Casey Milne

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ImprovingPublic Health Preparedness
Hot Topics in Preparedness

• Casey Milne Tom Milne
• Milne Associates, LLC
• January 20th, 2005

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Objectives for todays session

• Explain how improvement is a natural part of
  public health preparedness (not an extra)
• Identify an improvement process
• Apply improvement principles to emergency
  preparedness
• Describe resources (including colleagues) that
  could help you in improving your communitys
  preparedness
• Identify your next step

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Question
Within my PH agency/system our quality
improvement efforts can be best described as
A) formal, active and effective B)
non-existent C) informal, sporadic and somewhat
effective D) formal, inactive and ineffective
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Model for Improvement
Outcome
Global PHS
National PHS
Management
Practice
State-Local PHS
LPHS
LPHA
Structure
Process
Leadership
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Question
Which of the following help give focus to
improvement efforts
A) differences between standards and actual
practice B) examples of best practices C)
examples of lower cost/more productive
programs D) all of the above
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Areas to focus improvement efforts

• Where there are differences between standards,
  science and practice
• Identified recommendations from performance
  assessment (e.g. NPHPSP)
• Gaps in current practice from evidence-based
  and/or scientific knowledge
• Published evidence (3-4 articles)
• Where examples of better performance exist
• At least one sentinel organization
• Where others are achieving lower costs and/or
  improved outcomes

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Getting Started

• Identify describe the problems!
• Ask users, partners providers for feedback,
  review competencies and essential services
• Draft Charter to guide and lead improvement
  work
• Secure use mentors/experts/facilitators
• Find colleagues interested in improvement
  identify team
• Day-to-day leadership
• Technical expertise (clinical measurement)
• System leadership

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Charter

• The Charter guides and leads improvement efforts
  for an individual, a team, a county, a state, a
  nation or globally

• Vision
• Mission
• Operational principles
• Description of the problem
• Stretch goals
• Targeted measurable objectives
• Matrix of changes related key measures

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Starting the cycle of improvement

• Set an objective or aim
• Select 1-2 simple measures measure consistently
• Begin with easy/small actions/changes most apt to
  meet objective (improve practice)
• Begin, start small, measure and grow
• Secure support of senior leadership-keep them
  updated of progress, results and lessons learned

Cycle of Improvement
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Using Data for Quality Improvement
There must be a better way to make decisions.
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Examples of Measurable Objectives

• All communities within the jurisdiction are
  covered with a BT plan and are included in
  exercises on a prescriptive basis.
• 100 of LPHA in the state are certified as Public
  Health Ready.
• All community players are involved in BT
  preparedness practices, elected officials are
  present and involved.

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Question
Which of the following statements about
measurement in improvement efforts is NOT TRUE?
A) measurement should become a daily routine B)
all change leads to improvement C) improvement
occurs as a result of change D) measures need to
reflect improvement
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Tips on Measurement

• Measures should monitor an outcome that benefits
  those receiving service, contributes to health
  status, public health competencies, essential
  services, etc.
• Include measurement into daily routines
• Improvement occurs as a result of change
• All change does not lead to improvement
• Measures need to reflect the improvement
• Measures are used to guide improvement
• Not judgment
• Not research

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Remember
What gets MEASURED
gets DONE !
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Steps in Performance Improvement

• Organize participation for performance
  improvement
• Identify improvement team
• Develop Charter and identify structure
• Ensure leadership support and accountability
• Identify gaps between actual and desired
  performance
• Gaps in doing it and doing it well
• For example
• Low scores on EPHS 2 (Diagnose Investigate),
  2.2.2.4 Identify community assets that can be
  mobilized to respond to an emergency
• Low score on CDC performance goals, measure 13,
  timeliness of response to disease reports

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Steps in Performance Improvement

• Prioritize areas for action
• Low hanging fruit (whats working elsewhere?)
• Factored in size of the gap, resource
  potential,political interest, workforce
  proficiency, and current intentions to improve
• Summarize challenges and opportunities (analyze
  root causes of performance problems in system)
• Information, including expectations and feedback
• Materials and resources
• Methods (processes)
• Knowledge and skill
• Incentives, consequences

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Steps in Performance Improvement

• 5. Develop improvement plans
• Specific targets
• Strategies that address root causes
• Define accountabilities
• 6. Implement and manage results
• Carry out change on small scale
• Report analyze effects of change
• Act on what was learned
• Keep at it

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Identifying changes that improve practice

• Consider innovation from sentinel practices
• Use existing successes and knowledge
• Get feedback from users, partners providers
• Look for and adapt to local needs and conditions
• Listen for and consider building on lessons
  learned from other colleagues and partners
• Be strategic prioritize changes and action based
  on the objectives, known problems, and whats
  possible
• Stay in alignment with the over arching goals of
  the organization and community

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Learning Community
Site Visits Coaching
Communicate Learning Successes Barriers
Hunches Lessons Learned
Distance Learning Learning Sessions
Web Conferencing, Email Support
PD SA
PD SA
PD SA
PD SA
PD SA
PD SA
PD SA


Plan gt Do gt Study gt Act


Measure Plot Over Time




Monthly 1 page reports
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Inspiring Leading Improvement
What can we do to create more innovation change
leading to improvement in public health practice?
Early Adopters
Laggards
Early Majority
Late Majority
Innovators
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34
16
2.5
13.5
0
0 sd
0 - sd
0 - 2sd
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Question
When it comes to creating innovation and change,
I would describe myself as a
A) innovator B) early adopter C) early
majority D) late majority
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Youre not on the road to improvement when you

• Study the problem too long
• Wait for everyones buy-in (or permission)
• Educate without changing expectations or systems
• Measure everything
• Measure nothing
• Dont build support for change and improvement
• Settle for the status quo

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Model of a performance management system
Turning Point Performance Management National
Excellence Collaborative
Source Turning Point Performance Management
Collaborative, From Silos to Systems Using
Performance Management to Improve the Publics
Health , March 2003.
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Question

• Where would you start if you wanted to begin an
  improvement effort for your systems public
  health preparedness?
• What is your next step?

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Questions?
Comments?
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For additional details contact

• Milne Associates, LLC
• Casey Milne, Tom Milne
• 262 NW Royal Blvd
• Portland, OR 97210
• 503 203-1025 (Phone)
• 503 203-1026 (Fax)
• casey.milne_at_comcast.net
• tom.milne_at_comcast.net