue to follow up and provided post-crisis communication even after time passes.

Educate the community as to what they should do to remain safe – encourage them to take some personal responsibility.

Disseminate available resources to the public.

Keep communication open so community does not feel left out or cut off.

Improve health literacy.






Quadrant 1 - High Priority/Low Performance 3.1 Health Education and Promotion 3.2 Health Communication

Quadrant 2 - High Priority/High Performance 3.3 Risk Communication






a high priority and low performance. Scores in Quadrant 1 indicate that some increased attention is necessary

in order to perform at higher level, per the prioritization of this model standard; using public health practices

and resource allocation are two ways to improve Quadrant 1 scores. See the recommendations included for

each of the model standards for additional ideas for improvement. Scores in Quadrant 2 indicate that it is

important to maintain the current level of performance through utilization of public health best practices and

allocation of resources.


Model Standard 4.1 Constituency Development

Model Standard 4.2 Community Partnerships





LPHS Model Standard 4.1: Constituency Development

Constituents of the LPHS include all persons and organizations that directly contribute to or benefit from public

health. Constituents may include members of the public served by the local public health system (LPHS), the

governmental bodies it represents, and other health, environmental, and non-health-related organizations in

Essential Service #4: Mobilize Community Partnerships to Identify and Solve Health Problems



Identifying potential stakeholders who contribute to or benefit from public health and increase their awareness of the value of public health.

Building coalitions and working with existing coalitions to draw upon the full range of potential human and material resources to improve community health.

Convening and facilitating partnerships and strategic alliances among groups and associations (including those not typically considered to be health-related) in undertaking defined health improvement activities, including preventive, screening, rehabilitation, and support programs, and establishing the social and economic conditions for long-term health.


the community. Constituency development is the process of establishing collaborative relationships among the

LPHS and all current and potential stakeholders. As part of constituency development activities, the LPHS

develops and operationalizes a communications strategy designed to educate the community about the

benefits of public health and the role of the LPHS in improving community health. The LPHS operationalizes

the communications strategy through formal and informal community networks, which may include businesses,

schools, healthcare organizations, the faith community, and community associations.

For effective constituency development, the LPHS:

Has a process to identify key constituents for population-based health in general and for specific health

concerns (e.g., a particular health theme, disease, risk factor, life stage need).

Encourages the participation of its constituents in community health activities, such as in identifying

community issues and themes and engaging in volunteer public health activities.

Establishes and maintains a comprehensive directory of community organizations.

Uses broad-based communication strategies to strengthen linkages among LPHS organizations and to

provide current information about public health services and issues.

Model Standard 4.1 Constituency Development


4.1.1 Identification of key constituents or stakeholders 50

4.1.2 Participation of constituents in improving community health 50

4.1.3 Directory of organizations that comprise the LPHS 75

4.1.4 Communications strategies to build awareness of public health 50






Agencies/organizations are actively collaborating.

We value collaboration and see that it is necessary.

There are some resources already in place: 211, Pathfinders, Redline, Council on Aging, etc.

It is perceived that collaboration management diminishes funding.

Fear of losing control of the collaboration.

We do not engage the community that we are trying to impact with collaboration.

Need to do a better job with screening.

Constituents do not take the initiative to be a part of the collaboration We need to know who we are serving.

Recommendations

Flexibility of meetings - held when the community is available (i.e., various days and times).

Not only listen to constituents but propose action to support them.

Be intentional about providing community representation.

Look not only at community needs but their access as well.

Establish process for LPHS to identify stakeholders.


LPHS Model Standard 4.2: Community Partnerships

Community partnerships and strategic alliances describe a continuum of relationships that foster the sharing of

resources and accountability in undertaking community health improvement. Public health departments may

convene or facilitate the collaborative process. The multiple levels of relationships among public, private, or

nonprofit institutions have been described as 1) networking, exchanging information for mutual benefit; 2)

coordination, exchanging information and altering activities for mutual benefit and to achieve a common

purpose; 3) cooperation, exchanging information, altering activities, and sharing resources for mutual benefit

and to achieve a common purpose; and 4) collaboration, exchanging information, altering activities, sharing

resources, and enhancing the capacity of another for mutual benefit and to achieve a common purpose. Multi-

sector collaboration is thus defined as a voluntary strategic alliance of public, private, and nonprofit

organizations to enhance each other’s capacity to achieve a common purpose by sharing risks,

responsibilities, resources, and rewards. Multi-sector partnerships such as community health improvement

committees (community committees) exist in some communities as formally constituted bodies (e.g., a

community health planning council) while in other communities they are less formal groups. The community

committee is a dynamic collaboration designed to be comprehensive and inclusive in its membership and its

approach to community health improvement.


Establishes community partnerships and strategic alliances to assure a comprehensive approach to

improving health in the community.

Assures the establishment of a broad-based community health improvement committee.

Assesses the effectiveness of community partnerships and strategic alliances in improving community

health.

Model Standard 4.2 Community Partnerships


4.2.1 Partnerships for public health improvement activities 75

4.2.2 Community health improvement committee 75

4.2.3 Review of community partnerships and strategic alliances 25






The Center for Non-Profit Management started Collaboration College.

There are good examples of collaborations, such as Alignment Nashville, that can be successful working examples.

There is strong community engagement.

There is a lot of talent and expertise available.

Non-government philanthropic efforts are

Some of our efforts /talk is superficial – we sometimes talk the talk but do not walk the walk.

Employees working with the clients do not know our community partners and potential clients are turned away.

There is a lack of outcome measures.

Limited resources affect the ability to monitor progress to goals.


participating.

Collaborations between organizations are valued. Funding focus is on collaboration and is evidence-

based.

Looking at assets, not needs.

Collaboration process should be centralized.

Recommendations

Utilize more technology.

Keep information updated and disseminated.

Train front line staff to help those needing assistance.

Collaborate with other groups so that everyone can understand what is been done and what has not been done.

Safeguard what is available and build on it instead of duplicating it.






Quadrant 1 - High Priority/Low Performance 4.1 Constituency Development 4.2 Community Partnerships

Quadrant 2 - High Priority/High Performance





a high priority and low performance. Scores in Quadrant 1 indicate that some increased attention is necessary

in order to perform at higher level, per the prioritization of this model standard; using public health practices

and resource allocation are two ways to improve Quadrant 1 scores. See the recommendations included for

each of the model standards for additional ideas for improvement.



Model Standard 5.1 Governmental Presence at the Local Level

Model Standard 5.2 Public Health Policy Development

Model Standard 5.3 Community Health Improvement Process and Strategic Planning

Model Standard 5.4 Plan for Public Health Emergencies





LPHS Model Standard 5.1: Governmental Presence at the Local Level

Every community must be served by a governmental public health entity. As the line of first defense, local

governmental public health entities play a vital role in ensuring the safety, health, and well-being of

communities. The governmental public health entity works in partnership with the community to assure the

development and maintenance of a flexible and dynamic public health system that provides the Essential

Public Health Services. In doing this, the local governmental public health entity coordinates or assures the

provision of quality public health services. Typically, the local health department (LHD) or a local branch of the

state health agency serves as the local governmental public health entity.

To accomplish this, the local public health system (LPHS):

Essential Service #5: Develop Policies and Plans that Support Individual and Community Health Efforts



An effective governmental presence at the local level.

Development of policy to protect the health of the public and to guide the practice of public health.

Systematic community-level planning for health improvement and public health emergency response in all jurisdictions.

Alignment of local public health system (LPHS) resources and strategies with a community health improvement plan.


Includes a local governmental public health entity to assure the delivery of the Essential Public Health

Services to the community.

Assures the availability of adequate resources for the local health department’s contributions to the

provision of Essential Public Health Services.

Maintains an appropriate relationship with its local governing entity (e.g., local board of health, county

commission, state health agency).

Coordinates with the state public health system.



5.1.1 Governmental local public health presence 75

5.1.2 Resources for the local health department 50

5.1.3 Local board of health or other governing entity (not scored) 0

5.1.4 LHD work with the state public health agency and other state partners 38






Health Department is 90% community-based partnerships that enable us to do our jobs

Ensure a competent workforce with accreditation, trainings, and in-services.

Monitoring the health of the community.

Researching for new insights (new green building, new programs).

Constant evaluations for staff and programs.

Maintaining system-wide center of gravity for community partnerships / efforts.

Clarifying the roles of health services and community resources due to the changes through the years (possible unrealistic expectations).

Delivering services to those without Social Security numbers.

Recommendations

Develop and communicate clear strategy, goals, and expected outcomes.

Create and clarify goals and roles of LHD and communicate them to the community .

Annual lead testing.

Evaluate customer satisfaction and forward information to staff.

Increase community awareness and knowledge.

LPHS Model Standard 5.2: Public Health Policy Development

As used in this instrument, the phrase “policy development” involves the means by which problem

identification, technical knowledge of possible solutions, and societal values join to set a course of action (IOM,

1988). Policy development is not synonymous with the development of laws, rules, and regulations (which are

the focus of Essential Service # 6). Laws, rules, and regulations may be adopted as tools to implement policy,

but good policies must precede good legislation. Policy development is a process that enables informed

decisions to be made concerning issues related to the public’s health.


The LPHS works with the community to identify policy needs and gaps to develop policies to improve the

public’s health. The LPHS promotes the community’s understanding of, and advocacy for, policies to improve

health, and serves as a resource to elected officials to establish and maintain public health policies.

To assure effective public health policy, the LPHS:

Contributes to the development and/or modification of public health policy by facilitating community

involvement and engaging in activities that inform the policy development process.

Alerts policymakers and the public of potential public health impacts (both intended and unintended)

from current and/or proposed policies.

Reviews existing policies at least every three to five years

Model Standard 5.2 Public Health Policy Development


5.2.1 Contribution to development of public health policies 75

5.2.2 Alert policymakers/public of public health impacts from policies 50

5.2.3 Review of public health policies 50






Subject matter expertise at the table.

