4 Sustainable Improvement Appropriate goalsTransparent prioritizationIdentification of real causesSystem based countermeasures that address underlying causesExplicit strong actionsMeasurement of actionsTop leadership involvement/visibility
5 Systems Simple : standard recipe for success Complicated: combines multiple subsystems and recreates by following the same procedures (rocket to moon)Complex: multiple subsystems but each application is unique (raising a child)
6 Research Questions What is the right thing to do? How do you get people to do the right thing? (implementation is tougher)How do we close the gap between promise and delivery?
7 The Research QuestionSystems fail because we try to manage the pieces.How do we best manage the integration of the pieces?
8 Tools for Population Level Behavior Change EducationMarketing/MotivatingRisk CommunicationLeadershipPolicyLaw
13 Evidence-Based Strategies Physical activity - increaseFruits/vegetables - increaseBreastfeeding – promote and increase acceptanceConsumption sugar- sweetened beverages – decrease or eliminateIntake of high density foods - decreaseTV and screen time - decrease
20 Research QuestionsHow does urban planning/built environment affect obesity and how does it interplay with individual choice?What is the public health and dollar cost of overweight/obesity?What evidence is there that school nutrition policies impact childhood obesity?How can we create healthier environments so as to reduce/eliminate health disparities?What are the most effective health messages for general community, youth, or communities of color?What are the economic barriers to healthy eating and physical activity?How does the availability of bike-friendly streets/walking trails impact obesity?How do we best educate our policymakers?
21 Research QuestionsHow can a local health departments most effectively impact nutrition and physical activity?How can the public health system most effectively work together to positively impact nutrition and physical activity?How can public health and providers work more effectively together?
22 Decrease Tobacco Use and Addiction PriorityDecrease Tobacco Use and Addiction
23 Evidence Based Strategies Increase the price (tax)Mass media campaigns*Telephone quit lines*Smoking bansProvider reminder systems*Reducing patient out of pocket costs (NRT)* in combination with other strategies
24 House Enrolled Act (HEA) 1678 Effective July 2007Increased cigarette taxAll of the revenue went to health
30 100% Tobacco Free Colleges and Universities Baseline 20011 tobacco free college campus- Anderson College200834 completely tobacco free college and university campusesAs of January 1, 2008, all Indiana University campuses system-wide have enacted individually tailored smokefree policies.
31 100% Smoke Free Hospital Grounds 2001No 100% smoke free hospital grounds2008124 hospitals 100%32 of 36 critical access hospitalsBy hospital and health care facilities have tobacco free campusesRISE=Rural Indiana Smoke free Environment award from ITPC and IRHA
32 % Hoosiers Protected by Effective Local Smokefree Workplace Laws Effective=meets SGR recommendations for strong policy.
33 Research Questions How do we light the fires that motivate people? How can research help move the tobacco issue further onto the public policy agenda, particularly in the developing world?How do we improve cessation rates?How can public health and providers more effectively work together?
35 Research Questions How do we increase use of CHIRP? Is CHIRP the best registry system?How can we eliminate double entry of data?What impact will anti-vaccine sentiment have onimmunization rates?How do we use CHIRP (or other registry system) across the life continuum?
36 Priority Integrate Quality Improvement into Public Health Practice (and get ready for accreditation)
37 Indiana Public Health System Quality Improvement Program Judith A. Monroe, M.D.Indiana State Health CommissionerJulie Novak, DNSc, RN, MA, CPNPDirector, Purdue School of Nursing ClinicsProfessor of NursingPrincipal InvestigatorDavid McKinnis, PhDDirectorTechnical Assistance ProgramCo-Principal Investigator
38 Local Public Health System Assessments Distribution by RegionNorthern Region n=5Central Region n=9Southern Region n=6
39 PurposeTo engage Indiana’s local public health system partners in a continuous quality improvement process integrating:participation in the NPHPSP, Local, Version 2.0 assessmentsempowerment at the local level through a process of team building, leadership and problem solvingdevelopment of a unique, evidence-based, public health program designed to enhance delivery and quality of public healthdemonstration of performance improvement related to the 10 Essential Services of public health and Healthy People 2010 objectives
40 Phase I – Assessment CDC’s National Public Health Performance Standards Program Early user of Version 2.0 Local Instruments.Collaboration with partners is critical to developing clear, measurable standards for local public health systems.Final report provides a means of evaluating system-wide performanceResults provide a foundation for public health system quality improvement processes.
