Download - AHEC march 2011 spokane pp 2 pdf
Creating a Sustainable Model of Public Healthfor All of Montana: Strategies for Best Practices in Innovative Policy Development: The Journey of HB 173
Michele Sare, MSN, RN
Nurses for Nurses International
March 2011: AHECSpokane, WA
Prevents epidemics and the spread of diseaseProtects against environmental hazardsPrevents injuriesPromotes and encourages healthy behaviorsResponds to disasters and assists communities in recovery Assures the quality and accessibility of health services
(*CDC slide)
Public Health has some issues
10 million children…18 each minute
1 million girls and women
32 million with HIV/AIDS
13 million with TB
27 million with malaria…most children
½ of the world‟s children will go to bed hungry …again
Disparity - Inequity
20% of our population
“If you’ve seen one PH Department, you’ve seen one PHD”
7 days/week
HH care 2 – 3 x/d
No governance support for PH
Governance miss-management of funds
No cavalry
My Life as a LPHO
PH is a little broken…and has been neglected
Should not be ‘person-bound’….
A profession has guidelines, standards & ethics
Concern for regionalization, loss of services
Sustainable Local Public Health?
Poor Health/Healthcare Hurts
25% > 65 by 2015 in MC
18% poverty rate in MC….increasing
44% of all Montana children uninsured (therefore do not seek healthcare appropriately)
High rates of obesity (40%) in MC
Alcohol & drug abuse in MC
Leading causes of premature death in MC are heart disease, cancer & stroke – all early prevention
MVA, resistant microbial infections, STDs & other preventable factors disable or kill our citizens
Changing Paradigms
Evidence
Knowledge
Cultural Shifts
Collaboration
„De-siloing‟
Accountability
WE ASKED:
“WHAT’S UP WITH THIS?”
We Went Fishing…
Michele & Peggy & her crew – Mineral Co.
Dan & Gordon
MPHA, AMPHO & other Local HDs
DPHHS
___________
= HB 173
National & International ‘Mandates’ for PH
We ended Healthy People 2010
We’re headed toward a new set of national health goals in Healthy People 2020 (HP 2020)
MDG -The United Nations – with the World Health Organization (WHO) http://www.un.org/millenniumgoals/
1. End Poverty and Hunger
2. Universal Education
3. Gender Equality
4. Child Health
5. Maternal Health
6. Combat HIV/AIDS
7. Environmental Sustainability
8. Global Partnership
Millennium Development Goals
Mission:
Promote Physical and
Mental Health
and
Prevent Disease,
Injury, and Disability(*CDC slide)
Vision:
Healthy
People in
Healthy
Communities
National Trends…Others have been asking “What’s up w/ this?”
HC reform nationally – cost, quality and access
3,000 LHD nationwide…independent models …‟made-up/person-bound‟
Not standardized – Old mantra = “If you‟ve seen one LHD, you‟ve seen one LHD”
Dilution of services – vying for HC dollars
„Regionalization‟ and loss of services
National Guidelines
US DHHS CDC
PHAB
APHA
NACCHO, ASTHO & NALBOH
RWJF & W. K. Kellogg Foundation
Institute of Medicine (IOM)Reports
Tipped the HC world on its ear…
“Quality Chasms”
1988 PH Improvement came
assessment, policy development
& assurance
An update in 2003, The Future of the Public’s Health in the 21st Century
Still not doing too well…
State Laws & GuidelinesMontana Code Annotated (MCA) – Title 50-2 (http://data.opi.state.mt.us/bills/mca_toc/50.htm)Administrative Rules of Montana (ARM) – 37 – (http://www.mtrules.org)MPHAAMPHOLocal ordinancesMT Environmental Health AgenciesBON
PH Drivers
• IOM - The Institute of Medicine serves as adviser to the nation to improve health.
