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July 20, 2010Call in Information: 1-800-504-8071, code 8422006
WELCOME!NPHPSP User Webinar
National Public Health Performance Standards
Program – A Brief Overview
Trina S. Pyron, MA, CDC
National Public Health Performance Standards
Program – A Brief Overview
Trina S. Pyron, MA, CDC
Strengthening systems,
improving the public’s health
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.
To improve the quality of public health practice and performance of public health systems by:
Program Vision and GoalsProgram Vision and Goals
Assessment InstrumentsState public health systemLocal public health systemLocal public health governance
Supported by…GlossaryUser GuideOn-line Reporting SystemOn-line toolkit with links to all materials and partners, sample materials from the field, etc.All partner websites
NPHPSPNPHPSP
History of the NPHPSPHistory of the NPHPSP
Key Dates▲ Began in 1998▲ Version 1 instruments released in 2002▲ 2002-2007 – Version 1 instruments used in more than 30
states▲ Development of Version 2 instruments – 2005-2007▲ Release of Version 2 instruments – Fall 2007
Comprehensive Development of Instruments▲ Practice-driven development by CDC and ASTHO, NACCHO
and NALBOH Work Groups▲ Field testing▲ Validation studies
Version 2 InstrumentsVersion 2 Instruments
Process▲ Guided by peer-driven work groups▲ Utilized a variety of subject matter experts▲ Limited field testing in 2006▲ Release with OMB clearance in Fall 2007
Key Changes▲ Modernized and updated the content ▲ Streamlined and identified opportunities for greater user-
friendliness▲ Added “discussion boxes” feature▲ Altered response options▲ Included optional priority and agency contribution questionnaires
Four Concepts Applied in NPHPSPFour Concepts Applied in NPHPSP
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
Board of Health MembersState / Local Governmental agenciesHospitalsStatewide associations (e.g., medical, nursing, hospital)Primary care clinics and physiciansSocial service providersCivic organizationsProfessional organizationsFaith institutionsTransportation providers
Educational institutionsPublic safety and emergency response organizationsEnvironmental or environmental-health agenciesNon-profit organizations/advocacy groupsAppointed or elected officials / state or community leadersOther state or community organizations
Many System Partners Should be Involved!
Many System Partners Should be Involved!
NPHPSP Use in the FieldNPHPSP Use in the Field
Coordinated statewide approach▲ Statewide activities in improvement planning▲ Benefits in technical assistance, state/local
connections, and peer support
Individual System / Board Use
Reasons for Using NPHPSP (per State and Local evaluations)
▲ Establish a baseline measure of performance▲ Want a national developed & recognized
assessment tool to help improve performance ▲ NPHPSP the best tool available for improving public
health system effectiveness▲ Was part of the MAPP process (local users only)
NPHPSP State Instrument Use (Thru April 2010, n = 27 states + DC)
*Also includes sites using field test versions of the NPHPSP State Public Health System Performance Assessment.
NH
WA
OR
NV
CA
ID
MT
AK
UT
AZ
WY
CO
NM
ND
SD
NE
KS
TX
OK
LA
AR
MO
IA
MN
MS
OH
WI
INIL
MI
ME
KY
NY
PA
WVVA
NC
GA
TN
AL
FL
SC
VT
MA
RI
CT
HI
NJ
DE
MD
NH
MA
RI
CT
NPHPSP Local Instrument Use (Thru April 2010)
Moderate Use(33% - 66%)
Significant Use (67% or greater)
Limited Use(1% - 32%)
*Also includes sites using field test versions of the NPHPSP Local Public Health System Performance Assessment.
WA
OR
NV
CA
ID
MT
AK
UT
AZ
WY
CO
NM
ND
SD
NE
KS
TX
OK
LA
AR
MO
IA
MN
MS
OH
WI
INIL
MI
ME
KY
NY
PA
WVVA
NC
GA
TN
AL
FL
SC
VT
NJ
DE
MD
NH
MA
RI
CT
HI
NPHPSP Governance Instrument Use (Thru April 2010)
No Boards of Health
*Also includes sites using field test versions of the NPHPSP Local Public Health Governance Performance Assessment.
