1. Reaching Readiness: Steps Toward Accreditation, Performance Management, and Quality Improvement PEP Planning Evaluation and Policy Unit Monterey County Health Department Performance Management, Quality Improvement, & Accreditation Summit California Department of Public Health May 1, 2012 Patricia Zerounian, MPP

2. PEP Planning Evaluation and Policy Unit Monterey County Health Department Reaching Readiness Monterey County Steps Toward Accreditation, Performance Management, and Quality Improvement 1.Review potential documents to fulfill prerequisite deliverables 2.Taking stock of our staff resources and partnerships 3.Reinforcing our data-driven, PM, and QI culture 4.Planning further system upgrades and links 5.Strategizing our communications

3. PEP Planning Evaluation and Policy Unit Monterey County Health Department Reaching Readiness 1.Review potential documents to fulfill prerequisite deliverables Annual Health Assessments Periodic Reports and Briefs Strategic Plan Community Listening Sessions Process for completing Strategic Plan Initiatives

4. PEP Planning Evaluation and Policy Unit Monterey County Health Department 1. Prerequisite Deliverables: PHAB and NACCHO Guides, Reports, Forms

5. PEP Planning Evaluation and Policy Unit Monterey County Health Department 1. Prerequisite Deliverables: Annual Health Assessments, Reports, Briefs

6. Strategic Plan 2011-2015 PEP Planning Evaluation and Policy Unit Monterey County Health Department 1. Prerequisite Deliverables: Community Presentations, Listening Sessions

7. #1: Empower the community to improve health through programs, policies, and activities. #2: Enhance community safety. #3: Ensure access to culturally and linguistically appropriate, customer-friendly, quality health services. PEP Planning Evaluation and Policy Unit Monterey County Health Department 1. Prerequisite Deliverables: Initiative Identification, MAPP Process

8. PEP Planning Evaluation and Policy Unit Monterey County Health Department Reaching Readiness 2. Taking stock of our staff resources and partnerships Health in All Policies Health Department-convened Coalition Meetings Collaborations with Social Services, Probation, First 5 Monterey County, Children’s Council, others Partnerships with TCE Building Healthy Communities, Community Foundation, others

9. PEP Planning Evaluation and Policy Unit Monterey County Health Department 2. Taking Stock: Promoting Health in All Policies & Collaborating with County and City Planning Departments

10. PEP Planning Evaluation and Policy Unit Monterey County Health Department 2. Taking Stock: Collaboratives, Coalitions, & Committees

11. PEP Planning Evaluation and Policy Unit Monterey County Health Department 2. Taking Stock: Internal Collaboration with Behavioral Health, Probation, Social Services, Public Health, Clinic Services, Sherriff, Parks, Planning, others

12. PEP Planning Evaluation and Policy Unit Monterey County Health Department 2. Taking Stock: Grant and Contract Partnerships

13. PEP Planning Evaluation and Policy Unit Monterey County Health Department Reaching Readiness 3. Reinforcing data-driven, PM, QI, evaluation culture Raising the “data comfort level Inter-department data analysis Staff trainings Staff evaluation training & services External evaluation services Survey research development & processing New unit: Planning, Evaluation, & Policy

14. 3. Data, PM, QI, Evaluation Culture: Staff & Community Workshops & Trainings PEP Planning Evaluation and Policy Unit Monterey County Health Department

15. Medical Model: Personal Choices for an Individual’s Health Socio-Ecological Model: Social Influences on Community Health Discrimination Race/Ethnicity Gender Citizenship Sexual Orientation Disability Institutional Perpetration Schools Government agencies Corporations Choices Smoking Chronic Stress Nutrition Violence Risk-taking Neighborhood Conditions Physical deterioration Social segregation Crime/Gangs Poor performing schools Disease/Injury Chronic disease Communicable disease Homicide Suicide Accidents Years of Life Lost Infant Death Premature Death Poor Quality of Life 3. Data, PM, QI, Evaluation Culture: Prevention-Focused Approaches

16. Youth Comments Responses# IMPROVED COMMUNICATION20 SCHOOL/JOB SUPPORTS16 TALK THERAPY15 POSITIVE SERVICE DELIVERY14 SUBSTANCE ABUSE SERVICES13 NOTHING WAS HELPFUL13 UNDECIDED/ I DON’T KNOW12 OTHER RESPONSES18 TOTAL RESPONSES121 #1: Most helpful thing about services in past 6 months? PEP Planning Evaluation and Policy Unit Monterey County Health Department 3. Data, PM, QI, Evaluation Culture: Staff Data Presentations

17. 3. Data, PM, QI, Evaluation Culture: GIS Services

18. Problem: Too many juvenile offenders re-engage in criminal activities Program Goal: Decrease recidivism Activities Provide transitional housing and support services Resources Rancho Cielo, Vocational programs, employment opportunities Outputs Participation in training education peer activities independent living skills programs individual support plans Outcomes Greater percentage of youth discharged from Youth Center do not reoffend Stakeholders MCBH, Probation, Contracted Agency Strategy Engage youth in constructive activities and independent living skills PEP Planning Evaluation and Policy Unit Monterey County Health Department 3. Data, PM, QI, Evaluation Culture: Staff Evaluation Trainings & Workshops

