12/2/2011

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Quality Improvement and Quality

Planning for CHAs and CHIPs –

Part 2

Marlene (Marni) Mason,

MarMason Consulting, LLC

And

Keith Reed, Comanche, Caddo,

Cotton, & Kiowa County Health

Departments, Oklahoma

November 28, 2011

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Learning Objectives

At the completion of the session participants will be able to do the

following:

1. Discuss the overarching relationship between QI and accreditation.

2. Re-state the CHA/CHIP demonstration site project requirements for

using QI or QP techniques.

3. Describe the unique aspects of QP as compared to QI.

4. Apply at least one QI or QP technique to their preparations for the

health improvement process or preparations for the CHA.

5. Describe one LHD’s efforts to apply QI techniques to a CHA.

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CHA/CHIP Project Requirements for QI and QP

Use QI or quality planning techniques.

a. Sites with previous CHA and CHIP experience will apply QI techniques to

improve their efforts in a systematic and data-driven fashion for the purposes

of the project and/or improve their planning through use of quality planning

techniques.

b. Sites with no previous CHA and CHIP experience will use quality planning

techniques throughout their project.

*Essentially this boils down to being sure your site has documented use of at

least one QI or quality planning technique in its community health

improvement process. You will be required to submit this documentation and

describe this as part of your Community Health Improvement Process report

at the end of the project.

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Today’s Agenda

MarMason Consulting

•Review improvement methods and several tools for

optimizing planning processes, including meeting

effectiveness survey and criteria matrix

• Discuss the link between CHA/CHIPS/SP/QI plans and

meeting specific PHAB measures

•Hear examples of the application of quality planning tools to

optimize CHA and CHIP activities in a local health

department

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Tools We Reviewed and/or Practiced at Kick – Off

(July 20, 2011)

• Sector Mapping to identify Key Stakeholders and their needs

• Affinity Diagram to organize ideas or issues into categories

• Force Field Analysis to identify driving forces and restraining

forces

• Meeting Effectiveness Tool to improve the participation and

contribution of community partners

• Criteria and Prioritization Matrix for selecting health topics

• Gantt Charts for planning and tracking projects

• Sources for Promising or Model Practices

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QI – Rapid Cycle Improvement

M o d e l fo r Im p ro ve m e n t

Wh a t a re w e tryin g

to a c c o m p lish ?

Ho w w ill w e kn o w th a t a

c h a n g e is a n im p ro ve m e n t?

Ac t Pla n

DoStu d y

MarMason Consulting

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Example- AIM for Meeting Effectiveness

What are We Trying to Accomplish?

“Increase the effectiveness of Community Health

Assessment (CHA) planning meetings and maximize

stakeholder participation. We do this in order to increase

member engagement and contribution to the development of

the CHA.”

MarMason Consulting

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Questions for Meeting Effectiveness Survey

5 point Likert scale (not at all to extremely)

1) Commitment to the Group: To what extent was I committed to helping

achieve the group’s goals for this meeting?

2) Clear Goals: To what extent were the goals clear for this meeting?

3) Communication: To what extent was the discussion open, with sharing

of diverse ideas and perspectives?

4) Participation: To what extent did I say or contribute what I thought

was important to achieving our goals?

5) Effectiveness: Overall, how effective was the group in meeting its

goals?

6) Value: How valuable were the goals compared to other things we

need to accomplish?

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Evaluating Meeting Effectiveness

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How Will We Know When We Get

There? Measurements

•Increase in meeting attendance (% of members that

regularly attend)

•Increase in effectiveness (% of members rating meetings as

effective or valuable)

•Increase in engagement (% of members rating their

commitment as high)

•Increase in participation (% of members that contribute

resources to CHA/CHIP activities)

MarMason Consulting

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Criteria Matrix – Selecting Indicators (scoring: use high=3/med=2/low=1)

MarMason Consulting

Health

Indicator Availability

Impact

(size)

Validity

Relationship

community

vision

Other? Total

1. Immunization

Rates

2. Teen

Pregnancy

rates

3. Childhood

Obesity rates

4. HS

Graduation

rates

5. Alcohol/Drug

Use rates

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Criteria and Definitions for Indicators: Alexandria, VA