WA
OR
NV
CA
ID
MT
AK
UT
AZ
WY
CO
NM
ND
SD
NE
KS
TX
OK
LA
AR
MO
IA
MN
MS
OH
WI
INIL
MI
ME
KY
NY
PA
WVVA
NC
GA
TN
AL
FL
SC
VT
NJ
DE
MD
NH
MA
RI
CT
HI
Moderate Use(33% - 66%)
Significant Use (67% or greater)
Limited Use(1% - 32%)
Current partnership activity areasCurrent partnership activity areas
Promotion and communications
Technical assistance and training▲ Using the assessment instruments▲ Post-assessment and performance
improvement
Evaluation and research
Partnership coordination
Strategic integration and linkages
Related initiatives▲ MAPP▲ Accreditation ▲ Environmental Public Health Performance Standards▲ Laboratory System Performance Standards▲ International interest in NPHPSP, MAPP, public health
practice
Policy support▲ Healthy People 2010 Objective 23-11▲ Institute of Medicine reports▲ State legislation that provide for or mention use of NPHPSP
(e.g., IL, OH, NJ)
Strategic LinkagesStrategic Linkages
NPHPSP and EnvPHPSNPHPSP and EnvPHPS
Overall NPHPSP State, Local and Gov Instruments
MODULE
Conceptually▲ Based on same four concepts
• Essential Services framework, public health system, optimal standards, performance improvement
▲ Illustrate linkage between broad public health and deeper look at environmental health
Operationally▲ Frequent interaction and learning from each other▲ Linkages through CDC, NACCHO, and APHA
The future?▲ Opportunities for joint use, analysis and improvement
NPHPSP and L-SIPNPHPSP and L-SIP
Conceptually▲ Based on same four concepts
• Essential Services framework, public health system, optimal standards, performance improvement
▲ Connection with lab standards within NPHPSP▲ Similarities / differences in assessment process
Operationally▲ Linkages through CDC, ASTHO, and PHF▲ Steering Committee and PI workgroup▲ PHF on-line resource center
The future?
A few final points about the NPHPSP…A few final points about the NPHPSP…
Latest NPHPSP use in the field
Evaluation data indicate the “intangibles” are more often achieved as outcomes than the “tangibles”
Transitioning from assessment to performance improvement isn’t always easy and requires dedication and forethought.
The key concepts and framework have held up well over time.
Strengthening systems,
improving the public’s health
Environmental Public Health Performance Standards and Accreditation of Public
Health Departments
Environmental Public Health Performance Standards and Accreditation of Public
Health Departments
John Sarisky, RS, MPH, DAASNational Center for Environmental Health
Centers for Disease Control and Prevention
John Sarisky, RS, MPH, DAASNational Center for Environmental Health
Centers for Disease Control and Prevention
Centers for Disease Control and Prevention
National Center for Environmental Health
Environmental Health Services Branch
Mission:
To improve the practice of environmental health
www.cdc.gov/nceh/ehs
www.cdc.gov/nceh/ehs/ephli
Mission:
To improve the practice of environmental health
www.cdc.gov/nceh/ehs
www.cdc.gov/nceh/ehs/ephli
Goal of accreditation programGoal of accreditation program
Improve and protect the health of every community by advancing the quality and performance of public health departments
Improve and protect the health of every community by advancing the quality and performance of public health departments
OpportunityOpportunity
Environmental public health
– How do we currently measure performance?
– Quality of services?
– How do we know if we are improving?
– Are we doing the right things?
Environmental public health
– How do we currently measure performance?
– Quality of services?
– How do we know if we are improving?
– Are we doing the right things?
