Accreditation – A Driver for Change

Elissa J. Bassler, CEOIllinois Public Health Institute

MLC Grantee Meeting February 3, 2010

Illinois Certification

• Illinois Dept. Public Health certifies LHDs– 8 practice standards

• Deliverables: Community Health Assessment, Community Health Plan, Organizational Assessment/Strategic Plan

• Certain state funding contingent upon achieving certification

From Certification to Accreditation

• Overlap in foundational elements: assessment, planning, and strategy

• Overlap in vision: health, wellness, efficiency, accountability, and best practices

• Illinois LHDs’ experiences with certification pave the way for a LHDs to seek and obtain accreditation

Key Principals In Illinois

• Accreditation (either Illinois program or PHAB) is voluntary; LHDs have state certification option: Choices

• Strengthen infrastructure/contribute to QI• Minimize economic burden/provide adequate

financial resources• Achievable regardless of size (w/ high

standards)• Stakeholder/participant driven

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MLC – Testing Accreditation In Illinois

• Illinois Accred. standards measures and process – using Illinois certification standards & operational definition

• Pilot, evaluation, revision of measures– Certification standards PHAB Domains– Crosswalk to PHAB measures

• Illinois “equivalent” to PHAB?

Decision Point – Illinois or PHAB

• State action/direction needed “Deeming” of accredited LHDs – – Illinois program? PHAB? – One or the other or either?

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Decision Point – Illinois or PHAB

• Deemed certification foundational for uptake (LHDs: “only one process”)

• Certification = assurance

• Accreditation – Rigorous, includes Cert. components

• State review of accreditation; decision on deeming

• Keep Illinois at the forefront of PH practice

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Decision Point – Illinois Program or PHAB

• Assuming: PHAB recognition; deeming:

• Decision criteria -- 3 categories– Cost/resources: To LHDs; at state level– Leadership/will: Administration buy-in and

promotion; energy & effort; “slippery slope” concerns; local voice; state-level analog

– Best uptake: Labor/effort & costs, value to external customers, QI results; relevance

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Illinois – Poised for Accreditation

• Illinois state and locals: poised for accreditation/could be national leader– State health assessments & State Health

Improvement Plan; strategic plan?– Certification: IPLAN = community health

assessment; community health plan; org. assessment or strategic plan

• Years of learning through MLC – accreditation and QI

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1010

Step UP Step UP to the OSDH Performance Management to the OSDH Performance Management

System: Accreditation is System: Accreditation is Driving Driving ChangeChange in Oklahomain Oklahoma

Step UP“Strategies toward excellent performance----Unlimited Potential”

Oklahoma State Department of HealthPerformance Management System

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Goals Of Step UPGoals Of Step UP

Comprehensive, sustainable performance management system

Periodic and uniform measure of those indicators most important to success

Alignment of strategic initiatives Trained staff in key public health/QI concepts Accountability to stakeholders Data –driven decision making Institutionalization of quality improvement Preparation for Accreditation

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Development of StepUP

Poor Health Outcomes/Inconsistent Monitoring

Expert Expert MeetingMeeting

Develop

Framework

& Changes

Pilot Pilot 11

Pilot Pilot 22

Pilot Pilot 33

Implementation, Implementation, Spread and Spread and

Sustainability Sustainability

Step UP

Design Electronic Form Test

Online Pilot

Holding Holding the the

GainsGains

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The Step UP Performance Management System is a web-based application that will

centralize data collection.

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Nat’l & OK Framework

Overview

StrategicPlan

Action Plan

Annual Review

Five Stages of Step UP Application

* 5 Stages* 3 Templates

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Public Health Alignment & Overview Template

Alignment to Oklahoma & Nat’l Framework

County Demographic Information or Service Target Population Information

Customer Satisfaction

Community Assessment

Mandates Funding Sources FTE

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Strategic Plan Template 2-5 Goals 2-5 Objectives 1-5 Performance Measures Baseline Target and Trend Information Data Sources and Formulas Alignment to Strategic Map

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Sample Action Plan

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Annual Review Template

Report Actual Data to Target Scorecard Barriers/Lessons Learned Success Factors

2020

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Step UP: a cycle of Step UP: a cycle of Plan-Do-Check-ActPlan-Do-Check-Act

(PDCA)(PDCA)

Set Standards

QualityImprovement

Reporting

Measure Performance

Plan

Do

Check

Act Set action plans and

begin implementation

How did it go?

