Please mute your line by pressing *6 You can un-mute your line by pressing *7 Do not put your phone on hold. July 20, 2010 Call in Information: , code WELCOME! NPHPSP User Webinar

National Public Health Performance Standards Program – A Brief Overview Trina S. Pyron, MA, CDC

Strengthening systems, improving the public’s health

1.Providing performance standards for public health systems and encouraging their widespread use; 2.Engaging and leveraging national, state, and local partnerships to build a stronger foundation for public health preparedness; 3.Promoting continuous quality improvement of public health systems; and 4.Strengthening the science base for public health practice improvement. To improve the quality of public health practice and performance of public health systems by: Program Vision and Goals

Assessment Instruments State public health system Local public health system Local public health governance Supported by… Glossary User Guide On-line Reporting System On-line toolkit with links to all materials and partners, sample materials from the field, etc. All partner websites NPHPSP

History of the NPHPSP Key Dates ▲ Began in 1998 ▲ Version 1 instruments released in 2002 ▲ – Version 1 instruments used in more than 30 states ▲ Development of Version 2 instruments – ▲ Release of Version 2 instruments – Fall 2007 Comprehensive Development of Instruments ▲ Practice-driven development by CDC and ASTHO, NACCHO and NALBOH Work Groups ▲ Field testing ▲ Validation studies

Version 2 Instruments Process ▲ Guided by peer-driven work groups ▲ Utilized a variety of subject matter experts ▲ Limited field testing in 2006 ▲ Release with OMB clearance in Fall 2007 Key Changes ▲ Modernized and updated the content ▲ Streamlined and identified opportunities for greater user- friendliness ▲ Added “discussion boxes” feature ▲ Altered response options ▲ Included optional priority and agency contribution questionnaires

Four Concepts Applied in NPHPSP 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

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 Many System Partners Should be Involved!

NPHPSP Use in the Field Coordinated statewide approach ▲ Statewide activities in improvement planning ▲ Benefits in technical assistance, state/local connections, and peer support Individual System / Board Use Reasons for Using NPHPSP (per State and Local evaluations) ▲ Establish a baseline measure of performance ▲ Want a national developed & recognized assessment tool to help improve performance ▲ NPHPSP the best tool available for improving public health system effectiveness ▲ Was part of the MAPP process (local users only)

NPHPSP State Instrument Use (Thru April 2010, n = 27 states + DC) *Also includes sites using field test versions of the NPHPSP State Public Health System Performance Assessment. NH WA OR NV CA ID MT AK UT AZ WY CO NM ND SD NE KS TX OK LA AR MO IA MN MS OH WI INIL MI ME KY NY PA WV VA NC GA TN AL FL SC VT MA RI CT HI NJ DE MD NH MA RI CT

NPHPSP Local Instrument Use (Thru April 2010) Moderate Use (33% - 66%) Significant Use (67% or greater) Limited Use (1% - 32%) *Also includes sites using field test versions of the NPHPSP Local Public Health System Performance Assessment. WA OR NV CA ID MT AK UT AZ WY CO NM ND SD NE KS TX OK LA AR MO IA MN MS OH WI INIL MI ME KY NY PA WV VA NC GA TN AL FL SC VT NJ DE MD NH MA RI CT HI

NPHPSP Governance Instrument Use (Thru April 2010) No Boards of Health *Also includes sites using field test versions of the NPHPSP Local Public Health Governance Performance Assessment. WA OR NV CA ID MT AK UT AZ WY CO NM ND SD NE KS TX OK LA AR MO IA MN MS OH WI INIL MI ME KY NY PA WV VA NC GA TN AL FL SC VT NJ DE MD NH MA RI CT HI Moderate Use (33% - 66%) Significant Use (67% or greater) Limited Use (1% - 32%)

Current partnership activity areas Promotion and communications Technical assistance and training ▲ Using the assessment instruments ▲ Post-assessment and performance improvement Evaluation and research Partnership coordination Strategic integration and linkages

Related initiatives ▲ MAPP ▲ Accreditation ▲ Environmental Public Health Performance Standards ▲ Laboratory System Performance Standards ▲ International interest in NPHPSP, MAPP, public health practice Policy support ▲ Healthy People 2010 Objective ▲ Institute of Medicine reports ▲ State legislation that provide for or mention use of NPHPSP (e.g., IL, OH, NJ) Strategic Linkages

