1. Laboratory System Improvement Program (L-SIP) Presented by Mary F. Shaffran Senior Director, Public Health Programs Association of Public Health Laboratories APHA Session 3129 November 9, 2009, 10:30 am

2. Analysis, Answers, Action Presenter Disclosures Mary F. Shaffran The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose.

3. Analysis, Answers, Action Learning Objectives Describe the L-SIP Program Explain the concept of the State Public Health Laboratory System Describe how this systems approach was adapted to the Canadian Public Health Laboratory Network

4. Analysis, Answers, Action Laboratory System Improvement Program (L-SIP) Goal of Program: to conduct an assessment of the state public health laboratory system based on laboratory system performance standards – Brings together key partners to determine system performance – Measures capacity and performance of the state system in addressing national standards – Provides results (a starting point) for system improvement

5. Analysis, Answers, Action Vision of APHL’s L-SIP The capacity and performance of state public health laboratory systems meet or exceed performance standards

7. Analysis, Answers, Action L-SIP Program Milestones Feasibility Study- 2004 Development Phase- 10/05 – 6/06 Pilot Phase- April/May 2006 Field Test Phase- 10/06 – 5/07 Final Product Launched at 2007 APHL Annual Meeting- 6/07 Name change to L-SIP- 6/08 Implementation & Improvement- Ongoing Aim to have 100% state participation by 2011

8. Analysis, Answers, Action Slide Title

9. Analysis, Answers, Action Essential Services vs. Core Functions Essential ServicesLaboratory Core Functions 1. Monitor Health Status to Identify Community Health Problem 1. Disease prevention, control, and surveillance 2. Diagnose and Investigate Health Problems and Health Hazards in the Community 2. Integrated data management 4. Environmental health and protection 5. Food safety 8. Emergency response 3. Inform Educate and Empower People About Health Issues 10. Training and education 4. Mobilize Partnerships to Identify and Solve Health Problems 11. Partnerships and communication 5. Develop Policies and Plans that Support Individual and Community Health Efforts 7. Policy development

10. Analysis, Answers, Action Essential Services vs. Core Functions Essential Service Lab Core Function 6. Enforce laws and regulations that protect health & safety 6. Laboratory improvement and regulation 7. Link people to needed personal health services & assure provision of health care when unavailable 3. Reference and specialized testing 8. Assure a competent public and personal health care workforce 10. Training and education 9. Evaluate effectiveness, accessibility, & quality of personnel & population-based services 3. Reference and specialized testing 10. Research for new insights and innovative solutions to health problems 9. Public health-related research

11. Analysis, Answers, Action Technical Assistance Activities Video training for individuals coordinating assessment and for facilitators and others involved Technical assistance calls to help with planning SharePoint site containing all materials Users guides and assessment tool Providing $4000 mini grants to sites

12. Analysis, Answers, Action

13. Products – User’s Guide & Toolkit – Assessment Tool & Scoring Tool – Glossary – Power Point introduction – Train the Trainer for facilitators – Technical Assistance

14. Analysis, Answers, Action User’s Guide & Toolkit Program overview & framework System description & focus Tips for an effective assessment Sample Invitation Letters Sample Agenda Sample Evaluation

15. Analysis, Answers, Action The Assessment Tool Framed in the 10 ES & 11 CF Identifies Gold Standards Engages Participants in Dialogue Measures Performance of the SPH Laboratory System Provides a Basis for Improvement Work

16. Analysis, Answers, Action

17. The Assessment Process Discussion based on Essential Public Health Services and Core Functions and Capabilities of State Public Health Laboratories Each Essential Service section is further divided into several indicators, model standards, key ideas and discussion points Organized by the State Public Health Laboratory

18. Analysis, Answers, Action The Assessment Process (cont.) Participants divided into small groups, each led by a separate facilitator. Discuss key points for each Essential Service Move towards consensus by voting using color cards, which correspond to rating categories Theme takers track discussion and voting results, which they collect from each session and enter into a scoring tool

19. Analysis, Answers, Action Results Highest overall performance: – ES #2, Diagnose & Investigate Health Problems: Ave. Score = 68.0 – ES #1, Monitor Health Status: Ave. Score = 63. Lowest overall performance: – ES #9, Evaluate Effectiveness, Access & Quality: Ave. Score = 24.6 – ES #10, Research for New Insights & Innovations: Ave. Score = 25.3

20. Analysis, Answers, Action Online Resource Center

21. Analysis, Answers, Action Findings System assessment supports collaboration Assessment process generates action & interest in improvement Acknowledges roles & responsibilities Results verified gold standard as described in tool

22. Analysis, Answers, Action Summary Reports Labs develop summary reports – Areas for improvement identified – QI activities outlined – Session evaluations Common finding – Need for improved and increased communications

23. Analysis, Answers, Action Working with Canada Canadian Public Health Laboratory Network asked APHL to help develop an assessment Four month contract with Public Health Agency of Canada To evaluate public health laboratory systems

24. Analysis, Answers, Action Charter Mission: To establish optimal goals/measures to guide continuous improvement of public health laboratory practice related to the Public Health system in all national and provincial laboratories in Canada. Vision: A healthier Canada through leadership and quality laboratory practices supporting the public health system and contributing to improvements in public health practice.

25. Analysis, Answers, Action Canada Project Activities International Environmental Scan of tools, standards, quality indicators and processes Design or adapt an assessment mechanism to evaluate the capabilities and identify any gaps in the Canadian public health laboratory system Options for implementation and administration

26. Analysis, Answers, Action Environmental Scan Reviewed laboratory performance standards and related efforts in: – United Kingdom, European Union, Thailand, Japan, the United States, and Australia, and the World Health Organization. Conclusion: No other county has taken the public health systems performance standards approach that considers how the laboratory systems works in relation to the public health laboratory.

27. Analysis, Answers, Action Developing the Assessment Adapting to a new health system and a new culture – “Canadianizing” the tool – Two in-person meetings, numerous phone calls – Teams from Provincial and National Medical Laboratory senior managers to develop the essential services, indicators, key ideas, and specific examples

28. Analysis, Answers, Action Comparing the Approaches Many similarities – the Essential Services and most indicators remained the same Key differences – 10 Provinces, fewer people to help develop the tool – Different health system – government subsidized – More emphasis on ISO and international standards – Interest in assessing the national laboratory network comprising the NLM (CDC Equivalent) and the provincial public health laboratories – Preparedness focus - impetus for the assessment development

29. Analysis, Answers, Action Phase I Completed March 2009

30. Analysis, Answers, Action Next Steps Pilot the assessment tool in 2 Provinces – one large and one small Update assessment tool to reflect lessons learned. Interest in conducting the assessment in all 10 provinces and the national laboratory over the next few years. Timing – Spring 2010

31. Analysis, Answers, Action For additional information… www.aphl.org-www.aphl.org- go to Programs/Laboratory Systems and Standards http://www.aphl.org/lsiphttp://www.aphl.org/lsip - L-SIP Shortcut Tina Su Laboratory Systems and Standards Specialist bertina.su@aphl.org 240-485-2729