AHEC march 2011 spokane pp 2 pdf

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Rural and Frontier Counties worked to improve public health for jurisdictions of every size...public health for everyone...How two public health nurses effected positive change in Montana

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AHEC march 2011 spokane pp 2 pdf

  1. 1. Creating a Sustainable Model of Public Health for All of Montana: Strategies for Best Practices in Innovative Policy Development: The Journey of HB 173 Michele Sare, MSN, RN Nurses for Nurses International March 2011: AHEC Spokane, WA
  2. 2. Prevents epidemics and the spread of disease Protects against environmental hazards Prevents injuries Promotes and encourages healthy behaviors Responds to disasters and assists communities in recovery Assures the quality and accessibility of health services (*CDC slide)
  3. 3. Public Health has some issues
  4. 4. 10 million children…18 each minute 1 million girls and women 32 million with HIV/AIDS 13 million with TB 27 million with malaria…most children ½ of the world‟s children will go to bed hungry …again Disparity - Inequity
  5. 5. 20% of our population “If you’ve seen one PH Department, you’ve seen one PHD”
  6. 6. 7 days/week HH care 2 – 3 x/d No governance support for PH Governance miss-management of funds No cavalry My Life as a LPHO
  7. 7. PH is a little broken…and has been neglected Should not be ‘person-bound’…. A profession has guidelines, standards & ethics Concern for regionalization, loss of services Sustainable Local Public Health?
  8. 8. Poor Health/Healthcare Hurts 25% > 65 by 2015 in MC 18% poverty rate in MC….increasing 44% of all Montana children uninsured (therefore do not seek healthcare appropriately) High rates of obesity (40%) in MC Alcohol & drug abuse in MC Leading causes of premature death in MC are heart disease, cancer & stroke – all early prevention MVA, resistant microbial infections, STDs & other preventable factors disable or kill our citizens
  9. 9. Changing Paradigms Evidence Knowledge Cultural Shifts Collaboration  „De-siloing‟ Accountability
  10. 10. WE ASKED: “WHAT’S UP WITH THIS?”
  11. 11. We Went Fishing… Michele & Peggy & her crew – Mineral Co. Dan & Gordon MPHA, AMPHO & other Local HDs DPHHS ___________ = HB 173
  12. 12. National & International ‘Mandates’ for PH We ended Healthy People 2010 We’re headed toward a new set of national health goals in Healthy People 2020 (HP 2020) MDG -The United Nations – with the World Health Organization (WHO) http://www.un.org/millenniumgoals/
  13. 13. 1. End Poverty and Hunger 2. Universal Education 3. Gender Equality 4. Child Health 5. Maternal Health 6. Combat HIV/AIDS 7. Environmental Sustainability 8. Global Partnership Millennium Development Goals
  14. 14. Mission: Promote Physical and Mental Health and Prevent Disease, Injury, and Disability (*CDC slide) Vision: Healthy People in Healthy Communities
  15. 15. National Trends…Others have been asking “What’s up w/ this?” HC reform nationally – cost, quality and access 3,000 LHD nationwide…independent models …‟made-up/person-bound‟ Not standardized – Old mantra = “If you‟ve seen one LHD, you‟ve seen one LHD” Dilution of services – vying for HC dollars „Regionalization‟ and loss of services
  16. 16. National Guidelines US DHHS CDC PHAB APHA NACCHO, ASTHO & NALBOH RWJF & W. K. Kellogg Foundation
  17. 17. Institute of Medicine (IOM) Reports Tipped the HC world on its ear… “Quality Chasms” 1988  PH Improvement came assessment, policy development & assurance An update in 2003, The Future of the Public’s Health in the 21st Century Still not doing too well…
  18. 18. State Laws & Guidelines Montana Code Annotated (MCA) – Title 50-2 (http://data.opi.state.mt.us/bills/mca_toc/50.htm ) Administrative Rules of Montana (ARM) – 37 – (http://www.mtrules.org) MPHA AMPHO Local ordinances MT Environmental Health Agencies BON
