Association of State and Territorial Health Officials (ASTHO)
Big Cities, Big States: A Big Approach to Accreditation
Support for this program was provided by a grant from the Robert Wood Johnson
Foundation
During the first year of PHAB accreditation, only one state in the top ten most populous states applied for accreditation.
Large states face unique barriers to become accredited
Accreditation in Large Jurisdictions Initiative Background
Robert Wood Johnson Foundation has set a goal that 60% of the US population will be served by accredited public health agencies by 2015.
Through this project, RWJF and ASTHO are supporting 4 large states in organizing and applying for accreditation, and paving the way for other large jurisdictions.
Accreditation in Large Jurisdictions Initiative Vision
Provide targeted technical assistance to meet states’ unique needs for a successful accreditation application
Collect lessons learned and disseminate to the entire public health community
Identify best practices to include in the RWJF practice exchange.
States will submit their Statement of Intent to PHAB no later than November 15, 2014 .
Accreditation in Large Jurisdictions Initiative Goals
Funding and technical assistance will be provided to support these states to: ◦ Compile and collect documentation from across the state ◦ Document and create processes that the states need to
develop to meet PHAB standards ◦ Align local and state departments with effective processes ◦ Build a performance management system ◦ Create a workforce development plan ◦ Develop an on-going Quality Improvement (QI) Initiative◦ Complete PHAB pre-requisites: State Health Improvement
Plan, State Health Assessment, the Strategic Plan
State projects
After an application process, the RWJF selected four states to participate in this project: ◦ Illinois◦ Florida ◦ California*◦ New Jersey*
Selected States
*California and New Jersey Health Departments are awaiting final approval of funding from Robert Wood Johnson Foundation
RWJF Dr. Pamela Russo-Senior Program Officer
ASTHO Performance Team Jim Pearsol-Chief Program Officer Donna Marshall – Senior Director Lia Katz – Performance and Quality Analyst
Subject Matter Experts To be identified
National Project Team Members
Timeline
• Planning and Outreach to States
October 2012 – December 2012
• State applications to RWJF and selections
January 2013 – June 2013
• States prepare for accreditation using Subject Matter Experts and initial funding to support their efforts
• Conference calls provide states the opportunity to share lessons learned
• ASTHO collects lessons learned to compile and disseminate to Public Health Community
• All states submit Statement of Intent to apply to PHAB by November 2014, with all applications finalized by November, 2015
July 2013 – December 2014
Presenter introductions:
Big Cities, Big States: Working Toward
Accreditation in Illinois
Jerome Richardson, PhDDeputy Director, Office of Performance Management
Illinois Department of Public Health
10
Presentation Objectives
Previous accomplishments Shift to accreditation in large jurisdictions Possible models Next steps, future goals
11
Previous Accomplishments
Created Grants Management Office Established standard grant application and budget form Developed review and approval
process Organized grant review committees Developed scoring rubrics Created a uniform grant agreement
12
Previous Accomplishments (con’t)
Identified business requirements Prioritized requirements Published RFP, selected vendor
and began implementation Transitioned from paper to electronic grant system
13
Shift to Accreditation in Large Jurisdictions
Build performance measurement system Use similar methodology Conduct baseline assessment Develop indicators (business processes) Stress efficiency and effectiveness Prioritize indicators Create master list
14
Possible Models
Baldrige criteriaa. Leadershipb. Strategic planningc. Customer focusd. Measurement, Analysis, and Knowledge Managemente. Workforce focusf. Operations focusg. Results
15
Possible Models (cont.)
Public Health Informatics Institute a. Taking Care of Businessb. Common Ground seriesc. Requirements for Information Systemsd. The Big Picture: Developing an Enterprise View of Public Health Information Systems
16
Next Steps, Future Goals
Determine reporting frequency Create SharePoint dashboards Create SharePoint Lists Deploy Visual Indicators Automate Notification with Alerts
17
Big Cities, Big State: A Big Approach to Accreditation
June 12, 2013
19
Florida Departmentof Health
• Centralized Health Department
• Key Demographics– State Population: 19,042,458 + Visitors
– FDOH Budget: $2,767,574,448 (Fiscal Year 2012-2013)
– Agency Workforce: 16,000 positions (June 2013)
Service Model
Improvement Efforts
• By December 31, 2015 implement the components of a sustainable performance management system. (Agency Strategic Plan Objective)
• Performance Management is a repeatable process that involves:– all employees; – setting objectives based on an organization’s mission
and goals; – measuring performance over time; and – making improvements based on data.
Integrated Performance Management System
Plan required work tasks &
resources.
Determine the issues.
Measure progress towards desired
outcomes.
Do the work. Measure progress.
Leadership, Workforce and Infrastructure
Performance Management
System
Budget
Managem
ent
Eva
luat
ion
AssessmentStrategic
Planning
Ope
rati
onal
P
lann
ing
Decide priorities and how to attain
them.
Allocate resources.
