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Health Systems Learning Group Baseline Survey
Preliminary Findings
October 10, 2012
Kevin Barnett, DrPH, MCP
Senior Investigator
Public Health Institute
Purpose
• Establish an evidence base, or starting point for HSLG partners…
– Document and validate accomplishments to date
– Provide an objective, comparative analysis of relative progress towards transformation (i.e., beyond programs)
– Identify specific obstacles to the advancement of practices among diverse HSLG partners
– Identify and examine innovations undertaken by HSLG partners that may inspire and serve as tools for others to engage their leadership
Response rate - Summary totals
• Twenty (20) health system respondents out of 31 HSLG hospital partners = 65% response rate
– N of 31 does not include two HSLG partners that are not health systems (Camden Coalition and Southcentral Foundation)
• Represent total of 234 hospital facilities
– 80 facilities with 250 beds or more (34%)
– 58 facilities with 100 beds or less (25%)
– 32 teaching hospitals (14%)
– 13 Critical Access Hospitals (6%)
80
83
45
13
Distribution of Respondents by Hospital Size
250 beds or more
101-249 beds
26-100 beds
25 beds or less
59
38
137
Distribution by Health System Size
Hospitals in HS with 10or less facilities (N=13)
Hospitals in HS with 11-20 facilities (N-3)
Hospitals in HS with 21or more facilities (N=4)
HSLG Geographic Distribution
• Respondent health systems have hospitals in 23 states
• There are 8 states where multiple respondent health systems have hospitals.
• Twelve (12) of the 13 health system respondents with 10 or less facilities are located in a single state.
• AR, AZ, CA (4), CO (2), FL (2), GA (2), IA, IL, KS (2), KY, LA, MA, MI, MN, MO, MT, NJ, NM, NY, OH (2), NV, TN (2), TX (3)
0
2
4
6
8
10
12
10 or lesshospitals
11-20hospitals 21 or more
hospitals
2 2
1
6
1
1
3
2
Health System and Hospital Governance
HS BOT & FiduciaryBoards at someHospitals
HS BOT & FiduciaryBoards at all Hospitals
HS BOT Only
NR = 2
05
1015
20
25
30
35
40
45
7 8
2 1 1 2
8 8
45
23
40
8 4
3
40
27
Department Location for CB Function
Health Systems
Hospitals
Department Location for CB Function
• 183 out of 234 (75%) of hospitals had a designated department that housed the CB function.
• The other 51 hospitals could be smaller facilities with some percentage of staff FTE that reports to a department at larger proximal facility (TBD).
• Department determination appears to be driven by HS level decisions – justification TBD in follow up – 18 of 23 in Community Health (78%) in 3 HS
– 31 of 40 in Administration (78%) in 2 HS
– 15 of 27 in Marketing in 2 HS (other 12 in 5 HS)
– All 40 in Compliance (100%) in 2 HS
– All 8 in Public Affairs in 1 HS
– All 4 in HR in 1 HS
Reporting and Performance Criteria
• Reporting relationships for staff appear to be closely aligned with departmental base. Departmental priorities TBD.
• CB-related performance evaluation – 12 of 20 (60%) HS evaluate CB performance of CEOs
– 16 of 20 (80%) evaluate CB performance of other senior execs
– 7 of 20 (35%) evaluate CB performance of clinical staff/leaders
• Performance criteria – 9 of 20 (45%) use progress on health indicators, re-admission rates,
and/or a reduction in preventable ED/inpatient utilization
– 11 of 20 (55%) use scope/form of staff involvement
– 7 of 20 (35%) use external recognition
– 4 of 20 (20%) use no performance metrics
0
2
4
6
8
10
12
14
1615 15 15
12
15
HS Office Support for CB Function at Facility Level
HS Office Support for Facility Level CB Function
• 16 of 20 respondents, or 80% of HS have an office at the HS level to support CB functions at facility level.
• 15 of 20 respondents, or 75% of HS provide support to facilities in documentation, design, and monitoring of programs, and facilitate support from senior leaders. – 8 of 20 specifically identified assistance in documentation for
external reporting purposes
• 12 of 20 respondents, or 60% of HS facilitate access to internal financial and/or utilization data.
• Most significant challenges to hospital level advancement of practices TBD (e.g., survey didn’t address facility level FTEs, staff competencies)
0
2
4
6
8
10
12
14 13 12
8
6 6 6
HSLG Partner Data Collection and Analysis
HSLG Data Collection and Analysis
• Almost 2/3 of respondent HS are collecting and analyzing utilization data. Use at hospital level TBD
• Less than 1/3 of respondent HS are GIS coding utilization data. (2 additional HS indicated that first collection in process )
• Less than 1/3 of respondent HS are collecting data on SDH or community assets.
• Four HS are not collecting any of the forms of data identified.
• Three HS are collecting all the forms of data identified.
02468
10121416
11 11 9
4
9
6 8
11
15
9
5 8
4 5
Use of ROI Metrics
System
Hospital
HSLG Use of ROI Metrics
• 13 of HS respondents (65%) doing work on at least three categories of metrics.
