reaching readiness: steps toward accreditation, performance management, and quality improvement pep...
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Reaching Readiness: Steps Toward Accreditation, Performance Management, and Quality Improvement
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
Performance Management, Quality Improvement, & Accreditation Summit
California Department of Public Health
May 1, 2012
Patricia Zerounian, MPP
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
Reaching Readiness Monterey County Steps Toward Accreditation,
Performance Management, and Quality Improvement
1.Review potential documents to fulfill prerequisite deliverables
2.Taking stock of our staff resources and partnerships
3.Reinforcing our data-driven, PM, and QI culture
4.Planning further system upgrades and links
5.Strategizing our communications
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
Reaching Readiness
1.Review potential documents to fulfill prerequisite deliverables
• Annual Health Assessments
• Periodic Reports and Briefs
• Strategic Plan Community Listening Sessions
• Process for completing Strategic Plan Initiatives
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
1. Prerequisite Deliverables: PHAB and NACCHO Guides, Reports, Forms
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
1. Prerequisite Deliverables: Annual Health Assessments, Reports, Briefs
Strategic Plan
2011-2015
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
1. Prerequisite Deliverables: Community Presentations, Listening Sessions
#1: Empower the community to improve health through programs, policies, and activities.
#2: Enhance community safety.
#3: Ensure access to culturally and linguistically appropriate, customer-friendly, quality health services.
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
1. Prerequisite Deliverables: Initiative Identification, MAPP Process
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
Reaching Readiness
2. Taking stock of our staff resources and partnerships
• Health in All Policies
• Health Department-convened Coalition Meetings
• Collaborations with Social Services, Probation, First 5 Monterey County, Children’s Council, others
• Partnerships with TCE Building Healthy Communities, Community Foundation, others
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
2. Taking Stock: Promoting Health in All Policies & Collaborating with County and City Planning Departments
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
2. Taking Stock: Collaboratives, Coalitions, & Committees
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
2. Taking Stock: Internal Collaboration with Behavioral Health, Probation, Social Services, Public Health, Clinic Services, Sherriff, Parks, Planning, others
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
2. Taking Stock: Grant and Contract Partnerships
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
Reaching Readiness
3. Reinforcing data-driven, PM, QI, evaluation culture
• Raising the “data comfort level
• Inter-department data analysis
• Staff trainings
• Staff evaluation training & services
• External evaluation services
• Survey research development & processing
• New unit: Planning, Evaluation, & Policy
3. Data, PM, QI, Evaluation Culture: Staff & Community Workshops & Trainings
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
Medical Model:
Personal Choices for an
Individual’s Health
Socio-Ecological Model:
Social Influences on
Community Health
Discrimination
Race/Ethnicity GenderCitizenship Sexual OrientationDisability
Institutional
Perpetration
SchoolsGovernment agenciesCorporations
ChoicesSmokingChronic StressNutritionViolence Risk-taking
Neighborhood
Conditions
Physical deteriorationSocial segregationCrime/GangsPoor performing schools
Disease/Injury
Chronic disease CommunicablediseaseHomicideSuicideAccidents
Years of Life Lost
Infant DeathPremature DeathPoor Quality of Life
3. Data, PM, QI, Evaluation Culture: Prevention-Focused Approaches
Youth Comments
Responses #
IMPROVED COMMUNICATION 20
SCHOOL/JOB SUPPORTS 16
TALK THERAPY 15
POSITIVE SERVICE DELIVERY 14
SUBSTANCE ABUSE SERVICES 13
NOTHING WAS HELPFUL 13
UNDECIDED/ I DON’T KNOW 12
OTHER RESPONSES 18
TOTAL RESPONSES 121
#1: Most helpful thing about services in past 6 months?
Substance11%
Nothing11%
Undecided10%
Other15%
Pos Service Del
12%
School/Job Sup13%
Impv Com16%
Talk Therapy
12%
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
3. Data, PM, QI, Evaluation Culture: Staff Data Presentations
3. Data, PM, QI, Evaluation Culture: GIS Services
Problem: Too many juvenile offenders re-engage in criminal activitiesProgram Goal: Decrease recidivism
Activities
Provide transitional housing and support services
Resources
Rancho Cielo, Vocational programs, employment opportunities
Outputs
Participation in
• training
• education
• peer activities
• independent living skills programs
• individual support plans
Outcomes
Greater percentage of youth discharged from Youth Center do not reoffendStakeholders
MCBH, Probation, Contracted Agency
StrategyEngage youth in constructive activities and independent living skills
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
3. Data, PM, QI, Evaluation Culture: Staff Evaluation Trainings & Workshops
Patient Level: Patient chronic disease knowledge, self-management skills, and medical home utilization
Patient Goals IndicatorsShort-term outcomes
Data collection tools and sources
Data Collection Schedule
Within 4 months the focus population will experience:Greater stability in daily living (housing, transportation, food, medical care)Improved chronic disease self-management
Within 8 months the focus population will demonstrate: Greater utilization of a medical home and less utilization of ED for the effects of poorly controlled chronic disease.