Build capacity to do work
State and local program/ activity/ operational Plans
Routine performance review reports
Agency StrategicPlan with CHD alignment
State and local Program/DivisionBudgets
Integrated Performance Management System Documents s
Performance Management System
Budget
Managem
ent
Eva
luat
ion
Assessment
Strategic
Planning
Ope
ratio
nal
Pla
nnin
g
State and community health Improvement Plans
State and Community Health Assessments
Accreditation
State and local Program/activity metrics
Annual performance evaluation
Leadership, Workforce and Infrastructure
24
Integrated Performance Management System
Operational planning
Assessment Strategic Planning
BudgetManagement
Evaluation
Integrated Performance Management System
Operational planning
Assessment Strategic Planning
BudgetManagement
Evaluation
Integrated Performance Management System
Operational planning
Assessment Strategic Planning
BudgetManagement
Evaluation
Integrated Performance Management System
Operational planning
AssessmentStrategic Planning
BudgetManagement
Evaluation
Quality Improvement Plan
Integrated Performance Management System
• Workforce Development Plan– Undergoing a revision
process– Guided by the Workforce
Development Advisory Council.
– Alignment with the State Health Improvement Plan and the Agency Strategic Plan
Leadership, Workforce and Infrastructure
Operational planning
Assessment Strategic Planning
BudgetManagement
Evaluation
Integrated Performance Management System Documents s
Performance Management System
Budget
Managem
ent
Eva
luat
ion
Assessment
Strategic
Planning
Ope
ratio
nal
Pla
nnin
g
Accreditation
Leadership, Workforce and Infrastructure
Next Steps
Decision by 9/3014Applicant Statement of
IntentApplication Submission
Final Document Submission
State Office 4/22/13 6/30/13 9/30/13
County Health Departments
4/22/13 9/30/13 3/31/14
GOAL: Accreditation Decision bySeptember 31, 2014
Total Population: 19,042,458 (Source: CHARTS - All County 2012 Population Estimate)
Accreditation Approach
• Identify Department systems, processes, programs, policies that are applicable statewide
• Identify relevant documentation based on requirements
DOH Process: Infectious Disease Reporting
Are We There Yet?
Plan required work tasks &
resources.
Determine the issues.
Measure progress towards desired
outcomes.
Do the work. Measure progress.
Leadership, Workforce and Infrastructure
Budget
Managem
ent
Eva
luat
ion
AssessmentStrategic
Planning
Ope
rati
onal
P
lann
ing
Decide priorities and how to attain
them.
Allocate resources.
Performance Management
System
Office of Performance &Quality Improvement
• Rhonda White, Office Director and FDOH Accreditation Manager
• 850-245-4018
• Laura Reeves, Manager
• 850-245-4019
ACCREDITATION & QUALITY IMPROVEMENT AT HOUSTONHouston Department of Health and Human Services (HDHHS)Office of Surveillance and Public Health Preparedness (OSPHP)Performance Improvement and Accreditation Team (PIAT)
June 2013Ololade G. Coker, MPH, MS
QUESTION
5 | GRAND MASTER: Should be doing the presentation
4 | EXPERIENCED: Led/Conducted QI projects
3 | INTERMEDIATE: Some participation in QI projects
2 | NOVICE: Have attended some training, but …
1 | CLUELESS: I thought there was free food in this room
How would you rate your level of experience with Performance Management & Quality
Improvement?
CITY OF HOUSTON DEPARTMENT OF HEALTH AND HUMAN SERVICES (HDHHS)
POPULATION1: 2,099,451 LAND AREA1: Approx. 600 sq.
mi. HARRIS COUNTY POP1: 4,092,459
1 DATA SOURCE: U.S. CENSUS BUREAU, 2010 CENSUS SUMMARY FILE
OUR MISSION
“To work in partnership with the community to
promote and protect the health and social well-
being of all Houstonians”
CITY OF HOUSTON DEPARTMENT OF HEALTH AND HUMAN SERVICES (HDHHS)
POPULATION SERVED: 2.2 million
TOTAL EMPLOYEES: 1,007 ACCREDITATION STAFF: 3 FULL TIME
Performance Improvement & Accreditation Team (PIAT)
Housed within the Office of Surveillance and Public Health Preparedness (OSPHP) Led by
Dr. Raouf Arafat under Director Stephen Williams.
