Community Balanced Scorecards€¦ · & physical activity [1 & 9] Recommend & advocate for policies...

Community Balanced Scorecards to Mesh Strategic Planning, Health

Improvement Planning & Accreditation

Paul Epstein ([email protected])

Results That Matter Team (www.RTMteam.net)

For APHA Annual Meeting

Washington, DC November 1, 2011

mailto:[email protected]�

http://www.rtmteam.org/�

APHA Presenter Disclosures

(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

Paul David Epstein

“No relationships to disclose, other than the obvious relationship with my own consulting firm that does paid work of the type I am presenting.”

Results That Matter Team www.RTMteam.net

• Measuring & improving performance since 1985, mostly as Epstein & Fass Associates

• Use of RTM Team’s Community Balanced Scorecard (CBSC) expanding for strategic plans & health improvement plans

• Work with ASTHO, NACCHO, Public Health Foundation, & directly for PH organizations, hospitals, partnerships, others

• QI &Evaluation Coaching for LHDs across the U.S. (NACCHO)

• 3 chapters in The Public Health Quality Improvement Handbook

• Working with Inc. whose InsightVision software powers scaling-up the use of CBSC

3 Results That Matter Team (www.RTMteam.net)

http://www.rtmteam.net/�

CBSC: From a Promising to a Best Practice

1. Featured by CDC, NACCHO, ACHI, NNPHI, & Public Health Foundation at national training events

2. Delaware & New York strategic planning (started by ASTHO)

3. Adopted by county-led, nonprofit-led, & hospital-led community health partnerships focusing on local issues

4. NACCHO MRC Strategic Road Mapping

5. National strategic planning by NACCHO Preparedness Team & MAPP Team

6. Projects funded by CDC, HRSA, Surgeon General, others

7. In Public Health Foundation/American Society for Quality Public Health Quality Improvement Handbook

4

Agenda

1. Accreditation, Strategic Planning, Health Improvement Planning

2. CBSC: Solution to Many Challenges, e.g.: – Managing collaborations – Strategic plans & health improvement plans – Support accreditation, QI, performance

management



Public Health Accreditation

• Performance Improvement Orientation – Performance Mgt & QI built in

• Pre-requisites – Community or State Health Assessment (HA) – Community or State Health Improvement Plan (HIP) – Strategic Plan

• Standards & Measures, organized in 12 Domains including the Essential Services of PH



Health Improvement Planning

• Externally focused on state or community – Broad participation of PH system partners – Individuals & organizations responsible for implementation

• Other Health Improvement Plan components – Health priorities and measurable objectives – Improvement strategies – Performance measures with time-bound targets – Measurable health outcomes to monitor progress – Policy changes needed to accomplish health objectives



Why Should a HIP Be a Collaborative Plan?

8

Upstream prevention, e.g., Social determinants

Midstream prevention, e.g., Healthy behaviors, vaccinations

Downstream: Treat disease & injury

• Need multiple organizations to navigate each part of the stream • PH Challenge: Collaborative planning is hard to do well

And collaborative implementation can be overwhelming

Strategic Planning

• Internally focused on health dept, but – Can still involve key external partners for parts of the plan – Some external strategies needed to connect with HIP

• Strategic Plan components – Mission, vision, guiding principles/values – Strategic priorities – SWOT: Health dept strengths & weaknesses (SW), external

factors influencing population health or the dept (OT) – Goals & objectives with measurable time-bound targets – Links to Health Improvement Plan & QI Plan



Pulling it All Together

With Community Balanced Scorecard Tools • Structure HIPs, strategic plans, and

accreditation

AND

• Strengthen collaborative planning and outcome-focused implementation



Execution Gap

Community Balanced Scorecard tools (e.g., strategy maps) improve the Alignment and Execution of Strategies

No Strategic Alignment High Level Goals

Power of Strategic Alignment

Public Health

Outcomes

Other Public Agencies

Hospitals

Schools Community Groups

Faith Communities

Nonprofits State Health Dept

Families & Individuals

Local Health Depts

Employers

11

Community Balanced Scorecard Components

Performance Measures, Targets, &

Initiatives

Perspectives

Vision, Overall or by Issue or “Theme” or

Program

Organization, State, or Community

Priorities

Strategy Map(s) Strategic Objectives

Could also include Mission, Values, etc.