Within 12 months the focus population will demonstrate: Greater disease self-management, increased stability in basic needs, and stable or improved health outcomes.
Knowledge Patient knowledge of resources that provide stabilization in daily livingPatient knowledge of chronic disease symptoms, causes and triggersPatient knowledge of appropriate self-management behaviors, tools, and supports
Self-efficacy Patient accesses and maintains the use of stabilizing resources for daily needs Patient understands benefits of using a written action planPatient understands benefits of having and using a medical homePatient comfort with case manager and case management services
Within 4-6 months, focus population will demonstrate improved chronic disease self-management knowledge, skills, and use of resources/supports
Within 6-8 months, focus population will demonstrate improved utilization of a medical home and less utilization of ED for the effects of poorly controlled chronic disease
Within 12 months, focus population will demonstrate stable or improved hbA1c test results.
Case manager baseline and follow up interview instruments
Aggregated interview results
Epic data extraction
Baseline interview with follow up interviews at 6 and 12 months. Interviews conducted in-person by nurse case manager.
Patient health data (test results) and service utilization (number of appointments kept) at baseline, 6, and 12 months
Patient health data (test results) and service utilization (number of appointments kept) at baseline, 6, and 12 months
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
3. Data, PM, QI, Evaluation Culture: Evaluation Design & Monitoring
2011 CA Conference of Directors of Environmental Health Excellence in Environmental Health Award WinnerJune 30, 2011
Agricultural Field Toilet Inspection Program
Monterey County Health Department Environmental Health Bureau Director John Ramirez, MPA, REHS
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
3. Data, PM, QI, Evaluation Culture: Research and Reporting
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
3. Data, PM, QI, Evaluation Culture: Survey Research
Network
Evaluation
Knowledge
Girls’ Health in
Girls’ Hands
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
3. Data, PM, QI, Evaluation Culture: External Research Contracts
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
3. Data, PM, QI, Evaluation Culture: New Planning, Evaluation, & Policy unit
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
Reaching Readiness
4. Systems Upgrades and Links
• New EHR System for Behavioral Health, Use of Common Assessment Forms
• New EMR System for Clinic Services and upcoming link to Public Health
• Future (!) Health Information Technology Linking 4 hospitals and 60 clinics
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
4. Systems Upgrades & Links: EHR and EMR Systems, Behavioral Health Common Assessment Forms, Links between Public Health & Clinic Services
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
4. Systems Upgrades & Links: Future (!) Health Information Technology will Link four acute care hospitals and 60 clinics
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
Reaching Readiness
5. Communications
• Improved Website
• Quarterly “Director’s Message” to All Staff
• Quarterly Reports to Board of Supervisor’s Health & Human Services Commission
• Weekly Staff Newsletter
• New Leadership, New Facility
Bookshelf pubs
5. Communications: Improved Website
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
Message from the Director
To ensure employee awareness of critical initiatives and policies
2011-2012 Quarter 3Recent Grant Awards
From CDPH/Public Health Institute for Community Transformation: $253,000From CDC for youth violence prevention: $225,000 From Blue Shield CA Fnd. for ViaCare Low Income Health Plan planning: $200,000From Blue Shield CA Fnd. for ViaCare execution: $120,000From CHOMP for Seaside and Marina clinics: $75,000From Medicare for Laurel Internal clinic quality improvement: $35,000From Children's Miracle Network for school-based influenza program: $20,000From the Ad Council for mental illness anti-stigma campaign:$20,000From the City of Gonzales for a community health assessment:
$10,328TOTAL $958,328Pending ApplicationsTo Centers for Medicare & Medicaid for health care reforms: $24,967,518
MCHD Approaching Accreditation with Training & Evaluation
Public health departments across the U.S. are adopting specific standards and measures to assess their performance capacity and outcomes, thereby seeking accreditation that the health department has the ability to accomplish its mission and purpose.
Monterey County Health Department (MCHD) is poised to embark on its accreditation process within the next 30 days as a portion of work done by a new unit, Systems Policy and Analysis (SPA) unit, which will be housed within the Administration Bureau.
A series of trainings concerning the elements of accreditation will be held over the next few months, followed by a roll-out of methods for identifying, selecting, assessing, and documenting specific programs for accreditation review. Assessment tools will be developed or identified by SPA staff to engage in several program evaluation and ontinuous quality improvement
studies.
PHAB has beta-tested a seven step process for health departments to follow that covers the pre-application phase to reaccreditation, which occurs five years later.
Eventually, receipt of some types of federal grant funding will likely be contingent upon a health department being in good accreditation standing.
5. Communications: Quarterly, Monthly, Weekly communications
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
5. Communications: New leadership, new facilities for conferencing
Reaching Readiness: Steps Toward Accreditation, Performance Management, and Quality Improvement
•PEP••• Planning Evaluation and Policy Unit
Monterey County Health Department
Patricia Zerounian, MPP
contactzerounianp@co.monterey.ca.us
831.755.4583
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