Accreditation – A Driver for Change
Elissa J. Bassler, CEOIllinois Public Health Institute
MLC Grantee Meeting February 3, 2010
Illinois Certification
• Illinois Dept. Public Health certifies LHDs– 8 practice standards
• Deliverables: Community Health Assessment, Community Health Plan, Organizational Assessment/Strategic Plan
• Certain state funding contingent upon achieving certification
From Certification to Accreditation
• Overlap in foundational elements: assessment, planning, and strategy
• Overlap in vision: health, wellness, efficiency, accountability, and best practices
• Illinois LHDs’ experiences with certification pave the way for a LHDs to seek and obtain accreditation
Key Principals In Illinois
• Accreditation (either Illinois program or PHAB) is voluntary; LHDs have state certification option: Choices
• Strengthen infrastructure/contribute to QI• Minimize economic burden/provide adequate
financial resources• Achievable regardless of size (w/ high
standards)• Stakeholder/participant driven
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MLC – Testing Accreditation In Illinois
• Illinois Accred. standards measures and process – using Illinois certification standards & operational definition
• Pilot, evaluation, revision of measures– Certification standards PHAB Domains– Crosswalk to PHAB measures
• Illinois “equivalent” to PHAB?
Decision Point – Illinois or PHAB
• State action/direction needed “Deeming” of accredited LHDs – – Illinois program? PHAB? – One or the other or either?
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Decision Point – Illinois or PHAB
• Deemed certification foundational for uptake (LHDs: “only one process”)
• Certification = assurance
• Accreditation – Rigorous, includes Cert. components
• State review of accreditation; decision on deeming
• Keep Illinois at the forefront of PH practice
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Decision Point – Illinois Program or PHAB
• Assuming: PHAB recognition; deeming:
• Decision criteria -- 3 categories– Cost/resources: To LHDs; at state level– Leadership/will: Administration buy-in and
promotion; energy & effort; “slippery slope” concerns; local voice; state-level analog
– Best uptake: Labor/effort & costs, value to external customers, QI results; relevance
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Illinois – Poised for Accreditation
• Illinois state and locals: poised for accreditation/could be national leader– State health assessments & State Health
Improvement Plan; strategic plan?– Certification: IPLAN = community health
assessment; community health plan; org. assessment or strategic plan
• Years of learning through MLC – accreditation and QI
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Step UP Step UP to the OSDH Performance Management to the OSDH Performance Management
System: Accreditation is System: Accreditation is Driving Driving ChangeChange in Oklahomain Oklahoma
Step UP“Strategies toward excellent performance----Unlimited Potential”
Oklahoma State Department of HealthPerformance Management System
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Goals Of Step UPGoals Of Step UP
Comprehensive, sustainable performance management system
Periodic and uniform measure of those indicators most important to success
Alignment of strategic initiatives Trained staff in key public health/QI concepts Accountability to stakeholders Data –driven decision making Institutionalization of quality improvement Preparation for Accreditation
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Development of StepUP
Poor Health Outcomes/Inconsistent Monitoring
Expert Expert MeetingMeeting
Develop
Framework
& Changes
Pilot Pilot 11
Pilot Pilot 22
Pilot Pilot 33
Implementation, Implementation, Spread and Spread and
Sustainability Sustainability
Step UP
Design Electronic Form Test
Online Pilot
Holding Holding the the
GainsGains
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The Step UP Performance Management System is a web-based application that will
centralize data collection.
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Nat’l & OK Framework
Overview
StrategicPlan
Action Plan
Annual Review
Five Stages of Step UP Application
* 5 Stages* 3 Templates
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Public Health Alignment & Overview Template
Alignment to Oklahoma & Nat’l Framework
County Demographic Information or Service Target Population Information
Customer Satisfaction
Community Assessment
Mandates Funding Sources FTE
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Strategic Plan Template 2-5 Goals 2-5 Objectives 1-5 Performance Measures Baseline Target and Trend Information Data Sources and Formulas Alignment to Strategic Map
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Sample Action Plan
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Annual Review Template
Report Actual Data to Target Scorecard Barriers/Lessons Learned Success Factors
2020
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Step UP: a cycle of Step UP: a cycle of Plan-Do-Check-ActPlan-Do-Check-Act
(PDCA)(PDCA)
Set Standards
QualityImprovement
Reporting
Measure Performance
Plan
Do
Check
Act Set action plans and
begin implementation
How did it go?
