The Practical Playbook National Meeting 2016 www.practicalplaybook.org Bringing Public Health and Primary Care Together: The Practical Playbook National Meeting was at the Hyatt Regency in Bethesda, MD, May 22 - 24, 2016. The meeting was a milestone event towards advancing robust collaborations that improve population health. Key stakeholders from across sectors – representing professional associations, community organizations, government agencies and academic institutions – and across the country came together at the National Meeting to help catalyze a national movement, accelerate collaborations by fostering skill development, and connect with like-minded individuals and organizations to facilitate the exchange of ideas to drive population health improvement. The National Meeting was also a significant source of tools and resources to advance collaboration. These tools and resources are available below and include: Session presentations and materials Poster session content Photos from the National Meeting The conversation started at the National Meeting is continuing in a LinkedIn Group "Working Together for Population Health" and Twitter. Use #PPBMeeting to provide feedback on the National Meeting. The Practical Playbook was developed by the de Beaumont Foundation, the Duke University School of Medicine Department of Community and Family Medicine, the Centers for Disease Control and Prevention (CDC), and the Health Resources & Services Administration (HRSA).

1. A Framework for Healthcare and
Public Health Collaboration:
The Population Health Driver Diagram
May 23, 2016
Ron Bialek, MPP
Jack Moran, MBA, PhD
Public Health Foundation
www.phf.org

2. …PHF Mission:
We improve the public’s
health by strengthening the
quality and performance of
public health practice
www.phf.org
Experts in Quality Improvement,
Performance Management, and
Workforce Development

3. Session Learning Objectives
Describe a framework being used to build collaborative
healthcare and public health partnerships to impact a
health issue at the community level.
Describe successes that have been achieved using the
Population Health Driver Diagram framework.
Learn how to use three quality improvement tools - Force
Field Diagram, Process Decision Program Chart, and
Tree Diagram to help facilitate and build collaborative
partnerships.
Learn how to build and use a Population Health Driver
Diagram to map out and align collaborative healthcare
and public health interventions.

4. Today We Will Discuss
 How to develop a successful framework for healthcare
and public health to work in partnership, with defined roles
and responsibilities, and to impact the health of a
community.
 This framework has been successfully demonstrated to
address health issues such as the overuse of antibiotics,
vector control, and diabetes risk reduction.
 We will explore how this framework can be used to
address the overuse and abuse of opioids (prescription
opioid pain killers and heroin).

5. Exercise 1
 What are the driving and restraining forces to developing
successful partnerships/collaboration for healthcare and
public health to impact the health of a community?

6. Driving Forces Restraining Forces
Current State:
Healthcare and Public Health
Limited Collaboration
Force Field Diagram
FutureState:
Increased
Collaboration

7. Exercise 1
 What are the driving and restraining forces to developing
successful partnerships/collaboration for healthcare and
public health to impact the health of a community?

8. What is a
Population Health Driver Diagram?

10. What is a Population Health Driver Diagram?
 A population health driver diagram is used to identify primary and
secondary drivers of a community health improvement objective
 Serves as a framework for determining and aligning actions that can be
taken across multiple disciplines for achieving the objective
 Relies on healthcare and public health to work collaboratively rather than
competitively
 Grounded in the belief that healthcare and public health are more effective
when they combine their efforts and collaborate to address a health issue
than when they work separately
 Population health driver diagrams can be used to tackle challenges at
the crossroads of various sectors and stakeholders
 Helps reduce the “silo effect”

11. What is a Population Health Driver Diagram?
 A tool to show a potential change process across
many sectors of a community
 Shows the relationship between the AIM, goals to be
achieved, the primary drivers that contribute directly to
achieving desired change, and the secondary drivers
that are necessary to achieve the primary drivers
 A guide for the community health improvement team
to the appropriate actions to take to achieve their AIM
 Helps the team to have a shared view of the theory of
change in a system

12. What is a Population Health Driver Diagram?
 A population health driver diagram represents the team
members’ thinking on theories of “cause and effect” in
the system – what changes will likely cause the desired
effects.
 It sets the stage for defining the “how” elements of a
project – the specific changes or interventions that will
lead to the optimum desired outcome.
 It helps in defining which aspects of the system should
be measured and monitored, to see if the
changes/interventions are effective, and if the underlying
causal theories are correct.

