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Public Health Accreditation Board
Judy Monroe, MD
Tennessee Public Health Association
September 3, 2009
Presentation Overview• Introduction to PHAB• Program development and timeline• Practitioner involvement• Benefits and incentives• Questions from you
A Rising Tide…
CDC’s Future Initiatives
“Future of the Public’s Health”in the 21st Century (IOM)
Statewide Accreditation Programs
Exploring Accreditation
Accreditation “Fits” in 2008Accreditation, as envisioned by the Public
Health Accreditation Board, is in tune with heightened national movement
• The Healthiest Nation• Trust for America’s Health – Blueprint for a Healthier
America
Credentialing and Accreditation
• Credentialing is a concept that applies to individuals who seek public health certification.
• Accreditation is a concept of validating performance improvement that applies to state, local, tribal, and territorial health departments.
Commitment of the PHAB Board of Directors and Staff
• Create demand and successfully deliver PHAB accreditation– Develop and establish PHAB accreditation– Market and manage the PHAB brand– Promote strategic partnerships ***– Establish sufficient funding– Strengthen PHAB organizational
effectiveness
Robert Wood Johnson Foundation Goal
60% of the population will be covered 60% of the population will be covered by accredited health departments by by accredited health departments by 2015.2015.
The goal of a voluntary national accreditation program is to improve and protect the health of the public by advancing the quality and performance of state, local, territorial and tribal public health departments.
Voluntary Accreditation Goal
Public Health Accreditation Board• Established May 2007 in Alexandria, VA• Governed by state, tribal and local public
health officials and board of health members
• Health department involvement:– Board of Directors representation– Workgroups oversee development– Volunteer opportunities
Executive Committee
• Chair: Paul K. Halverson• Vice Chair: unfilled• Secretary/Treasurer: Ed Harrison• Immediate Past President: Marie Fallon
• Kaye Bender, President and CEO
• Rex Archer (MO)• Shepard Cohen (MA)• Leah Devlin (NC)• Marie Fallon (OH)• Fernando A. Guerra TX)• Paul K. Halverson (AR)• Edward Harrison (IL)
PHAB Board of Directors
•Kenneth Kerik (OH)•Carol Moehrle (ID)•Judy Monroe (IN)•Bud Nicola (WA)•Alonzo Plough (CA)•William Riley (MN)•F. Douglas Scutchfield (KY)•H. Sally Smith (AK)
Funding Partners
Eligible Applicants
All variations of state, local, tribal and territorial health departments can apply for national accreditation
Developmental Work
• Standards Workgroup
• Assessment Process Workgroup
• Beta test
• Equivalency Recognition Workgroup
• Research and Evaluation Committee
• Fees & Incentives Workgroup
• Marketing and Communication
PHAB Timeline2007 2008 2009 2010 2011
1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4
Internal Operations
Standards and Measures
Assessment Process
18 Month Beta Test
Applications
Standards Development Workgroup
• Workgroup comprises state and local health department leaders and BOH members
• Collaborative, consensus, iterative process
• Facilitated by consultant with standards development expertise– MCPP Healthcare Consulting, Inc
Standards Development Workgroup• Leah Devlin (NC): Co-Chair• Carol Moehrle (ID): Co-Chair• Terry Allan (OH)• Rex Archer (MO)• Tim Callahan (CT)• Rick Danko (TX)• Robert Fulton (MN)• John Gwinn (OH)• Mary Kushion (MI)• Richard Morrissey( KS)• Rita Parris (NE)
• Sylvia Pirani (NY)• Joy Reed (NC)• Stephen Ronck (OK)• Jane Smilie (MT)• Torney Smith (WA)• Bonita Sorenson (CA)• Jeffrey Stoll (CO)• Susan Turner (FL)• Harvey Wallace (MI)• Christina Welter (IL)• Kathy Vincent (AL)• Barbara Worgess (AZ)
Standards and Measures Development
• Develop standards for all health departments
• Measures specific to local and state health departments
• Guidance for documentation and demonstration of department performance on meeting standards and measures
• Scoring and weighting methodology
Standards and Measures: Principles• Advance the collective practice
• Be simple, reduce redundancy
• Minimize burden