We have formed strong partnerships.

Strong science for policy development.

Being informed by the community; they are receptive to training, dialogue.

Use of science doesn’t always help – it is not fully developed yet or community does not understand.

Preemption legislation attached work can only be achieved at state level. Policy implementation proposed on the local and state level without funding included.

Recommendations

Customer/citizen feedback should be included in policy discussions.

New needs/discoveries/research should be advanced/obtained before new policies are proposed.

Involve “boots on the ground” people.

Ensure diversity in policy making.

LPHS Model Standard 5.3: Community Health Improvement Process and Strategic Planning

Community health improvement includes traditional public health, environmental health, and health services

categories, as well as business, economic, housing, land use, health equity and other community issues

affecting the public’s health. The community health improvement process involves an ongoing collaborative,

community-wide effort by the LPHS to identify, analyze, and address health problems; assess applicable data;

inventory community health assets and resources; identify community perceptions; develop and implement

coordinated strategies; develop measurable health objectives and indicators; identify accountable entities; and

cultivate community “ownership” of the entire process. The community health improvement process provides

the opportunity to develop a community-owned plan that will lead to a healthier community.


The community health improvement process is further strengthened by the organizational strategic planning

activities of LPHS members, including the local health department. To effectively leverage community

resources and optimize outcomes, organizations within the LPHS make efforts to review and align their

organizational strategic plans with the community health improvement process.


Establishes a community health improvement process, which includes broad-based participation and

uses information from community health assessments as well as perceptions of community residents.

Develops strategies to achieve community health improvement objectives and identifies accountable

entities to achieve each strategy.

Because the activities of the local health department should be focused on community public health

needs and issues, specific attention is given to this organization’s strategic plan. The local health

department: Conducts organizational strategic planning activities and reviews its organizational

strategic plan to determine how it can best be aligned with the community health improvement process.

Model Standard 5.3 Community Health Improvement Process and Strategic Planning


5.3.1 Community health improvement process 71

5.3.2 Strategies to address community health objectives 75

5.3.3 Local health department (LHD) strategic planning process 100






There is an established community improvement policy (MAPP).

Communication is lacking regarding the minimal focus on special needs, defined as anyone with functional needs.

Those leaving the military may come back to the community with unique problems that must be addressed.

What functional needs are being addressed, e.g. – public housing, undocumented workers, lack of insurance in community.

Recommendations

System of care coordination – no matter what the situation is – housing, insurance, unemployment.

Improve coordination of care and follow-up for those with special needs.

Incorporate new technology.


LPHS Model Standard 5.4: Plan for Public Health Emergencies

An “All-Hazards” emergency preparedness and response plan describes the roles, functions and

responsibilities of LPHS and other entities in the event of one or more types of public health emergencies.

LPHS entities, including the local health department, emergency management, law enforcement, fire

departments, health care providers, and other partners work collaboratively to formulate emergency response

plans and procedures. Careful planning and mobilization of resources and partners prior to an event is crucial

to a prompt and effective response. The plan should create an all-hazards response infrastructure, in that it

outlines the capacity of the LPHS to respond to all public health emergencies (including natural and intentional

incidents and disasters), while taking into account the unique and complex challenges presented by chemical,

biological, radiological, nuclear and explosive incidents. These plans describe community interventions

necessary to prevent, monitor and control the incident.

In order to plan for public health emergencies, the LPHS:

Establishes a task force to develop and maintain emergency preparedness and response plans.

Develops a plan that defines public health disasters and emergencies that might trigger implementation

of the LPHS emergency response plan, describes organizational responsibilities, and establishes

standard operating procedures and clearly outlines alert and evacuation protocols.

Tests the plan through the staging of one or more “mock events,” and revises the plan as necessary at

least every two years.

Model Standard 5.4 Plan for Public Health Emergencies


5.4.1 Community task force or coalition for emergency preparedness and response plans 75

5.4.2 All-hazards emergency preparedness and response plan 100

5.4.3 Review and revision of the all-hazards plan 100






Office of Emergency Management leads exercises and involves lead agencies.

Successful departmental collaboration.

Hazard Vulnerability Analysis (HVA) based plan is a big improvement.

Emergency management cycle conducts constant evaluation and plans revision.

All Hazard planning.

Community collaboration has increased since the ice storm .

Hospital accreditation is successful.

Since the 2010 flood, a disaster mental health plan has been developed.

Lack of practice drills according to HVA results

Office of Emergency Management control center is not tornado proof.

Dwindling funds.

Lack of drilling.


Recommendations

Increase funding.

Metro administration needs to buy-in at all levels/department – not just Metro but all community programs need to work together.

Conduct more drills - POD plan needs to happen regularly – involve everyone.

Check as to what other buildings have safety deficiencies (such as not being tornado proof).






Quadrant 1 - High Priority/Low Performance 5.1 Government Presence at the Local Level 5.2 Public Health Policy Development

Quadrant 2 - High Priority/High Performance 5.3 Community Health Improvement Process 5.4 Plan for Public Health Emergencies





a high priority. Scores in Quadrant 1 indicate that some increased attention is necessary in order to perform at

higher level, per the prioritization of this model standard; using public health practices and resource allocation

are two ways to improve Quadrant 1 scores. Scores in Quadrant 2 indicate that it is important to maintain the

current level of performance through utilization of public health best practices and allocation of resources.

Essential Service #6 Enforce Laws and Regulations that Protect Health and Ensure Safety

Overall Score: 93 (Optimal)


The review, evaluation, and revision of laws, regulations, and ordinances designed to protect health and safety to assure that they reflect current scientific knowledge and best practices for achieving compliance.

Education of persons and entities obligated to obey or to enforce laws, regulations, and ordinances designed to protect health and safety in order to encourage compliance.

Enforcement activities in areas of public health concern, including, but not limited to the protection of drinking water; enforcement of clean air standards; emergency response; regulation of care provided



Model Standard 6.1 Review and Evaluation of Laws, Regulations, and Ordinances

Model Standard 6.2 Involvement in the Improvement of Laws, Regulations, and Ordinances

Model Standard 6.3 Enforcement of Laws, Regulations, and Ordinances





LPHS Model Standard 6.1: Review and Evaluation of Laws, Regulations, and Ordinances

The local public health system (LPHS) reviews existing federal, state, and local laws, regulations, and

ordinances relevant to public health in the community, including laws, regulations, and ordinances addressing

environmental quality and health-related behavior. The review focuses on the authority established for laws,

regulations, and ordinances as well as the impact of existing laws, regulations, and ordinances on the health of

the community. The review also assesses compliance, opinions of constituents, and whether laws, regulations,

and ordinances require updating.

In order to accomplish this, the LPHS:

Identifies public health issues that can only be addressed through laws, regulations, or ordinances.

Is knowledgeable about current federal, state, and local laws, regulations, and ordinances that protect

the public’s health.

Reviews public health laws, regulations, and ordinances at least once every five years.

Has access to legal counsel for assistance in the review of laws, regulations, and ordinances.

in health care facilities and programs; re-inspection of workplaces following safety violations; review of new drug, biologic, and medical device applications; enforcement of laws governing the sale of alcohol and tobacco to minors; seat belt and child safety seat usage; and childhood immunizations.


Model Standard 6.1 Review and Evaluation of Laws, Regulations, and Ordinances


6.1.1 Identification of public health issues to be addressed through laws, regulations, and ordinances

100

6.1.2 Knowledge of laws, regulations, and ordinances 100

6.1.3 Review of laws, regulations, and ordinances 75

6.1.4 Access to legal counsel 100






Well-established environmental protection programs with very experienced and well- respected staff.

Support from the Mayor’s Office.

Good coordination between partners.

Multiple layers of regulation and complex laws are not well-understood .

Need more full-time policy analysts for a county our size.

Need more awareness and education of changes being implemented.

Unclear about public health transparencies.

Not clear how to implement policies.

Emotional issues around public health legislation.

Recommendations

Routine discussion of health importance of policies.

Political environment beneficial to businesses.

Create office support for policy analysis in public health.

Formal review process of current laws.

LPHS Model Standard 6.2: Involvement in the Improvement of Laws, Regulations, and Ordinances

Having identified local public health issues that are not adequately being addressed through existing laws,

regulations, and ordinances, the LPHS participates actively in the modification of existing laws, regulations,

and ordinances and the formulation of new laws, regulations, and ordinances designed to assure and improve

the public’s health. This participation includes the drafting of proposed legislation and regulations, involvement

in public hearings, and periodic communication with legislators and regulatory officials.

In order to accomplish this, the LPHS:

Identifies local public health issues that are not adequately addressed through existing laws,

regulations, and ordinances.

Participates in the modification of existing laws, regulations, and ordinances and/or the formulation of

new laws, regulations, and ordinances designed to assure and improve the public’s health.

Provides technical assistance for drafting proposed legislation, regulations, and ordinances.


Model Standard 6.2 Involvement in the Improvement of Laws, Regulations, and Ordinances


6.2.1 Identification of public health issues not addressed through existing laws 75

6.2.2 Development or modification of laws for public health issues 100

6.2.3 Technical assistance for drafting proposed legislation, regulations, or ordinances 100






Multiple public forums available to discuss the issues.

Asset-rich community with lots of technical expertise.

Well-respected leadership.

Leadership weighs-in on the issues.

Health Insurance Portability and Accountability Act (HIPPA) does not allow us to share medical information.

Only one legislation liaison.

Voices are not always aligned across agencies.

Disconnect between federal drivers (regulations passed that become mandated laws) that require local compliance – locals have no say.

Lack of unified voice.

Politicians will not support a health benefit (such as needle exchange) although the health benefits have been proven – similar to tobacco use across the 50 states.

