The National Public Health Performance Standards 201: Tips and Tricks for Successful Implementation

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The National Public Health Performance Standards
201 Tips and Tricks for Successful Implementation

• Christine Abarca, Florida Department of Health
• Teresa Daub, CDC

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Learning Objectives

• Following this session, you will be able to
• Describe the framework and concepts that underpin
  the three assessment tools of the NPHPS
• Discuss the similarities and differences between
  Versions 2 and the re-engineered Local NPHPS
• Identify at least one option for conducting an
  NPHPS assessment
• List three or more tips for implementing the
  NPHPS assessment

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Understanding NPHPS Key Concepts and Tools
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NPHPS Vision

• A partnership effort
• to improve the
• quality of
• public health practice
• and
• performance of
• public health systems

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Four Concepts Applied in NPHPS
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1. The Essential Public Health Services

• Monitor health status
• Diagnose and investigate health problems
• Inform and educate
• Mobilize communities to address health problems
• Develop policies and plans
• Enforce laws and regulations
• Link people to needed health services
• Assure a competent health services workforce

1. Evaluate health services
2. Conduct research for new innovations

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2. Public Health System
Fire
Mental Health
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3. Optimal Level of Performance

• Each performance standard represents the gold
  standard
• Provide benchmarks to which state and local
  systems can strive to achieve
• Stimulate higher achievement

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4. Stimulate Quality Improvement

• Standards should result in identification of
  areas for improvement
• Link results to an improvement process
• NPHPS Local Instrument - used within the MAPP
  planning process

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NPHPS Materials

• Assessment Instruments
• State public health system
• Local public health system
• Local governance
• User Guidance
• Glossary

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NPHPS Version 2.0 (2007) and Re-Engineered (2012)

• Both versions
• Are grounded in the 10 Essential Public Health
  Services
• Use a semi-qualitative rating scale
• Can contribute to health improvement planning as
  well as strategic planning activities
• Re-engineered
• Has fewer scored questions
• Incorporates plain language principles
• More discussion-focused (relies more heavily on
  facilitation)
• Has increased quality improvement focus

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Version 2 Instrument Format
Essential Service
Model Standard
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Version 2 Instrument Format
Measures or Questions
Discussion Toolbox
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(No Transcript)
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Re-engineered NPHPS Fall 2012

• Streamlined the assessment tools
• Enhanced systems building aspects of the
  assessment process
• Increased quality and performance improvement
  activities
• Strengthened linkages with accreditation

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• Essential Service
• Description
• Includes list of potential system partners for
  each Essential Service

Field Test DRAFT
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• Model Standard
• Description
• Uses plain language

Field Test DRAFT
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• Model Standard
• Discussion Questions and Performance Measures
• More discussion
• Fewer scored questions

Field Test DRAFT
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• Essential Service Summary Notes Page
• Framework for identifying
• Strengths
• Weaknesses
• Opportunities
• Priorities

Field Test DRAFT
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Supplemental Questionnaires

• Both Versions
• Priority Questionnaire (optional)
• On a scale of 1 to 10, what is the priority of
  this model standard?
• Agency Questionnaire (optional)
• What best reflects the contribution of the
  agency to this model standard?

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Planning for the Assessment
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Planning for the Assessment

1. Assess readiness
2. Select assessment option
3. Determine timeline and create project plan
4. Identify and invite system partners
5. Select and train facilitators and recorders
6. Prepare orientation and assessment materials

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Assess Readiness

• Determine Who Will Lead the NPHPS process
• Assess Readiness
• Leadership Commitment
• Purpose and Benefits
• Resources
• Strategic Fit
• Move Forward

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Select Assessment Option

• Common Options
• Large Meeting/Retreat
• Small Group Activities
• Series of Meetings
• Choose the option that best meets needs of
  participants

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Large Meeting/ Retreat

• Generally 1-2 days
• Advantages
• Short timeframe
• Maintains momentum
• Drawbacks
• Requires time commitment
• Can be overwhelming

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Small Group Activities

• Advantages
• Allows for expertise, as needed
• Less overwhelming
• Drawbacks
• Less cross-learning
• Less consistency in response development

Tip! Many larger sites use small breakout groups
during a large meeting process!
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Series of Meetings

• Advantages
• Allows for expertise, as needed
• Gets the work done in small pieces
• Drawbacks
• Participation changes with meeting attendance
• Process may seem to drag on

Tip! This option works especially well for
boards of health, which can address one or two
Essential Services at each board meeting.
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Timeline and Project Plan

• Varies depending upon assessment approach
• Allowing 3-5 months is reasonable
• Find sample project plans online

Tip! Engage a small planning team of agency or
system representatives to plan the process.
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Identify Participants

• Key questions
• Who plays a role in the public health system or
  providing the Essential Services?
• What broad, cross-sector participation is needed?
• What expertise is needed?
• How many people should participate?
• Ensure consistency or a core group among
  respondents
• Agency and system participants are both
  important!