• CDC – Overall lead for coordination
• ASTHO – Develop and support state instrument
• NACCHO – Develop and support local instrument; MAPP
• NALBOH – Develop and support governance instrument
• APHA –Marketing and communications
• PHF- Performance improvement; data collection and reporting system
• NNPHI – Support through institutes, training workshop and user calls
• PHAB - In order to improve the health of the public, the Public Health Accreditation Board (PHAB) is developing a national voluntary accreditation program for state, local, territorial and tribal public health departments
(*from a CDC slide)
Strengthening systems, improving the public’s health
History of the NPHPSP
Key Dates
– Began in 1998
– Version 1 instruments released in 2002
– 2002-2007 – Version 1 instruments used in more than 30 states
– Development of Version 2 instruments – 2005-2007
Comprehensive Development of Instruments
– Practice-driven development by CDC and ASTHO, NACCHO and NALBOH Work Groups
– Field testing
– Creation of PHAB – 2007(*CDC slide)
Schools
Community
Centers
Employers
Transit
Elected
Officials
Doctors
EMS
Law
Enforcement
Nursing
Homes
Fire
Corrections
Mental
Health
Faith Institutions
Civic Groups
Non-Profit
Organizations
Neighborhood
Organizations
Laboratories
Home
Health
CHCs
Hospitals
Tribal Health
Drug
Treatment
Public Health
Agency
Public Health System
(*CDC slide)
Existing Tools
Tools to Implement 173
‘10 Essentials’
The ‘PH Wheel’ (10 Essentials)
NACCHO’s Operational Definition of a Functional Local Health Department & Metric
NALBOH’s Local PH Governance Instrument, Version 2
PHAB Domains, Standards & Measures and corresponding tools – in beta
ANA Scope & Standards of PHN….(& MCA & BON)
Evidenced Based Practice (EBP): research, literature reviews, journals & current texts
Operational Definition of a Functional Local Health Department:
NACCHO
+ Metrics
PHAB’s Purpose
“In order to improve the health of the public, the Public Health Accreditation Board (PHAB) is developing a national voluntary accreditation program for state, local, territorial and tribal public health departments. The goal of the accreditation program is to improve and protect the health of every community by advancing the quality and performance of public health departments.” www.phaboard.org/
PHAB Draft Tools (Based on the ’10 Essentials’)
Local Standards & Measures Self-Assessment Tool
Health Department Readiness Checklist
Guide to National Voluntary Accreditation
Domains, Standards & Measures (final)
PHAB Beta Test: Paralleling 173
30 PH Departmentso 3 Tribal
o 8 State HD
o 19 Local HD
o Beta testing Domains, Standards & Measures
o Accreditation tools in draft form as beta test continues
o Existing tools in-use
o Beta Test - October 2009 – December 2010
We are on the crest of a great wave of change in public health….
So….How did we ‘do It’?
Tools Synergy
Rule no. 1 to effecting a
positive policy change (and this is the biggy – the foundation for all
others) – do your dandiest to
create a ‘win-win’ situation for all
stakeholders
11 Rules to Effective Policy Change
Infrastructure
Federal „HD‟ HHS
SHD
State Laws
LHD
Local Governance
RULE NO. 2 TO
POSITIVE POLICY CHANGE: RECRUIT YOUR
LEGISLATIVE CALVARY
RULE NO. 3: EDUCATE, EDUCATE,
EDUCATE!
RULE NO. 4: NEVER CONSIDER ASKING FOR MORE MONEY FOR A PROGRAM IN A POOR STATE THAT IS ALREADY AWARDING TONS OF MONEY (IN THE LEGISLATOR’S VIEW) TO A PROGRAM THAT SOUNDS
AN AWFUL LOT LIKE WHAT YOU’RE TRYING
TO DO
RULE NO. 5: CLEARLY DEFINE THE ROLES AND
RESPONSIBILITIES OF STAKEHOLDERS
Partners & Stakeholders
Montana Legislature
Taxpayers – Mineral County citizens, governance & HC entities
Representative Gordon Hendrick & Education Policy Advisor Dan Villa
DPHHS – PH Improvement group
NWCPHP
PHAB & MLC III
PHSITF
HB 0173 Pilot Projects
BON, ANA, NLN +
National PH Agencies
RULE NO. 6 OF POLICY CHANGE: IT IS ‘S-L-O-W’, BE PATIENT
AND THOROUGH (THIS 18 MONTHS WAS ACTUALLY
PRETTY SPEEDY!