Recommendations

Disconnect emotional decision from health data.

Be better advocates.

Provide educational outreach to politicians and public regarding public health issues.

Listening sessions with all stakeholders throughout the county.

If you see something, say something (feedback concerning issues).

LPHS Model Standard 6.3: Enforcement of Laws, Regulations, and Ordinances

The LPHS recognizes the unique role of the government to enforce public health laws, regulations, and

ordinances. The authority of the governmental organizations within the LPHS to enforce public health laws,

regulations, and ordinances varies from state to state and between jurisdictions within states. In many

communities, the local health department exercises regulatory enforcement that is delegated or contracted to it

by federal, state, county, or municipal government entities. In other communities, enforcement authority may

be retained by the state or delegated to one or more private entities whose authority may cross local

jurisdictional boundaries.

To enforce laws, regulations, and ordinances, the LPHS:

Identifies organizations within the LPHS that have authority to enforce public health laws, regulations,

or ordinances.


Assures that a local governmental public health entity is appropriately empowered through laws and

regulations to act in public health emergencies and implement necessary community interventions.

Assures that all enforcement activities are conducted in accordance with laws, regulations, and

ordinances.

Informs and educates individuals and organizations of the meaning and purpose of public health laws,

regulations, and ordinances with which they are required to comply.

Evaluates the compliance of regulated organizations and entities.

Model Standard 6.3 Enforcement of Laws, Regulations, and Ordinances


6.3.1 Authority to enforce laws, regulation, ordinances 100

6.3.2 Public health emergency powers 100

6.3.3 Enforcement in accordance with applicable laws, regulations, and ordinances 100

6.3.4 Provision of information about compliance 75

6.3.5 Assessment of compliance 100






Conduct audits on a regular basis.

Contains a well -trained and experienced staff.

Culture of service.

Established framework that works.

Davidson County’s Public Health Dept. is large enough to enforce laws county-wide.

Administrative support.

Dwindling resources.

Not always adept to properly deal with advocacy groups.

Not a lot of flexibility because of established past.

Some laws are not up to date.

Recommendations

More resources (e.g. staff and financial support).

Stay relevant to population size.

Centralized tracking of cases.

Offer greater flexibility with new technology such as tablets.

Offer new trainings.







Quadrant 1 - High Priority/Low Performance

Quadrant 2 - High Priority/High Performance 6.1 Review and Evaluate Laws, Regulations, and Ordinances 6.2 Involvement in the Improvement of Laws, Regulations, and Ordinances 6.3 Enforce Laws, Regulations and Ordinances





a high priority. Scores in Quadrant 2 indicate that it is important to maintain the current level of performance

through utilization of public health best practices and allocation of resources.


Model Standard 7.1 Identification of Personal Health Service Needs of Populations

Model Standard 7.2 Assuring the Linkage of People to Personal Health Services



The table on the page below shows the scores for each model standard, including the range of scores from

each of the questions in the model standard.

Essential Service #7 Link People to Needed Personal Health Services and Assure the Provision of Health Care when Otherwise Unavailable

Overall Score: 47 (Moderate)


Identifying populations with barriers to personal health services.

Identifying personal health service needs of populations with limited access to a coordinated system of clinical care.

Assuring the linkage of people to appropriate personal health services through coordination of provider services and development of interventions that address barriers to care (e.g., culturally and linguistically appropriate staff and materials, transportation services).


LPHS Model Standard 7.1: Identification of Personal Health Service Needs of Populations

The local public health system (LPHS) identifies populations who may encounter barriers to personal health

services. Identified barriers may be due to age, lack of education, poverty, culture, race, language, religion,

national origin, physical and/or mental disability, or lack of health insurance. In order to ensure equitable

access to personal health services, the LPHS has defined and agreed upon roles and responsibilities for the

local governmental public health entity, hospitals, managed care plans, and other community health care

providers in relation to providing these services.


Identifies populations in the community who may experience barriers to the receipt of personal health

services.

Defines personal health service needs for the general population and for those populations who may

experience barriers to personal health services. This includes defining specific preventive, curative, and

rehabilitative health service needs for the jurisdiction.

Assesses the extent to which personal health services in the jurisdiction are available and utilized by

populations who may encounter barriers to care.

Model Standard 7.1 Identification of Personal Health Service Needs of Populations


7.1.1 Identification of populations who experience barriers to care 50

7.1.2 Identification of personal health service needs of populations 50

7.1.3 Assessment of personal health services available to populations who experience barriers to care

50






Moderate activity in providing linkage to medical home.

Safety net clinics.

Lack of specialty care.

Not sharing data; some data used is not comprehensive.


TENNderCare / Bridges to Care.

Special organizations look out for their population.

Nashville is an educational mecca.

Limited prevention and education interventions.

Lack of insurance.

Community doesn’t know what is out there.

Recommendations

Conduct more assessments/ screenings.

Use data we have and find expertise to share data.

We should become more culturally and linguistically responsive/ involved.

Create an evaluation mechanism.

LPHS Model Standard 7.2: Assuring the Linkage of People to Personal Health Services

The LPHS supports and coordinates partnerships and referral mechanisms among the community’s public

health, primary care, oral health, social service, and mental health systems to optimize access to needed

personal health services. The LPHS seeks to create innovative partnerships with organizations such as

libraries, parenting centers, and service organizations that will help to enhance the effectiveness of LPHS

personal health services.


Links populations to personal health services, including populations who may encounter barriers to

care.

Provides assistance in accessing personal health services in a manner that recognizes the diverse

needs of unserved and underserved populations.

Enrolls eligible beneficiaries in state Medicaid or Medical and Prescription Assistance Programs.

Coordinates the delivery of personal health and social services to optimize access

Model Standard 7.2 Assuring the Linkage of People to Personal Health Services


7.2.1 Link populations to needed personal health services 50

7.2.2 Assistance to vulnerable populations in accessing needed health services 50

7.2.3 Initiatives for enrolling eligible individuals in public benefit programs 50

7.2.4 Coordination of personal health and social services 25






Safety Net Consortium .

Limited pharmacy formulary makes affordable medication available.

Diminished enrollment capacity.

Needs are so great that concerns are not effectively communicated.

Lack of access and specialty care.

Lack of early interventions and limited prevention capabilities.

Diverse needs of the underserved/ uninsured


population are not met.

No evaluation mechanism.

Recommendations

Need a unified voice to speak to elected officials and help make this a priority for the city.

Conduct more assessments and screenings.

Use and share data.

Be culturally/ linguistically involved

The health department should continue to be a political advocate by keeping needs in front of lobbyist. .

Need more providers – they are retiring with no one to replace them.

Money made available to pay new providers.

Develop an evaluation mechanism.

Tuition forgiveness for those that work with the underserved and uninsured population.






Quadrant 1 - High Priority/Low Performance 7.1 Identification of Populations with Barriers to Personal Health Services 7.2 Assuring the Linkage of People to Personal Health Services






a high priority and or low performance. Scores in Quadrant 1 indicate that some increased attention is

necessary in order to perform at higher level, per the prioritization of this model standard; using public health

practices and resource allocation are two ways to improve Quadrant 1 scores. See the recommendations

included for each of the model standards for additional ideas for improvement.



Model Standard 8.1 Workforce Assessment, Planning, and Development

Model Standard 8.2 Public Health Workforce Standards

Model Standard 8.3 Life-Long Learning through Continuing Education, Training and Mentoring

Model Standard 8.4 Public Health Leadership Development





LPHS Model Standard 8.1: Workforce Assessment, Planning, and Development

Workforce assessment is the process of determining the competencies, skills, and knowledge; categories and

number of personnel; and training needed to achieve public health and personal health goals. It is a community

process that includes the identification of those available to contribute to the provision of the Essential Public

Health Services and the particular strengths and assets that each brings. Workforce assessment includes the

projection of optimal numbers and types of personnel and the formulation of plans to address identified

workforce shortfalls or gaps.

To accomplish this, organizations within the local public health system (LPHS):

Essential Service #8 Assure a Competent Public & Personal Care Workforce



Assessment of all of the workers within the local public health system (LPHS) (including agency, public, and private workers, volunteers, and other lay community health workers) to meet community needs for public and personal health services.

Maintaining public health workforce standards, including efficient processes for licensure/credentialing of professionals and incorporation of core public health competencies needed to provide the Essential Public Health Services into personnel systems.

Adoption of continuous quality improvement and life-long learning programs for all members of the public health workforce, including opportunities for formal and informal public health leadership development.


Establish a collaborative process to periodically determine the competencies, composition, and size of

the public and personal health workforce that provides the Essential Public Health Services.

Identify and address gaps in the public and personal health workforce, ideally using information from

the assessment.

Distribute information from the workforce assessment to community organizations, including governing

bodies and public and private agencies, for use in their strategic and operational plans.

Model Standard 8.1 Workforce Assessment, Planning, and Development


8.1.1 Assessment of the LPHS workforce 75

8.1.2 Identification of shortfalls and/or gaps within the LPHS workforce 75

8.1.3 Dissemination of results of the workforce assessment / gap analysis 50






Used a systems approach that addresses the model standard.

Multiple organizations involved in assessment.

The health department is starting to build competencies into our HR infrastructure, focusing on how to do business.

Acknowledging that the system goes beyond the health department and identify additional system partners to bring to the table.

Workforce needs of the local health department, Tennessee Department of Health, and academic institutions are being met.

There hasn’t been a recent full assessment.

Most of the focus has been on the assessment of composition gaps with the local public health department, instead of focusing on the local public health system.

The Health Learning Collaborative sessions include 20-30 people representing groups – not a lot of organizations and groups are affected with these small numbers – need to reach out more.

Recommendations

Strengthen diversity of individuals in the public health system to better represent the changing population.

Disseminate tools and best practices to a broader audience.

Broaden the base - who is not included and bring them to the table .

