THE ROLE OF SACCHOS IN BUILDING CAPACITY FOR ACCREDITATION AND QI

Linda Wagner, New York State Association of County Health Officials

Tami Dillman, North Dakota State Association of County and City Health Officials

ACCREDITATION PREPARATION

& STRATEGIC PLANNING

NYS Association of County Health Officials

Accreditation Context in NYSNYSACHO: includes NYC Dept. of Health and Mental Hygiene, serving 8.2 million people, & 57 County Health Departments serving populations ranging from 5,000 (Hamilton) to 1.5 million (Suffolk).

PHAB accreditation requires:•Strategic Plan: NYS Department of Health (NYSDOH) has just completed one. NYSACHO survey: Few LHDs in NYS have one.•Community Health Assessment (CHA): NYS gathers health data statewide; LHDs must complete CHA every four years, next due in 2013; Hospitals must coordinate Community Service Plan with LHDs.•Community Health Improvement Plan: NYSDOH now developing a State Health Improvement Plan (SHIP) to guide LHDs in developing their CHAs and CHIPS in accordance with five Prevention Agenda Priorities, based on CHA data.

NYSDOH is seeking PHAB accreditation as a state agency.

Several LHDs in NYS have begun accreditation application process.

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NYSACHO supports accreditation efforts

• Oct. 2010 Session at NYSACHO’s Annual Leaders Summit featured PHAB and NYS LHDs that participated in beta testing either as a site or site visitor

• Aug. 2011 all-day session on Accreditation and Strategic Planning featured PHAB, NACCHO, LHDs, NYS Health Department and Academic Partners

• Feb. 2012 Workshop explained Accreditation to local elected officials at statewide counties conference

• March 2012 Session at NYSACHO meeting featured QI efforts at one LHD and State Health Department

• NYSACHO applied for and received NACCHO Accred. Support Initiative focused on LHD Strategic Planning

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NYSACHO’s Local Health Department Strategic Planning

Initiative • Goal: Assist LHDs in accreditation readiness• NYSACHO facilitated a strategic planning process in four

model counties:• Herkimer – Pop. 62,236• Chautauqua – Pop. 133,503• Dutchess – Pop. 293,562• Westchester – Pop. 955,962

All LHDs in NYS were polled for interest and willingness to meetproject goals by June 2012 deadline; these four were selectedas representative in location, population

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Project Work Plan – Facilitator Role

• NYSACHO hired Strategic Planning Consultant (NY Council on Nonprofits-NYCON) to facilitate for each LHD

• Staff & consultant held planning call with the 4 LHDs• Consultant collected/reviewed LHD documents (CHAs,

budgets, org charts, governance structure)• Survey tool developed with input from participating LHDS• Consultant administered customized surveys and

provided key findings for each LHD• Additional stakeholder data gathered• Consultant met with each LHD to identify key issues

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Facilitator Role (continued)

• NYCON planned and facilitated retreats with each LHD

• Retreat results summarized and distributed

• Based on all input, consultant drafted strategic plans

• LHDs reviewed, revised, finalized drafts in collaboration with facilitator

• FOUR LHDs completed strategic plans by May 31

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Westchester - Process• Administered survey to division

directors, supervisors, Board of Health members; allowed for anonymous feedback

• Key issues:• Organizational Structure,

Internal Communications• External Communications,

Collaboration• Data & Information

Management• Facilities

• Participants met to give more feedback, discuss mission/vision, key issues & goals.

• Four workgroups developed strategic goals

FAST FACTS“Extra Large” County

Urban/Suburban430.5 sq.miles

2,204.7 people per sq. mile 68.1% White14.5% Black

21.6% Hispanic5.4% Asian

> 1% Native American/Alaska

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Westchester - Outcomes

Benefits: •Opportunity to participate in open process•Expertise of facilitator moved process forward•Development of strategic plan will help focus organizational efforts, inform Quality Improvement (QI) and position department for accreditation

Next steps: Develop and implement specific action plans that focus on operationalizing the strategic actions and objectives identified in the plan so that concrete activities can be monitored and tracked to expand departmental quality improvement efforts.

