The National Public Health Performance Standards 201: Tips and Tricks for Successful Implementation Christine Abarca, Florida Department of Health Teresa Daub, CDC

Learning Objectives Following 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 Vision A 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 Services 1.Monitor health status 2.Diagnose and investigate health problems 3.Inform and educate 4.Mobilize communities to address health problems 5.Develop policies and plans 6.Enforce laws and regulations 7.Link people to needed health services 8.Assure a competent health services workforce 9.Evaluate health services 10.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 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 Model Standard Essential Service

Version 2 Instrument Format Discussion Toolbox Measures or 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 Service Description Includes list of potential system partners for each Essential Service Field Test DRAFT

17 Model Standard Description Uses plain language Field Test DRAFT

18 Model Standard Discussion 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 Questionnaires Both 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 Assessment 1.Assess readiness 2.Select assessment option 3.Determine timeline and create project plan 4.Identify and invite system partners 5.Select and train facilitators and recorders 6.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 development Tip! Many larger sites use small breakout 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 boards of health, which can address one or two Essential Services at each board 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 agency or system representatives to plan 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 be a starting point for diverse 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, , 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 charts or a laptop/projector so that everyone can see the 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 other sites and revise as needed!

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 brainstorming exercise – 10 flip charts around the walls – as both orientation and input! Orient Participants

“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 (ARS) if available. Color-coded cards are a more low-tech way to gather votes from all participants – template cards are on-line!

Submitting Version 2 Assessment Data Obtain a User ID Enter and Submit Data Download Reports All at:

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 improvement and next steps as they go through each section, this can easily be collected into a master draft that can jumpstart immediate performance 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

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 Information Christine Abarca Florida Department of Health ext Teresa Daub Centers for Disease Control and Prevention