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Community Balanced Scorecards to Mesh Strategic Planning, Health
Improvement Planning & Accreditation
Paul Epstein ([email protected])
Results That Matter Team (www.RTMteam.net)
For APHA Annual Meeting
Washington, DC November 1, 2011
APHA Presenter Disclosures
(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:
Paul David Epstein
“No relationships to disclose, other than the obvious relationship with my own consulting firm that does paid work of the type I am presenting.”
Results That Matter Team www.RTMteam.net
• Measuring & improving performance since 1985, mostly as Epstein & Fass Associates
• Use of RTM Team’s Community Balanced Scorecard (CBSC) expanding for strategic plans & health improvement plans
• Work with ASTHO, NACCHO, Public Health Foundation, & directly for PH organizations, hospitals, partnerships, others
• QI &Evaluation Coaching for LHDs across the U.S. (NACCHO)
• 3 chapters in The Public Health Quality Improvement Handbook
• Working with Inc. whose InsightVision software powers scaling-up the use of CBSC
3 Results That Matter Team (www.RTMteam.net)
CBSC: From a Promising to a Best Practice
1. Featured by CDC, NACCHO, ACHI, NNPHI, & Public Health Foundation at national training events
2. Delaware & New York strategic planning (started by ASTHO)
3. Adopted by county-led, nonprofit-led, & hospital-led community health partnerships focusing on local issues
4. NACCHO MRC Strategic Road Mapping
5. National strategic planning by NACCHO Preparedness Team & MAPP Team
6. Projects funded by CDC, HRSA, Surgeon General, others
7. In Public Health Foundation/American Society for Quality Public Health Quality Improvement Handbook
4
Agenda
1. Accreditation, Strategic Planning, Health Improvement Planning
2. CBSC: Solution to Many Challenges, e.g.: – Managing collaborations – Strategic plans & health improvement plans – Support accreditation, QI, performance
management
5 Results That Matter Team (www.RTMteam.net)
Public Health Accreditation
• Performance Improvement Orientation – Performance Mgt & QI built in
• Pre-requisites – Community or State Health Assessment (HA) – Community or State Health Improvement Plan (HIP) – Strategic Plan
• Standards & Measures, organized in 12 Domains including the Essential Services of PH
6 Results That Matter Team (www.RTMteam.net)
Health Improvement Planning
• Externally focused on state or community – Broad participation of PH system partners – Individuals & organizations responsible for implementation
• Other Health Improvement Plan components – Health priorities and measurable objectives – Improvement strategies – Performance measures with time-bound targets – Measurable health outcomes to monitor progress – Policy changes needed to accomplish health objectives
7 Results That Matter Team (www.RTMteam.net)
Why Should a HIP Be a Collaborative Plan?
8
Upstream prevention, e.g., Social determinants
Midstream prevention, e.g., Healthy behaviors, vaccinations
Downstream: Treat disease & injury
• Need multiple organizations to navigate each part of the stream • PH Challenge: Collaborative planning is hard to do well
And collaborative implementation can be overwhelming
Strategic Planning
• Internally focused on health dept, but – Can still involve key external partners for parts of the plan – Some external strategies needed to connect with HIP
• Strategic Plan components – Mission, vision, guiding principles/values – Strategic priorities – SWOT: Health dept strengths & weaknesses (SW), external
factors influencing population health or the dept (OT) – Goals & objectives with measurable time-bound targets – Links to Health Improvement Plan & QI Plan
9 Results That Matter Team (www.RTMteam.net)
Pulling it All Together
With Community Balanced Scorecard Tools • Structure HIPs, strategic plans, and
accreditation
AND
• Strengthen collaborative planning and outcome-focused implementation
10 Results That Matter Team (www.RTMteam.net)
Execution Gap
Community Balanced Scorecard tools (e.g., strategy maps) improve the Alignment and Execution of Strategies
No Strategic Alignment High Level Goals
Power of Strategic Alignment
Public Health
Outcomes
Other Public Agencies
Hospitals
Schools Community Groups
Faith Communities
Nonprofits State Health Dept
Families & Individuals
Local Health Depts
Employers
11
Community Balanced Scorecard Components
Performance Measures, Targets, &
Initiatives
Perspectives
Vision, Overall or by Issue or “Theme” or
Program
Organization, State, or Community
Priorities
Strategy Map(s) Strategic Objectives
Could also include Mission, Values, etc.