• Meaningful & actionable

• Stability, reliability, & timeliness

• Outcome-oriented

• Provide easy to understand

information

• Prompt discussion and debate

• Facilitate the building of

coalitions

• Act as a catalyst for action

• Result in change

Content courtesy of Allen Lomax- 7-2011

• Definitions of data quality

• Definitions of data

• Data collection methods

• Frequency of data

collection and reporting

• Processes for data sharing

• Challenges to data sharing

• Barriers to data sharing

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Link between CHAs/CHIPs/SP/QI & PHAB

• Required as prerequisites (CHA/CHIP/SP)

• CHA: Explicitly required in Domain 1 and address

requirements Domain 4, Standard 1

• CHIP: Address requirements in Domain 4 and are explicitly

required in Domain 5, Standard 2

• These documents provide evidence for some of the

requirements in these standards

MarMason Consulting

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Scope of Domain 1

Domain 1: Health Status and PH Issues Data

Monitoring and Reporting

Population health data from a variety of sources

Current services provided

Assessment information on website; press

releases, waiting rooms, annual report

Samples of emails; SharePoint sites

4 Standards

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Domain 1: Conduct & disseminate assessments

[of] population health status…

Standard 1.1 Conduct and disseminate assessments focused on

population health status….

1.1.1 S/T/L: Participate in or conduct a partnership for the development of

a comprehensive community health assessment of the population served by

the HD

1.1.2 S/T.L: Complete a state/tribal/local community health assessment

1.1.3 S/T/L: Ensure that the SHIP/CHIP is accessible to agencies,

organizations and the general public

MarMason Consulting

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Scope of Domain 4

Domain 4: Engage the Community to Identify &

Address Health Problems

•Current collaborations – Family planning advisory

councils – Great Start collaboratives, flu coalitions,

child-death review teams

•Does not have to be agency facilitated, but agency

must actively participate

•Engage the community on policy development to

promote public health

•2 Standards

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Domain 4: Engage with the community to

identify and address health problems Standard 4.1 B: Engage the public

health system and the community in

identifying and addressing public

health problems through

collaborative processes

4.1.1 A: Establish and /or actively

participate in partnerships and

coalitions to address specific public

health issues or populations

4.1.2 T/L: Link stakeholders and

partners to technical assistance

regarding models of engaging with

the community

Standard 4.2 B: Promote the

Communities’ understanding of

and support for policies and

strategies that will improve the

public’s health

4.2.1 A: Engage the community

about policies and /or strategies that

will promote the public’s health

4.2.2 A: Engage with governing

entities, advisory boards, and

elected officials about policies

and/or strategies that will promote

the public’s health

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Scope of Domain 5

Domain 5: Develop & Implement PH Policies and

Plans

• Conduct a process to develop a community/state

health improvement plan

• Maintaining an all-hazards emergency operations plan

• 4 Standards

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Domain 5: Develop public health policies

and plans Standard 5.2 : Conduct a

comprehensive planning process

resulting in a Tribal/State/Community

Health Improvement Plan

5.2.1 L: Conduct a process to develop a

community health improvement plan

5.2.2 L: Produce a community health

improvement plan as a result of the

community health improvement process

5.2.3 A: Implement elements and

strategies of the health improvement

plan, in partnership with others

5.2.4 A: Monitor progress on

implementation of strategies in the

community health improvement plan in

collaboration with broad participation

from stakeholders and partners

Standard 5.3 : Develop and implement

a health department organizational

strategic plan

5.3.1 A: Conduct a department strategic

planning process

5.3.2 A: Adopt a department strategic

plan

5.3.3 A: Implement the department

strategic plan

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Link to PHAB v1-Standard 9.1 & 9.2

MarMason Consulting

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Standard 9.1

Use a Performance Management

System to Monitor Achievement of

Organizational Objectives 9.1.1A:

Engage staff at all organizational levels

in establishing or updating a performance

management system

9.1.2A:

