Support for this program was provided by a grant from the Robert Wood Johnson Foundation

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


24


Operational planning

Assessment Strategic Planning

BudgetManagement

Evaluation




BudgetManagement

Evaluation




BudgetManagement

Evaluation



AssessmentStrategic Planning

BudgetManagement

Evaluation

Quality Improvement Plan


• 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




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


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.


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

• [email protected]

• 850-245-4018

• Laura Reeves, Manager

• [email protected]

• 850-245-4019

mailto:[email protected]


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

[email protected]
