The National Public Health Performance Standards Using the Assessment Instruments

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The National Public Health Performance
StandardsUsing the Assessment Instruments
Louis Rowitz, PhD
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The NPHPS Program
Is a partnership effort to improve the practice
of public health and the performance of public
health systems
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Program Vision and Goals

• To improve the quality of public health practice
  and performance of public health systems by
• Providing performance standards for public health
  systems and encouraging their widespread use
• Engaging and leveraging national, state, and
  local partnerships to build a stronger foundation
  for public health preparedness
• Promoting continuous quality improvement of
  public health systems and
• Strengthening the science base for public health
  practice improvement.

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Partners

• CDC Overall lead for coordination
• ASTHO Develop test state instrument
• NACCHO Develop test local instrument
• NALBOH Develop test govern. instrument
• APHA Marketing communications
• PHF- Research activities
• NNPHI Support through institutes

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History

• Began in 1998
• Partnership effort between CDC and five national
  public health organizations
• APHA, ASTHO, NACCHO, NALBOH, PHF
• Numerous working groups
• Extensive Field Testing
• TX, FL, HI, MO, OH, MN, MS, NY, MA
• National launch in June 2002

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The Assessment Instruments

• State public health system
• Local public health system
• Local governance
• International

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Field Testing of Assessment Instruments
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Four 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

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1. The Essential Services as a Framework

• Provides a foundation for any public health
  activity
• Describes public health at both the state and
  local levels
• Instruments include sections addressing each ES

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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
• Evaluate health services
• Conduct research for new innovations

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2. Focus on the System

• More than just the public health agency
• Public health system
• All public, private, and voluntary entities that
  contribute to public health in a given area.
• A network of entities with differing roles,
  relationships, and interactions.
• All entities contribute to the health and
  well-being of the community.

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The Public Health System
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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
• NPHPSP Local Instrument - used within the MAPP
  planning process

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How Does MAPP Fit In?

• Mobilizing for Action through Planning and
  Partnerships (MAPP)
• Developed by NACCHO and CDC
• Community strategic planning tool
• Web-based tool www.naccho.org

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Coordination with MAPP

• Use of NPHPSP within MAPP ensures broad-based
  involvement
• MAPP provides the process for addressing
  strengths and weaknesses
• MAPP includes three other assessments

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Connections to Other Initiatives

• Essential Public Health Services
• Healthy People 2010
• MAPP
• Turning Point
• Bioterrorism and emergency response
• CDC BT cooperative agreement
• Focus Area A

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Instrument Format
Essential Service
Indicator
Model Standard
Measures
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Key Steps in the Process

• Identify and recruit participants
• Orient participants
• Complete the instrument
• Use facilitators and recorders
• Gain consensus responses
• Submit responses to CDC
• Discuss CDC report with participants
• Determine challenges and opportunities

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Identifying Participants

• Key questions
• Who plays a role in the public health system?
• Who has a hand in providing the Essential
  Services?
• What broad, cross-sector participation is needed?
• What consumers can be included?
• Who else needs to be included (e.g., to assure
  expertise in certain areas)
• How many people should participate?
• Ensure consistency or a core group among
  respondents

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Different Approaches

• Retreat (1 2 days)
• Pro Short timeframe maintains momentum
• Con Requires time commitment can be
  overwhelming
• Small Group Activities
• Pro Allows for expertise, as needed Less
  overwhelming
• Con Less cross-learning Less consistency in
  response development
• Series of Meetings
• Pro Allows for expertise, as needed Gets the
  work done in small pieces
• Con Participation changes with meeting
  attendance process may seem to drag on

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Determining Responses

• All responses should be consensus
• Think about the focus of the question
• System diffusion Do more than 25, 50, (or)
  75 of the partners who make up the system do
  this?
• Dispersion through program areas
• Extent of activity
• Frequency of activity
• Quality of activity

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Determining Responses
Low Partial
High Partial
No
Yes
High dispersion Low quality Or Low
dispersion High quality
No dispersion No quality
High dispersion High quality
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Facilitator and Recorder Tips

• Facilitators
• Ensure everyone agrees to the process
• Keep the discussion moving
• Review the model standards
• Gain consensus responses!!
• Recorders
• Track responses
• Track discussion points / ideas for improvement

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Submitting Responses for a CDC Report

• Get User ID from CDC or state contact
• Log on to CDC web-based instrument
• Respond to basic demographics questionnaire
• Submit NPHPSP results to CDC website
• CDC analyzes the data
• CDC generates a report for the respondent

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Summary Scores NPHPSP Local Public Health
Performance Assessment InstrumentCounty Name
State Name
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(No Transcript)
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Summary of Performance on Model Standards
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Sample Report Information

• Narrative
• Chart of Summary Scores
• Bar Charts by Essential Service
• Table of indicators ranked by Met, Substantially
  Met, Partially Met, Not Met
• Pie Charts

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Coordinated Statewide Process

• Use of multiple NPHPSP instruments in a
  coordinated approach
• Benefits
• Coordinated orientation, training, and technical
  assistance opportunities
• Aggregate reports of assessment results
• Coordinated quality improvement planning

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Moving toward Quality Improvement - The Final Step

• Collectively discuss scores and results
• Refer to comments and ideas made during the
  instrument completion process
• Identify priority areas to address
• Collectively develop strategies to address
  priorities
• Connection with MAPP

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From Standards to Performance ManagementSupporti
ng System Performance Improvement
Performance Standards (optimal level of
performance)
Manage Performance (institutionalize system
performance improvement)
Performance Measurement (assessing current
performance against standards)
Identification of Gaps (quantitative and
qualitative analysis)
Planning for System Performance Improvement
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Using the Results for Quality Improvement
Examples from the Field

• Mississippi
• Used the information to develop legislative
  language for a capital improvement bond
• Used data for BT grant proposal
• Used data for the Sunset Commission report
• Used data for a proposal addressing environmental
  health improvement

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User Benefits

• Improves organizational and community
  communication
• Brings partners to same table
• Promotes cohesion and collaborative work among
  system members
• Provides a systems view of public health services
  delivery
• Provides a benchmark for public health practice
  improvements

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Potential Uses of NPHPSP Data and Information

• Community mobilization
• Alliance building
• Resource allocation
• Program evaluation
• Policy development
• Grant-writing
• Public accountability

• Benchmarking
• Needs assessment
• Strategic planning
• Quality improvement
• Performance Management

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Resources

• www.phppo.cdc.gov/nphpsp
• The three instruments
• User Guide
• Frequently Asked Questions
• Glossary
• Competency Handbook
• Other online resources
• MAPP at mapp.naccho.org
• www.phf.org/PerformanceTools/NPHPSPtoolsEPHS.pdf
• CDC and partner staff
• CDC toll-free help line 1-800-PHPPO-49

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Why Is this Important?
Healthy People - Protected - in Healthy
Communities
Served by high-performing public health systems
that provide science-based health and
health-enhancing services effectively