• Comments – “Too early in our process”
– “We are evaluating models such as EV-ROI”
– “…we use a number of metrics to measure need and success”
– “…hospitals may use these metrics and still not be tracking ROI”
– “Just beginning a health inpatient utilization home project”
– “We are building systems to take into account a, c, d, and e.”
– “We are in a very embryonic stage” (cite 3 projects; one CMS)
0123456789
10
4 3
4 3
4
2
9 10
9
7
9
5
CHI Integration - Org Strategic Plan
Hospital
System
CHI Integrated into Org Strategic Plan
• 10 of 20 HSLG respondents (50%) have CHI reporting as part of OSP.
• 9 of 20 HSLG respondents (45%) have CHI language as org priority, do prospective budgeting for CHI, and have annual metrics for CHI.
• Form of metrics and associated incentives and disincentives TBD.
• Relatively low rate of cross-department responsibility (35%) suggests limits to CB programmatic focus.
0
5
10
15
20 15 18
12 11 11 14
Program Monitoring
Program Monitoring
• Predominance of administrative staff (80%) and clinicians (75%) responsible for program monitoring.
• Appears to be expansion in hiring of staff with evaluation expertise (60%); unclear if focused on individual programs (e.g., externally funded projects).
• Substantial engagement of external public health and higher education institutions (55%) in program monitoring; unclear if broad or focused on individual programs.
• Substantial engagement of community stakeholders in program monitoring; TBD specific roles.
0
10
20
30
40
50
60
70
80
90
100 Community Partnerships
Monitor Program
Lead Program
Staff/Space
Program Design
CB CTE
Advisory CTE
Set Priorities
Data Collection
CHNA Input
0 5 10 15
Input on CHNA
Data Collection
Set Priorities
Advisory CTE
CB CTE
Program Design
Staff/Space
Lead Program
Monitor Program
15
9
8
13
5
7
6
8
4
13
6
6
6
4
3
3
2
2
Faith Leaders and Neighborhood Associations
NeighborhoodAssociations
Faith Leaders
0 5 10 15 20
Input on CHNA
Data Collection
Set Priorities
Advisory CTE
CB CTE
Program Design
Staff/Space
Lead Program
Monitor Program
16
11
8
9
3
7
8
9
7
12
6
3
4
4
5
3
5
3
15
12
8
7
2
7
5
2
5
Hospitals, CHC, Law Enforcement
Hospital(s)
Law Enforcement
CHC
Preliminary Findings
• Input on CHNAs ranged from high of 17 (85%) for LPHAs to low of 11 (55%) for local business.
• Participation in priority setting ranged from high of 13 (65%) for LPHAs to low of 1 (5%) for local advocacy groups. Other groups on low end included law enforcement (15%), local business (20%), and neighborhood associations (30%).
• Involvement in program design ranged from 10 (50%) for LPHAs to 2 (10%) for local business. Other groups on low end included local clergy (35%), neighborhood associations (15%), CHCs and hospitals (35%), law enforcement (25%), & advocacy groups (15%).
• Scope of involvement in advisory/board CTES at hospital level TBD
• Scope of contributions from other stakeholders TBD
• Scope of program engagement TBD
Obstacles to Partnership - Rankings
10
2
3
3
0
2
4
1
0
3
1
3
2
3
2
0 5 10 15
Assumption that hospital shouldbe core funder
Lack of community understandingof shared responsibility
Lack of alignment betweenhospital and community priorities
Lack of understanding andsupport from hospital leaders
Lack of hospital understanding ofshared responsibility
First
Second
Third
Obstacles to Partnership
• Important to examine source of community misperception (and antidote)
• Reflection that central issue is one of working towards shared priorities; may often require deferment and deeper examination of broader purpose.
0 5 10 15
Legal
Accounting
Marketing
Fund Development
Physical Infrastructure
Other
3
4
14
13
12
6
Forms of Technical Assistance
Forms of Technical Assistance
• Impetus, specific form, and impact of technical assistance TBD.
• Relatively undeveloped form of CB that reinforces concept of shared ownership for health in community context; not well understood in hospital/HS leadership.
• Relatively unexplored opportunity to date in policy advocacy arena (e.g., UMMHS Hope Coalition)
Relevance to HSLG Working Groups
• Success in the work of all three groups requires
– Data systems (incl. GIS) to ensure evidence-based focus
– Attention to ROI and movement to SROI
– Institution-wide alignment (objectives, metrics, accountability)
– Intersectoral engagement with shared ownership
– Leverage resources / alignment of institution & community assets
– Seamless continuum of care AND action
– Focus on elimination of health disparities
– Move from innovative programs to transformational practices
Next Steps
• Follow up and integrate data from non-respondents and non HS partners.
• Follow up with respondents and fill gaps in information (TBD).
• Flesh out and ID additional promising practices, channel to Working Groups.
Contact Information
• Kevin Barnett, Dr.P.H., M.C.P.
Public Health Institute
555 12th Street, 10th Floor
Oakland, CA 94607
Tel: 510-285-5569 Mobile: 510-917-0820
Email: [email protected]