12 Results That Matter Team (www.RTMteam.net)
HIP & SP
SP
HIP & SP
One for each strategic priority in HIP & SP
HIP & SP
Some strategy maps can link HIP & SP
Not covered today
Perspectives in Current Practice for Public Health Community Balanced Scorecards & Strategy Maps
Community Assets
Community Implementation
Community Health Status
Community Process & Learning
13 Results That Matter Team (www.RTMteam.net)
# 1 Assess, Disse-
minate Population Health Status &
PH Issues
# 7 Promote
Strategies to Improve Access
to Services
# 2 Investigate, Contain PH Problems &
Hazards
H2. Minimize Risks
# 6 Enforce Public Health Laws
“Top Level Strategy Map” Based on PHAB Domains: a TEMPLATE to Align More Detailed Strategies
# 3 Inform, Educate About PH Issues (Promote Health)
# 4 Engage the
Community to ID & Address Health
Problems
# 5 Develop PH Policies &
Plans
# 9 Evaluate &
Improve Processes, Programs, & Interventions
# 10 Contribute to & Apply the
Evidence Base of PH
# 8 Maintain a
Competent PH Workforce
#12 Maintain Capacity to Engage the PH Governing Entity
STRATEGIC OBJECTIVES (“Generic Categories” for Issue-specific Strategic Objectives) Perspectives
Community Health Status
Health Outcomes, Disparities, Determinants, Risks.
Community Implementation
Projects, services, & actions to improve health or the conditions for health.
Community Process & Learning All policy, planning, & decision processes that can affect health. Also, gathering & using information.
Community Assets
Financial & non-financial resources (e.g., people, organizations, partnerships, facilities, equipment) and how they function to support health strategies.
H1. Improve Health
Outcomes & Eliminate
Disparities
#11 Maintain
Administrative & Management
Capacity 14
You often need to “zoom in” from: • a “top level” strategy map • to maps with more details.
15 Results That Matter Team (www.RTMteam.net)
Delaware DPH Priority Issue or “Thematic” Strategies to be Mapped
STRATEGIC ISSUES OR “THEMES” Perspectives
Community Assets
Community Health Status
Community Implemen-
tation
Community Process & Learning
Health Reform
Core Services Transformation
Reducing Health Disparities
Reducing Obesity
16
Decrease prevalence of diseases related to obesity
STRATEGIC OBJECTIVES Perspective
Com
mun
ity
Hea
lth
Stat
us
Com
mun
ity
Impl
emen
tatio
n
Vision: All Delawareans live, work, learn, and play in healthier communities, live healthier lives, and achieve and maintain healthier weights.
Strategic Focus: Decrease obesity in the African American population.
Promote healthy behaviors
Implement policies, practices & programs that support healthy
eating & physical activity
Support enforcement of policies for healthy eating &
physical activity
Increase active living & healthy eating, & reduce screen time
Decrease prevalence of overweight & obesity
17
Decrease prevalence of diseases related to obesity
Increase active living & healthy eating, & reduce screen time
Promote healthy behaviors
STRATEGIC OBJECTIVES Perspective
Com
mun
ity
Hea
lth
Stat
us
Com
mun
ity
Impl
emen
-ta
tion
Com
mun
ity P
roce
ss
& L
earn
ing
Implement policies, practices & programs that support healthy
eating & physical activity
Vision: All Delawareans live, work, learn, and play in healthier communities, live healthier lives, and achieve and maintain healthier weights.
Strategic Focus: Decrease obesity in the African American population.
Support enforcement of policies for healthy eating &
physical activity
Implement a comprehensive monitoring and evaluation system
related to healthy behaviors
Develop a QI system to assure use of best practices
Recommend & advocate for policies that promote
healthy behaviors
Recommend & advocate for policies promoting a health- oriented built environment
Decrease prevalence of overweight & obesity
18
Decrease prevalence of diseases related to obesity
Increase active living & healthy eating, & reduce screen time
Promote healthy behaviors
STRATEGIC OBJECTIVES Perspective
Com
mun
ity
Asse
ts
Com
mun
ity
Hea
lth
Stat
us
Com
mun
ity
Impl
emen
-ta
tion
Com
mun
ity P
roce
ss
& L
earn
ing
Implement policies, practices & programs that support healthy
eating & physical activity
Implement a comprehensive monitoring and evaluation system
related to healthy food choices & physical activity
Recommend & advocate for policies that promote
healthy behaviors
Vision: All Delawareans live, work, learn, and play in healthier communities, live healthier lives, and achieve and maintain healthier weights.
Strategic Focus: Decrease obesity in the African American population.