  19. 19. PH Drivers • IOM - The Institute of Medicine serves as adviser to the nation to improve health. • CDC – Overall lead for coordination • ASTHO – Develop and support state instrument • NACCHO – Develop and support local instrument; MAPP • NALBOH – Develop and support governance instrument • APHA –Marketing and communications • PHF- Performance improvement; data collection and reporting system • NNPHI – Support through institutes, training workshop and user calls • PHAB - In order to improve the health of the public, the Public Health Accreditation Board (PHAB) is developing a national voluntary accreditation program for state, local, territorial and tribal public health departments (*from a CDC slide)
  20. 20. Strengthening systems, improving the public’s health
  21. 21. History of the NPHPSP Key Dates – Began in 1998 – Version 1 instruments released in 2002 – 2002-2007 – Version 1 instruments used in more than 30 states – Development of Version 2 instruments – 2005-2007 Comprehensive Development of Instruments – Practice-driven development by CDC and ASTHO, NACCHO and NALBOH Work Groups – Field testing –  Creation of PHAB – 2007 (*CDC slide)
  22. 22. Schools Community Centers Employers Transit Elected Officials Doctors EMS Law Enforcement Nursing Homes Fire Corrections Mental Health Faith Institutions Civic Groups Non-Profit Organizations Neighborhood Organizations Laboratories Home Health CHCs Hospitals Tribal Health Drug Treatment Public Health Agency Public Health System (*CDC slide)
  23. 23. Existing Tools
  24. 24. Tools to Implement 173 ‘10 Essentials’ The ‘PH Wheel’ (10 Essentials) NACCHO’s Operational Definition of a Functional Local Health Department & Metric NALBOH’s Local PH Governance Instrument, Version 2 PHAB Domains, Standards & Measures and corresponding tools – in beta ANA Scope & Standards of PHN….(& MCA & BON) Evidenced Based Practice (EBP): research, literature reviews, journals & current texts
  25. 25. Operational Definition of a Functional Local Health Department: NACCHO + Metrics
  26. 26. PHAB’s Purpose “In order to improve the health of the public, the Public Health Accreditation Board (PHAB) is developing a national voluntary accreditation program for state, local, territorial and tribal public health departments. The goal of the accreditation program is to improve and protect the health of every community by advancing the quality and performance of public health departments.” www.phaboard.org/
  27. 27. PHAB Draft Tools (Based on the ’10 Essentials’) Local Standards & Measures Self- Assessment Tool Health Department Readiness Checklist Guide to National Voluntary Accreditation Domains, Standards & Measures (final)
  28. 28. PHAB Beta Test: Paralleling 173 30 PH Departments o 3 Tribal o 8 State HD o 19 Local HD o Beta testing Domains, Standards & Measures o Accreditation tools in draft form as beta test continues o Existing tools in-use o Beta Test - October 2009 – December 2010
  29. 29. We are on the crest of a great wave of change in public health….
  30. 30. So….How did we ‘do It’? Tools  Synergy
  31. 31. Rule no. 1 to effecting a positive policy change (and this is the biggy – the foundation for all others) – do your dandiest to create a ‘win-win’ situation for all stakeholders 11 Rules to Effective Policy Change
  32. 32. Infrastructure Federal „HD‟  HHS SHD State Laws LHD Local Governance
  33. 33. RULE NO. 2 TO POSITIVE POLICY CHANGE: RECRUIT YOUR LEGISLATIVE CALVARY
  34. 34. RULE NO. 3: EDUCATE, EDUCATE, EDUCATE!
  35. 35. RULE NO. 4: NEVER CONSIDER ASKING FOR MORE MONEY FOR A PROGRAM IN A POOR STATE THAT IS ALREADY AWARDING TONS OF MONEY (IN THE LEGISLATOR’S VIEW) TO A PROGRAM THAT SOUNDS AN AWFUL LOT LIKE WHAT YOU’RE TRYING TO DO
  36. 36. RULE NO. 5: CLEARLY DEFINE THE ROLES AND RESPONSIBILITIES OF STAKEHOLDERS
  37. 37. Partners & Stakeholders Montana Legislature Taxpayers – Mineral County citizens, governance & HC entities Representative Gordon Hendrick & Education Policy Advisor Dan Villa DPHHS – PH Improvement group NWCPHP PHAB & MLC III PHSITF HB 0173 Pilot Projects BON, ANA, NLN + National PH Agencies
  38. 38. RULE NO. 6 OF POLICY CHANGE: IT IS ‘S-L-O-W’, BE PATIENT AND THOROUGH (THIS 18 MONTHS WAS ACTUALLY PRETTY SPEEDY!