Implement a performance management

system

9.1.3A:

Use a process to determine and report on

achievement of goals, objectives, and

measures set by the performance

management system

Standard 9.2

Develop and Implement Quality

Improvement Processes Integrated

Into Organizational Practice,

Programs, Processes, and

Interventions

9.2.1:

Establish a quality improvement

program based on organizational

policies and direction. (required

documentation is a written QI Plan)

9.2.2:

Implement quality improvement

activities

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CHA/CHIP/SP/QI Plan Alignment

Strategic Plan

• Emerging and New Initiatives may not be in other 2 plans

QI Plan

• Operational Issues and Current Data on Process Outcomes may not be in other 2 plans

CHIP

• Health Status and Health Risk Interventions to address Health Assessment may not be in other 2 plans

Community Health

Assessment informs all three agency plans

Some initiatives or activities overlap

2 or 3 of the Plans

MarMason Consulting

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In Summary…

•Using Quality Planning methods and tools can

improve public health planning processes

•Be intentional about which methods and tools to use

for optimizing planning processes based on the topic

and needs

•Be consistent in documenting the CHA & CHIP

planning and implementation activities in order to

provide evidence for PHAB requirements

MarMason Consulting

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Comanche County Health Department

Centralized Public Health System

Supported by local funding

Staffed by state employees

PHAB Beta Test Participant:

Missing key prerequisites:

Community Health Assessment

Community Health Improvement Plan

Complete Strategic Plan

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Comanche County

Population: Approximately 124,000

CHD Budget: 3.5 Million

FTE: 55

Unique County Demographics:

Combination of rural and urban population

4 hospitals: private, public, military, Indian Health

1 university, with multiple trade schools

Large army installation (18,000 plus population)

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Quality Improvement vs. Quality Planning

QI vs. QP

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Plan QI/QP Team: 5 person team

Following a brainstorming session, the team met and

determined that a Prioritization Matrix would help us narrow

our identified “problem” areas that were inhibiting us from

developing a CHA/CHIP.

Improvement in available

data

Improving community

engagement

Community assessment.

Imp

rove

me

nt i

n

Ava

ilab

le D

ata

Imp

rovi

ng

Co

mm

un

ity

Enga

gem

en

t

Co

mm

un

ity

Ass

ess

me

nt

Ro

w T

ota

l

Improvement in Available Data 1 1 2

Improving Community Engagement 10 5 15

Community Assessment 1 5 6

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Plan Original Aim Statement:

By December 2010, the Comanche County Health Department will improve

community engagement as evidenced by: 60% of invited partners will attend

meetings; an average score of 4 on the Meeting Effectiveness Survey;

completion of all four assessments of the MAPP process demonstrating

progress toward a CHIP; and completion of a local strategic plan.

Final Aim Statement:

By December 2010, the Comanche County Health Department will improve

community engagement as evidenced by: 60% of community sectors will be

represented at meetings, with an average score of 4 on the Meeting

Effectiveness Survey.

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Force Field Analysis

Desired State: A partnership which includes broad-based representation, including a strong cross

section of community sectors. Community members will unselfishly share a common goal, the

health of the community, and actively participate in a health improvement process.

+ Driving Forces Restraining Forces -

Shared Vision of a Healthy Community

Mostly Collaborative Spirit

Collective Motivation for Change

Willingness to Participate

Grant Opportunities

LHD is Developing Trust Among Partners

LHD is Earning Respect Among Partners

Local Champions

Urgency due to Poor Current Health Status

Ambivalent Support, Inconsistent

Organization Goals Take Priority - Credit

Frustration In Results/Delay Gratification

Meeting Fatigue/Excessive Workloads

No Additional Funding by Agencies

Past Failures to Produce Meaningful Results

History of Internal Focus at the LHD

Limited Time

Different Messages Being Delivered

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Plan

We selected community engagement as our QI/QP project recognizing that it

would help contribute to a successful CHA and CHIP.

As a result of root cause analysis, we

identified the need for more productive

meetings, demonstrating a strong

respect for community partner’s time

and commitment.

