Health Systems Learning Group Baseline Survey

Preliminary Findings

October 10, 2012

Kevin Barnett, DrPH, MCP

Senior Investigator

Public Health Institute

Purpose

• Establish an evidence base, or starting point for HSLG partners…

– Document and validate accomplishments to date

– Provide an objective, comparative analysis of relative progress towards transformation (i.e., beyond programs)

– Identify specific obstacles to the advancement of practices among diverse HSLG partners

– Identify and examine innovations undertaken by HSLG partners that may inspire and serve as tools for others to engage their leadership

Response rate - Summary totals

• Twenty (20) health system respondents out of 31 HSLG hospital partners = 65% response rate

– N of 31 does not include two HSLG partners that are not health systems (Camden Coalition and Southcentral Foundation)

• Represent total of 234 hospital facilities

– 80 facilities with 250 beds or more (34%)

– 58 facilities with 100 beds or less (25%)

– 32 teaching hospitals (14%)

– 13 Critical Access Hospitals (6%)

80

83

45

13

Distribution of Respondents by Hospital Size

250 beds or more

101-249 beds

26-100 beds

25 beds or less

59

38

137

Distribution by Health System Size

Hospitals in HS with 10or less facilities (N=13)

Hospitals in HS with 11-20 facilities (N-3)

Hospitals in HS with 21or more facilities (N=4)

HSLG Geographic Distribution

• Respondent health systems have hospitals in 23 states

• There are 8 states where multiple respondent health systems have hospitals.

• Twelve (12) of the 13 health system respondents with 10 or less facilities are located in a single state.

• AR, AZ, CA (4), CO (2), FL (2), GA (2), IA, IL, KS (2), KY, LA, MA, MI, MN, MO, MT, NJ, NM, NY, OH (2), NV, TN (2), TX (3)

0

2

4

6

8

10

12

10 or lesshospitals

11-20hospitals 21 or more

hospitals

2 2

1

6

1

1

3

2

Health System and Hospital Governance

HS BOT & FiduciaryBoards at someHospitals

HS BOT & FiduciaryBoards at all Hospitals

HS BOT Only

NR = 2

05

1015

20

25

30

35

40

45

7 8

2 1 1 2

8 8

45

23

40

8 4

3

40

27

Department Location for CB Function

Health Systems

Hospitals

Department Location for CB Function

• 183 out of 234 (75%) of hospitals had a designated department that housed the CB function.

• The other 51 hospitals could be smaller facilities with some percentage of staff FTE that reports to a department at larger proximal facility (TBD).

• Department determination appears to be driven by HS level decisions – justification TBD in follow up – 18 of 23 in Community Health (78%) in 3 HS

– 31 of 40 in Administration (78%) in 2 HS

– 15 of 27 in Marketing in 2 HS (other 12 in 5 HS)

– All 40 in Compliance (100%) in 2 HS

– All 8 in Public Affairs in 1 HS

– All 4 in HR in 1 HS

Reporting and Performance Criteria

• Reporting relationships for staff appear to be closely aligned with departmental base. Departmental priorities TBD.

• CB-related performance evaluation – 12 of 20 (60%) HS evaluate CB performance of CEOs

– 16 of 20 (80%) evaluate CB performance of other senior execs

– 7 of 20 (35%) evaluate CB performance of clinical staff/leaders

• Performance criteria – 9 of 20 (45%) use progress on health indicators, re-admission rates,

and/or a reduction in preventable ED/inpatient utilization

– 11 of 20 (55%) use scope/form of staff involvement

– 7 of 20 (35%) use external recognition

– 4 of 20 (20%) use no performance metrics

0

2

4

6

8

10

12

14

1615 15 15

12

15

HS Office Support for CB Function at Facility Level

HS Office Support for Facility Level CB Function

• 16 of 20 respondents, or 80% of HS have an office at the HS level to support CB functions at facility level.

• 15 of 20 respondents, or 75% of HS provide support to facilities in documentation, design, and monitoring of programs, and facilitate support from senior leaders. – 8 of 20 specifically identified assistance in documentation for

external reporting purposes

• 12 of 20 respondents, or 60% of HS facilitate access to internal financial and/or utilization data.

• Most significant challenges to hospital level advancement of practices TBD (e.g., survey didn’t address facility level FTEs, staff competencies)

0

2

4

6

8

10

12

14 13 12

8

6 6 6

HSLG Partner Data Collection and Analysis

HSLG Data Collection and Analysis

• Almost 2/3 of respondent HS are collecting and analyzing utilization data. Use at hospital level TBD

• Less than 1/3 of respondent HS are GIS coding utilization data. (2 additional HS indicated that first collection in process )

• Less than 1/3 of respondent HS are collecting data on SDH or community assets.

• Four HS are not collecting any of the forms of data identified.

• Three HS are collecting all the forms of data identified.

02468

10121416

11 11 9

4

9

6 8

11

15

9

5 8

4 5

Use of ROI Metrics

System

Hospital

HSLG Use of ROI Metrics

• 13 of HS respondents (65%) doing work on at least three categories of metrics.