Seek missing assessment information – other information is still out there that we have not found/ included.

Models are here to diffuse competencies into the local public health systems, but we need to explain what we are doing so others can see how it can benefit them.

Develop a system to look at/evaluate local public health system competencies to diffuse and disseminate it into the committee.

Information needs to be readily available.


LPHS Model Standard 8.2: Public Health Workforce Standards

Organizations within the LPHS develop and maintain public health workforce standards for individuals who

deliver and/or contribute to the Essential Public Health Services. Public health workforce qualifications include

certifications, licenses, and education required by law or established by local, state, or federal policy

guidelines. In addition, core and specific competencies that are needed to provide the Essential

Public Health Services are incorporated into personnel systems. These standards are linked to job

performance through clearly written position descriptions and regular performance evaluations.

To accomplish this, organizations within the LPHS:

Are aware of and in compliance with guidelines and/or licensure/certification requirements for personnel

contributing to the Essential Public Health Services.

Periodically develop, use, and review job standards and position descriptions that incorporate specific

competency and performance expectations.

Evaluate members of the public health workforce on their demonstration of core public health

competencies and those competencies specific to a work function or setting and encourage staff to

respond to evaluations and performance goal adjustments by taking advantage of continuing education

and training opportunities.

Workforce standards are essential for each organization within the local public health system, but are

particularly important for the local health department (LHD) where a large concentration of public health

professionals exists.

To fulfill these important obligations the LHD:

Develops written job standards and/or position descriptions for all LHD personnel.

Conducts annual performance evaluations of personnel within the LHD.

Model Standard 8.2 Public Health Workforce Standards


8.2.1 Awareness of guidelines and/or licensure/certification requirements 100

8.2.2 Written job standards and/or position descriptions 75

8.2.3 Annual performance evaluations 75

8.2.4 LHD written job standards and/or position descriptions 100

8.2.5 LHD performance evaluations 100






Standards are hardwired into the system – our specifications are spelled out – license/ certification online can be checked online.

There is always room for improvement.

There are very broad job descriptions for non-licensed personnel – we are just now starting to


Courses/webinars are available and accessible online - there are coordinated efforts to continue trainings.

write in job competencies.

Have not extended public health training outside of local public health departments.

Job descriptions should include emerging issues, e.g. – training in case there is a shooting on campus.

Recommendations

Identify a set of public health competencies to partners that might improve their ability.

Provide a website that would identify places to obtain additional training to learn workplace standards.

Post job descriptions that might help those reaching for public health competencies.

LPHS Model Standard 8.3: Life-Long Learning through Continuing Education, Training, and Mentoring

Continuing education and training include formal and informal educational opportunities. This may encompass

distance learning, workshops, seminars, national and regional conferences, and other activities intended to

strengthen the professional knowledge and skills of employees contributing to the provision of the Essential

Public Health Services. Experienced mentors and coaches are available to less experienced staff to provide

advice and assist with skill development and other needed career resources. Opportunities are available for

staff to work with academic and research institutions, particularly those connected with schools of public

health, public administration, and population health disciplines. Through these academic linkages, the public

health workforce, faculty, and students are provided with opportunities for relevant interaction, which enriches

both settings.

The complexity of promoting health and preventing disease in a country as diverse as the United States

requires the public health workforce to continually learn and apply this new knowledge. The population in the

United States continues to be diverse in terms of race, ethnicity, faith beliefs, age, economics, education, life-

style preference and other demographic characteristics. Factors such as the social environment, physical

environment, economic status, genetic predisposition, behavioral risk factors, and health care also influence

health and well-being. An understanding and respect for this diversity and the underlying factors that address

health are critical to the performance of all of the Essential Public Health Services. The LPHS respects diverse

perspectives and cultural values and expects staff to demonstrate cultural competence in all interactions based

on the dignity and value of each individual as a professional colleague or community member.


Identify education and training needs and encourage opportunities for workforce development.

Provide opportunities for all personnel to develop core public health competencies.

Provide incentives (e.g., improvements in pay scale, release time, tuition reimbursement) for the public

health workforce to pursue education and training.

Provide opportunities for public health workforce members, faculty and student interaction to mutually

enrich practice-academic settings.

Model Standard 8.3 Life-Long Learning through Continuing Education, Training, and Mentoring


8.3.1 Identification of education and training needs for workforce development 75

8.3.2 Opportunities for developing core public health competencies 50


8.3.3 Educational and training incentives 25

8.3.4 Interaction between personnel from LPHS and academic organizations 75






Partnerships with academic community are strong – a decade long process.

Nashville has the most resources in the state.

Tennessee Department of Health is also meeting these needs through partnerships.

The leadership within LPHS is engaged and involved – from the top down.

One of the Learning Collaboratives focuses on cultural competency.

Willingness to offer out-of-the-box training based on problems within public health not normally considered.

Sponsorships are available for community members to attend national conferences.

Neighborhood Resource Center and Scarritt-Bennett offer trainings..

It would be ideal to offer more incentives.

Some sectors of the public health system still need opportunities for additional trainings.

Recommendations

Provide more incentives.

Expand opportunities for partnerships to participate.

Sponsor non-academic / health department partners in trainings/ conferences.

LPHS Model Standard 8.4: Public Health Leadership Development

LPHS leadership is demonstrated by both individuals and organizations that are committed to improving the

health of the community. Leaders play a vital role in assuring the creation of a public health system, the

implementation of the Essential Public Health Services, and the creation and achievement of a shared vision of

community health and well-being. LPHS leadership may be provided by the local governmental public health

entity, may emerge from the public and private sectors or the community, or may be shared by multiple

stakeholders. The LPHS encourages the development of leadership capacity that is inclusive, representative of

community diversity, and respectful of the community’s perspective.

To accomplish this, the organizations within the LPHS:

Provide formal (e.g., educational programs, leadership institutes) and informal (e.g., coaching,

mentoring) opportunities for leadership development for employees at all organizational levels.

Promote collaborative leadership through the creation of a public health system with a shared vision

and participatory decision-making.

Assure that organizations and/or individuals have opportunities to provide leadership in areas where

their expertise or experience can provide insight, direction, or resources.


Provide opportunities for development of diverse community leadership to assure sustainability of

public health initiatives.



8.4.1 Development of leadership skills 50

8.4.2 Collaborative leadership 75

8.4.3 Leadership opportunities for individuals and/or organizations 75

8.4.4 Recruitment and retention of new and diverse leaders 25






The number of consortiums/ collaborations involving community members.

Collaborations with academic institutions.

Longevity of consortiums/ committees.

Collaborations of public agencies.

Mayor’s support.

Not enough incentives offered.

There is not a national method used to achieve results – often organizations find themselves reinventing the wheel.

Recommendations

Improve on the formal leadership training process

Need opportunities for additional trainings so other partners can thrive. After-hours meetings to allow greater participation for the entire community. Meeting locations are also important –

important to be centrally located so that community can access.

Address issues that are important to various segments of the community.

Maintain leadership focus on incorporating health in development decisions.

Document and share success with other communities.

Engage Neighborhood Resource Center to identify and develop leadership.

Utilize Health Impact Assessments.







Quadrant 1 - High Priority/Low Performance 8.3 Life-Long Learning Through Continuing Education, Training, and Mentoring 8.4 Public Health Leadership Development

Quadrant 2 - High Priority/High Performance 8.1 Workforce Assessment Planning, and Development 8.2 Public Health Workforce Standards





a high priority and either low or high performing. Scores in Quadrant 1 indicate that some increased attention is

necessary in order to perform at a higher level, per the prioritization of this model standard; using public health

practices and resource allocation are two ways to improve Quadrant 1 scores. Scores in Quadrant 2 indicate

that it is important to maintain the current level of performance through utilization of public health best practices

and allocation of resources.


Model Standard 9.1: Evaluation of Population-Based Health Services

Model Standard 9.2: Evaluation of Personal Health Services

Model Standard 9.3: Evaluation of the Local Public Health System





Essential Service #9 Evaluate Effectiveness, Accessibility, and Quality of Personal and Population-Based Health Services



Evaluating the accessibility and quality of services delivered and the effectiveness of personal and population-based programs provided.

Providing information necessary for allocating resources and reshaping programs.


LPHS Model Standard 9.1: Evaluation of Population-Based Health Services

The local public health system (LPHS) regularly evaluates the accessibility, quality, and effectiveness of

population-based health services (e.g., injury prevention, physical activity, immunizations) and progress

towards program goals. The LPHS has established performance criteria, or used externally established

performance criteria (e.g., Healthy People 2010 objectives or The Guide to Community Preventive Services),

to evaluate specific indicators for population-based services. The evaluation of population-based health

services is built on the analysis of health status, service utilization, and community satisfaction data to assess

program effectiveness and to provide information to allocate resources and reshape programs.


Evaluates population-based health services against established criteria for performance, including the

extent to which program goals are achieved for these services.

Assesses community satisfaction with population-based services and programs through a broad-based

process, which includes residents who are representative of the community and groups at increased

risk of negative health outcomes.

Identifies gaps in the provision of population-based health services.

Uses evaluation findings to modify the strategic and operational plans of LPHS organizations to

improve services and programs.

Model Standard 9.1 Evaluation of Population-Based Health Services


9.1.1 Evaluation of population-based health services 75

9.1.2 Assessment of community satisfaction with population-based health services 25

9.1.3 Identification of gaps in the provision of population-based health services 50

9.1.4 Use of population-based health services evaluation 75







Strong Immunization focus.

National Behavioral Risk Factors Surveillance System.

Number of population-health based programs. Key result measures are set before evaluation.

Not getting the communication out there.

Sustainability.

Competing funding streams prevent collaboration.

A focus generated by one agency may not be relevant to other agencies

Recommendations

Better coordination to prevent redundancies in population-based health services.