41 Phase II - Training Four Day Training Course: Team Building, Leadership and Problem Solving Participants learn team building and leadership skills.Teams learn how to apply problem solving methodologies and tools to 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.
42 Phase III Performance Improvement Programs Identify written performance objectives based on RCAIdentify key public health partners to collaborateCreate strategies to meet objectivesDesign and implement plan
43 Findings of the first 20 local public system assessments revealed the following areas for performance improvement in the pilot counties:Essential Service 1: Monitor Health Status to Identify Community Health ProblemsModel Standard Population-Based Community Health Profile %Model Standard Current Technology to Manage/Communicate Health Data %Essential Service 4: Mobilize Community Partnerships to Identify and Solve Health ProblemsModel Standard Community Partnerships %Essential Service 5: Develop Policies and Plans that Support Individualand Community Health EffortsModel Standard Community Health Improvement Process/Strategic Planning %Essential Service 8: Assure a Competent Public and Personal WorkforceModel Standard Workforce Assessment, Planning, and Development %Essential Service 9: Evaluate effectiveness, accessibility, and quality of personal andpopulation-based health services.Model Standard Evaluation of Local Public Health Systems %
44 Research QuestionFollowing the completion PHSQI Year 1, survey of the pilot counties indicates an overwhelming response that - focus on evaluation of the local public health system has strengthened both communication and collaboration among partners.However, by far, the majority of counties indicate that it has not improved 'capacity' of their local public health system.How can effective approaches be developed to utilize existing and now more recognized local partnerships to improve and enhance the 'capacity' of the public health services delivered within the system - such that there is an improved infrastructure and measurable outcome in the population served?
45 Research QuestionsWith the knowledge that the local public health department workforce is aging, that recruitment is difficult due to salaries, and there exists in many areas minimal competency for the type of essential services required to be performed (accreditation requirements), what is the potential/future status of maintaining the local public health department workforce? What strategies should be considered now to prevent a brain-drain/ experience drain when retirements occur and new practitioners are not available to support the LHD services? How close are we in IN to experiencing a reduction in LHD workforce? Would salary increases make a difference or is it the type of work that does not interest nurses and environmentalists?
46 Improve Public Health Preparedness PriorityImprove Public Health Preparedness
48 Research Questions How do we improve the usefulness of training? What is the optimal design and implementation of training?What is the optimal design and structure for integrating preparedness into public health?How do we improve communication?What are the factors for successful response/recovery in a community?How should we measure preparedness?How do we effectively stockpile resources?
52 Goal of the Medical Error Reporting System Obtain dataAssess data to identify patient safety issues and issue annual reportUtilize information to develop and implement patient safety initiativesEvaluate outcomes
53 Goal of the Medical Error Reporting System Obtain dataAssess data to identify patient safety issues and issue annual reportUtilize information to develop and implement patient safety initiativesEvaluate outcomes
54 Number of reported events 2006: 85 – total reported events2007: 105 – total reported events
55 Top four reported events for 2006 and 2007 Stage 3 or 4 pressure ulcers acquired after admission – 26 in 2006 / 27 in 2007Retention of a foreign object in patient after surgery – 23 in 2006 / 24 in 2007Surgery performed on the wrong body part – 11 in 2006 / 23 in 2007Death or serious disability associated with a medication error – 6 in 2006 / 8 in 2007
56 Outcomes of Medical Error Reporting Increased awareness of medical errorsAllocation of resources to patient safetyIncrease in number and activity of patient safety coalitionsOutcomes:1. media attention / increased public awarenessDevelopment of regional coalitionsDevelopment of Indiana Patient Safety CenterExpectation that problem will be addressed2008 plans:Publishing the 2007 Report in AugustNumber of events will increaseUpdate reporting rule
57 Quality Indicator System ISDH will contract with an entity to collect, analyze, interpret, and disseminate findings on a statewide basis regarding patient safetyEntity will develop policies, best practices, and procedures that enhance patient safety
58 Research QuestionsHow do we make catching and reporting mistakes the norm and reward this behavior?How do we speed up our journey of culture change?How do we make it easy to do the right thing?