The National Public Health Performance Standards 201: Tips and Tricks for Successful

ImplementationChristine Abarca, Florida Department

of Health Teresa Daub, CDC

Learning ObjectivesFollowing this session, you will be able to:•Describe the framework and concepts that underpin the three assessment tools of the NPHPS•Discuss the similarities and differences between Versions 2 and the re-engineered Local NPHPS•Identify at least one option for conducting an NPHPS assessment•List three or more tips for implementing the NPHPS assessment

Understanding NPHPS Key Concepts and Tools

3

NPHPS VisionA partnership effort

to improve the quality of

public health practice and

performance of public health systems

Four Concepts Applied in NPHPS

1. Based on the ten Essential Public Health Services

2. Focus on the overall public health system

3. Describe an optimal level of performance

4. Support a process of quality improvement

1. The Essential Public Health Services1. Monitor health status2. Diagnose and investigate health

problems3. Inform and educate4. Mobilize communities to address

health problems5. Develop policies and plans6. Enforce laws and regulations7. Link people to needed health

services8. Assure a competent health

services workforce

9. Evaluate health services10.Conduct research for new

innovations

2. Public Health System

Schools

Community Centers

Employers

Transit

Elected Officials

Doctors

EMS

Law Enforcement

Nursing Homes

Corrections

Faith Institutions

Civic GroupsCivic Groups

Non-Profit Organizations

Neighborhood Organizations

Laboratories

Home Health

CHCs

Hospitals

Tribal Health

Drug Treatment

Public Health Agency

Mental Health

Fire

3. Optimal Level of Performance • Each performance standard

represents the “gold standard”

• Provide benchmarks to which state and local systems can strive to achieve

• Stimulate higher achievement

4. Stimulate Quality Improvement• Standards should result in identification of areas for improvement

• Link results to an improvement process

• NPHPS Local Instrument - used within the MAPP planning process Plan

DoStudy

Act

NPHPS Materials• Assessment Instruments

– State public health system– Local public health system– Local governance

• User Guidance• Glossary

NPHPS Version 2.0 (2007) and Re-Engineered (2012)• Both versions:

– Are grounded in the 10 Essential Public Health Services

– Use a semi-qualitative rating scale– Can contribute to health improvement planning

as well as strategic planning activities

• Re-engineered:– Has fewer scored questions– Incorporates plain language principles– More discussion-focused (relies more heavily on

facilitation)– Has increased quality improvement focus

Version 2 Instrument Format

ModelStandard

Essential Service

Version 2 Instrument Format

DiscussionToolbox

Measuresor Questions

Re-engineered NPHPS – Fall 2012• Streamlined the assessment tools• Enhanced systems building aspects

of the assessment process• Increased quality and performance

improvement activities • Strengthened linkages with

accreditation

16

Essential ServiceDescription

•Includes list of potential system partners for each Essential Service

Field Test DRAFT

17

Model StandardDescription

•Uses plain language

Field Test DRAFT

18

Model StandardDiscussion Questions and Performance Measures

•More discussion•Fewer scored questions

Field Test DRAFT

19

Essential Service Summary Notes Page

Framework for identifying:•Strengths•Weaknesses•Opportunities•Priorities

Field Test DRAFT

Supplemental QuestionnairesBoth Versions•Priority Questionnaire (optional)

– “On a scale of 1 to 10, what is the priority of this model standard?”

•Agency Questionnaire (optional)– “What best reflects the contribution of the agency to this

model standard?”

Planning for the Assessment

21

Planning for the Assessment1. Assess readiness 2. Select assessment option3. Determine timeline and create project

plan4. Identify and invite system partners5. Select and train facilitators and recorders6. Prepare orientation and assessment

materials

Assess Readiness• Determine Who Will Lead the NPHPS

process• Assess Readiness

• Leadership Commitment• Purpose and Benefits• Resources• Strategic Fit

• Move Forward

Select Assessment Option• Common Options

– Large Meeting/Retreat– Small Group Activities– Series of Meetings

• Choose the option that best meets needs of participants

Large Meeting/ Retreat• Generally 1-2 days• Advantages:

– Short timeframe– Maintains momentum

• Drawbacks:– Requires time commitment– Can be overwhelming

Small Group Activities• Advantages:

– Allows for expertise, as needed– Less overwhelming

• Drawbacks: – Less cross-learning– Less consistency in response

developmentTip! Many larger sites use small breakout Tip! Many larger sites use small breakout groups during a large meeting process!groups during a large meeting process!

Series of Meetings• Advantages:

– Allows for expertise, as needed– Gets the work done in small pieces

• Drawbacks:– Participation changes with meeting

attendance– Process may seem to “drag on”

Tip! This option works especially well for Tip! This option works especially well for boards of health, which can address one or boards of health, which can address one or

two Essential Services at each board two Essential Services at each board meeting.meeting.

Timeline and Project Plan

• Varies depending upon assessment approach

• Allowing 3-5 months is reasonable• Find sample project plans online

Tip! Engage a small planning team of Tip! Engage a small planning team of agency or system representatives to plan agency or system representatives to plan

the process. the process.

Identify Participants• Key questions:

• Who plays a role in the public health system or providing the Essential Services?

• What broad, cross-sector participation is needed?

• What expertise is needed?• How many people should participate?

• Ensure consistency or a core group among respondents

• Agency and system participants are both important!Tip! Existing coalitions or committees can Tip! Existing coalitions or committees can

be a starting point for diverse be a starting point for diverse representation!representation!