HIP & SP

SP

HIP & SP

One for each strategic priority in HIP & SP

HIP & SP

Some strategy maps can link HIP & SP

Not covered today


Perspectives in Current Practice for Public Health Community Balanced Scorecards & Strategy Maps

Community Assets

Community Implementation

Community Health Status

Community Process & Learning



# 1 Assess, Disse-

minate Population Health Status &

PH Issues

# 7 Promote

Strategies to Improve Access

to Services

# 2 Investigate, Contain PH Problems &

Hazards

H2. Minimize Risks

# 6 Enforce Public Health Laws

“Top Level Strategy Map” Based on PHAB Domains: a TEMPLATE to Align More Detailed Strategies

# 3 Inform, Educate About PH Issues (Promote Health)

# 4 Engage the

Community to ID & Address Health

Problems

# 5 Develop PH Policies &

Plans

# 9 Evaluate &

Improve Processes, Programs, & Interventions

# 10 Contribute to & Apply the

Evidence Base of PH

# 8 Maintain a

Competent PH Workforce

#12 Maintain Capacity to Engage the PH Governing Entity

STRATEGIC OBJECTIVES (“Generic Categories” for Issue-specific Strategic Objectives) Perspectives


Health Outcomes, Disparities, Determinants, Risks.


Projects, services, & actions to improve health or the conditions for health.

Community Process & Learning All policy, planning, & decision processes that can affect health. Also, gathering & using information.

Community Assets

Financial & non-financial resources (e.g., people, organizations, partnerships, facilities, equipment) and how they function to support health strategies.

H1. Improve Health

Outcomes & Eliminate

Disparities

#11 Maintain

Administrative & Management

Capacity 14

You often need to “zoom in” from: • a “top level” strategy map • to maps with more details.



Delaware DPH Priority Issue or “Thematic” Strategies to be Mapped

STRATEGIC ISSUES OR “THEMES” Perspectives

Community Assets


Community Implemen-

tation


Health Reform

Core Services Transformation

Reducing Health Disparities

Reducing Obesity

16

Decrease prevalence of diseases related to obesity

STRATEGIC OBJECTIVES Perspective

Com

mun

ity

Hea

lth

Stat

us

Com

mun

ity

Impl

emen

tatio

n

Vision: All Delawareans live, work, learn, and play in healthier communities, live healthier lives, and achieve and maintain healthier weights.

Strategic Focus: Decrease obesity in the African American population.

Promote healthy behaviors

Implement policies, practices & programs that support healthy

eating & physical activity

Support enforcement of policies for healthy eating &

physical activity

Increase active living & healthy eating, & reduce screen time

Decrease prevalence of overweight & obesity

17





Com

mun

ity

Hea

lth

Stat

us

Com

mun

ity

Impl

emen

-ta

tion

Com

mun

ity P

roce

ss

& L

earn

ing






physical activity

Implement a comprehensive monitoring and evaluation system

related to healthy behaviors

Develop a QI system to assure use of best practices

Recommend & advocate for policies that promote

healthy behaviors

Recommend & advocate for policies promoting a health- oriented built environment


18





Com

mun

ity

Asse

ts

Com

mun

ity

Hea

lth

Stat

us

Com

mun

ity

Impl

emen

-ta

tion

Com

mun

ity P

roce

ss

& L

earn

ing




related to healthy food choices & physical activity


healthy behaviors



Create & maintain oversight and funding for the healthy

lifestyle agenda

Mobilize and support key partnerships

Educate and expand a culturally competent workforce


physical activity

Develop a QI system to assure use of best practices

Recommend & advocate for policies promoting a health- oriented built environment


19



Promote healthy Behaviors [3]