Environmental Public Health Performance Standards
Environmental Public Health Performance Standards
• Continual performance improvement to build capacity, consistency, and accountability
• Identify service gaps in environmental health programs
• Develop improvement plan
• Continual performance improvement to build capacity, consistency, and accountability
• Identify service gaps in environmental health programs
• Develop improvement plan
Environmental Public Health Performance Standards
Environmental Public Health Performance Standards
• Based on ten essential services of environmental public health
• Assess capacity of program, agency, and system to provide essential services
• Based on ten essential services of environmental public health
• Assess capacity of program, agency, and system to provide essential services
Environmental Health Essential Services Environmental Health Essential Services• MONITOR environmental and health status to identify and solve community environmental health
problems.
• DIAGNOSE AND INVESTIGATE environmental health problems and health hazards in the community.
• INFORM, EDUCATE AND ENPOWER people about environmental health issues.
• MOBILIZE community partnerships to identify and solve environmental health problems.
• DEVELOP POLICIES AND PLANS that support individual and community environmental health efforts.
• ENFORCE laws and regulations that protect health and ensure safety.
• LINK people to needed environmental health services and assure the provision of environmental health services when otherwise unavailable.
• ASSURE a competent environmental health workforce.
• EVALUATE the effectiveness, accessibility and quality of personal and population based environmental health services.
• RESEARCH new insights and innovative solutions to environmental health problems and issues.
• MONITOR environmental and health status to identify and solve community environmental health problems.
• DIAGNOSE AND INVESTIGATE environmental health problems and health hazards in the community.
• INFORM, EDUCATE AND ENPOWER people about environmental health issues.
• MOBILIZE community partnerships to identify and solve environmental health problems.
• DEVELOP POLICIES AND PLANS that support individual and community environmental health efforts.
• ENFORCE laws and regulations that protect health and ensure safety.
• LINK people to needed environmental health services and assure the provision of environmental health services when otherwise unavailable.
• ASSURE a competent environmental health workforce.
• EVALUATE the effectiveness, accessibility and quality of personal and population based environmental health services.
• RESEARCH new insights and innovative solutions to environmental health problems and issues.
Environmental health and accreditation standards
Environmental health and accreditation standards
• Assess department’s ability to meet standards
• Engage in improvement efforts where indicated
• Incorporate quality improvement into all operations
• Assess department’s ability to meet standards
• Engage in improvement efforts where indicated
• Incorporate quality improvement into all operations
Environmental health and accreditation standards
Environmental health and accreditation standards
• Conduct community health assessment
• Develop community health improvement plan
• Do organizational strategic planning
• Conduct community health assessment
• Develop community health improvement plan
• Do organizational strategic planning
Why EH performance standards?Why EH performance standards?
• Allows detailed assessment of EH activities
• Comprehensive approach to the identification of strengthens and areas in need of improvement
• Engage external partners in development and implementation of performance improvement plan
• Allows detailed assessment of EH activities
• Comprehensive approach to the identification of strengthens and areas in need of improvement
• Engage external partners in development and implementation of performance improvement plan
Why EH performance standards?Why EH performance standards?
• Build new internal partnerships
• Better understanding of what EH does and barriers to program improvement
• Help prepare EH for the department accreditation process
• Build new internal partnerships
• Better understanding of what EH does and barriers to program improvement
• Help prepare EH for the department accreditation process
Why EH performance standards?Why EH performance standards?
• Build national data base of self-assessment findings
• Inform CDC and other federal agencies of environmental health issues and trends
• Help assure the national environmental public health services system has capacity to address current and emerging issues
• Build national data base of self-assessment findings
• Inform CDC and other federal agencies of environmental health issues and trends
• Help assure the national environmental public health services system has capacity to address current and emerging issues
Environmental Public Health Performance Standards
Environmental Public Health Performance Standards
• Improve performance of environmental public health programs
– Deliver high quality services
– Improve efficiency and effectiveness
– Reduce exposure to environmental risk factors
– Reduce environmentally related disease
– Reduce health care expenditures
• Improve performance of environmental public health programs
– Deliver high quality services
– Improve efficiency and effectiveness
– Reduce exposure to environmental risk factors
– Reduce environmentally related disease
– Reduce health care expenditures
Why performance standards?Why performance standards?