Focus on healthy homes – assessment then follow-up.

LPHS Model Standard 9.2: Evaluation of Personal Health Services

The LPHS regularly evaluates the accessibility, quality, and effectiveness of personal health services, ranging

from prevention services to acute care to hospice care. Special attention is given to the ability of community

providers to deliver services across life stages and population groups. An important component of the

evaluation is a survey of client satisfaction. The clients surveyed are representative of all actual and potential

users of the system. The survey addresses satisfaction with access to the system by populations with barriers

to personal health services, usability of the system by all clients, and inclusiveness of services.


Evaluate the accessibility, quality, and effectiveness of personal health services.

Evaluate personal health services against established standards.

Assess the satisfaction of clients (including those at increased risk of negative health outcomes).

Use information technology to assure quality of personal health services and communication among

providers.

Use evaluation findings to modify their strategic and operational plans and to improve services and

programs.

Model Standard 9.2 Evaluation of Personal Health Services


9.2.1.In Personal health services evaluation 50

9.2.2 Evaluation of personal health services against established standards 75

9.2.3 Assessment of client satisfaction with personal health services 50

9.2.4 Information technology to assure quality of personal health services 50

9.2.5 Use of personal health services evaluation 75







Surveys are taking place to assess client satisfaction.

Accreditation/ magnet status. Data used for program improvement.

Surveys do not measure the quality of care.

Recommendations

We should use multiple tools of evaluation to capture quality timelines, customer services, medical care, and cultural competence.

Ensure data (subjective and objective questions) are utilized.

Communicate results and the follow-up to address issues.

LPHS Model Standard 9.3: Evaluation of the Local Public Health System

A local public health system includes all public, private, and voluntary entities, as well as individuals and

informal associations that contribute to the delivery of the Essential Public Health Services within a jurisdiction.

The evaluation focuses primarily on the performance of the LPHS as a whole. The local governmental public

health entity takes a lead role in convening a collaborative evaluation process. Organizations engaged in the

evaluation process use established criteria to assess LPHS activities, the achievement of goals, and any

lapses in quality. The standards used are consistent with NPHPSP or similar standards. Community

perceptions are a vital component of the evaluation. The evaluation findings are regularly used to inform the

community health improvement process and to improve services and programs.


Identifies community organizations or entities that contribute to the delivery of the Essential Public

Health Services.

Evaluates the comprehensiveness of LPHS activities against established criteria at least every five

years and ensures that all organizations within the LPHS contribute to the evaluation process.

Assesses the effectiveness of communication, coordination, and linkage among LPHS entities.

Uses information from the evaluation process to refine existing community health programs, to

establish new ones, and to redirect resources as needed to accomplish LPHS goals.

Model Standard 9.3 Evaluation of the Local Public Health System


9.3.1 Identification of community organizations or entities that contribute to the EPHS 75

9.3.2 Periodic evaluation of LPHS 0

9.3.3 Evaluation of partnership within the LPHS 50

9.3.4 Use of LPHS evaluation to guide community health improvements 25







Good cross section attended this assessment.

This was a safe forum for open, respectful dialogue.

Attendance was lacking, e.g., need more representation from TDH, Urban League, Department of Mental Health and Substance Abuse, hospitals, civil right and minority groups, faith-based organizations, ADA and special needs community.

Recommendations

Expand community representation to include all groups.

Furnish more information / explanation, allowing participants to have more information before assessment voting.

Use information technology to gather more information.






Quadrant 1 - High Priority/Low Performance 9.1 Evaluation of Population-based Health Services 9.3 Evaluation of the Local Public Health System


Quadrant 3 - Low Priority/High Performance Quadrant 4 - Low Priority/Low Performance 9.2 Evaluation of Personal Health Care Services




low performing, and given either a high or low priority rating. Scores in Quadrant 1 indicate that some

increased attention is necessary in order to perform at higher level, per the prioritization of this model standard;

using public health practices and resource allocation are two ways to improve Quadrant 1 scores. Scores in

Quadrant 4 indicate these activities could be improved, but are of low priority. They may need little or no

attention at this time and may serve as an area from which resources can be shifted to the high priority areas.



Model Standard 10.1 Fostering Innovation

Model Standard 10.2 Linkage with Institutions of Higher Learning and/or Research

Model Standard 10.3 Capacity to Initiate or Participate in Research





LPHS Model Standard 10.1: Fostering Innovation

Organizations within the local public health system (LPHS) foster innovation to strengthen public health

practice. Innovation includes practical field-based efforts to foster change in public health practice as well as

academic efforts to encourage new directions in scientific research.


Enable staff to identify new solutions to health problems in the community by providing the time and

resources for staff to pilot test or conduct studies to determine the feasibility of implementing new ideas.

Propose public health issues to organizations that do research for inclusion in their research agendas.

Research and monitor best practice information from other agencies and organizations at the local,

state, and national level.

Essential Service #10: Research for New Insights and Innovative Solutions to Health Problems



A continuum of innovative solutions to health problems ranging from practical field-based efforts to foster change in public health practice, to more academic efforts to encourage new directions in scientific research.

Linkages with institutions of higher learning and research.

Capacity to undertake timely epidemiological and health policy analyses and conduct health systems research.


Encourage community participation in research development and implementation (e.g., identifying

research priorities, designing studies, preparing related communications for the general public).

Model Standard 10.1 Fostering Innovation


10.1.1 Encouragement of new solutions to health problems 75

10.1.2 Proposal of public health issues for inclusion in research agenda 75

10.1.3 Identification and monitoring of best practices 50

10.1.4 Encouragement of community participation in research 50






Willingness to work together to implement new ideas and openness to new ways of doing things.

Explicit research resources for linking with public health.

Needs more community participation.

Lack of information dissemination to the public.

Roadblocks to building partnerships because of lack of time.

Lack of link between research and public health practice.

Recommendations

Cultivate practice–based researchers.

Provide more incentives which would allow new ideas to grow to fruition.

Provide opportunities to pilot ideas.

Find new methods to disseminate findings.

Provisions for research dollars to benefit the community .

Dedicate time for practitioners to work in and rotate through community- based clinics.

Develop diverse leadership to advise research.

LPHS Model Standard 10.2: Linkage with Institutions of Higher Learning and/or Research

The LPHS establishes a wide range of relationships with institutions of higher learning and/or research

organizations, including patterns of mutual consultation, and formal and informal affiliation. Such relationships

can occur with schools of public health as well as with schools and departments of medicine, nursing,

pharmacy, allied health, business and environmental science. The LPHS establishes linkages with other

research organizations, such as federal and state agencies, associations, private research organizations, and

research departments or divisions of business firms. The LPHS links with one or more institutions of higher

learning and/or research organizations to co-sponsor continuing education programs.


Develops relationships with these institutions that range from patterns of consultation to formal and

informal affiliations.


Partners with institutions of higher learning or research to conduct research activities related to the

public’s health, including community-based participatory research.

Encourages collaboration between the academic/research and practice communities, including field

training experiences and continuing education opportunities.

Model Standard 10.2 Linkage with Institutions of Higher Learning and/or Research


10.2.1 Relationships with institutions of higher learning and/or research organizations 75

10.2.2 Partnerships to conduct research 100

10.2.3 Collaboration between the academic and practice communities 75






Several academic institutions are headquartered in Nashville and can be used as a resource.

Growing number of community organizations interested in research.

Formal and informal relationships have been formed which offer opportunities for learning.

Mission statements of some institutions do not have “engaging with the community” included.

A lot of work is done but very little is published resulting in a lack of dissemination.

Lack of establishing work as ‘best practices.’

Mutuality of benefit is rare among consultations.

Recommendations

Formalize expectations among students to have a list of competencies that they need to accomplish.

Need some value as to what MPHD brings to the table, whether it is consultation or something else.

Utilize “Give – Get Model,” developed by East Tennessee State University, for developing mutually beneficial relationships between organizations and local public health departments.

Plan and evaluate relationships with community/ academic partners.

Continued support for students participating in Community Based Participatory Research in LPHS .

LPHS Model Standard 10.3: Capacity to Initiate or Participate in Research

Organizations within the LPHS initiate and/or participate in research that contributes to epidemiological and

health policy analyses and improved health system performance. Health systems research encompasses both

population-based and personal health care services research. This research includes the examination of

factors related to the efficient and effective implementation of the Essential Public Health Services (public

health systems research) as well as the study of variables that influence health care quality and service

delivery (health services research).

The capacity to initiate or participate in timely epidemiological, policy, and health systems research begins with

ready access to researchers with the knowledge and skill to design and conduct research in those areas. This

capacity also includes the availability of resources, such as a technical library, on-line services, and information

technology. Capacity also includes facilities for analyses, and the ability to disseminate and apply research

findings to improve public health practice.



Includes or has access to researchers with the knowledge and skill to design and conduct health-

related studies.

Ensures the availability of resources (e.g., databases, information technology) to facilitate research.

Disseminates research findings to public health colleagues and others (e.g., publication in journals,

websites).

Evaluates the development, implementation, and impact of LPHS research efforts on public health

practice.

Model Standard 10.3 Capacity to Initiate or Participate in Research


10.3.1 Access to researchers 50

10.3.2 Access to resources to facilitate research 50

10.3.3 Dissemination of research findings 25

10.3.4 Evaluation of research activities 25






There is access to data and research tools that are routinely used.

There are many research/ public health needs allowing opportunity for research.

Lack of time and resources.

Not enough focus on practice-based research

Community burn-out due to lack of dissemination.

Lack of perceived benefits.

Lack of dissemination to personal health providers.

Recommendations

Greater dissemination of public health research to community practitioners.

Create a process within the health department starting with intuition and moving through question, data, analysis, and ending with interpretation / translation for community

More community focused research .

More openness to community – relevant defined research.