NPHPSP and EnvPHPS Overall NPHPSP State, Local and Gov Instruments MODULEMODULE Conceptually ▲ Based on same four concepts Essential Services framework, public health system, optimal standards, performance improvement ▲ Illustrate linkage between broad public health and deeper look at environmental health Operationally ▲ Frequent interaction and learning from each other ▲ Linkages through CDC, NACCHO, and APHA The future? ▲ Opportunities for joint use, analysis and improvement

NPHPSP and L-SIP Conceptually ▲ Based on same four concepts Essential Services framework, public health system, optimal standards, performance improvement ▲ Connection with lab standards within NPHPSP ▲ Similarities / differences in assessment process Operationally ▲ Linkages through CDC, ASTHO, and PHF ▲ Steering Committee and PI workgroup ▲ PHF on-line resource center The future?

A few final points about the NPHPSP… Latest NPHPSP use in the field Evaluation data indicate the “intangibles” are more often achieved as outcomes than the “tangibles” Transitioning from assessment to performance improvement isn’t always easy and requires dedication and forethought. The key concepts and framework have held up well over time.

Strengthening systems, improving the public’s health

Environmental Public Health Performance Standards and Accreditation of Public Health Departments John Sarisky, RS, MPH, DAAS National Center for Environmental Health Centers for Disease Control and Prevention John Sarisky, RS, MPH, DAAS National Center for Environmental Health Centers for Disease Control and Prevention

National Center for Environmental Health Environmental Health Services Branch

Mission: To improve the practice of environmental health

Goal of accreditation program Improve and protect the health of every community by advancing the quality and performance of public health departments

Opportunity Environmental public health –How do we currently measure performance? –Quality of services? –How do we know if we are improving? –Are we doing the right things?

Environmental Public Health Performance Standards Continual performance improvement to build capacity, consistency, and accountability Identify service gaps in environmental health programs Develop improvement plan

Environmental Public Health Performance Standards Based on ten essential services of environmental public health Assess capacity of program, agency, and system to provide essential services Based on ten essential services of environmental public health Assess capacity of program, agency, and system to provide essential services

Environmental Health Essential Services MONITOR environmental and health status to identify and solve community environmental health problems. DIAGNOSE AND INVESTIGATE environmental health problems and health hazards in the community. INFORM, EDUCATE AND ENPOWER people about environmental health issues. MOBILIZE community partnerships to identify and solve environmental health problems. DEVELOP POLICIES AND PLANS that support individual and community environmental health efforts. ENFORCE laws and regulations that protect health and ensure safety. LINK people to needed environmental health services and assure the provision of environmental health services when otherwise unavailable. ASSURE a competent environmental health workforce. EVALUATE the effectiveness, accessibility and quality of personal and population based environmental health services. RESEARCH new insights and innovative solutions to environmental health problems and issues. MONITOR environmental and health status to identify and solve community environmental health problems. DIAGNOSE AND INVESTIGATE environmental health problems and health hazards in the community. INFORM, EDUCATE AND ENPOWER people about environmental health issues. MOBILIZE community partnerships to identify and solve environmental health problems. DEVELOP POLICIES AND PLANS that support individual and community environmental health efforts. ENFORCE laws and regulations that protect health and ensure safety. LINK people to needed environmental health services and assure the provision of environmental health services when otherwise unavailable. ASSURE a competent environmental health workforce. EVALUATE the effectiveness, accessibility and quality of personal and population based environmental health services. RESEARCH new insights and innovative solutions to environmental health problems and issues.