Every system is perfectly designed to achieve exactly the results it gets!
If you want to change your results you need to change your system.
Deming
Every system is perfectly designed to achieve exactly the results it gets!
If you want to change your results you need to change your system.
Deming
Thank you for your attention
Thank you for your attention
APHL’s Laboratory System Improvement Program (L-SIP)
NPHPSP TeleconferenceTuesday, July 20, 2010
Tina, MPHSpecialist, Laboratory Systems and Standards
Association of Public Health Laboratories
Laboratory System Improvement Program (L-SIP)
• Formerly called the State Public Health Laboratory System Performance Assessment Program. Changed name to L-SIP in 2008.
• L-SIP History• Feasibility Study• Field Test Phase• Final Product• Target: 100% participation by 2011
• Goal of Program: To conduct an assessment of the state public health laboratory
system based on laboratory system performance standards
Vision of APHL’s Laboratory System
Improvement Program
• The capacity and performance of state public health laboratory systems meet or exceed performance standards
• Highly functioning laboratory system a healthy world
Intended Results• Conduct an assessment of the state public health
laboratory system which:
• Brings together key partners to evaluate system performance
• Measures capacity and performance of the state system in addressing national standards
• Provides results (a starting point) for system improvement
The Assessment
• Will take one day and will be facilitated by independent professionals skilled in public health and facilitation.
• Will provide for dialogue including information shared by participants.
• A consensus will be reached and collated into a state-wide response. The results will tell states how they compare to the L-SIP “gold standards.”
Essential Services Vs. Lab Core FunctionsEssential Services Laboratory Core Functions
1. Monitor Health Status to Identify Community Health Problems
1. Disease prevention, control, and surveillance
2. Diagnose and Investigate Health Problems and Health Hazards in the Community
2. Integrated data management3. Reference and specialized testing4. Environmental health and protection5. Food safety8. Emergency response
3. Inform Educate and Empower People About Health Issues
10. Training and Education11. Partnerships and communication
4. Mobilize Partnerships to Identify and Solve Health Problems
11. Partnerships and communication
5. Develop Policies and Plans that Support Individual and Community Health Efforts
7. Policy development
Essential Service Lab Core Function
6. Enforce laws and regulations that protect health & safety
6. Laboratory improvement and regulation
7. Link people to needed personal health services & assure provision of health care when unavailable
3. Reference and specialized testing
8. Assure a competent public and personal health care workforce
10. Training and education
9. Evaluate effectiveness, accessibility, & quality of personnel & population-based services
3. Reference and specialized testing6. Laboratory improvement and regulation
10. Research for new insights and innovative solutions to health problems
9. Public health-related research
Essential Services Vs. Lab Core Functions
Laboratory System Improvement Program Ratings Categories
Technical Assistance Activities for the Assessment
• SharePoint site containing related materials• User’s guide and assessment tool• Technical assistance calls to help with planning• Video training for individuals coordinating
assessment and for facilitators and others involved• Providing $4,000 mini grants to sites
L-SIP Mini-Grants
• APHL will provide funding (up to $4,000) to SPHLs or their partners supporting the use of the L-SIP instrument.
• Funding can be used for:• Food• Facilities• Facilitators• Supplies
Technical Assistance Activities -- Focus on Improvement
• Sustainable state public health laboratory system assessment plan which includes an improvement component • Improvement subcommittee
• L-SIP Update (newsletter)
Online Resource Center
International Implications
• Canada Public Health Laboratory Network (CPHLN) Contracting with APHL to “Canadianize” L-SIP• National Laboratory as well as Provincial
Laboratories participating• Final product presented at the CPHLN-Annual
Meeting in April 2009• Next phase will include piloting the instrument
For additional information…
APHL
Tina Su, MPH
Specialist, Laboratory Systems and Standards
240.485.2729
www.aphl.org/lsip
Questions?