Quadrant 1 - High Priority/Low Performance 10.1 Fostering Innovation 10.3 Capacity to Initiate or Participate in Research

Quadrant 2 - High Priority/High Performance 10.2 Linkage with Institutions of Higher Learning and/or Research




displayed in the "low" performance quadrants. All of the model standards for Essential Service 10 were rated

as a high priority and either low or high performing. Scores in Quadrant 1 indicate that some increased

attention is necessary in order to perform at higher level, per the prioritization of this model standard; using

public health practices and resource allocation are two ways to improve Quadrant 1 scores. Scores in

Quadrant 2 indicate that it is important to maintain the current level of performance through utilization of public

health best practices and allocation of resources.


LPHSA Follow-Up: Root Cause Analysis

On October 25, 2013, 18 of the 57 LPHSA participants reconvened to take part in a follow-up to the

assessment. After disseminating the initial report results, the participants broke out into the same four

Essential Services groups to prioritize all of the model standards that did not score Optimal for their group. The

small groups used the following two questions to prioritize the model standards:

On a scale from 1 to 5, with 1 being lowest impact, and 5 being greatest impact, how great of an impact

(consider impacts on system effectiveness, health outcomes, size of population affected) does this

model standard have on local public health system?

On a scale from 1 to 5, how feasible (considering resources, support within LPHS to address the

issues) is it that improvements to this model standard could be addressed in the near future?

High Impact – median or above

High Feasibility - median or above

These are first priority for fishbone exercise.

High Impact – median or above

Low Feasibility –below median

These are second priority for fishbone

exercise.

Low Impact – below median

High Feasibility – median or above

These are third priority for fishbone exercise.

Low Impact –below median

Low Feasibility –below median

These are last priority for fishbone exercise.

Once scored, the small groups took the top scoring priority model standard(s) for their group and did a

Fishbone Diagram, or root cause analysis. See Appendix F for the Root Cause Analysis Process Instructions.


Group 1 – Model Standards 1, 2 & 6

Group 1 completed 2 fishbone diagrams for their top two priority model standards. They addressed the

following model standards:

Model Standard 1.2 Current Technology to Manage and Communicate Population Health Data




Group 2 – Model Standards 3, 4 & 7

Group 2 completed 2 fishbone diagrams for their top two priority model standards. They addressed the

following model standards:


Model Standard 7.2 Assuring the linkage of People to Personal Health Services



Group 3 – Model Sandards 5 & 9

Group 3 completed 1 fishbone diagram for their tip priority model standard. They addressed the following

model standard:



Group 4 – Model Standads 8 & 10

Group 4 completed 1 fishbone diagram for their top priority model standard. They addressed the following

model standard:



Bibliography

National Association of County and City Health Officials. (2008, February). Mobilizing for Action through

Planning. Retrieved September 2013, from NACCHO Web Site:

http://www.naccho.org/topics/infrastructure/mapp/framework/upload/MAPP-Fact-Sheet-System-


Appendices

Appendix A

Healthy Nashville Leadership Council Executive Order

Article I. EXECUTIVE ORDER NO. 025

Section 1.01 THE METROPOLITAN GOVERNMENT OF NASHVILLE AND DAVIDSON

COUNTY

Section 1.02 KARL F. DEAN , MAYOR

SUBJECT: Healthy Nashville Leadership Council

I, Karl Dean, Mayor of the Metropolitan Government of Nashville and Davidson County, by virtue of the power and authority vested in me, do hereby amend former Mayor Purcell Executive Order No. 019 and find, direct and order the following:

I. The Metropolitan Government desires to improve the health of its citizens by assessing citizen’s health status, the current health systems available to provide essential services, and potential forces of change affecting citizen health and establishing strategic priorities for health improvement; and

II. Much of the chronic disease burden is preventable and the underlying contributors to chronic diseases include unhealthy diet, lack of physical activity, and tobacco use; and

III. Community-wide action is necessary to improve health, including action by individuals, families, schools, employers and businesses, community groups, religious communities, and government; and

IV. The Healthy Nashville Leadership Council has been successful in drawing community-wide attention to and encouraging ownership of important public health problems and their solutions.

1. Healthy Nashville Leadership Council: There is a Davidson County citizens’ council called the Healthy Nashville Leadership Council (hereinafter Council).

2. Council’s duties: The Council shall be charged with: a. Assessing the health status and quality of life of Davidson County residents, assessing health systems for essential services, and assessing potential forces of change, and b. Establishing strategic priorities and mobilizing community initiatives to achieve improvements in health.

3. Council members: The Council shall be composed of eighteen (18) members appointed by the Mayor. a. One of the members shall be a member of the Metropolitan Board of Health; and b. One of the members shall be the Director of Health or her/his designee. c. Other appointees to the Council shall include, but not be limited to, representatives of health care organizations, community organizations, and other interested community members. d. Members of the Council shall be appointed with a conscious intention of reflecting a diverse mixture with respect to race, ethnicity, gender, and age.

4. Terms for Council members:


a. With the exception of the Director of Health, the regular term of a member of the council shall be three (3) years. b. However, of the initial membership of the Council, five (5) members will serve one (1) year, six (6) members will serve two (2) years, and six (6) members will serve three (3) years so that the terms are staggered as to replace no more than one third (1/3) of the members each year. [Note: The Mayor will designate the term length for each initial Council member at the time of appointment.] c. Members of the Council shall continue in office until the expiration of the terms for which they were respectively appointed and until such time as their successors are appointed, unless a member is administratively removed from the Council pursuant to section 10 below.

5. Vacancies: A vacancy shall be filled in the same manner as a regular appointment.

6. Compensation: Members of the Council shall not be compensated for services rendered.

7. Chair: The Mayor shall appoint a chair from among the members.

8. Officers: The Council shall elect other officers as the Council finds necessary and appropriate.

9. Quorum: A quorum for approving decisions by the Council shall consist of a majority of the currently filled positions on the Council.

10. Removal of Members: A member who fails to attend three (3) or more meetings in a calendar year will cease to be a member absent a vote of retention by the Council.

11. Staff: The Metropolitan Public Health Department shall provide staff support for the Council.

Ordered, Effective and Issued:

Karl F. Dean Mayor

Date: March 17, 2008


Appendix B

Understanding Data Limitations

Respondents to the self-assessment should understand what the performance scores represent and potential

data limitations. All performance scores are a composite; stem question scores represent a composite of the

stem question and subquestion responses; model standard scores are a composite of the question scores

within that area, and so on. The responses to the questions within the assessment are based upon processes

that utilize input from diverse system participants with different experiences and perspectives. The gathering of

these inputs and the development of a response for each question incorporates an element of subjectivity,

which can be minimized through the use of particular assessment methods. Additionally, while certain

assessment methods are recommended, processes can differ among sites. The assessment methods are not

fully standardized and these differences in administration of the self-assessment may introduce an element of

measurement error. In addition, there are differences in knowledge about the public health system among

assessment participants. This may lead to some interpretation differences and issues for some questions,

potentially introducing a degree of random non-sampling error.

Because of the limitations noted, the results and recommendations associated with these reported data should

be used for quality improvement purposes. More specifically, results should be utilized for guiding an overall

public health infrastructure and performance improvement process for the public health system. These data

represent the collective performance of all organizational participants in the assessment of the local public

health system. The data and results should not be interpreted to reflect the capacity or performance of any

single agency or organization.

Assessment results represent the collective performance of all entities in the local public health system and not

any one organization. Therefore, system partners should be involved in the discussion of results and

improvement strategies to assure that this information is appropriately used. The assessment results can drive

improvement planning within each organization as well as system-wide. In addition, coordinated use of the

Local Instrument with the Governance Instrument or state-wide use of the Local Instrument can lead to more

successful and comprehensive improvement plans to address more systemic statewide issues.


Appendix C

LPHSA Agenda

LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT

Martin Professional Development Center August 14, 2013

8:00 AM Registration

8:30 AM Welcome and Orientation (Turner Halls B&C)

8:50 AM Breakout Groups

A. Essential Services 1, 2 & 6 (Classroom 1)

B. Essential Services 3, 4, & 7 (Classroom 6)

C. Essential Services 5 & 9 (Classroom 2)

D. Essential Services 8 & 10 (Classroom 7)

TBD Lunch (Turner Halls B&C)

TBD Return to breakout groups (Classrooms)

3:00 PM Closeout (Turner Halls B&C)


Appendix D

Key Comments from Voting

Question 1.1.1: Has the LPHS conducted a community health assessment?

1st Vote

Optimal Significant X Moderate Minimal No

Key comments from discussion on vote (if applicable)

2nd Vote (optional)

Optimal Significant Moderate Minimal No

Question 1.1.2: Does the LPHS compile data from the community health assessment(s) into a community health profile (CHP)?

1st Vote

Optimal Significant Moderate X Minimal No


2nd Vote (optional)


Question 1.1.3: Is community-wide use of community health assessment or CHP data promoted?

1st Vote

Optimal Significant Moderate X Minimal No


2nd Vote (optional)


Question 1.2.1: Does the LPHS use state-of-the-art technology to support health profile databases?

1st Vote

Optimal X Significant Moderate Minimal No


2nd Vote (optional)



Question 1.2.2: Does the LPHS have access to geocoded health data?

1st Vote


2nd Vote (optional)


Question 1.2.3: Does the LPHS use computer-generated graphics to identify trends and/or compare data by relevant categories (i.e., race, gender, age group)?

1st Vote

Optimal Significant X Moderate Minimal No


2nd Vote (optional)


Question 1.3.1: Does the LPHS maintain and/or contribute to one or more population health registries?

1st Vote



2nd Vote (optional)


Question 1.3.2: In the past year, has the LPHS used information from one or more population health registries?

