reaching readiness:

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



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



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



1. Prerequisite Deliverables: PHAB and NACCHO Guides, Reports, Forms



1. Prerequisite Deliverables: Annual Health Assessments, Reports, Briefs

Strategic Plan

2011-2015



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.



1. Prerequisite Deliverables: Initiative Identification, MAPP Process



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



2. Taking Stock: Promoting Health in All Policies & Collaborating with County and City Planning Departments



2. Taking Stock: Collaboratives, Coalitions, & Committees



2. Taking Stock: Internal Collaboration with Behavioral Health, Probation, Social Services, Public Health, Clinic Services, Sherriff, Parks, Planning, others



2. Taking Stock: Grant and Contract Partnerships



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



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%



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



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



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



3. Data, PM, QI, Evaluation Culture: Research and Reporting



3. Data, PM, QI, Evaluation Culture: Survey Research

Network

Evaluation

Knowledge

Girls’ Health in

Girls’ Hands



3. Data, PM, QI, Evaluation Culture: External Research Contracts



3. Data, PM, QI, Evaluation Culture: New Planning, Evaluation, & Policy unit



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



4. Systems Upgrades & Links: EHR and EMR Systems, Behavioral Health Common Assessment Forms, Links between Public Health & Clinic Services



4. Systems Upgrades & Links: Future (!) Health Information Technology will Link four acute care hospitals and 60 clinics



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



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



5. Communications: New leadership, new facilities for conferencing

Reaching Readiness: Steps Toward Accreditation, Performance Management, and Quality Improvement



Patricia Zerounian, MPP

[email protected]

831.755.4583

reaching readiness:

Documents

evaluation cultureraising

partnerships health

qi cultureplanning

social services

behavioral health

staff resources

clinic services

community presentations