Potential Participants• Board of Health

Members• State / Local

Governmental agencies• Hospitals• Statewide associations

(e.g., medical, nursing, hospital)

• Primary care clinics and physicians

• Social service providers• Civic organizations• Professional

organizations• Faith institutions• Transportation providers

• Educational institutions• Public safety and

emergency response organizations

• Environmental or environmental-health agencies

• Non-profit organizations/advocacy groups

• Appointed or elected officials / state or community leaders

• Other state or community organizations

Invite Participants• Set the tone

– Invite participants to a meeting for understanding and improving the public health system (not to complete a questionnaire)

– Establish expectations that this is for improving performance right from the start!

• Consider sending some brief information as orientation

• Use personal or leadership connections to gain interest– Extend invitations to participate via personal letters, email,

or phone calls.– Best extended by the local health director or other senior HD

staff.

Select and Train Facilitators & Recorders

• Number needed may vary• Training should cover:

– Orientation to NPHPS– Assessment Materials and Process– Expectations of Role

Facilitator Roles• General responsibilities

– Establish and adhere to ground rules– Manage group process – set the pace– Get input from everyone– Draw out different points of view– Reflect and check group opinion

• NPHPS responsibilities:– Keep the focus on the “system”– Review model standards and facilitate open discussion– Discuss key questions and gather group responses– Re-open discussion where needed– Obtain a decision on the final response

Recorder Roles• Record group responses

– Different votes (optional)– Final consensus response

• Record key ideas and comments from the discussion– Note issues and qualitative information that

shape group responses– Strengths and weaknesses – Areas for immediate improvement– Priorities

• Assist the facilitator to manage time

Tip! Consider using flip Tip! Consider using flip charts or a charts or a

laptop/projector so that laptop/projector so that everyone can see the everyone can see the

responses and comments!responses and comments!

Preparing for the NPHPS• The Online Tool Kit includes sample:

– Participant Selection Table– Recruitment / Invitation Letters– Preparations Checklist– Pre-Assessment Press Releases– Meeting Agendas Tip! Use samples from Tip! Use samples from

other sites and revise other sites and revise as needed!as needed!www.cdc.gov/nphpsp/

Conducting the Assessment• Convene and orient participants

• Assess and document system performance

• Submit assessment data

• Advance and/or on-site orientation• Key topics:

– Essential Services– Public Health System– Purpose of the assessment– The process– What next? Using the results to improve!Tip! Consider using the Essential Services Tip! Consider using the Essential Services

brainstorming exercise – 10 flip charts brainstorming exercise – 10 flip charts around the walls – as both orientation and around the walls – as both orientation and

input!input!

Orient Participants

Thomas Nelson Community College –

Center for Workforce

Development

Center for Excellence in Aging & Geriatric

Health

Peninsula Health District(PHD)

Wmbg Gov’t JCC Gov’t

PHD Emergency Preparedness and Response

Wmbg Dept of Human Services

Medical Reserve Corp,

Virginia Department of

Health

YC/Poquoson Social

Services

YC Dept of Community

Services

YC Gov’t

JCC Dept of Emergency Managemen

t

Alzheimer’s

Association

JCC Parks & RecYC Division of

Housing and Neighborhood Revitalization

Historic Triangle Substance Abuse

Coalition

United Way of Greater

Wmbg

Wmbg Community

Health Foundation

Riverside Health System

Foundation

Salvation Army of Wmbg

Sentara Wmbg Regional Medical

Center

Eastern State HospitalRiverside School

of Health Careers

Lackey Free Clinic

Olde Towne Medical Center

Wmbg/JCC Public Schools

YC Children’s Services

Child Development Resources,

Inc

JCC Social Services

Historic Triangle Senior

Center

Care Options

AARP

Respite Care of Wmbg United

Methodist Church

Bayada Nurses

Peninsula Agency on

Aging

Comfort Keepers

Bay Aging

Patriot’s Colony at

Wmbg (Riverside)

Home Instead

Senior Care

Senior Services Coalition

“Customized Egg Chart”Peninsula Health District, VA

Assessment Process• Review and Discuss Model Standard• Read and Discuss Questions• Preliminary Vote• Consensus Building• Essential Service Wrap-Up

Tip! Use an Audience Response System Tip! Use an Audience Response System (ARS) if available. Color-coded cards are a (ARS) if available. Color-coded cards are a more low-tech way to gather votes from all more low-tech way to gather votes from all participants – template cards are on-line!participants – template cards are on-line!

Submitting Version 2 Assessment Data• Obtain a User ID• Enter and Submit Data

• Download Reports All at: www.nphpsp-results.org

Immediately after the Assessment• Report out the summary of findings

– Overview of the EPHS strengths and weaknesses

– Insights that shaped group judgments– Impressions and early ideas for

improving the system Tip! If groups compile opportunities for Tip! If groups compile opportunities for improvement and next steps as they go improvement and next steps as they go through each section, this can easily be through each section, this can easily be collected into a master draft that can collected into a master draft that can

jumpstart immediate performance jumpstart immediate performance improvement!improvement!

Conducting the Assessment• Assessment Instruments and Model

Standards• User Guide• The Online Tool Kit includes sample:

– Assessment Agendas– Assessment Meeting Guide– Ground Rules– Evaluation Forms

www.cdc.gov/nphpsp/

NPHPS User Experiences• Tips from our most successful users:

– Involve broad system participation– Ensure visible leadership– Conduct assessment within context of

broader state/community health improvement process or performance improvement effort

– Provide strong facilitation, which is critical to a positive experience and building momentum

Contact InformationChristine AbarcaFlorida Department of Health Christine_Abarca@doh.state.fl.us 850-245-4444 ext. 2071

Teresa DaubCenters for Disease Control and Preventiontdaub@cdc.gov 404-498-0317