Adopt/modify/drop based upon data & report results
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Accreditation: A Driver for Change
Redesign of Step UP system elements
Tie improvement planning, assessment, and strategic planning through Step UP
Standardized improvement planning and assessment for CHDs/service areas
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Accreditation: A Driver for Change
Tie to core measures throughout state services and county health departments
Cross-cutting STAT teams
Senior Leadership & Board involvement
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Accreditation: A Driver for Change
Alignment of resources
Tie to individual performance appraisals
Institutionalize QI
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Transitioning to Accreditationin Washington State
February 2010
Rita Schmidt, DOH
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Local Health Agencies/Population Served
Adams
Benton-Franklin Health District
Chelan-Douglas Health District
Clallam
Clark
ColumbiaCowlitz
Garfield
Grant
Island
Jefferson
Kitsap
Kittitas
Klickitat
Lewis
Lincoln
Mason
Northeast Tri-County Health
District
Okanogan
Pacific
San Juan Skagit
Skamania
Snohomish
Spokane
PierceThurston
WahkiakumWalla Walla
Whatcom
Whitman
Yakima
Grays Harbor
Asotin
ChelanDouglas
FerryStevens Pend
Oreille
Benton Franklin
18,000
21,500
169,300
72,60069,500
431,200
4,10099,600
37,600
7,800
72,700 2,250
86,10071,200
29,000King
39,900
20,200
75,200
10,450
40,500
21,800
12,900
813,600
118,900
10,800
704,300
465,000
44,000
4,100
16,300
59,200
193,100
43,300
238,400
Washington State Total Population as of June 2009 – 6,668,200Office of Financial Management Official 2009 Population Estimate www.ofm.wa.gov/pop
249,800
56,800
80,300
247,6001,909,300
Washington State Local Health Jurisdictions
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Washington State Standards Process
• Developed collaboratively by local and state public health agencies in 1999
• Used every three years to review the performance of the public health system in Washington
• Baseline measurement in 2002
• Re-measurements in 2005 and 2008
• Public Health Improvement Leadership-1993
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Benefits of Washington’s Process
• Provides a system-wide snapshot
• Common language
• Create common expectationso What every person has a right to expect
• Capacity measures
• Site performance measureable over time
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Standards for Public Health in Washington
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2008 System-wide Review
• Overall system report
• Individual site and special reports
• What we learnedo Relationship of budget and FTEs to overall performance is nearing
random
(little or no correlation)
• Significant improvement over time
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Comparison to Accreditation
Washington System
•System-wide snapshot
•Specific QI recommendations
•Full participation
•Full disclosure of scores
Accreditation
•County by county
•Pass or fail
•Confidential scores
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Washington Challenge
• Transition to accreditation
• Maintain our statewide results
• Maintain participation
• Make the process useful for Washington
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Decision Making Tools
• Assessment of Washington process – comparison to accreditation
• Crosswalk of Washington standards with PHAB standards
• Communication plano PHAB standardso Our options
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Our Options
• Continue our process without adjustments
• End the Washington process
• Develop an accreditation process
• Blend of PHAB and Washington process to prepare for accreditation
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Discussions about Accreditation
• Presentations to• Washington State Association of Local Public Health Officials• Health Officers and Administrators• Nursing and Environmental Health Directors• State Board of Health
• Review and vet the PHAB standards
• PHAB Director, Kaye Bender, invited for special session
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Participation in Beta Test
• All sites in Washington encouraged to participate
• State health agency and several local health agencies submitted applications
• State health agency selected
• Site visit in June of 2010
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Revisions to the Public Health Improvement Partnership (PHIP) Structure• Focus on governmental health agencies
• Smaller more focused committees and structure
• Change Public Health Improvement Plan focuso Public Health Assessment Improvement Plan
• Performance Management Committeeo Standards and measureso Accreditation support
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Revisions to the Standards
• Permission from PHAB to use the PHAB standards for Washington reviewo 80% of Washington measures align
• Include the Washington standards and measures that were not part of the PHAB standards
• Optional standards – those PHAB standards that were not part of the Washington reviews in the past
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Revisions to the Process
• Results of the DOH Beta Test as the Washington review
for DOHo All PHAB standards plus Washington standards and measures
• Schedule local health reviews for Spring of 2011o Optional PHAB standards and measures
• Use all results to prepare for accreditation
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State Agency Preparation for Beta Test
• Agency preparation assigned to Performance and Accountability Manager, Susan Ramsey
• Training with key staff
• Standards teamo Every division representedo Work session monthlyo Mock reviews
• Use electronic collection of documentationo Mind Manager
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The New Washington Standards Process for 2010-2011
• Use trained staff as reviewers for local health in 2011
• Sites will have the information to prepare for accreditation
• Results will give sites information for next cycle, or for accreditation preparation
• Washington will have state-wide results – “snapshot” of the state
• Washington will have recommendations for the public health system
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Additional Changes• Sites required to submit materials ahead of time
• 60% of Measures must have documentation to get a site visit
• Much of the review will be done offsite
• DOH is rethinking the Public Health Improvement Plan
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Our Goal
A predictable level of public health protection throughoutthe state
“What every person has a right to expect.”
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