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Dutchess - Process• Created a Strategic Planning

Team (SPT) and a Strategic Advisory Response Team (StART)

• Administered separate SWOT analysis surveys to staff members and community stakeholders

• Reviewed existing mission, vision, values, goals and objectives from previous planning process

• SPT held retreat to review SWOT data and revised mission, vision, goals and strategies;

• StART reviewed information from SPT and came up with objectives and activities for each goal.

FAST FACTS“Large” County

Rural to urban communities795.63 sq. miles

373 people per sq. mile80.1% white9.9% Black

10.5% Hispanic/Latino3.5% Asian

> 1% Native American/Alaska

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Dutchess - OutcomesBenefits•Prior knowledge of steps needed for successful implementation due to previous strategic planning experience•Engaged staff through volunteers from cross-section of department programs•StART allowed a safe venue to brainstorm, identify salient issues for future planningNext Steps: Use strategic plan to align Department for organizational and funding changes and for accreditation. Present plan to staff in smaller division meetings. Involve top leadership in implementation. Develop learning opportunities for staff related to accreditation and create action teams to move LHD towards accreditation-readiness.

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Chautauqua - Process• Administered a single

survey to staff, Board of Health members, community partners & county legislators

• Reviewed findings with division managers and junior planner

• In-person meeting w/facilitator to finalize plan and develop strategic goals

FAST FACTS“Medium” County

Rural/Small Urban1065 sq. miles

127.2 person per sq. mile92.4% White2.2% Black

6.2% Hispanic>1% Asian, Native American/Alaska

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Chautauqua - OutcomesBenefits:•High survey participation rate provided important feedback•Redefined mission•Focus on prevention is reshaping community health and environmental health programs•Renewed focus on need for health education•Good preparation for accreditation and quality improvement

Next steps: Establishing and implementing employee and community communications plans, and planning strategies to address need for focus on health education

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Herkimer - Process• Herkimer is a “partial service”

county, i.e. State Health Dept. provides Environmental Health services

• Administered single survey to staff, Professional Advisory Board members, community partners, county legislators and select state health department staff.

• Held retreat to develop strategic plan

• Completed draft plan

FAST FACTS“Small” Rural County

1414.5 sq. miles48.5 person per sq. mile

96.4% white1.1% Black

1.6% Hispanic>1% Asian, Native American/Alaska

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Herkimer - Outcomes

Benefits:•Helped plan for significant restructuring of department after major change in funding and services provided•The process helped create a new respect for one another’s commitment to the work of the department

Next steps: Do not plan to pursue accreditation during restructuring period. Plan to solidify tangible markers of quality achievement, and work to present accomplishments within the department and to local legislators

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Results - ValuesWe value: (Dutchess) •The pursuit of innovation•Adherence to ethical principles•Expertise in all areas of public health practice•Efficient and dedicated service

Our Traits are: (Westchester)•Teamwork•Respect•Accountability•Innovation•Transparency•Service

Our Values (Herkimer)•Respect •Integrity•Quality•Caring

Draft Values Statement (Chautauqua)•With integrity and compassion, our department will apply best practices to provide safe and efficient services and assistance to the public, as driven by the needs of the community.

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Results – Mission Statements• The mission of Dutchess County Department of Health

is to assess, protect, and promote the health of our communities and our environment.

• The mission of the Westchester County Department of Health is to protect health, reduce environmental risks, prevent disease, and promote access to care and a healthy lifestyle for people of all ages.

• Our mission is to protect and promote our residents’ health and well-being in all phases of the life cycle. (Herkimer)

• The Chautauqua County Health Department will protect and promote the health and environment of County residents.

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Results - Vision• The Dutchess CDOH will be a trusted leader, advocate and

partner with the community to prevent risks and promote public health.