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Do

Improvement Planning

• Ensure clear and concise meeting agendas are prepared, with relevant objectives.

• Draft agendas will be sent out at least 4 weeks in advance.

• An RSVP will be added to all meeting invitations, allowing us to see the level of

engagement and to identify missing partners/sectors.

• In response to the RSVP, we will make a concerted effort to engage missing, key

partners /sectors through personal contact via a phone call or face to face visit.

• Meeting request will have a clear, concise goal and beginning and end time.

• Each meeting will conclude with a meeting effectiveness survey.

• Adjustments will be made based on survey results and partner input.

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Check 40% increased to 70%

sector representation

Meeting Effectiveness Score

went from 3.4 – 4.6

Improved Community Engagement

by increasing the sectors represented, and

creating an environment that encouraged greater

participation, we have already increased the

quality of our CHA and fully expect that our CHIP

will benefit as well.

0

10

20

30

40

50

60

70

80

90

100

Se

cto

r P

art

icip

ati

on

Average Participation by Sectors

Percentage of

Sector Representation

0

1

2

3

4

5 Commitment

Clear Goals

Communication

Participation

Effectiveness

Value

Meeting Effectiveness Survey

Meeting # 1 Meeting # 2

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Act

Having been successful, we implemented the

changes with minor adjustments.

Remove/adjust requirement for 4 week meeting

notice with draft agendas.

Continue to show that strong respect for

community partners.

Continue to re-evaluate.

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Lessons Learned

The foundation of our community engagement success is truly at the point

of engagement!

The quality of the meetings are critical…

Must be respectful of our partner’s time.

Must communicate clearly to avoid frustration.

Must be a perceived value.

Must share a vision beyond our own needs.

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Back To The Beginning…

3 Prerequisites for Accreditation

Strategic Plan

Community Health Assessment

Community Health Improvement Plan

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Community Health Assessment

Top Issues:

• Alcohol Use

• Poverty/Access to Care

• Sexual health

• Obesity

• Child Health

• Tobacco

• Cardiovascular Health

• Diabetes

• Cancer

• Mental Health

• Violence

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CHIP Planning Meeting

Review and Discussion of Data

Advance material via email

Highlight data from featured topics

Voting on Priority Areas

Three votes each

Top 5 selected

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Highlights of our Quality Approach…. The BIG Payoff!

CHIP meeting included key officials that had been difficult

to engage:

Mayor

City Council Members

CEOs from both major hospitals***

City Manager

County Commissioner

Representatives from every major coalition

Representatives from outlying communities

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5 Priority Areas Selected

- Obesity

- Tobacco Use and Prevention

- Violence

- Sexual Health

- Access to Care

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Local Public Health System

….