• Reinforce local and state health departments’ roles, demonstrate shared accountability
• Apply to all sizes and all forms of governance structure
• Based on American National Standards Institute principles
Principles continuedBased on a body of existing work
Essential PH ServicesNACCHO Operational DefinitionNational Public Health Performance Standards ProgramState ExperiencesASTHO Survey Data
Essentially all of the concepts in the Operational Definition and NPHPSP have been addressed
Standards Development Timeline• Draft standards and measures
developed by workgroups
• Alpha test/desk review
• Public vetting
• Revised based on feedback
• PHAB Board approval
• Beta testing
Feb 08-Feb 09
Oct 08-Nov 08
Feb 09-April 09
May 09-June 09
July 09
Late summer 09-Nov 10
Now, To The Standards
11 Domains
31 Standards
>100 Measures
Documentation
Draft Standards Framework
Eleven DomainsPart AAdministrative Capacity and GovernancePart B1. Conduct assessment activities focused on population
health status and health issues facing the community 2. Investigate health problems and environmental public
health hazards to protect the community 3. Inform and educate about public health issues and
functions 4. Engage with the community to identify and solve health
problems
5. Develop public health policies and plans6. Enforce public health laws and regulations7. Promote strategies to improve access to
healthcare services8. Maintain a competent public health workforce9. Evaluate and continuously improve processes,
programs, and interventions10. Contribute to and apply the evidence base of
public health
Eleven Domains (cont.)
Monitor Health
Indiana monitors influenza activity at sentinel sites throughout the state. Testing determines influenza activity and which strains are circulating. Our first confirmed case of the novel H1N1 influenza was detected through one of our sentinel sites.
Diagnose and Investigate• When new cases of confirmed novel
H1N1 influenza were diagnosed, public health did case investigations to determine the epidemiology of this new emerging influenza virus.
Inform, Educate, Empower• Public health quickly informed the public
about the threat of the novel H1N1 influenza virus and developed educational tools.
Mobilize Community Partnerships
• The novel H1N1 influenza virus called upon public health to mobilize community partners to prevent the spread of the virus.
Develop Policies
• The novel H1N1 influenza virus required policy development for school closure, vaccine target groups, etc.
Enforce Laws
• Quarantine/isolation• Worker’s compensation
Link to/provide care
• Uninsured and indigent • Emergency departments• Vaccine administration
Assure Competent Workforce• Vaccinators• Call centers• Medical and public health
Evaluate
• School policies• Collecting and reporting cases• Communications• Unintended consequences
Research
• Viral mutation• Risk factors
Indiana Public Health System Quality Improvement Project
Statewide initiative led by the state healthcommissioner in partnership with PurdueUniversityObjectives
1. Promote quality improvement processes2. Engage public health system partners3. Prepare Indiana for national accreditation
Phase I Phase I –– AssessmentAssessmentCDCCDC’’s National Public Health Performance Standards Programs National Public Health Performance Standards Program
• Early user of Version 2.0 Local and State Instruments.
• Collaboration with partners is critical to developing clear, measurable standards for local and state public health systems.
• Final report provides a means of evaluating system-wide performance
• Results provide a foundation for public health system quality improvement processes.
Phase II Phase II -- TrainingTrainingFour Day Training Course: Team Building, Leadership and Four Day Training Course: Team Building, Leadership and
Problem SolvingProblem Solving
• Participants learn team building and leadership skills.
• Teams learn how to apply problem solving methodologies and toolsto identify primary causal factors limiting program success in public health.
• Teams create a foundation for implementation plans to mitigate/remove primary causal factors and improve program performance related to the 10 Essential Services and Healthy People 2010 objectives.