• Westchester CDH is the valued leader, partner, and resource in preventing and responding to public health issues that affect the health and well being of our community.

• Herkimer County residents and business will turn to our Department for valuable health resources, information, and support.

• The Chautauqua County DOH will be a trusted, respected leader for protecting the health of all in Chautauqua County and for providing essential human services, especially for those least able to help themselves.

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SWOT Analysis – Internal (all)Selected Strengths Selected Weaknesses•Highly qualified, dedicated and experienced staff

•Quality services

•Good leadership; diverse workforce

•Ability to set and achieve goals

•Strong multi-disciplinary approach to service delivery

•Strong community partnerships.

•Multiple locations throughout the county

•Department, at times, is fragmented and silo’d across units

•Internal communication is not as smooth or timely as it could be

•Aging workforce

•Decreasing and limited resources/ decreased staff capacity

•Frequent policy changes and/or lack of policies to guide staff

•Not utilizing technology effectively

•Limited resources for marketing and promotion of services

•Staff cuts have lead to decreased morale

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SWOT Analysis – External (all)Selected Opportunities Selected Threats•Increase staff training and education

•Enhanced collaborations with community partners

•Strengthen network of NYS County Health Departments and related government entities to enhance technology efficiency

•Better use of media, particularly electronic and social media, for information dissemination and engagement

•Ongoing funding cuts negatively impacting effectiveness

•Loss of staff

•Natural and other disasters

•Changes in state mandates

•Overall economy

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Lessons Learned• Strategic Planning can be a positive opportunity to pro-

actively engage staff and community partners.• Where possible, engage staff who want to be involved

further• May tend to serve as a forum to address immediate

issues or address unresolved concerns• Don’t overdo program-specific data collection (i.e. SWOT

of 10 essentials).• Assigning responsibilities can be challenging and require

creativity. • LHDs express confusion and uncertainty about

accreditation in general and about the expectations for the Community Health Improvement Plan.

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Sharing our Results• May 24th webinar for all 58 LHDs in NYS shared the

similarities and differences in approach taken by each locale participating in the project; identified common themes and challenges, and provided an opportunity for questions and discussion.

• Strategic Plan Templates (de-identified plans) and survey tools posted on NACCHO and NYSACHO web sites.

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Discussion/Questions

• For more information, contact Linda Wagner, linda@nysacho.org; 518-456-7905

Many thanks to NACCHO for funding and supporting this project, and to PHAB and NACCHO for providing other tools to facilitate accreditation of local health departments.

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NACCHO Accreditation Support Initiative

“Moving the Needle in North Dakota on Public

Health Accreditation Preparation”June 20, 2012

ND Public Health Structure:28 LHD’s – urban & ruralmajority (75%) serve

single, county, city or combined city/county jurisdictions (Eastern ND)

25% serve multi-county jurisdictions (Western ND)

State population –

672,591

(2010 U.S. Census)

Project Partners:

Collaborative effort between state and local public health

North Dakota State Association of City & County Health Officials (ND

SACCHO)

Project Goal: Apply for Accreditation!

Go from here

To HERE!

Three required

components

Community health assessment

Community health improvement plan

Agency strategic plan

Accreditation process1.Appoint accreditation coordinator2.Complete PHAB’s orientation to PH

accreditation3.Work on the Prerequisites4.Prepare documentation for the

Standards and Measures.

Project Activities:

1. Form a State Health Department Accreditation Team

2. Review of PHAB Standards and Measures (State/Local/Tribal)

3. Prioritize Health Status Areas for six local public health departments

4. Develop a State Health Department Performance Improvement Plan

 

Implementation Strategies:ND utilized a core team of state and local

representatives (with subject matter expertise).

Clearly identified participation criteria and deliverables.

Scheduling was coordinated directly by the facilitators.

Report templates and materials were provided.

Built on what works (roundtables) and tools already in place (NACCHO document tracker).

“The most effective leaders forever alter the course of your

life.”