Create & maintain oversight and funding for the healthy
lifestyle agenda
Mobilize and support key partnerships
Educate and expand a culturally competent workforce
Support enforcement of policies for healthy eating &
physical activity
Develop a QI system to assure use of best practices
Recommend & advocate for policies promoting a health- oriented built environment
Decrease prevalence of overweight & obesity
19
Decrease prevalence of diseases related to obesity
Increase active living & healthy eating, & reduce screen time
Promote healthy Behaviors [3]
STRATEGIC OBJECTIVES Perspective
Com
mun
ity
Asse
ts
Com
mun
ity
Hea
lth
Stat
us
Com
mun
ity
Impl
emen
-ta
tion
Com
mun
ity P
roce
ss
& L
earn
ing
Implement policies, practices & programs that support healthy
eating & physical activity [7]
Implement a comprehensive monitoring and evaluation system
related to healthy food choices & physical activity [1 & 9]
Recommend & advocate for policies that promote
healthy behaviors [5]
Vision: All Delawareans live, work, learn, and play in healthier communities, live healthier lives, and achieve and maintain healthier weights.
Strategic Focus: Decrease obesity in the African American population.
Mobilize and support key partnerships [4]
Educate and expand a culturally competent
workforce [8]
Support enforcement of policies for healthy eating &
physical activity [6]
Develop a QI system to assure use of best practices [9]
Recommend & advocate for policies promoting a health-
oriented built environment [5]
Decrease prevalence of overweight & obesity
20 Create & maintain oversight and funding for the healthy
lifestyle agenda [11]
Vision: Osceola County will be a community where all uninsured and underinsured residents have full ACCESS TO THE HEALTH CARE services that they need. (A systemic issue)
STRATEGIC OBJECTIVES Perspective
Community Assets
Community Health Status
Community Implemen-
tation
Community Process & Learning
Target our initiatives to areas of most need
[5]
Increase access to specialty care [7]
Measure our success [1]
Improve delivery & quality of care by using evidenced-based best
practices [9]
Ensure access to comprehensive health care [7]
Sustain best practice
programs [5]
Maximize resources and engage new & existing partners in developing solutions [4]
Ensure the public health workforce is skilled to address health issues [8]
Increase enrollment in a medical home [7]
Improve outcomes of people with, or at risk of, Diabetes Mellitus and Cardiovascular disease
21
Assess housing health issues by analyzing surveillance systems &
databases
STRATEGIC OBJECTIVES
Com
mun
ity
Heal
th S
tatu
s Co
mm
unity
Pro
cess
&
Lear
ning
Perspective
Com
mun
ity
Asse
ts
Reduce health risks from hazards related to the home environment
Reduce illnesses, injuries, & other adverse health outcomes related to the home environment
Develop & implement an investigative agenda that focuses
resources in areas of known high risk
Collaborate with state & local agencies to improve enforcement of
home environment laws & regulations
Collaborate/coordinate with housing stakeholders to identify solutions for
improving home health
Modernize healthy housing legal, policy, and program frameworks
to close public health gaps
Vision: All New Yorkers enjoy healthy built environments that reduce risks from environmental exposures and hazards that cause illness and injury
Com
mun
ity
Impl
emen
tatio
n
Assemble and promote an inventory of service resources that improve housing health
Implement theme-based healthy housing education
tailored to specific audiences
Implement a research agenda for the home environment
and a process for translating findings to practice
Implement environmental public health cross training
Share the results of evaluations the with partners to improve program effectiveness
Strategic Focus: Create Healthier Homes
Find and promote opportunities to improve the quality of informatics to better support public health goals and objectives
STRATEGIC OBJECTIVES
Com
mun
ity
Heal
th S
tatu
s Co
mm
unity
Pro
cess
&
Lear
ning
Perspective
Com
mun
ity
Asse
ts
Mitigate and reduce exposure to health risks
Improve health outcomes and eliminate disparities by providing access to
comprehensive health information
Enforce & promote data & systems standards consistent with related laws and regulations
Improve health investigation & containment through enhanced
technology and data sharing
Collaborate with partners to prioritize & address public health informatics needs
Ensure technology projects are driven by
public health goals
Encourage and support the workforce to adapt and improve
Ensure adequate technology and resources to support PH
information exchange
Provide the public health community and partners with improved
monitoring and analysis capabilities driven by end user needs