Com

mun

ity

Asse

ts

Com

mun

ity

Hea

lth

Stat

us

Com

mun

ity

Impl

emen

-ta

tion

Com

mun

ity P

roce

ss

& L

earn

ing


eating & physical activity [7]


related to healthy food choices & physical activity [1 & 9]


healthy behaviors [5]



Mobilize and support key partnerships [4]

Educate and expand a culturally competent

workforce [8]


physical activity [6]

Develop a QI system to assure use of best practices [9]

Recommend & advocate for policies promoting a health-

oriented built environment [5]


20 Create & maintain oversight and funding for the healthy

lifestyle agenda [11]

Vision: Osceola County will be a community where all uninsured and underinsured residents have full ACCESS TO THE HEALTH CARE services that they need. (A systemic issue)


Community Assets


Community Implemen-

tation


Target our initiatives to areas of most need

[5]

Increase access to specialty care [7]

Measure our success [1]

Improve delivery & quality of care by using evidenced-based best

practices [9]

Ensure access to comprehensive health care [7]

Sustain best practice

programs [5]

Maximize resources and engage new & existing partners in developing solutions [4]

Ensure the public health workforce is skilled to address health issues [8]

Increase enrollment in a medical home [7]

Improve outcomes of people with, or at risk of, Diabetes Mellitus and Cardiovascular disease

21

Assess housing health issues by analyzing surveillance systems &

databases

STRATEGIC OBJECTIVES

Com

mun

ity

Heal

th S

tatu

s Co

mm

unity

Pro

cess

&

Lear

ning

Perspective

Com

mun

ity

Asse

ts

Reduce health risks from hazards related to the home environment

Reduce illnesses, injuries, & other adverse health outcomes related to the home environment

Develop & implement an investigative agenda that focuses

resources in areas of known high risk

Collaborate with state & local agencies to improve enforcement of

home environment laws & regulations

Collaborate/coordinate with housing stakeholders to identify solutions for

improving home health

Modernize healthy housing legal, policy, and program frameworks

to close public health gaps

Vision: All New Yorkers enjoy healthy built environments that reduce risks from environmental exposures and hazards that cause illness and injury

Com

mun

ity

Impl

emen

tatio

n

Assemble and promote an inventory of service resources that improve housing health

Implement theme-based healthy housing education

tailored to specific audiences

Implement a research agenda for the home environment

and a process for translating findings to practice

Implement environmental public health cross training

Share the results of evaluations the with partners to improve program effectiveness

Strategic Focus: Create Healthier Homes

Find and promote opportunities to improve the quality of informatics to better support public health goals and objectives

STRATEGIC OBJECTIVES

Com

mun

ity

Heal

th S

tatu

s Co

mm

unity

Pro

cess

&

Lear

ning

Perspective

Com

mun

ity

Asse

ts

Mitigate and reduce exposure to health risks

Improve health outcomes and eliminate disparities by providing access to

comprehensive health information

Enforce & promote data & systems standards consistent with related laws and regulations

Improve health investigation & containment through enhanced

technology and data sharing

Collaborate with partners to prioritize & address public health informatics needs

Ensure technology projects are driven by

public health goals

Encourage and support the workforce to adapt and improve

Ensure adequate technology and resources to support PH

information exchange

Provide the public health community and partners with improved

monitoring and analysis capabilities driven by end user needs

Public Health Information Management Vision: An integrated public health information and communication structure that uses information effectively to improve the health and safety of the people of New York

Com

mun

ity

Impl

emen

tatio

n Achieve effective and efficient use of data and information to improve

services

Provide channels & processes to facilitate data exchange & dissemination

of public health information

Develop policies, protocols, & standards

to enable improved systems & use of data

Promote and expand use of informatics to build the

evidence base of public health

PH Info Mgt: An Infrastructure Issue

Top Level Strategy Map


Zoom in: Map for a

strategic priority

Zoom in again: Info on specific

objectives

Link to performance management


• Objective Description

• Desired Change: From-To Gap

• Performance measures & time-bound targets

• “Owner” & team

• Existing initiatives & priority new initiatives

• Later: Implement initiatives & collect periodic data for a strategic performance management system Implement & report on Strategic Plan (PHAB measure 5.3.3) &

meet PHAB standard 9.1 on Performance management

Info on CBSC Objectives to Manage the Strategy

Results That Matter Team (www.RTMteam.net) 25

HIP & Strategic Plan

HIP & Strategic Plan

HIP

HIP


Cascading Strategy Maps by Priority (“Theme”) to Align the SHIP/CHIP or Strategic Plan

