Performance Standards: Opportunities for Quality

Improvementfor Maternal and Child Health

Dennis Lenaway, PhD, MPHCenters for Disease Control and Prevention

Public Health Program Practice Office

1988 Institute of Medicine (IOM) Report

Public health – “assuring conditions in which people can be healthy”Identified three core functions– Assessment– Assurance – Policy DevelopmentFocused attention on governmental public health

Institute of Medicine Report

The Future of the Public’s Health (2002)Builds on the 1988 report but with a broader scopeRecommendation #13 – “develop a research agenda … to build the

evidence base that will guide policy-making for public health practice.”

Other recommendations address specific aspects of public health practice and public health systems

Essential Public Health Services

Developed by the Core Public Health Functions Steering Committee (1994)– Included reps from national

organizations and federal agencies

– Charge: To provide a description and definition of public health

Vision:Healthy People in Healthy Communities

Mission:Promote Physical and Mental Health

andPrevent Disease, Injury, and Disability

The Essential Public Health Services

1. Monitor health status2. Diagnose and

investigate health problems

3. Inform and educate4. 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

Infrastructure

Building Public Health Infrastructure

"...It’s vital that we take steps to address current inadequacies and ensure that our public health infrastructure is prepared to meet the challenges of any public health crisis.”

– Senator Bill Frist, MD, June 2000

Infrastructure

A Growing Focus on the Public Health System

More than just the public health agency“Public health system” – All public, private, and voluntary entities that

contribute to the delivery of public health services within a jurisdiction.

– A network of entities with differing roles, relationships, and interactions.

– All entities contribute to the health and well-being of the community.

The Public Health System

MCOs

Home Health

Parks

Economic Developmen

t

Mass Transit

Employers

Nursing Homes

Mental Health

Drug Treatment

Civic GroupsCHCs

Laboratory

Facilities

Hospitals

EMS Community Centers

Doctors

Health Department

Churches

Philanthropist

Elected Officials

Tribal Health

Schools

Police

Fire

Corrections

Environmental Health

NPHPSP Overview

Began in 1998 Partnership effort between CDC and six national public health organizations– APHA, ASTHO, NACCHO, NALBOH, PHF,

NNPHI– Numerous working groups

Extensive Field Testing – TX, FL, HI, MO, OH, MN, MS, NY, MA

National launch in June 2002

Healthy People 2010

Chapter 23 – Public Health InfrastructureSome examples:– #11 - “…meet performance standards for

essential services.”– #12 “…have a health improvement plan.”– #16 “…categorize expenditures by essential

services.”– #8 “…integrate competencies in essential

services into personnel systems.”

MAPP

Mobilizing for Action through Planning and Partnerships (MAPP)Developed by NACCHO and CDCCommunity strategic planning toolWeb-based tool – www.naccho.org

The MAPP Model

Coordination with MAPP

Use of NPHPSP within MAPP ensures broad-based involvement

MAPP provides the process for addressing strengths and weaknesses

NPHPSP 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.

Partners

CDC – Overall lead for coordinationASTHO – State instrumentNACCHO – Local instrument and MAPPNALBOH – Governance instrumentAPHA –Marketing & communicationsPHF- Research activitiesNNPHI – Support through institutes

The Assessment Instruments

State public health systemLocal public health systemLocal governanceInternational

Indicator

ModelStandard

Measures

Essential Service

Instrument FormatInstrument Format

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 Services as a Framework

Provides a foundation for any public health activityDescribes public health at both the state and local levelsInstruments include sections addressing each ES

2. Focus on the “System”

More than just the public health agency“Public health system”– All public, private, and

voluntary entities that contribute to public health in a given area.

– A network of entities with differing roles, relationships, and interactions.

– All entities contribute to the health and well-being of the community.

3. Optimal Level of Performance

Each performance standard represents the “gold standard”Provide benchmarks to which state and local systems can strive to achieveStimulate higher achievement

4. Stimulate Quality Improvement

Standards should result in identification of areas for improvementLink results to an improvement processNPHPSP Local Instrument - used within the MAPP planning process

Four components of a performance management system

Source: Turning Point Performance Management Collaborative, From Silos to Systems: Performance Management in Public Health (in press).

Potential Uses of NPHPSP Data and Information

BenchmarkingNeeds assessmentStrategic planningQuality improvementPerformance Management

Community mobilizationAlliance buildingResource allocationProgram evaluationPolicy developmentGrant-writingPublic accountability

NPHPSP: Moving Towards Quality Improvement

Review scores and resultsDiscuss comments and ideas made during the instrument completion processIdentify priority areas to addressCollectively develop strategies to address prioritiesManagement of change

Using the Results for Quality Improvement:

Examples from the Field

Mississippi – Used the information to develop legislative language for a capital improvement bondUsed data for BT grant proposalUsed data for the Sunset Commission reportUsed data for a proposal addressing environmental health improvement

Coordinated Statewide Process

Use of multiple NPHPSP instruments in a coordinated approachBenefits:– Coordinated orientation, training,

and technical assistance– Aggregate reports of assessment

results– Coordinated quality improvement

planning

Statewide Activities

Pilot / Field Test States Currently using or planning for use statewide

NPHPSP in Practice

Ohio – establishing an accreditation process which

sets minimum agency standards for local health agencies and also requires all local areas to complete the NPHPSP Local Instrument.

New Jersey – by regulation, requires statewide use of local

and governance instruments.

Illinois – recently passed legislation with NPHPSP

Quality Improvement and Science

Provide information and consensus-based direction for quality improvementDevelop practice data about performance and models of effective public health systems

What gets

MEASUREDgets

DONE !

What gets

MEASUREDgets

DONE !