1st Vote

X Optimal Significant Moderate Minimal No


2nd Vote (optional)



Question 2.2.1: Does the LPHS maintain written protocols for implementing a program of case finding, contact tracing, source identification, and containment for communicable diseases or toxic exposures?

1st Vote


Question 2.2.2: Does the LPHS have current epidemiological case investigation protocols to guide immediate investigations of public health emergencies?

1st Vote


Question 2.2.3: Has the LPHS designated an individual to serve as an Emergency Response Coordinator within the jurisdiction?

1st Vote


Question 2.2.4: Can LPHS personnel rapidly respond to natural and intentional disasters?

1st Vote


Question 2.2.5: Does the LPHS have capacity to mobilize volunteers during a disaster?

1st Vote


Question 2.3.1: Does the LPHS maintain ready access to laboratories capable of meeting routine diagnostic and surveillance needs?

1st Vote


Question 2.3.2: Does the LPHS have ready access to laboratory services to support investigations of public health threats, hazards, and emergencies?

1st Vote



Question 2.3.3: Does the LPHS utilize only laboratories that are licensed and/or credentialed?

1st Vote


Question 2.3.4: Does the LPHS maintain current guidelines or protocols for handling laboratory samples?

1st Vote


Question 3.1.1: Does the LPHS provide the general public, policymakers, and public and private stakeholders with information on community health?

1st Vote

Optimal 2 Significant 13 Moderate Minimal No

Question 3.1.2: Does the LPHS plan and conduct health education and/or health promotion campaigns?

1st Vote

Optimal 10 Significant 3 Moderate 2 Minimal No


Depth-wise, it may not meet the caliber that we are looking for

80,000 students in MNPS – hat % get PE every day?

2nd Vote (optional)


Question 3.1.3: Do LPHS organizations work together to plan, conduct, and implement health education and promotion activities?

1st Vote

Optimal Significant 2 Moderate 13 Minimal No


Question 3.2.1: Have LPHS organizations developed health communication plans?

1st Vote


Optimal Significant 3 Moderate 10 Minimal 1 No


One person was out of the room during vote

Question 3.2.2: Does the LPHS establish and utilize relationships with the media?

1st Vote



Took a couple of years for us to address the immunization until it became a problem

2nd Vote (optional)


Question 3.2.3: Has the LPHS identified and designated individuals such as public information officers to provide important health information and answers to public and media inquiries?

1st Vote



Minimal activity – a lot of agencies not represented with media

Local media has bias

Are they in place or are they utilized

Do organizations have public information officers – depends on content – the media needs to

go to the appropriate person that knows topic

Media does not want to talk to PIOs, they want to talk to the person that is knowledgeable

2nd Vote (optional)


Question 3.3.1: Has the LPHS developed emergency communications plan(s) that can be adapted to different types of emergencies (i.e., disease outbreaks, natural disasters, bioterrorism)?

1st Vote

3 Optimal 11 Significant Moderate Minimal No

Question 3.2.2: Does the LPHS have resources to ensure rapid communications response?

1st Vote



Question 3.3.3: Does the LPHS provide crisis and emergency communications training for new and current staff?

1st Vote

1 Optimal 7 Significant 4 Moderate Minimal 1 No


1 abstaining

Emergency communication does not exist in all organizations

Depends on the crisis

Health dept. staff is trained and staff have reached out to other organizations

Difference between crisis and communications

A lot of entities have not been trained

If training has happened after 2010, it has not been done in other organizations

2nd Vote (optional)

Optimal 4 Significant 8 Moderate 1 Minimal 1 No

Question 3.3.4: Does the LPHS have policies and procedures in place to ensure rapid, mobile response by public information officers?

1st Vote

1 Optimal 10 Significant 1 Moderate Minimal No

Question 4.1.1: Does the LPHS have a process for identifying key constituents or stakeholders?

1st Vote



Process not definable

Lists are siloed – they are not shared lists

Not a unified process

Needs to be one system

2nd Vote (optional)


Question 4.1.2: Does the LPHS encourage constituents from the community-at-large to identify community issues and themes through a variety of means?

1st Vote


Question 4.1.3: Does the LPHS maintain a current directory of organizations that comprise the LPHS?


1st Vote

2 Optimal 6 Significant 5 Moderate 1 Minimal No


2nd Vote (optional)


Question 4.1.4: Does the LPHS use communications strategies to build awareness of the importance of public health?

1st Vote



2nd Vote (optional)


Question 4.2.1: Do partnerships exist in the community to maximize public health improvement activities?

1st Vote



Collaborations on radar

Question is do partnerships exist?

2nd Vote (optional)


Question 4.2.2: Does the LPHS have a broad-based community health improvement committee?

1st Vote



No one voted green because it is broad based and no one knows about it

Broad based and not known

2nd Vote (optional)


Question 4.2.3: Does the LPHS review the effectiveness of partnership participation strategic alliances developed to improve community health?


1st Vote

Optimal Significant Moderate 10 Minimal 2 No

Question 5.1.1: Does the LPHS include a governmental local public health presence (i.e. local health department) to assure the provision of Essential Public Health Services to the community?

1st Vote

Optimal 11 Significant Moderate Minimal No


One person did not vote because he/she did not understand the question

Question 5.1.2: Does the LPHS assure the availability of resources for the local health department’s contributions to the Essential Public Health Services?

1st Vote

Optimal Significant 10 Moderate 1 Minimal 1 No

Question 5.1.3: Does a local board of health or other governing entity conduct oversight for the local health department (this question is not scored)?

7 Yes 3 No Two did not vote

Question 5.1.4: Does the LHD work with the state public health agency and other state partners to assure the provision of public health services?

1st Vote


Question 5.2.1: Does the LPHS contribute to the development of public health policies?

1st Vote



All policy recommendations come from LPH so everything is working correctly (optimal vote).

Moderate– because of lack of knowledge

2nd Vote (optional)



Question 5.2.2: Does the LPHS alert policymakers and the public of public health impacts from current and/or proposed policies?

1st Vote


Question 5.2.3: Does the LPHS review public health policies at least every three to five years?

1st Vote



Two did not vote

Question 5.3.1: Has the LPHS established a community health improvement process (e.g., MAPP, PACE EH)?

1st Vote


Question 5.3.2: Has the LPHS developed strategies to address community health objectives?

1st Vote



They don’t know much about the strategies so they voted “moderate”.

The ones who voted “significant” are more aware.

2nd Vote (optional)


Question 5.3.3: Does the local health department (LHD) conduct a strategic planning process?

1st Vote



Question 5.4.1: Do LPHS organizations participate in a task force or coalition of community partners to develop and maintain local and/or regional emergency preparedness and response plans?

1st Vote



Significant rating was based on what they heard

2nd Vote (optional)


Question 5.4.2: Does the LPHS have an all-hazards emergency preparedness and response plan?

5 Optimal Significant 1 Moderate Minimal No

Question 5.4.3: Has the All-Hazards plan been reviewed and, if appropriate, revised within the past two years?


Question 6.1.1: Does the LPHS identify local public health issues that can only be addressed through laws, regulations, and ordinances?

1st Vote


Question 6.1.2: Is the LPHS knowledgeable about federal, state, and local laws, regulations, and ordinances that protect the public’s health?

1st Vote


Question 6.1.3: Does the LPHS review the laws, regulations, and ordinances that protect public health at least once every five years?

1st Vote



Question 6.1.4: Do governmental entities within the LPHS have access to legal counsel to assist with the review of laws, regulations, and ordinances related to the public’s health?

1st Vote


Question 6.2.1: Does the LPHS identify local public health issues that are not adequately addressed through existing laws, regulations, and ordinances?

1st Vote


Question 6.2.2: Within the past five years, have LPHS organizations participated in the development or modification of laws, regulations, or ordinances for public health issues that re not adequately addressed through existing laws, regulations, and ordinances?

1st Vote


Question 6.2.3: Do LPHS organizations provide technical assistance to legislative, regulatory or advocacy groups for drafting proposed legislation, regulations, or ordinances?

1st Vote


Question 6.3.1: Do governmental public health entities within your LPHS have the authority to enforce laws, regulations, or ordinances related to the public’s health?

1st Vote


Question 6.3.2: Is the local health department or governmental public health entity empowered through laws and regulations to implement necessary community interventions in the event of a public health emergency?

1st Vote


Question 6.3.3: Does the LPHS assure that all enforcement activities are conducted in accordance with applicable laws, regulation, and ordinances?

1st Vote



Question 6.3.4: Does the LPHS provide information about public health laws, regulations, and ordinances to the individuals and organizations who are required to comply with them?

1st Vote

X Optimal (9) X Significant (9) Moderate Minimal No

Question 6.3.5: In the past five years, has the LPHS assessed the compliance of institutions and businesses in the community (e.g., schools, food establishments, day care facilities) with laws, regulations, and ordinances designed to ensure the public’s health?

1st Vote


Question 7.1.1: Does the LPHS identify any populations who may experience barriers to personal health services?

1st Vote


Question 7.1.2: Has the LPHS identified the personal health services needs of populations in its jurisdiction?

1st Vote


Question 7.1.3: Has the LPHS assessed the extent to which personal health services in its jurisdiction are available to populations who may experience barriers to care?

1st Vote



SafetyNet Consortium paid for TSU to do study 2 years ago.

An extensive study was done. Projected for 10 years.

Mental health and dental care has been shared but no one has taken action to address the results

2nd Vote (optional)


Question 7.2.1: Does the LPHS link populations to needed personal health services?


1st Vote


Question 7.2.2: Does the LPHS provide assistance to vulnerable populations in accessing needed health services?

1st Vote



We don’t know enough about the vulnerable population

ERs are abused by insured or non-insured alike

2nd Vote (optional)


Question 7.2.3: Does the LPHS have initiatives to enroll eligible individuals in public benefit programs such as Medicaid, and/or other medical or prescription assistance programs?