19. Patient Level: Patient chronic disease knowledge, self-management skills, and medical home utilization Patient GoalsIndicators Short-term outcomes Data collection tools and sources Data Collection Schedule Within 4 months the focus population will experience:  Greater stability in daily living (housing, transportation, food, medical care)  Improved chronic disease self- management Within 8 months the focus population will demonstrate:  Greater utilization of a medical home and less utilization of ED for the effects of poorly controlled chronic disease. Within 12 months the focus population will demonstrate:  Greater disease self-management, increased stability in basic needs, and stable or improved health outcomes. Knowledge  Patient knowledge of resources that provide stabilization in daily living  Patient knowledge of chronic disease symptoms, causes and triggers  Patient knowledge of appropriate self- management behaviors, tools, and supports Self-efficacy  Patient accesses and maintains the use of stabilizing resources for daily needs  Patient understands benefits of using a written action plan  Patient understands benefits of having and using a medical home  Patient comfort with case manager and case management services  Within 4-6 months, focus population will demonstrate improved chronic disease self- management knowledge, skills, and use of resources/supports  Within 6-8 months, focus population will demonstrate improved utilization of a medical home and less utilization of ED for the effects of poorly controlled chronic disease  Within 12 months, focus population will demonstrate stable or improved hbA1c test results. Case manager baseline and follow up interview instruments Aggregated interview results Epic data extraction Baseline interview with follow up interviews at 6 and 12 months. Interviews conducted in- person by nurse case manager. Patient health data (test results) and service utilization (number of appointments kept) at baseline, 6, and 12 months PEP Planning Evaluation and Policy Unit Monterey County Health Department 3. Data, PM, QI, Evaluation Culture: Evaluation Design & Monitoring

20. 2011 CA Conference of Directors of Environmental Health Excellence in Environmental Health Award Winner June 30, 2011 Agricultural Field Toilet Inspection Program Monterey County Health Department Environmental Health Bureau Director John Ramirez, MPA, REHS PEP Planning Evaluation and Policy Unit Monterey County Health Department 3. Data, PM, QI, Evaluation Culture: Research and Reporting

21. PEP Planning Evaluation and Policy Unit Monterey County Health Department 3. Data, PM, QI, Evaluation Culture: Survey Research

22. Network Evaluation Knowledg e Girls’ Health in Girls’ Hands PEP Planning Evaluation and Policy Unit Monterey County Health Department 3. Data, PM, QI, Evaluation Culture: External Research Contracts

23. PEP Planning Evaluation and Policy Unit Monterey County Health Department 3. Data, PM, QI, Evaluation Culture: New Planning, Evaluation, & Policy unit

24. PEP Planning Evaluation and Policy Unit Monterey County Health Department Reaching Readiness 4. Systems Upgrades and Links New EHR System for Behavioral Health, Use of Common Assessment Forms New EMR System for Clinic Services and upcoming link to Public Health Future (!) Health Information Technology Linking 4 hospitals and 60 clinics

25. PEP Planning Evaluation and Policy Unit Monterey County Health Department 4. Systems Upgrades & Links: EHR and EMR Systems, Behavioral Health Common Assessment Forms, Links between Public Health & Clinic Services

26. PEP Planning Evaluation and Policy Unit Monterey County Health Department 4. Systems Upgrades & Links: Future (!) Health Information Technology will Link four acute care hospitals and 60 clinics

27. PEP Planning Evaluation and Policy Unit Monterey County Health Department Reaching Readiness 5. Communications Improved Website Quarterly “Director’s Message” to All Staff Quarterly Reports to Board of Supervisor’s Health & Human Services Commission Weekly Staff Newsletter New Leadership, New Facility

28. Bookshelf pubs 5. Communications: Improved Website PEP Planning Evaluation and Policy Unit Monterey County Health Department

29. Message from the Director To ensure employee awareness of critical initiatives and policies 2011-2012 Quarter 3 Recent Grant Awards From CDPH/Public Health Institute for Community Transformation: $253,000 From CDC for youth violence prevention: $225,000 From Blue Shield CA Fnd. for ViaCare Low Income Health Plan planning:$200,000 From Blue Shield CA Fnd. for ViaCare execution:$120,000 From CHOMP for Seaside and Marina clinics: $75,000 From Medicare for Laurel Internal clinic quality improvement: $35,000 From Children's Miracle Network for school-based influenza program: $20,000 From the Ad Council for mental illness anti-stigma campaign: $20,000 From the City of Gonzales for a community health assessment: $10,328 TOTAL $958,328 Pending Applications To Centers for Medicare & Medicaid for health care reforms:$24,967,518 MCHD Approaching Accreditation with Training & Evaluation Public health departments across the U.S. are adopting specific standards and measures to assess their performance capacity and outcomes, thereby seeking accreditation that the health department has the ability to accomplish its mission and purpose. Monterey County Health Department (MCHD) is poised to embark on its accreditation process within the next 30 days as a portion of work done by a new unit, Systems Policy and Analysis (SPA) unit, which will be housed within the Administration Bureau. A series of trainings concerning the elements of accreditation will be held over the next few months, followed by a roll-out of methods for identifying, selecting, assessing, and documenting specific programs for accreditation review. Assessment tools will be developed or identified by SPA staff to engage in several program evaluation and ontinuous quality improvement studies. PHAB has beta-tested a seven step process for health departments to follow that covers the pre-application phase to reaccreditation, which occurs five years later. Eventually, receipt of some types of federal grant funding will likely be contingent upon a health department being in good accreditation standing. 5. Communications: Quarterly, Monthly, Weekly communications

30. PEP Planning Evaluation and Policy Unit Monterey County Health Department 5. Communications: New leadership, new facilities for conferencing

31. Reaching Readiness: Steps Toward Accreditation, Performance Management, and Quality Improvement PEP Planning Evaluation and Policy Unit Monterey County Health Department Patricia Zerounian, MPP contact zerounianp@co.monterey.ca.us 831.755.4583