Schools

Community

Centers

Employers

Transit

Elected Officials

Doctors

EMS

Law Enforcement

Nursing Homes

Fire

Corrections

Mental Health

Faith Institutions

Civic Groups

Non-Profit

Organizations

Neighborhood

Organizations

Laboratories

Home

Health

CHCs

Hospitals

Tribal Health

Drug Treatment Public Health

Agency

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Schools

Community

Centers

Chamber of

Commerce

Transit

Elected Officials

Doctors

EMS

Law Enforcement

Lawton-Ft. Sill

Community

Coalition

Fire

SW Tobacco Free

Coalition

JT Community

Mental Health

Ctr

Faith Institutions

Gang Intervention

Steering

Committee

Non-Profit

Organizations

Fit Kids of SW OK

Laboratories

SW

Medical

Center

Lawton

Community

Health Ctr

Comanche

County

Memorial

Hospital

Ft. Sill

Indian Health Comanche

CHD

Schools

Community

Centers

Chamber of

Commerce

Transit

Elected Officials

Doctors

EMS

Law Enforcement

Lawton-Ft. Sill

Community

Coalition

Fire

SW Tobacco Free

Coalition

JT Community

Mental Health

Ctr

Faith Institutions

Gang Intervention

Steering

Committee

Comanche CHD

Fit Kids of SW OK

Laboratories

SW

Medical

Center

Lawton

Community

Health Ctr

Comanche

County

Memorial

Hospital

Ft. Sill

Indian Health

CHIP

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Schools

Community

Centers

Chamber of

Commerce

Transit

Elected Officials

Doctors

EMS

Law Enforcement

Lawton-Ft. Sill

Community

Coalition

Fire

SW Tobacco Free

Coalition

JT Community

Mental Health

Ctr

Faith Institutions

Gang Intervention

Steering

Committee

Comanche CHD

Fit Kids of SW OK

Laboratories

SW

Medical

Center

Lawton

Community

Health Ctr

Comanche

County

Memorial

Hospital

Ft. Sill

Indian Health

CHIP

Schools

Community

Centers

Chamber of

Commerce

Transit

Elected Officials

Doctors

EMS

Law Enforcement

Lawton-Ft. Sill

Community

Coalition

Fire

SW Tobacco Free

Coalition

JT Community

Mental Health

Ctr

Faith Institutions

Gang Intervention

Steering

Committee

Comanche CHD

Fit Kids of SW OK

Laboratories

SW

Medical

Center

Lawton

Community

Health Ctr

Comanche

County

Memorial

Hospital

Ft. Sill

Indian Health

CHIP

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Schools

Community

Centers

Chamber of

Commerce

Transit

Elected Officials

Doctors

EMS

Law Enforcement

Lawton-Ft. Sill

Community

Coalition

Fire

SW Tobacco Free

Coalition

JT Community

Mental Health

Ctr

Faith Institutions

Gang Intervention

Steering

Committee

Comanche CHD

Fit Kids of SW OK

Laboratories

SW

Medical

Center

Lawton

Community

Health Ctr

Comanche

County

Memorial

Hospital

Ft. Sill

Indian Health

CHIP

Schools

Community

Centers

Chamber of

Commerce

Transit

Elected Officials

Doctors

EMS

Law Enforcement

Lawton-Ft. Sill

Community

Coalition

Fire

SW Tobacco Free

Coalition

JT Community

Mental Health

Ctr

Faith Institutions

Gang Intervention

Steering

Committee

Comanche CHD

Fit Kids of SW OK

Laboratories

SW

Medical

Center

Lawton

Community

Health Ctr

Comanche

County

Memorial

Hospital

Ft. Sill

Indian Health

CHIP

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Schools

Community

Centers

Chamber of

Commerce

Transit

Elected Officials

Doctors

EMS

Law Enforcement

Lawton-Ft. Sill

Community

Coalition

Fire

SW Tobacco Free

Coalition

JT Community

Mental Health

Ctr

Faith Institutions

Gang Intervention

Steering

Committee

Comanche CHD

Fit Kids of SW OK

Laboratories

SW

Medical

Center

Lawton

Community

Health Ctr

Comanche

County

Memorial

Hospital

Ft. Sill

Indian Health

CHIP

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Which is Better Quality?

Vision Test…

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Schools

Community

Centers

Chamber of

Commerce

Transit

Elected Officials

Doctors

EMS

Law Enforcement

Lawton-Ft. Sill

Community

Coalition

Fire

SW Tobacco Free

Coalition

JT Community

Mental Health

Ctr

Faith Institutions

Gang Intervention

Steering

Committee

Non-Profit

Organizations

Fit Kids of SW OK

Laboratories

SW

Medical

Center

Lawton

Community

Health Ctr

Comanche

County

Memorial

Hospital

Ft. Sill

Indian Health Comanche

CHD

Schools

Community

Centers

Chamber of

Commerce

Transit

Elected Officials

Doctors

EMS

Law Enforcement

Lawton-Ft. Sill

Community

Coalition

Fire

SW Tobacco Free

Coalition

JT Community

Mental Health

Ctr

Faith Institutions

Gang Intervention

Steering

Committee

Comanche CHD

Fit Kids of SW OK

Laboratories

SW

Medical

Center

Lawton

Community

Health Ctr

Comanche

County

Memorial

Hospital

Ft. Sill

Indian Health

CHIP

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Thank You

QUESTIONS & DISCUSSION