Adopt/modify/drop based upon data & report results

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Accreditation: A Driver for Change

Redesign of Step UP system elements

Tie improvement planning, assessment, and strategic planning through Step UP

Standardized improvement planning and assessment for CHDs/service areas

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Accreditation: A Driver for Change

Tie to core measures throughout state services and county health departments

Cross-cutting STAT teams

Senior Leadership & Board involvement

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Accreditation: A Driver for Change

Alignment of resources

Tie to individual performance appraisals

Institutionalize QI

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Transitioning to Accreditationin Washington State

February 2010

Rita Schmidt, DOH

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Local Health Agencies/Population Served

Adams

Benton-Franklin Health District

Chelan-Douglas Health District

Clallam

Clark

ColumbiaCowlitz

Garfield

Grant

Island

Jefferson

Kitsap

Kittitas

Klickitat

Lewis

Lincoln

Mason

Northeast Tri-County Health

District

Okanogan

Pacific

San Juan Skagit

Skamania

Snohomish

Spokane

PierceThurston

WahkiakumWalla Walla

Whatcom

Whitman

Yakima

Grays Harbor

Asotin

ChelanDouglas

FerryStevens Pend

Oreille

Benton Franklin

18,000

21,500

169,300

72,60069,500

431,200

4,10099,600

37,600

7,800

72,700 2,250

86,10071,200

29,000King

39,900

20,200

75,200

10,450

40,500

21,800

12,900

813,600

118,900

10,800

704,300

465,000

44,000

4,100

16,300

59,200

193,100

43,300

238,400

Washington State Total Population as of June 2009 – 6,668,200Office of Financial Management Official 2009 Population Estimate www.ofm.wa.gov/pop

249,800

56,800

80,300

247,6001,909,300

Washington State Local Health Jurisdictions

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Washington State Standards Process

• Developed collaboratively by local and state public health agencies in 1999

• Used every three years to review the performance of the public health system in Washington

• Baseline measurement in 2002

• Re-measurements in 2005 and 2008

• Public Health Improvement Leadership-1993

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Benefits of Washington’s Process

• Provides a system-wide snapshot

• Common language

• Create common expectationso What every person has a right to expect

• Capacity measures

• Site performance measureable over time

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Standards for Public Health in Washington

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7

2008 System-wide Review

• Overall system report

• Individual site and special reports

• What we learnedo Relationship of budget and FTEs to overall performance is nearing

random

(little or no correlation)

• Significant improvement over time

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9

Comparison to Accreditation

Washington System

•System-wide snapshot

•Specific QI recommendations

•Full participation

•Full disclosure of scores

Accreditation

•County by county

•Pass or fail

•Confidential scores

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Washington Challenge

• Transition to accreditation

• Maintain our statewide results

• Maintain participation

• Make the process useful for Washington

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Decision Making Tools

• Assessment of Washington process – comparison to accreditation

• Crosswalk of Washington standards with PHAB standards

• Communication plano PHAB standardso Our options

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Our Options

• Continue our process without adjustments

• End the Washington process

• Develop an accreditation process

• Blend of PHAB and Washington process to prepare for accreditation

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Discussions about Accreditation

• Presentations to• Washington State Association of Local Public Health Officials• Health Officers and Administrators• Nursing and Environmental Health Directors• State Board of Health

• Review and vet the PHAB standards

• PHAB Director, Kaye Bender, invited for special session

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Participation in Beta Test

• All sites in Washington encouraged to participate

• State health agency and several local health agencies submitted applications

• State health agency selected

• Site visit in June of 2010

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Revisions to the Public Health Improvement Partnership (PHIP) Structure• Focus on governmental health agencies

• Smaller more focused committees and structure

• Change Public Health Improvement Plan focuso Public Health Assessment Improvement Plan

• Performance Management Committeeo Standards and measureso Accreditation support

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Revisions to the Standards

• Permission from PHAB to use the PHAB standards for Washington reviewo 80% of Washington measures align

• Include the Washington standards and measures that were not part of the PHAB standards

• Optional standards – those PHAB standards that were not part of the Washington reviews in the past

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Revisions to the Process

• Results of the DOH Beta Test as the Washington review

for DOHo All PHAB standards plus Washington standards and measures

• Schedule local health reviews for Spring of 2011o Optional PHAB standards and measures

• Use all results to prepare for accreditation

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State Agency Preparation for Beta Test

• Agency preparation assigned to Performance and Accountability Manager, Susan Ramsey

• Training with key staff

• Standards teamo Every division representedo Work session monthlyo Mock reviews

• Use electronic collection of documentationo Mind Manager

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The New Washington Standards Process for 2010-2011

• Use trained staff as reviewers for local health in 2011

• Sites will have the information to prepare for accreditation

• Results will give sites information for next cycle, or for accreditation preparation

• Washington will have state-wide results – “snapshot” of the state

• Washington will have recommendations for the public health system

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Additional Changes• Sites required to submit materials ahead of time

• 60% of Measures must have documentation to get a site visit

• Much of the review will be done offsite

• DOH is rethinking the Public Health Improvement Plan

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Our Goal

A predictable level of public health protection throughoutthe state

“What every person has a right to expect.”

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