Public Health Accreditation and Quality Improvement

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Public Health Accreditation and Quality
Improvement

• Ron Chapman, MD, MPH
• Director and State Health Officer
• California Department of Public Health

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California

• 37.6 Million Californians
• 61 Local Health Departments
• California Department of Public Health (CDPH)
• 3800 employees
• 3.5 billion
• 40 field offices
• 200 programs

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www.phaboard.org
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National Accreditation Program

• The goal of the national public health
  accreditation program is to improve and protect
  the health of the public by advancing the quality
  and performance of state, local, territorial and
  tribal health departments.
• Accreditation will drive public health
  departments to continuously improve the quality
  of the services they deliver to the community.

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The Value of Accreditation

• Drive organizational change.
• Create a quality improvement infrastructure.
• Improve business operations.
• Improve accountability and monitoring.
• Increase credibility.

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Overview

• CDC and RWJ funded since 2007
• Beta-Test site visits 2009-2010
• Standards published July 2011
• Launch Event September 2011
• Voluntary Accreditation-two categories
• Accredited (5 years)
• Not Accredited

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Accreditation Structure

• Domains (12)
• Standards (30)
• Measures (106)

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Domains

1. Conduct and disseminate assessments focused on
   population health status and public health issues
   facing the community.
2. Investigate health problems and environmental
   public health hazards to protect the community.
3. Inform and educate about public health issues and
   functions.
4. Engage with the community to identify and address
   health problems.
5. Develop public health policies and plans.
6. Enforce public health laws.

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Domains

• Promote strategies to improve access to health
  care services.
• Maintain a competent public health workforce.
• Evaluate and continuously improve health
  department processes, programs, and
  interventions.
• Contribute to and apply the evidence base of
  public health.
• Maintain administrative and management capacity.
• Maintain capacity to engage the public health
  governing entity.

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Public Health Accreditation Critical Elements

• Strategic Plan
• Quality Improvement
• State Health Assessment
• Lets Get Healthy California www.chss.ca.gov
• State Health Improvement Plan

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Standard 9.2 Develop and implement quality
improvement processes integrated into
organizational practice, programs, processes, and
interventions.

• Written quality improvement plan.
• Describe a culture of quality and the desired
  future state of quality in the department.
• QI communication plan.
• QI training plan.

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The World Is Flat

• We see the world from one place - OURS.
• What if we could see the world through a thousand
  eyes?
• Easy to blame the people when the system has no
  name and is hard to identify.

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The World Is Round Systems Run Our lives

• People create systems
• Each system is perfectly designed to serve the
  purpose for what is was intended.
• People are not the system.
• Need to analyze and change the system, not the
  people.

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What is the System?

• Pipes where demand for services goes in one end
  and a service/product comes out the other end.
• History and a series of decisions makes the pipes
  long and tortuous.
• The pipes need to be straightened and shortened.

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Expectations

• People will learn and use the tools to analyze
  and transform systems.
• People will be empowered to use these tools and
  to make the systems changes.
• The system will be changed to provide better and
  faster services for our customers.
• Process will not be sacrificed for product.

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What Performance Management and QI Are Not

• Not a replacement for
• Leadership skills
• Functional teams (team building)
• Governance

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The Tools

• QI is a set of tools to help people understand,
  analyze, and transform systems.
• Need to tear apart the house to see the pipes.
• QI principles
• Systems and customer focus
• Evidence-based and data driven
• Shared decision making
• Multidisciplinary process (many eyes!)
• Continuous Quality Improvement (CQI)
• Plan, Do, Study, Act (PDSA)

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Contracts

• Problem Contracts are not being executed timely
  (3,000 contracts in CDPH)
• Severely harmed credibility
• Risk of losing Federal funding
• Baseline Data
• Department of General Services (DGS) routinely
  rejected 60 70 of contracts
• Review all of the DGS Rejections for past year
• Unclear and/or Poor Scope of Work and Budget 75
• Conflicting Exhibits 25

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Results

• Of last 900 contracts only 4 were returned from
  DGS 0.4 rejection rate.
• Some programs given streamlined contract
  authority from DGS.
• Customers have noted improved contracting process.

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Office of Quality Performance and Accreditation
(OQPA)

• Established July 2012.
• Deputy Director reporting to CDPH Director.
• Staff integrated from across CDPH.
• CQI training for executives teams July-Sept.
• CQI Academy to train all 3,800 employees.
• Disseminate to local public health.

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Hire Experts

• External expertise for training/coaching
• Public Health Foundation Dr. Jack Moran
• July 2012 Executive Management training
• August 2012 Two-day QI team training (4)
• Patricia Porter QI Consultant
• September 2012 Current Coaching of QI teams
  (4)

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Pioneer QI Teams

• Four QI teams
• Human Resources, Communicable Disease, Employee
  Satisfaction and Vital Records

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Next Steps

• Performance Management System
• Build department knowledge on accreditation
  requirements
• Deploy web based Quality Improvement training
  (mandatory) for all current/future employees
• State Health Assessment and Plan
• Hire dedicated accreditation staff