RULE NO. 7: CREATE A COMPELLING
PURPOSE THAT EVERYONE
CAN UNDERSTAND –
‘BRAND’ IT.
RULE NO. 8: CREATE BUY-IN BY MAKING SURE THAT IT ISN’T
ABOUT ‘YOU’ IT IS
ABOUT THE GREATER GOOD
RULE NO. 9: BE A MASTER
COMMUNICATOR AND LEAVE NO
ROCK UN-TURNED WHEN COMMUNICATING!
RULE NO. 10: BELIEVE IN YOUR
POLICY ‘PRODUCT’ AND LEARN THE BUSINESS OF
‘SALES’!
RULE NO. 11 IS AN ‘EXTRA’ – IT IS WHAT
YOU BECOME WHEN YOU WORK TO CREATE A WIN-
WIN – NO. 11 IS A BENEFIT – GAINING A SENSE OF
GROWTH AND
CONTRIBUTION
HB 0173 Sites
1. Butte-Silverbow
2. Yellowstone (Riverstone)
3. Richland
4. Mineral
5. Cascade
6. Hill
7. Prairie
Purpose
1. Determine what it takes to create a sustainable model of a local PHD in our frontier setting
2. Determine what it takes to create a sustainable model of an accredited local PHD in our frontier setting
4 Over-Riding Tasks
1. Conduct a Self-assessment based on the PHAB Self-Assessment Tool
2. Conduct a Community Health Assessment (CHA)
3. Develop a Community Health Improvement Plan (CHIP)
4. Develop a PH Strategic Plan (PHSP)
Who We Are Accountable To (who is watching us, wants reports & where the
money came from)
ARRA – The American Recovery & Reinvestment Act: Montana RRA $
“ARRA funds are targeted toward rebuilding infrastructure and positioning the country to grow the next
generation economy”.
Also Accountable To:
Legislators & Legislative Interim
Committee
Local Governance
DPHHS PH Improvement group
PHITF
Bruce & Jack (contractors to DPHHS –from NWCPHP)
PHAB
Little cross-over w/ RWJF & the MLC III
Project Schedule
Began 11/1/2009
Self-assessment 1/2010 – 4/30/2010
Began Community Health Assessment (CHA)
9/2010
Report to Legislative Interim Committee August
24, 2010
Year 1 – completed 6/30/2010
Year 2 – 7/1/2010 – 6/30/2011
Year 2 – CHA, CHIP & PHSP
MEASURING ACCOUNTABILITY:
Based on the language of
HB 0173http://data.opi.mt.gov/bills/2009/billhtml/HB0173.htm
Role of DPHHS & PHITF
Oversight of HB 0173 progress
Guidance materials and assistance
Resource
Technical assistance
Guidance
PHAB
CDC
NACCHO
Interpret & facilitate the guidance:
NWCPHP
PHSITF
DPHHS
The New Public Health
Together - We have work to do!
The End… …References
• CDC: http://www.cdc.gov/od/ocphp/nphpsp/
• PHAB: http://www.phaboard.org/
• NACCHO: http://www.naccho.org/
• IOM: http://www.iom.edu/
• MAPP: http://www.naccho.org/topics/infrastructure/MAPP/index.cfm
• PDSA: http://www.valuebasedmanagement.net/methods_demingcycle.html
• NFNI: http://www.nursesfornursesinternational.com