1. The National Public Health Performance Standards 101 Jennifer McKeever Trina Pyron

2. This session will help you... Describe the NPHPS and how it can be used to drive performance improvement at state and local levels; Discuss how NPHPS and PHAB accreditation complement each other; and Discuss the opportunities and plans for the NPHPS in the future.

3. History of the NPHPS Key Dates – Began in 1998 – Version 1 instruments released in 2002 – 2002-2007 – Version 1 instruments used in more than 30 states – Development of Version 2 instruments – 2005-2007 – Release of Version 2 instruments – Fall 2007-present – Re-engineering efforts underway – 2011

4. CDC – Overall lead for coordination ASTHO – Develop and support state instrument; SHIP NACCHO – Develop and support local instrument; MAPP NALBOH – Develop and support governance instrument APHA – Marketing and communications PHF – Performance improvement; data collection and reporting system NNPHI – Co-coordination of partnership, support through institutes, training workshop and bi-monthly webinars NPHPS National Partnership

5. NPHPS Vision A partnership effort to improve the quality of public health practice and performance of public health systems

6. 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

7. Assessment Instruments State public health system Local public health system Local public health governance NPHPS Comprehensive Development of Instruments Practice-driven development by CDC and ASTHO, NACCHO and NALBOH Work Groups Field testing Validation studies

8. Based on Ten Essential Services

9. NPHPS State Instrument Use (Through April 2012, n = 29 states + DC) *Also includes sites using field test versions of the NPHPS 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

10. NPHPS Local Instrument Use (Through April 2012) Moderate Use (33% - 66%) Significant Use (67% or greater) Limited Use (1% - 32%) *Also includes sites using field test versions of the NPHPS 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

11. NPHPS Governance Instrument Use (Through April 2012) No Boards of Health *Also includes sites using field test versions of the NPHPS 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%)

12. NPHPS Vision and Goals To improve the quality of public health practice and performance of public health systems by: 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.

13. NPHPS Use in the Field (What the evaluation data tell us) Reasons for Using NPHPS – State and Local – Establish a baseline measure of performance – Wanted a nationally developed & recognized assessment tool to help improve performance – NPHPS the best tool available for improving public health system effectiveness – Was part of the MAPP process (local users only) State evaluation data gathered through ASTHO survey 10/05-1/06 – 80% response rate (9 respondents reporting completion of State NPHPS). Local evaluation data gathered through NACCHO survey to known NPHPS and MAPP users in 01/06 – 05/06; 212 total respondents (149 respondents reporting completion of Local NPHPS).

14. NPHPS Outcomes Achieved Percentage of respondents indicating achievement of these outcomes was partial/medium or high Data based on evaluation conducted by ASTHO and NACCHO in 2005-06. Findings are consistent with Respondent Information Form data, August 2007 – present.

15. Health Department + PH System + Community Partners + Workforce Operational Capacity (infrastructure) Every Community Program and Public Health Activity (Chronic Disease, Inf Disease, EH) Builds Impacts Which leads to Investments here Pay big dividends here Better Health Outcomes Reduced Disparities Better Preparedness Framework for Improving Performance

16. NPHPS: Strengthening systems The value of strengthening systems Diminishing resources Increasing service demands Complex problems Collaborative service delivery systems Policy development New opportunities (e.g., health reform) Accountability Considerations: Important to strengthen both the agency and the system

17. NPHPS and Public Health Agency Accreditation: complementary tools for strengthening public health NPHPS Based on the ten Essential Public Health Services Focus on the overall public health system (but acknowledges agency as hub / convener) Describe an optimal level of performance 4. Support a process of quality improvement Accreditation Same – also includes domains about admin / governance Focus on agency (but acknowledges importance of the system and agency in building the system) Standards / measures that can be met, but also have “stretch” opportunities. Support a process of quality improvement

18. Future Directions Re-engineering the NPHPS

19. Reengineering will sustain and continue to enhance the NPHPS as a tool for systems building, assessment and improvement activities Reengineering guided by... Program evaluation data User feedback Opportunities in the field The Re-engineered NPHPS

20. Goal: To sustain and enhance the NPHPS as a tool for systems building, assessment and improvement activities Re-engineering priorities: – Streamline assessment tools – Enhance systems building aspects of assessment process – Strengthen linkages with accreditation – Promote quality and performance improvement activities The Re-engineered NPHPS

21. Current and more community-friendly standards Streamlined assessments Comprehensive and seamless package of tools that most effectively promote systems engagement and performance improvement

22. Re-engineering Timeline DateActivity Fall 2010State, Local, and Governance Instrument Update workgroups convened Jan – May 2011Draft field test instruments Jun – Sept 2011Finalize field test instruments; Identify and confirm field test sites Sept – Dec 2011Conduct field test; desktop review; follow up interviews Jan 2012 – May 2012Complete final revisions to instruments; revise supporting documents Summer 2012Develop new instrument layout/design; revise online materials Fall 2012Launch new instruments!

23. Phase1 Organize and convene public health system partners Identify and define system partners, including development of a customized visual representation of system partners and relationships Phase 2 Model Standards Review and System Assessment Streamlined assessment that culminates in the identification of strengths, weaknesses, immediate priorities, and initial next steps Phase 3 System Improvement Planning and Implementation Utilize results to conduct one of three improvement actions: systems improvement plan; state/community health improvement plan; or board of health improvement plan Phase 4 Sustaining Action and Achieving Outcomes Implement and evaluate improvement actions; refine plans and improvement activities; repeat assessments within 3-5 years to identify areas of progress Phases

24. Four Re-engineering Priorities Streamline the assessment tools Enhance systems building aspects of the assessment process Strengthen linkages with accreditation Promote quality and performance improvement activities

25. Streamline Assessment Tools Fewer scored questions – Scoring at stem question level only Emphasize use of plain language

26. Enhance Systems Building Implementation Guide highlights techniques to build system connections List of potential system partners included at Essential Service level in State and Local Instruments Revised stem question language to reinforce system orientation – “At what level does the system...”

27. Strengthen Linkages with Accreditation Draft cross-walk between accreditation standards and NPHPS – Two potential supplemental components: 1.Recommendations for ways to document/act upon NPHPS work for accreditation purposes and 2.Questionnaire/note-taking format for accreditation coordinators.

28. Promote Quality and Performance Improvement Implementation Guide emphasizes improvement orientation throughout the assessment process (pre-, during, and post-assessment) Assessment includes a framework to identify improvement opportunities within each Essential Service Revised template and guidance for identifying priorities

29. THANK YOU!