LG

P

C

F

L2

P2 P4

C2 C3

F1 F3

L1

C1

L3

Top-Level Strategy Map

F2

C4

P1 P3

LG

P

C

F

L L L

P P

C C C

F F

LG

P

C

F

L L

P P

C C

F F

L LG

P

C

F

L L L

P P

C C C

F F

Theme Strategy Map: Reducing Disparities

Theme Strategy Map: Reducing Obesity

Theme Strategy Map: Health Reform

F2

C1

P2

L1

F3

C3

P4

L3

C2

P3

L2


Top level map creates alignment of all thematic strategies

Aligns these strategies in the performance management system


LG

P

C

F

Cascading Strategy Maps by Program or Organization Unit for More Alignment

L2

P2 P4

C2 C3

F1 F3

L1

C1

L3

Top-Level Strategy Map F2

C4

P1 P3

LG

P

C

F

L L L

P P

C C C

F F

LG

P

C

F

L L

P P

C C

F F

L LG

P

C

F

L L L

P P

C C C

F F

Unit B Strategy Map Program A Strategy Map

Program C Strategy Map

F2

C1

P2

L1

F3

C3

P4

L3

C2

P3

L2


Top level map creates alignment of all unit or program plans

Aligns these plans in the performance management system


# 1 Assess, Disse-

minate Population Health Status &

PH Issues

# 7 Promote

Strategies to Improve Access

to Services

# 2 Investigate, Contain PH Problems &

Hazards

H2. Minimize Risks

# 6 Enforce Public Health Laws

“Top Level Strategy Map” Based on PHAB Domains to Align More Detailed Strategies

# 3 Inform, Educate About PH Issues (Promote Health)

# 4 Engage the

Community to ID & Address Health

Problems

# 5 Develop PH Policies &

Plans

# 9 Evaluate &

Improve Processes, Programs, & Interventions

# 10 Contribute to & Apply the

Evidence Base of PH

# 8 Maintain a


#12 Maintain Capacity to Engage the PH Governing Entity

STRATEGIC OBJECTIVES (“Generic Categories” for Issue-specific Strategic Objectives) Perspectives


Health Outcomes, Disparities, Determinants, Risks.


Projects, services, & actions to improve health or the conditions for health.

Community Process & Learning All policy, planning, & decision processes that can affect health. Also, gathering & using information.

Community Assets

Financial & non-financial resources (e.g., people, organizations, partnerships, facilities, equipment) and how they function to support health strategies.

H1. Improve Health

Outcomes & Eliminate

Disparities

#11 Maintain

Administrative & Management

Capacity 28

# 6 Enforce

Environmental Health Codes

# 4 Engage the

Community to Reduce Need for

Enforcement

# 5 Develop

Policies that Incentivize Compliance

# 9 Continually Improve Quality

# 8 Maintain a


STRATEGIC OBJECTIVES Perspectives

Possible Cascaded Strategy Map for Environmental Health (EH) Enforcement Group

29

H2. Minimize EH Risks &

Disparities in Risk

H1. Improve EH Outcomes &

Eliminate Disparities

Community Assets


Community Implemen-

tation


# 2 Investigate,

Contain Environ-mental Health

Hazards


Broader Alignment with Accreditation

• PHAB domains in the top level strategy map align all strategy maps with accreditation.

• Documented progress on strategic objectives on these maps provides documentation for improvements in PHAB accreditation domains.

• A strategy map & scorecard can be created for “Achieving Accreditation” to zoom from domains to standards & measures.


For More Information

Paul Epstein: [email protected] or 212-349-1719

Website: RTMteam.net

Questions?


mailto:[email protected]�


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