1st Vote



We don’t enroll, we link

2nd Vote (optional)


Question 7.2.4: Does the LPHS coordinate the delivery of personal health and social services to optimize access to services for populations who may encounter barriers to care?

1st Vote


Question 8.1.1: Within the past three years, has an assessment of the LPHS workforce been conducted?

1st Vote




Main divide is between moderate and significant.

Assessment done at MPHD was over 3 years ago. New staff coming in is young.

Question of public health competencies. Some disagree of when assessment was last done.

Need to come to a consensus on which groups we are referring to; hospitals, nursing homes, MPHD,

etc.?

Actually assessment was done 2 years ago. We are voting on the system as a whole.

2nd Vote (optional)


Question 8.1.2: Whether or not a formal assessment has been conducted, have shortfalls and/or gaps within the LPHS workforce been identified?

1st Vote



None

2nd Vote (optional)


Question 8.1.3: Were the results of the workforce assessment and/or gap analysis disseminated for use in LPHS organizations’ strategic or operational plans?

1st Vote



Split between Moderate and Significant. Health Promotion for instance, occurs only within certain

organizations.

2nd Vote (optional)


Question 8.2.1: Are organizations within the LPHS aware of guidelines and/or licensure/certification requirements for personnel contributing to the Essential Public Health Services?

1st Vote



None

2nd Vote (optional)



Question 8.2.2: Have organizations within the LPHS developed written job standards and/or position descriptions for all personnel contributing to the Essential Public Health Services?

1st Vote



Split between moderate and significant. Outside of MPHD there are not many contributing.

2nd Vote (optional)


Question 8.2.3: Do organizations within the LPHS conduct annual performance evaluations?

1st Vote



None

2nd Vote (optional)


Question 8.2.4: Does the LHD develop written job standards and/or position descriptions for all personnel?

1st Vote



None

2nd Vote (optional)


Question 8.2.5: Does the LHD conduct performance evaluations?

1st Vote




None

2nd Vote (optional)


Question 8.3.1: Does the LPHS identify education and training needs so as to encourage opportunities for workforce development?

1st Vote



Limited access to places outside of LPHD

2nd Vote (optional)


Question 8.3.2: Does the LPHS provide opportunities for all personnel to develop core public health competencies?

1st Vote


Key comments from discussion on vote (if applicable) -- NONE

2nd Vote (optional)


Question 8.3.3: Are incentives provided to the workforce to participate in educational and training experiences?

1st Vote



None

2nd Vote (optional)


Question 8.3.4: Are there opportunities for interaction between staff of LPHS organizations and faculty from academic and research institutions, particularly those connected with schools of public health?

1st Vote




None

2nd Vote (optional)


Question 8.4.1: Do organizations within the LPHS promote the development of leadership skills?

1st Vote



None

2nd Vote (optional)


Question 8.4.2: Do organizations within the LPHS promote collaborative leadership through the creation of a shared vision and participatory decision-making?

1st Vote



None

2nd Vote (optional)


Question 8.4.3: Does the LPHS provide leadership opportunities for individuals and/or organizations in areas where their expertise or experience can provide insight, direction, or resources?

1st Vote



None

2nd Vote (optional)


Question 8.4.4: Does the LPHS recruit and retain new leaders who are representative of the population diversity within their community?

1st Vote




Split between moderate and minimal. Participation from all socioeconomic classes is difficult.

2nd Vote (optional)


Question 9.1.1: In the past three years, has the LPHS evaluated population-based health services?

1st Vote


2nd Vote (optional)


Question 9.1.2: Does the LPHS assess community satisfaction with population-based health services?

1st Vote

Optimal Significant Moderate 6 Minimal 1 No

Question 9.1.3: Does the LPHS identify gaps in the provision of population-based health services?

1st Vote



3 people did not vote

Question 9.1.4: Do organizations within the LPHS use the results of population-based health services evaluation in the development of their strategic and operational plans?

1st Vote


Question 9.2.1: In the past three years, have organizations within the LPHS evaluated personal health services for the community?

1st Vote




One person did not vote

2nd Vote (optional)


Question 9.2.2: Are specific personal health services in the community evaluated against established standards (e.g., JCAHO, State licensure, HEDIS)?

1st Vote


Question 9.2.3: Does the LPHS access client satisfaction with personal health services?

1st Vote



Moderate because the extent of the surveys are not in depth

2nd Vote (optional)


Question 9.2.4: Do organizations within the LPHS use information technology to assure quality of personal health services?

1st Vote

Optimal Significant 3 Moderate Minimal 1 No


Lack of information from participants. The question was not structured well for understanding.

Question 9.2.5: Do organizations within the LPHS use the results of the evaluation in the development of their strategic and operational plans?

1st Vote



Moderate – thinks that most do

Significant – think they are being forced to use the results of the evaluations. In order to succeed, you

have to evaluate.

2nd Vote (optional)



Question 9.3.1: Has the LPHS identified community organizations or entities that contribute to the delivery of the Essential Public Health Services?

1st Vote

Optimal 7 Significant Moderate Minimal No

Question 9.3.2: Is an evaluation of the LPHS conducted every three to five years?

1st Vote

Optimal Significant 2 Moderate Minimal 5 No

Question 9.3.3: Has a partnership assessment been conducted that evaluates the relationships among organizations that comprise the LPHS (e.g., the NPHPSP or an evaluation of a partnership within the MAPP process)?

1st Vote



Moderate because we are revamping the process

Minimal because of color description

2nd Vote (optional)


Question 9.3.4: Does the LPHS use results from the evaluation process to guide community health improvements?

1st Vote


2nd Vote (optional)


Question 10.1.1: Do LPHS organizations encourage staff to develop new solutions to health problems in the community?

1st Vote




Split between significant and moderate. We could do more, but those who do it, do it well.

2nd Vote (optional)


Question 10.1.2: During the past two years, have LPHS organizations proposed to research organizations one or more public health issues for inclusion in their research agenda?

1st Vote



None

2nd Vote (optional)


Question 10.1.3: Do LPHS organizations identify and stay current with best practices developed by other public health agencies or organizations?

1st Vote



Split between significant and moderate. We do not practice, but we know about it.

2nd Vote (optional)


Question 10.1.4: Do LPHS organizations encourage community participation in the development or implementation of research?

1st Vote



Split between significant and moderate. We encourage, but it is not always successful.

2nd Vote (optional)


Question 10.2.1: Does the LPHS develop relationships with institutions of higher learning and/or research organizations?

1st Vote




None

2nd Vote (optional)


Question 10.2.2: Does the LPHS partner with at least one institution of higher learning and/or research organization to conduct research related to the public’s health?

1st Vote


Key comments from discussion on vote (if applicable) ..NONE

2nd Vote (optional)


Question 10.2.3: Does the LPHS encourage collaboration between the academic and practice communities?

1st Vote



None

2nd Vote (optional)


Question 10.3.1: Does the LPHS have access to researchers (either on staff or through other arrangements)?

1st Vote



None

2nd Vote (optional)


Question 10.3.2: Is there access to resources to facilitate research within the LPHS?

1st Vote



Key comments from discussion on vote (if applicable): Split between moderate and minimal. MPHD is a

localized thing with so much to do with little staff.

2nd Vote (optional)


Question 10.3.3: Does the LPHS disseminate findings from their research?

1st Vote



None

2nd Vote (optional)


Question 10.3.4: Does the LPHS evaluate its research activities?

1st Vote



Split between moderate / minimal / no

Childhood obesity example, huge issue.

2nd Vote (optional)



Appendix E

Evaluation

30 individuals of the 60 who attended the Local Public Health System Assessment on August 14, 2013,

provided a response to the evaluation survey. Feedback was generally positive, and an opportunity for

suggestions for improving future assessments was provided. The results of the evaluation survey are provided

below.




Additionally, in response to the question asking for successful and/or effective elements the assessment

process, the following themes emerged:

Planning & Execution of the Process

Facilitation of Process

Participant Dialogue

Consensus Voting

Sharing of Knowledge of Resources

Discussion of System Strengths & Weaknesses

In response to the question asking for recommendations for improving the assessment process, the following

themes emerged:

Inform Participants of the Whole Picture of the Assessment (Process, Their Role, Outcomes, etc.) in

advance of process

Provide More Background on Essential Services

More Discussion of the Public Health Department’s Role and the Role of the Local Public Health

System and How to Frame Voting


Appendix F

Fishbone Exercise

Instructions

The following steps describe how to carry out a root causes analysis using the fishbone diagram.

1. Agree on a problem statement (this will be the model standard). Be specific, and use data to specify the

problem where possible. Place it in a box on the right side of a writing surface. Allow plenty of space.

Examples of problem statements:

“Only 40% of notifiable disease reports are submitted within required time frames”

“ No community health profile is produced regularly as described in NPHPSP model

standard 1.1”

2. Brainstorm the major categories of causes of the problem, or use generic headings such

as the following. Draw a line from each category to the backbone of the fishbone chart.

• Methods/Procedures

• Motivation/Incentives

• Materials/Equipment (including technology)

• People (including personnel, patients, partners, or providers)

• Information/feedback

• Environment

• Policy

3. Brainstorm all the possible causes of the problem. Ask: “Why does this happen?” As each idea is given,

the facilitator will write it as a branch from the appropriate category. Causes can be written in several

places if they relate to several categories.

4. Again ask, “Why does this happen?” about each cause. Write sub-causes branching off the causes.

Continue to ask “Why?” and generate deeper levels of causes. Push for deeper understanding but

know when to stop.

5. Look for causes that appear repeatedly within or across major categories. When the group runs out of

ideas, focus attention to places on the chart where ideas are few.

Mobilizing for Action through Planning and Partnerships (MAPP)assets.thehcn.net/content/sites/nashville/LPHSA_REPORT... · 2013. 8. 14. · Services in Nashville?" Assessment results

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