Root Cause AnalysisThe general principles of root cause analysis are:
•Targeting corrective measures at root causes is more effective than treating the symptoms of a problem•To be effective, RCA must be performed systematically, and conclusions must be backed up by evidence•There is usually more than one root cause for any given problem
Phase IIIPhase IIIPerformance Improvement ProgramsPerformance Improvement Programs
• Identify written performance objectives based on root cause analysis
• Identify key public health partners to collaborate
• Create strategies to meet objectives
• Design and implement plan
Project Charter StepsStep #1 – Define the Problem• Problem Statement• Goal Statement• Project Scope• Output MetricsStep #2 – Analyze the Problem• Current Process Map• Future State Process Map• Cause and Effect Diagram (5 Whys)• Process Observation Worksheet• Spaghetti Diagram• Interviews & Records Reviewed
Project Charter Steps
Step #3 – Evaluate Possible Solutions• Impact & Effort Matrix• Solution ListStep #4 – Test & Implement Solutions• Implementation Plan• Milestones & Completion DatesStep #5 – Standardize and Sustain Solutions• Action Item List
Delaware County, IndianaChildhood Obesity
Effects of being overweight for children
“caused by”
Causes
1. Misbehavior in school Limited parental involvement in family meals or physical activities
2. Lower test scores Inability to concentrate due to sleep disorders
3. Poor general health (increased risk for high blood pressure, asthma, high cholesterol, & type 2 diabetes)
Overweight due to sedentary lifestyle
4. Low self-esteem and isolation from peers
Ridicule about weight from peers
5. Visits to school psychologist or nurse
Poor nutrition and healthy food-insufficiency
1 2 3 4 5 A continuum of causes for childhood obesity
Cause and EffectCause and Effect
Adult and Childhood
Obesity
Poor Nutrition
Caused By
Sedentary Lifestyle
•Less expensive junk food•Easy access to fast food
•Fewer family meals•Lack of nutrition education
•Poor grocery shopping habits
•Marketing high fat foods•Super-sized options•Calorie dense foods
•Skipping meals•Sweetened beverages
Caused By
Caused By
•More time watching television
•Less recess•Limited access to facilities
•Less need for manual activities
•Attractive sedentary options (i.e., video games &
ipods)•Limited PE requirements
•Fewer family outdoor events
•Lack of motivation•Increased time on computer
•Inconvenient to exercise
Causal Tree
Too much television & computer time at home
Lack of meal times together
Using food as a reward
Childhood and Adult Obesity
FamiliesSchools
EnvironmentCommunity
Making unhealthy food purchases
Reliance on processed meals
Using activity as punishment
Healthy food is expensive Lower SES community
Fast food is more convenient
Limited access to exercise facilities
Societal reliance on quick fixes
High fat/calorie menuProhibiting recess as
punishment
Lack of side walks
Cost & convenience of videos & gaming options
Outdoor recreational safety concernsLack of motivation to
change
Minimal time for recess
Lack of nutrition education
School parties & events with unhealthy foods
Food pantry items not healthy
Lack of awareness about resources
Parents not role modeling healthy behaviors
No time set aside in day for exercise
Little advocacy for value of nutrition and physical education
Fish Bone DiagramFish Bone Diagram
Logic ModelInputs
Healthy Living Take Charge!
Delaware County Schools
Delaware County Health
Department
Community Agencies &
Organizations
YMCA
Purdue Extension
Activities
Communicate Healthy Living Take Charge! updates at civic, school, and
community events
Identify educational resources for schools
Assign HLTC team members to website
development & continue to update it
Document current participation of Kidz Marathon of schools
Develop pilot project timeline to propose to 2-3 interested schools
Submit budget to ISDH
Promote new physical activity & nutrition
programs
Facilitate growth of existing community
programs
Outputs
Healthy Living Take Charge
team members shares activities with constituents
Expand on the developments and
news items that are significant
Team member creates a website to track progress
Assess gaps at schools to develop resources that fit
their needs
Start preliminary work for
implementing new fall project w/
parent involvement
Outcomes-Impact
Short Term Medium Term Long Term
Residents of county can see that Healthy Living Take Charge! exists and wants to
make a difference in health outcomes
Create or improve awareness of
resources for the schools and families
Teacher liasion, students & parents actively involved in
project
Collaborate with community agencies
and schools in programs that lead to more physical activity and includes nutrition
component
Students and parents participate in physical activity and nutrition education program
More schools and organizations apply for mini-grants to
implement programs
Delaware County schools and residents are better aware of
community resources for nutrition
education and physical activity.
Increased participation of kids in available physical activity
and nutrition programs.