Public Health Information Management Vision: An integrated public health information and communication structure that uses information effectively to improve the health and safety of the people of New York
Com
mun
ity
Impl
emen
tatio
n Achieve effective and efficient use of data and information to improve
services
Provide channels & processes to facilitate data exchange & dissemination
of public health information
Develop policies, protocols, & standards
to enable improved systems & use of data
Promote and expand use of informatics to build the
evidence base of public health
PH Info Mgt: An Infrastructure Issue
Top Level Strategy Map
24 Results That Matter Team (www.RTMteam.net)
Zoom in: Map for a
strategic priority
Zoom in again: Info on specific
objectives
Link to performance management
• Objective Description
• Desired Change: From-To Gap
• Performance measures & time-bound targets
• “Owner” & team
• Existing initiatives & priority new initiatives
• Later: Implement initiatives & collect periodic data for a strategic performance management system Implement & report on Strategic Plan (PHAB measure 5.3.3) &
meet PHAB standard 9.1 on Performance management
Info on CBSC Objectives to Manage the Strategy
Results That Matter Team (www.RTMteam.net) 25
HIP & Strategic Plan
HIP & Strategic Plan
HIP
HIP
Cascading Strategy Maps by Priority (“Theme”) to Align the SHIP/CHIP or Strategic Plan
LG
P
C
F
L2
P2 P4
C2 C3
F1 F3
L1
C1
L3
Top-Level Strategy Map
F2
C4
P1 P3
LG
P
C
F
L L L
P P
C C C
F F
LG
P
C
F
L L
P P
C C
F F
L LG
P
C
F
L L L
P P
C C C
F F
Theme Strategy Map: Reducing Disparities
Theme Strategy Map: Reducing Obesity
Theme Strategy Map: Health Reform
F2
C1
P2
L1
F3
C3
P4
L3
C2
P3
L2
26 Results That Matter Team (www.RTMteam.net)
Top level map creates alignment of all thematic strategies
Aligns these strategies in the performance management system
LG
P
C
F
Cascading Strategy Maps by Program or Organization Unit for More Alignment
L2
P2 P4
C2 C3
F1 F3
L1
C1
L3
Top-Level Strategy Map F2
C4
P1 P3
LG
P
C
F
L L L
P P
C C C
F F
LG
P
C
F
L L
P P
C C
F F
L LG
P
C
F
L L L
P P
C C C
F F
Unit B Strategy Map Program A Strategy Map
Program C Strategy Map
F2
C1
P2
L1
F3
C3
P4
L3
C2
P3
L2
27 Results That Matter Team (www.RTMteam.net)
Top level map creates alignment of all unit or program plans
Aligns these plans in the performance management system
# 1 Assess, Disse-
minate Population Health Status &
PH Issues
# 7 Promote
Strategies to Improve Access
to Services
# 2 Investigate, Contain PH Problems &
Hazards
H2. Minimize Risks
# 6 Enforce Public Health Laws
“Top Level Strategy Map” Based on PHAB Domains to Align More Detailed Strategies
# 3 Inform, Educate About PH Issues (Promote Health)
# 4 Engage the
Community to ID & Address Health
Problems
# 5 Develop PH Policies &
Plans
# 9 Evaluate &
Improve Processes, Programs, & Interventions
# 10 Contribute to & Apply the
Evidence Base of PH
# 8 Maintain a
Competent PH Workforce
#12 Maintain Capacity to Engage the PH Governing Entity
STRATEGIC OBJECTIVES (“Generic Categories” for Issue-specific Strategic Objectives) Perspectives
Community Health Status
Health Outcomes, Disparities, Determinants, Risks.
Community Implementation
Projects, services, & actions to improve health or the conditions for health.
Community Process & Learning All policy, planning, & decision processes that can affect health. Also, gathering & using information.
Community Assets
Financial & non-financial resources (e.g., people, organizations, partnerships, facilities, equipment) and how they function to support health strategies.
H1. Improve Health
Outcomes & Eliminate
Disparities
#11 Maintain
Administrative & Management
Capacity 28
# 6 Enforce
Environmental Health Codes
# 4 Engage the
Community to Reduce Need for
Enforcement
# 5 Develop
Policies that Incentivize Compliance
# 9 Continually Improve Quality
# 8 Maintain a
Competent PH Workforce
STRATEGIC OBJECTIVES Perspectives
Possible Cascaded Strategy Map for Environmental Health (EH) Enforcement Group
29
H2. Minimize EH Risks &
Disparities in Risk
H1. Improve EH Outcomes &
Eliminate Disparities
Community Assets
Community Health Status
Community Implemen-
tation
Community Process & Learning
# 2 Investigate,
Contain Environ-mental Health
Hazards
30 Results That Matter Team (www.RTMteam.net)
Broader Alignment with Accreditation
• PHAB domains in the top level strategy map align all strategy maps with accreditation.
• Documented progress on strategic objectives on these maps provides documentation for improvements in PHAB accreditation domains.
• A strategy map & scorecard can be created for “Achieving Accreditation” to zoom from domains to standards & measures.
For More Information
Paul Epstein: [email protected] or 212-349-1719
Website: RTMteam.net
Questions?
31 Results That Matter Team (www.RTMteam.net)