PRIMARY ROLE WITHIN HDHHS
ACCREDITATION: Documentation Collection, Review,
& Submission Reporting Application
QUALITY IMPROVEMENT (QI) & PERFORMANCE MANAGEMENT (PM): PM/QI Training Performance Management System Material Development Monitoring QI Projects
ACCREDITATION TIMELINE
2011
2012 Accreditation readiness
and documentation review
Completed: 2nd Performance
Management Self Assessment
Completed: Community Health Assessment
(CHA)
2013 Completed: Community Health
Improvement Plan (CHIP)
Submitted: Statement of Intent
WILL APPLY FOR ACCREDITATIONBY END of 2013
2010 NPHII GRANT RECIEVED
PIAT Team Formed Completed: 1st Performance
Management Self Assessment 2012
2011
2010
2013
QI STATUS
Trained 80% of staff on accreditation
More than 50% staff from all levels trained on Performance Management & Quality Improvement
Integrated SMART Goals into employee performance requirements (evaluation)
Hosted 2 four day workshops that resulted in 8 smaller QI projects
Assisting in several large scale (department-wide) QI projects
P.M. / Q.I. AT “HDHHS”HOUSTON DEPARTMENT OF HEALTH AND HUMAN SERVICES
HDHHS QI: BIRD’S EYE VIEW Pre-existing infrastructure:
fragmented
Began working to integrate QI in 2011
GOAL: Improve Service to community
Method: Create a new culture which maximizes use of human capital and enables innovation
1st Step: Self Assessment
SELF ASSESSMENT TOOL
Public Health Foundation (PHF) tool
5 section questionnaire
6th section added: Accreditation Readiness (2011) and Evidence-Based Practices (2012)
Given to managers and supervisors
Exposed several areas of need
SELF ASSESSMENT | QI PROFILE
Do you have a process(es) to improve quality or performance?
Is there a regular timetable for your QI process?
Does staff have the authority to make certain changes to improve performance?
2011 2012
Is there a process or mechanism to coordinate QI efforts among programs, divisions, or organizations that share the same performance targets?Is QI training available to managers and staff?
Are personnel and financial resources allocated to your QI process?
SELF ASSESSMENT | QI PROFILE2011 2012
When you hear this term, what comes to mind?
PERFORMANCE MANAGEMENT!
SOME OF WHAT WE HEARD…
Fear
Organization
Evaluation
Intrusion
Inspection
More work
Assessment
Micro-managing
Anxiety
review
Judgment
Measurement
Unfair
WHAT PERFORMANCE MANAGEMENT IS NOT A fancy term for “Annual Appraisal” or
“Employee Evaluation”
A “top-down” approach for imposing change
A threat to job stability
CHANGING PERCEPTIONWHAT TO DO WHAT WE DID
1) Gain Leadership Support
Supervisor and Director function as Champions of Accreditation among internal and external leadership
Presented at leadership meetings Stressed QI as a portion of accreditation
2) Empower Employees Stressed grass-roots ownership rather than top-down change
Promoted focus on processes, not individuals
3) Train Staff Created trainings on basic tools
4) Support Staff Provide TA on QI projects as needed Monitor Progress
FIRST REACTIONS TO QI
FEAR AND LOATHING CONFUSION DISINTEREST
Common reaction
Fear: threat to job stability
Fear: more work
Fear: it will (or won’t) change the status quo
Poor understanding of accreditation and QI
Incorrect understanding of the need or purpose for accreditation or QI (“I don’t see why we need this” or “don’t we already do this?”)
Lack of understanding of relationship between accreditation and work (connecting bird’s eye view to field)
Expectation (real or perceived) that there isn’t enough high level support
ADDRESSING FIRST REACTIONS TO QI
FEAR AND LOATHING CONFUSION DISINTEREST
Stress value of grass-roots ownership
Do not portray QI as a mandatory initiative
Addressed by Education (Training on what QI is and its value)
Provide examples of successful project
Addressed by Education (Training on what QI is and its value, 10 Essential PH services)
Stress Leadership role
Provide examples of successful projects
ELATION
Marked by extreme joy or relief
May include intermittent laughing or smiling
Sustained by continuing to spotlight, promote, reward, and otherwise incentivize QI activity
ROBERT WOOD JOHNSON FOUNDATION
BIG CITIES INITIATIVE FUNDING:
To supply financial and technical assistance to big cities and states to catalyze application to the Public Health Accreditation Board for accreditation of their public health agencies
PRIMARY FOCUS
Assistive staff
Equipment
ADMS: Accreditation Documentation Management System
RWJF BIG CITIES INITIATIVE
Who can identify with this picture?
How many of you are using some combination of these items to work your accreditation process out:
emails, spreadsheets, shared-folders, etc.
TYPICAL DOCUMENTATION PROCESS… 1) Search for
documents2) Save documents 3) Repeat until done4) Status report? 5) Piles of Work
ADMS
Support a more systematic approach to collection and review protocol
Enforce consistency in [documentation] record quality
Facilitate more advanced levels of analysis, status monitoring, and reporting
Promote continuity of process (by existing as a fully autonomous system independent of potential issues caused by changes in staffing)
Provide a tool for other departments to use, modify, or build from
ADMS… BIRD’S EYE VIEW
DATA ENTRY REVIEW QUERY & REPORTING
Fill out pre-defined forms per document according to PHAB criteria and added record-keeping measures
e.g.) source, date, production schedule, gaps check, description, etc.
Filled forms are sent to 2nd and 3rd level reviewers
Once reviewed, marked as complete
On-time reports on sources, dates, etc…
Automated reporting for expiring documentation
QUESTIONS?
CONTACT INFORMATION
Ololade Coker MPH, MSEpidemiologistHouston Department of Health and Human Services (HDHHS)Office of Surveillance and Public Health Preparedness (OSPHP)Performance Improvement & Accreditation Team (PIAT)Phone: 832.393.4204