Schools utilizing nutrition and
physical activity resources in the
classroom
Improved awareness by community members of
resources and capabilities
Evaluation methods developed
to track health outcomes noting better lifestyle
habits to reduce prevalence of
obesity in county.GOAL:Preventing obesity in Delaware County by increasing awareness of healthy food
choices and physical activity benefits.
Influential FactorsSchool time off, YMCA
coordination to implement and sustain
programs, Healthy Living Take Charge!
members’ participation, student and parent support, support by
schools, Delaware Co. Health Department &
ISDH budget.
Public Health SystemPublic Health SystemPublic Health System
Local HealthDepartm ent
G atew ay
W astewater D ist.
PurdueExtension
Environm enta l C t.
CountyC om m issioners
Schools
U nitedW ay
H eadStart
AdultP rotection
Child P rotection
TBAssociation
C om m unityFoundation
E lected O fficia ls
JudgesBall
Foundation
O ther LHD s
BM H Foundation
D D AH ousing Authority
C ity
EM S
EM A
FirePolice
Sanitation
U tility
W aterQ uality
Tow nshipTrusteesM ayor’s Adv. C om m .
O n Health Ed.
M HA
PlanningCom m .
C om m .C enters
Ball M em oria lHospita l (BH M )
Little R edDoor
O pen D oorC lin ic
O pen DoorBM H
TEAM workQ val
M inorityH ealth
L iving HealthyBoard
C ardinalG reenway
R ed C ross
Am erican D iabetesAssociation
Am erican HeartAssociation
Boys andG irls C lub
PublicA id
Relig iousO rganizations
Food Pantries
M O M s
A BetterW ay
Bridges
ChristianM inistries
ShepherdC enter
C ancer Socie ty
F irst C hoicePregnancy
C enter
Lifestream
YM C APlannedParenthood
Fam ilyServices
U W CA
Future C hoices
TobaccoC oalition H ealth M others
H ealth Babies
M uncieM ission
Partnersh ipCom m Im p
Sherry Labs
In-Am erH 20
PathAssoc
M edC onsultants
M erid ianServices
H om e H ealthcareAgencies
HealthcareProviders
Assisted L ivingC enters
H oosier M icrob ialLab
ISD HBall S tateUniversity
BSU F IFW G
BSUSVS BSU School
O f Nursing
BSUC C VA
BSU School o fHealth Sciences
IN ActionH ealth K ids
BSU S tud.
W ellness
BSUSBES
IvyTechAction Inc.
Suicide P revention
Center
IndianaBusiness College
CD C
EPA
FDA
Lion’s
Rotary
A ltrusa
K iwanis
IN -S t ExH o. IEH A
CivicNationalStatePrivateNonprofitCityDelaware County
Legend
Domain 1: Conduct assessment activities focused on population health status and health issues facing the community
Standard 1.1 B: Collect and Maintain Population Health Data
Collect and maintain reliable, comparable, and valid data that provide information on conditions of public health importance and on the health status of the population.
Measure Documentation and Scoring Guidance Type of Measure
Type of Review
1.1.1 B: Assure a surveillance system is in place for receiving reports 24/7 and for identifying health problems, threats, and hazards
Documentation should address:• Processes and protocols to maintain the
comprehensive collection, review, and analysis of data from multiple sources,
• Processes and protocols to assure data are maintained in a secure and confidential manner
• Current 24/7contact information, in the form of a designated telephone line or a designated contact person (which may be provided in rural areas via regional or state agreements)
• Reports of testing 24/7 contact systems, such as, internet, fax, page phone line, etc.
Capacity HealthDepartmentLevel
1.1.2 B: Communicate with surveillance sites on at least an annual basis.
Documentation should address:• List of providers and public health partners who
may be surveillance sites
Process HealthDepartmentLevel
Standards VettingWhy?Improve standards and measures
What?Standards, measures and documentation guidance
How? Through a variety of online and in-person opportunities
When?February-April 2009
We need to hear from YOU!