  39. 39. RULE NO. 7: CREATE A COMPELLING PURPOSE THAT EVERYONE CAN UNDERSTAND – ‘BRAND’ IT.
  40. 40. RULE NO. 8: CREATE BUY-IN BY MAKING SURE THAT IT ISN’T ABOUT ‘YOU’ IT IS ABOUT THE GREATER GOOD
  41. 41. RULE NO. 9: BE A MASTER COMMUNICATOR AND LEAVE NO ROCK UN-TURNED WHEN COMMUNICATING!
  42. 42. RULE NO. 10: BELIEVE IN YOUR POLICY ‘PRODUCT’ AND LEARN THE BUSINESS OF ‘SALES’!
  43. 43. RULE NO. 11 IS AN ‘EXTRA’ – IT IS WHAT YOU BECOME WHEN YOU WORK TO CREATE A WIN- WIN – NO. 11 IS A BENEFIT – GAINING A SENSE OF GROWTH AND CONTRIBUTION
  44. 44. HB 0173 Sites 1. Butte-Silverbow 2. Yellowstone (Riverstone) 3. Richland 4. Mineral 5. Cascade 6. Hill 7. Prairie
  45. 45. Purpose 1. Determine what it takes to create a sustainable model of a local PHD in our frontier setting 2. Determine what it takes to create a sustainable model of an accredited local PHD in our frontier setting
  46. 46. 4 Over-Riding Tasks 1. Conduct a Self-assessment based on the PHAB Self- Assessment Tool 2. Conduct a Community Health Assessment (CHA) 3. Develop a Community Health Improvement Plan (CHIP) 4. Develop a PH Strategic Plan (PHSP)
  47. 47. Who We Are Accountable To (who is watching us, wants reports & where the money came from) ARRA – The American Recovery & Reinvestment Act: Montana RRA $ “ARRA funds are targeted toward rebuilding infrastructure and positioning the country to grow the next generation economy”.
  48. 48. Also Accountable To: Legislators & Legislative Interim Committee Local Governance DPHHS PH Improvement group PHITF Bruce & Jack (contractors to DPHHS – from NWCPHP) PHAB Little cross-over w/ RWJF & the MLC III
  49. 49. Project Schedule Began 11/1/2009 Self-assessment 1/2010 – 4/30/2010 Began Community Health Assessment (CHA) 9/2010 Report to Legislative Interim Committee August 24, 2010 Year 1 – completed 6/30/2010 Year 2 – 7/1/2010 – 6/30/2011 Year 2 – CHA, CHIP & PHSP
  50. 50. MEASURING ACCOUNTABILITY: Based on the language of HB 0173 http://data.opi.mt.gov/bills /2009/billhtml/HB0173.htm
  51. 51. Role of DPHHS & PHITF Oversight of HB 0173 progress Guidance materials and assistance Resource Technical assistance
  52. 52. Guidance PHAB CDC NACCHO Interpret & facilitate the guidance: NWCPHP PHSITF DPHHS
  53. 53. The New Public Health Together - We have work to do!
  54. 54. The End… …References • CDC: http://www.cdc.gov/od/ocphp/nphpsp/ • PHAB: http://www.phaboard.org/ • NACCHO: http://www.naccho.org/ • IOM: http://www.iom.edu/ • MAPP: http://www.naccho.org/topics/infrastructure/MAPP/ index.cfm • PDSA: http://www.valuebasedmanagement.net/methods_d emingcycle.html • NFNI: http://www.nursesfornursesinternational.com

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