Environmental health and accreditation standards Assess department’s ability to meet standards Engage in improvement efforts where indicated Incorporate quality improvement into all operations Assess department’s ability to meet standards Engage in improvement efforts where indicated Incorporate quality improvement into all operations

Environmental health and accreditation standards Conduct community health assessment Develop community health improvement plan Do organizational strategic planning Conduct community health assessment Develop community health improvement plan Do organizational strategic planning

Why EH performance standards? Allows detailed assessment of EH activities Comprehensive approach to the identification of strengthens and areas in need of improvement Engage external partners in development and implementation of performance improvement plan Allows detailed assessment of EH activities Comprehensive approach to the identification of strengthens and areas in need of improvement Engage external partners in development and implementation of performance improvement plan

Why EH performance standards? Build new internal partnerships Better understanding of what EH does and barriers to program improvement Help prepare EH for the department accreditation process Build new internal partnerships Better understanding of what EH does and barriers to program improvement Help prepare EH for the department accreditation process

Why EH performance standards? Build national data base of self-assessment findings Inform CDC and other federal agencies of environmental health issues and trends Help assure the national environmental public health services system has capacity to address current and emerging issues Build national data base of self-assessment findings Inform CDC and other federal agencies of environmental health issues and trends Help assure the national environmental public health services system has capacity to address current and emerging issues

Environmental Public Health Performance Standards Improve performance of environmental public health programs –Deliver high quality services –Improve efficiency and effectiveness – Reduce exposure to environmental risk factors –Reduce environmentally related disease –Reduce health care expenditures Improve performance of environmental public health programs –Deliver high quality services –Improve efficiency and effectiveness – Reduce exposure to environmental risk factors –Reduce environmentally related disease –Reduce health care expenditures

Why performance standards? Every system is perfectly designed to achieve exactly the results it gets! If you want to change your results you need to change your system. Deming Every system is perfectly designed to achieve exactly the results it gets! If you want to change your results you need to change your system. Deming

Thank you for your attention

APHL’s Laboratory System Improvement Program (L-SIP) NPHPSP Teleconference Tuesday, July 20, 2010 Tina, MPH Specialist, Laboratory Systems and Standards Association of Public Health Laboratories

Laboratory System Improvement Program (L-SIP) Formerly called the State Public Health Laboratory System Performance Assessment Program. Changed name to L-SIP in L-SIP History Feasibility Study Field Test Phase Final Product Target: 100% participation by 2011 Goal of Program: To conduct an assessment of the state public health laboratory system based on laboratory system performance standards

Vision of APHL’s Laboratory System Improvement Program The capacity and performance of state public health laboratory systems meet or exceed performance standards Highly functioning laboratory system  a healthy world

Intended Results Conduct an assessment of the state public health laboratory system which: Brings together key partners to evaluate system performance Measures capacity and performance of the state system in addressing national standards Provides results (a starting point) for system improvement

The Assessment Will take one day and will be facilitated by independent professionals skilled in public health and facilitation. Will provide for dialogue including information shared by participants. A consensus will be reached and collated into a state-wide response. The results will tell states how they compare to the L-SIP “gold standards.”

Essential Services Vs. Lab Core Functions Essential ServicesLaboratory Core Functions 1. Monitor Health Status to Identify Community Health Problems 1. Disease prevention, control, and surveillance 2. Diagnose and Investigate Health Problems and Health Hazards in the Community 2. Integrated data management 3. Reference and specialized testing 4. Environmental health and protection 5. Food safety 8. Emergency response 3. Inform Educate and Empower People About Health Issues 10. Training and Education 11. Partnerships and communication 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

Essential ServiceLab 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 6. Laboratory improvement and regulation 10. Research for new insights and innovative solutions to health problems 9. Public health-related research Essential Services Vs. Lab Core Functions

Laboratory System Improvement Program Ratings Categories

Technical Assistance Activities for the Assessment SharePoint site containing related materials User’s guide and assessment tool Technical assistance calls to help with planning Video training for individuals coordinating assessment and for facilitators and others involved Providing $4,000 mini grants to sites

L-SIP Mini-Grants APHL will provide funding (up to $4,000) to SPHLs or their partners supporting the use of the L-SIP instrument. Funding can be used for: Food Facilities Facilitators Supplies

Technical Assistance Activities -- Focus on Improvement Sustainable state public health laboratory system assessment plan which includes an improvement component Improvement subcommittee L-SIP Update (newsletter)

Online Resource Center

International Implications Canada Public Health Laboratory Network (CPHLN) Contracting with APHL to “Canadianize” L-SIP National Laboratory as well as Provincial Laboratories participating Final product presented at the CPHLN-Annual Meeting in April 2009 Next phase will include piloting the instrument

For additional information… APHL Tina Su, MPH Specialist, Laboratory Systems and Standards

Questions?