– Tom Rath & Barry Conchie, from “Strengths Based Leadership”

Project Partners:

Collaborative effort between state and local public health

North Dakota State Association of City & County Health Officials (ND

SACCHO)

ND Department of Health Accreditation Team

ND SACCHO PHAB Standards & Measures Videoconference – 3/21/2012

• PHAB standards and measures reviewed by local public health departments

20 of 28 LHDs (71%)

• PHAB application process described

• Training for LHDs on NACCHO documentation tracker for acceptable documentation

CVHD PHAB Beta Site Visit – June 2010

Domain 1 –Conduct and disseminate assessments focused on population health status and PH issues facing the community.

Data management system – Ahlers – provides data.

Disease surveillance and investigation – State function no need MOU with Disease Control

Community Assessment documentation and the Community Improvement Plan

Domain 12 – Maintain capacity to engage the PH governing entity.

Board of health bylawsHow do you inform your board of

health – narrative reportsMinutes of board meetings

CVHD PHAB Beta Site Visit -Lessons LearnedReview documents before submitting!Important to date everything!

Important to sign everything!Stick to official documents when possible

Apply only if you are able to have evidence for everything

100% Support and Engagement of the facility is key.

ND Public Health Roundtables (6)

• 23 counties represented

• 121 participants

• 68 organizations

Documentation for Standard 1.1 and Standard 5.2!

 

http://www.ndhealth.gov/HealthData/CountyHealthProfiles

/

County Health Data

• Concerning/ Alarming?• What is Going

Well?• Organize into

Health Status Areas - THEMES

Southwestern District Health Unit – Dickinson, ND

“The process helped bring the group together and gave us the direction needed to come up with a plan.”

– Sherry Adams, Executive Officer

Wells County District Health Unit – Fessenden, NDPresident City Council – engaging restaurants county wide for weekly messaging for place-mats, napkins etc. with Character Counts Hospital CEO – LED sign with weekly message. School Supt. – sporting activities beginning with weekly message announcement and program with recognition. Radio Stations – weekly message promotion and “Student spotlight” Banks – “Good Neighbor” recognition. 

Brenda Stallman (Left), ND SACCHO Chair

Karen Volk (Right), Nurse AdministratorWells County District Health Unit

Overall Health Status Areas:Consistent overall with 2010 statewide

data: Infrastructure (housing, emergency

services, etc.) substance abuse (including alcohol abuse

and tobacco use)emotional health (including bullying and

suicide)access to healthcare chronic disease

Simply discussing the data with a key group of partners can lead to

action!

ND Department of Health: Determine the level

to which the department is conforming to the measures.

Identified documentation that demonstrated conformity.

Created Performance improvement plan from a gap analysis based on section reviews.

Brenda Stallman (Left), ND SACCHO ChairKelly Nagel (Right), ND Local Public Health

Liaison – kjnagel@nd.gov

 

Challenges:Coordinating schedules – facilitator and

roundtable site partners.

Maintaining focus on health issues and not the quality or access to care issues.

Creating buy-in from the section chiefs and other key staff to see the value and roles in accreditation.

Outcomes and Impact:Made progress in completing community

health assessments and community health improvement plans.

 Established and dedicated groups (local and state levels) devoted to working on the health improvement plan and implementation strategies.  (ex., State Health Department Performance Improvement Plan)

 

Next Steps (July – Dec 2012):Complete requirements to apply for public

health accreditation in 2013.

Continue developing the community health improvement plan by formulating goals, objectives and strategies.

Carry out components of the State Health Department’s Performance Improvement Plan.

ND Department of Health:Complete a State Health Assessment

Implement a State Health Improvement Plan

Implement the Strategic Plan

Develop a State Health Assessment Process

Create a QI plan

Contact:

Tami DillmanND SACCHO Director

(701)952-8184 tdillman@nd.gov

ND SACCHO PO Box 880 Jamestown, ND 58402

http://www.centralvalleyhealth.org/NDSACCHO.htm

Questions/Comments . . .

Thank You!