Tip! Existing coalitions or committees can be a
starting point for diverse representation!
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Potential Participants

• Educational institutions
• Public safety and emergency response
  organizations
• Environmental or environmental-health agencies
• Non-profit organizations/advocacy groups
• Appointed or elected officials / state or
  community leaders
• Other state or community organizations

• Board of Health Members
• State / Local Governmental agencies
• Hospitals
• Statewide associations (e.g., medical, nursing,
  hospital)
• Primary care clinics and physicians
• Social service providers
• Civic organizations
• Professional organizations
• Faith institutions
• Transportation providers

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Invite Participants

• Set the tone
• Invite participants to a meeting for
  understanding and improving the public health
  system (not to complete a questionnaire)
• Establish expectations that this is for improving
  performance right from the start!
• Consider sending some brief information as
  orientation
• Use personal or leadership connections to gain
  interest
• Extend invitations to participate via personal
  letters, email, or phone calls.
• Best extended by the local health director or
  other senior HD staff.

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Select and Train Facilitators Recorders

• Number needed may vary
• Training should cover
• Orientation to NPHPS
• Assessment Materials and Process
• Expectations of Role

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Facilitator Roles

• General responsibilities
• Establish and adhere to ground rules
• Manage group process set the pace
• Get input from everyone
• Draw out different points of view
• Reflect and check group opinion
• NPHPS responsibilities
• Keep the focus on the system
• Review model standards and facilitate open
  discussion
• Discuss key questions and gather group responses
• Re-open discussion where needed
• Obtain a decision on the final response

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Recorder Roles
Tip! Consider using flip charts or a
laptop/projector so that everyone can see the
responses and comments!

• Record group responses
• Different votes (optional)
• Final consensus response
• Record key ideas and comments from the discussion
• Note issues and qualitative information that
  shape group responses
• Strengths and weaknesses
• Areas for immediate improvement
• Priorities
• Assist the facilitator to manage time

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Preparing for the NPHPS

• The Online Tool Kit includes sample
• Participant Selection Table
• Recruitment / Invitation Letters
• Preparations Checklist
• Pre-Assessment Press Releases
• Meeting Agendas

Tip! Use samples from other sites and revise as
needed!
www.cdc.gov/nphpsp/
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Conducting the Assessment

• Convene and orient participants
• Assess and document system performance
• Submit assessment data

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Orient Participants

• Advance and/or on-site orientation
• Key topics
• Essential Services
• Public Health System
• Purpose of the assessment
• The process
• What next? Using the results to improve!

Tip! Consider using the Essential Services
brainstorming exercise 10 flip charts around
the walls as both orientation and input!
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Customized Egg Chart Peninsula Health District,
VA
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Assessment Process

• Review and Discuss Model Standard
• Read and Discuss Questions
• Preliminary Vote
• Consensus Building
• Essential Service Wrap-Up

Tip! Use an Audience Response System (ARS) if
available. Color-coded cards are a more low-tech
way to gather votes from all participants
template cards are on-line!
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Submitting Version 2 Assessment Data

• Obtain a User ID
• Enter and Submit Data
• Download Reports

All at www.nphpsp-results.org
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Immediately after the Assessment

• Report out the summary of findings
• Overview of the EPHS strengths and weaknesses
• Insights that shaped group judgments
• Impressions and early ideas for improving the
  system

Tip! If groups compile opportunities for
improvement and next steps as they go through
each section, this can easily be collected into a
master draft that can jumpstart immediate
performance improvement!
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Conducting the Assessment

• Assessment Instruments and Model Standards
• User Guide
• The Online Tool Kit includes sample
• Assessment Agendas
• Assessment Meeting Guide
• Ground Rules
• Evaluation Forms
• www.cdc.gov/nphpsp/

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NPHPS User Experiences

• Tips from our most successful users
• Involve broad system participation
• Ensure visible leadership
• Conduct assessment within context of broader
  state/community health improvement process or
  performance improvement effort
• Provide strong facilitation, which is critical to
  a positive experience and building momentum

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Contact Information

• Christine AbarcaFlorida Department of Health
  Christine_Abarca_at_doh.state.fl.us
• 850-245-4444 ext. 2071
• Teresa Daub
• Centers for Disease Control and Prevention
• tdaub_at_cdc.gov
• 404-498-0317