Vetting Details
• February 2, 2009: Draft standards, measures and documentation guidance
• Multiple ways to provide feedback
• Questions? E-mail [email protected]
Equivalency Recognition Work Group Report
• Acknowledge states with existing programs that advised the national process
• Not a grandfathering process
• Recognizes programs that conform to the national program
• Not “PHAB accreditation,” but eligible for same benefits
Equivalency Workgroup Products
•Definition
•Guiding Principles
•Eligibility Criteria
•Recognition Criteria
• Application Process (and Fees)
• PHAB SER Review Process
• Scoring Methodology
• Glossary
More Recent Work on State-Based Accreditation
Think Tank to further the discussion
More work to come…..
Equivalency Recognition Workgroup
• Bud Nicola (WA): Chair• Rex Archer (MO)• Janet Canavese (MO)• Shepard Cohen (MA)• Kathleen MacVarish (MA)• Joan Brewster (WA)• Pamela Butler (OH)
• Martha Gelhaus (IA)• Joe Kyle (SC)• Edd Rhoades (OK)• Rachel Stevens (NC)• Debra Tews (MI)• Lee Thielen (CO)
Assessment Process Workgroup
• Determine how to evaluate whether a health department has achieved accreditation status
• Determine how health departments can appeal decisions
• Professional Accreditation Consultant– Michael Hamm and Associates
• Bud Nicola (WA): Chair• Christine Abarca (FL)• Joan Ascheim (NH)• Janet Canavese (MO)• Alan Kalos (KY)• Jerald King (IN)
Assessment Process Workgroup
•Laura Rasar King (DC)•Richard Matheny (CT)•Bruce Pomer (CA)•Rita Schmidt (WA)•David Stone (NC)•Jeffrey J. Zayach (CO)
Assessment Process
Process to include:– Readiness Review– Application Form– Self-assessment– Site Visit– Findings and
Recommendations Report– Final Determination – Appeals Process– Maintenance of
Performance– Re-accreditation
Assessment Process: Principles
–The assessment process should reduce anxiety and increase comfort for the applicant
–PHAB will offer training, technical assistance, and informational materials on the accreditation process
–All applicants will be required to participate in PHAB training on the application process
60
Research and Evaluation Committee
• Develop a plan for evaluating the assessment processes and identifying research that would improve the standards-setting and accreditation program.
• Review standards and measures for validity and reliability.
• Provide consultation on data collection and interface with accreditation tracking and application online system.
Research and Evaluation Committee
• William Riley (MN): Chair• Christine Bean (NH)• Mary Davis (NC)• Seth Foldy (WI)• Les Beitsch (FL)
• Paul Erwin (TN)• Kerry Gateley (VA)• Brenda Joly (ME)• Laura Landrum (IL)• Glen Mays (AR)
Financing
• Workgroup on fees and incentives
• Affordability of fees critical to success
• Accreditation process should be designed with cost controls in mind
Why participate?
Benefits of AccreditationAccountability & credibilityAccountability & credibility
Tool for improvement
Tool for improvement
Greater collaboration
Greater collaboration
Recognition & validationRecognition & validationBetter
understanding of public health
Better understanding
of public health
Team buildingTeam building
Highlights HD
strengths
Highlights HD
strengthsAccreditationAccreditation
IncentivesUniformly positiveParticipate in learning communityInformed by UNC researchPossible tangible incentives
Improved access to fundingGrants application requirementsGrants reporting requirements
Incentives Research
• What matters to State HDs?– Financial incentives
• Accredited agencies – 60%• Agencies applying for accreditation – 32%
– Infrastructure/quality improvement – 36%– Grants application and administration – 20%
Incentives Research
• What matters to Local HDs?– Financial incentives
• Agencies considering accreditation – 51%• Accredited agencies – 37%
– Infrastructure/quality improvement – 33%– Technical assistance and training – 27%
Incentives Underway
Areas for Further Exploration
• Incentives thresholds• Incentives from States to Locals• Providing incentives
– Menu– Sequencing
• Incentives for Tribal Health Departments
Your Next Steps…..• Review Exploring Accreditation Final Recommendations
• Visit www.phaboard.org often for updates
• Convene key “thought leaders” to discuss next steps in your agency
• Work with your association– ASTHO, NACCHO, NALBOH
• Employ the National Public Health Performance Standards
• Employ NACCHO’s Operational Definition for Local Health Departments
• Comment on the Standards!
www.phaboard.org
Contact Kaye Benderor any Board Member
703.778.4549