• Comments – “Too early in our process”

– “We are evaluating models such as EV-ROI”

– “…we use a number of metrics to measure need and success”

– “…hospitals may use these metrics and still not be tracking ROI”

– “Just beginning a health inpatient utilization home project”

– “We are building systems to take into account a, c, d, and e.”

– “We are in a very embryonic stage” (cite 3 projects; one CMS)

0123456789

10

4 3

4 3

4

2

9 10

9

7

9

5

CHI Integration - Org Strategic Plan

Hospital

System

CHI Integrated into Org Strategic Plan

• 10 of 20 HSLG respondents (50%) have CHI reporting as part of OSP.

• 9 of 20 HSLG respondents (45%) have CHI language as org priority, do prospective budgeting for CHI, and have annual metrics for CHI.

• Form of metrics and associated incentives and disincentives TBD.

• Relatively low rate of cross-department responsibility (35%) suggests limits to CB programmatic focus.

0

5

10

15

20 15 18

12 11 11 14

Program Monitoring

Program Monitoring

• Predominance of administrative staff (80%) and clinicians (75%) responsible for program monitoring.

• Appears to be expansion in hiring of staff with evaluation expertise (60%); unclear if focused on individual programs (e.g., externally funded projects).

• Substantial engagement of external public health and higher education institutions (55%) in program monitoring; unclear if broad or focused on individual programs.

• Substantial engagement of community stakeholders in program monitoring; TBD specific roles.

0

10

20

30

40

50

60

70

80

90

100 Community Partnerships

Monitor Program

Lead Program

Staff/Space

Program Design

CB CTE

Advisory CTE

Set Priorities

Data Collection

CHNA Input

0 5 10 15

Input on CHNA

Data Collection

Set Priorities

Advisory CTE

CB CTE

Program Design

Staff/Space

Lead Program

Monitor Program

15

9

8

13

5

7

6

8

4

13

6

6

6

4

3

3

2

2

Faith Leaders and Neighborhood Associations

NeighborhoodAssociations

Faith Leaders

0 5 10 15 20

Input on CHNA

Data Collection

Set Priorities

Advisory CTE

CB CTE

Program Design

Staff/Space

Lead Program

Monitor Program

16

11

8

9

3

7

8

9

7

12

6

3

4

4

5

3

5

3

15

12

8

7

2

7

5

2

5

Hospitals, CHC, Law Enforcement

Hospital(s)

Law Enforcement

CHC

Preliminary Findings

• Input on CHNAs ranged from high of 17 (85%) for LPHAs to low of 11 (55%) for local business.

• Participation in priority setting ranged from high of 13 (65%) for LPHAs to low of 1 (5%) for local advocacy groups. Other groups on low end included law enforcement (15%), local business (20%), and neighborhood associations (30%).

• Involvement in program design ranged from 10 (50%) for LPHAs to 2 (10%) for local business. Other groups on low end included local clergy (35%), neighborhood associations (15%), CHCs and hospitals (35%), law enforcement (25%), & advocacy groups (15%).

• Scope of involvement in advisory/board CTES at hospital level TBD

• Scope of contributions from other stakeholders TBD

• Scope of program engagement TBD

Obstacles to Partnership - Rankings

10

2

3

3

0

2

4

1

0

3

1

3

2

3

2

0 5 10 15

Assumption that hospital shouldbe core funder

Lack of community understandingof shared responsibility

Lack of alignment betweenhospital and community priorities

Lack of understanding andsupport from hospital leaders

Lack of hospital understanding ofshared responsibility

First

Second

Third

Obstacles to Partnership

• Important to examine source of community misperception (and antidote)

• Reflection that central issue is one of working towards shared priorities; may often require deferment and deeper examination of broader purpose.

0 5 10 15

Legal

Accounting

Marketing

Fund Development

Physical Infrastructure

Other

3

4

14

13

12

6

Forms of Technical Assistance

Forms of Technical Assistance

• Impetus, specific form, and impact of technical assistance TBD.

• Relatively undeveloped form of CB that reinforces concept of shared ownership for health in community context; not well understood in hospital/HS leadership.

• Relatively unexplored opportunity to date in policy advocacy arena (e.g., UMMHS Hope Coalition)

Relevance to HSLG Working Groups

• Success in the work of all three groups requires

– Data systems (incl. GIS) to ensure evidence-based focus

– Attention to ROI and movement to SROI

– Institution-wide alignment (objectives, metrics, accountability)

– Intersectoral engagement with shared ownership

– Leverage resources / alignment of institution & community assets

– Seamless continuum of care AND action

– Focus on elimination of health disparities

– Move from innovative programs to transformational practices

Next Steps

• Follow up and integrate data from non-respondents and non HS partners.

• Follow up with respondents and fill gaps in information (TBD).

• Flesh out and ID additional promising practices, channel to Working Groups.

Contact Information

• Kevin Barnett, Dr.P.H., M.C.P.

Public Health Institute

555 12th Street, 10th Floor

Oakland, CA 94607

Tel: 510-285-5569 Mobile: 510-917-0820

Email: kevinpb@pacbell.net