13. Components of a Population Health Driver Diagram
 AIM of the Improvement Project
 Goals – Improvement Outcomes
 Primary Drivers
 Secondary Drivers

14. 30,000 Foot View
20,000 Foot View
10,000 Foot View
Goals
50,000 Foot View

20. 16 Step Process to Develop and Implement
a Population Health Driver Diagram

21. Process to Develop and Implement a
Population Health Driver Diagram
“Start Small, Think Big, and Scale Fast”
 Come up with the right:
 metrics to be used
 baseline
 improvement goals
 timeline
 Then think forward about the mid- to long-term of what you want to
fundamentally change and where you want to get to
 Once you’ve got clear objectives, strategy-led initiatives can develop and
progress quickly.

23. Process to Develop and Implement
a Population Health Driver Diagram
1. Pre-Work
2. Define the AIM of the community health issue
3. Identify a series of guiding principles for the initiative (optional)
4. Development of an Inventory of current activities – What is in my
backyard
5. Understanding the cost of the population health issue
6. Identify the goals of the AIM
7. Identify Primary and Secondary Drivers
8. Appoint Primary Driver team leads and team members
9. Develop partner contracts and commitments (optional)
10. Refine each Primary and Secondary Driver using an
Agree/Add/Change Matrix and Group Round Robin Input Process

24. Process to Develop and Implement
a Population Health Driver Diagram
11. Develop Action Areas of Secondary Drivers
12. Analyze Action Areas (AA) for overlap to other secondary drivers using
a matrix diagram
13. Develop Action Area Groupings to Implement
14. Measurement
15. Trial Implementation
16. Finalize the Change Package

25. Exercise 2 – What Could Go Wrong in
Healthcare and Public Health Collaborations?
 Use a Process Decision Program Chart
Drive to the
Pharmacy
What Could Go Wrong?
Flat Tire
No Spare
Spare Flat
Out of
Gas
Accident
Likelihood
L
H
M
L
Countermeasures

26. Exercise 3: Driver Diagram Overview
 Driver diagrams can be used to plan improvement
project activities. They provide a way of systematically
laying out aspects of an improvement project so they
can be discussed and agreed on.
 A driver diagram organizes information on proposed
activities so the relationships between the AIM of the
improvement project and the changes to be tested and
implemented are made clear.
 A driver diagram has three columns - Outcome, Primary
Drivers, and Secondary Drivers.

27. Population Health Driver Diagram
Overview
 Outcome: Aim Statement needs to be clear and
concise.
 Primary Drivers: A set of factors or improvement areas
that we believe must be addressed to achieve the
desired outcome.
 Secondary Drivers: Specific areas where we plan
changes or interventions. Each secondary driver will
contribute to at least one primary driver.

30. http://www.thecommunityguide.org/obesity/behavioral.html

31. Changes that Result
in Improvement
A P
C D
A P
S C
Very Small
Scale Test
Follow-up
Tests
Wide-Scale Tests of
Change
Implementation of
Change

33. Exercise 4: Driver Diagram Overview
 A big part of the equation to the opioid crisis in our
community are the individual community members who
are using opioids.
 As public health and population health professionals we
need to understand the whole person and the impact
culture, society, and the environment have on a
person's health journey.
 In our community, how do we help individuals to make
changes in their lifestyle to help reduce/eliminate the
opioid crisis we are targeting?

34. Summary
 Remember Population Health Driver Diagrams are
“living” documents.
 They can and should be modified as you test your
theories of improvement and learn what drivers and
interventions are important for achieving your desired
results.
 As a Population Health Driver Diagram evolves, it helps
to capture the learning that the participants have
uncovered about the initiative.

35. Summary
 Population health improvement projects can lose
momentum or derail because transformation at the
community levels requires navigating often difficult
economic, social, cultural, and political terrain.
 Population Health Driver Diagrams help overcome these
hurdles to progress that can be entrenched or
unpredictable in any project since we can test and retest
theories of improvement.
 The Population Health Driver Diagram lets everyone in
the community to have the opportunity to be involved,
have their ideas of change considered. and possibly
tested to determine the impact to the issue

36. Public Health Foundation
Strengthening the Quality and Performance
of Public Health Practice
LEARNING MANAGEMENT NETWORK
The nation’s premier learning network for
professionals and volunteers who protect the
public’s health – over ONE MILLION registered
learners and thousands of training opportunities
www.train.org
LEARNING RESOURCE CENTER
Where public health, health care, and allied
health professionals find high quality training
materials at an affordable price
• Comprehensive selection of publications
• Many consumer-oriented health education
publications
• Stories and webinars on using the Guide to
Community Preventive Services
bookstore.phf.org
www.phf.org/communityguide
www.phf.org
TECHNICAL ASSISTANCE & TRAINING
Performance management, quality improvement,
and workforce development services
• Customized onsite workshops and retreats
• Strategic planning, change facilitation,
accreditation preparation
• Tools, case stories, articles, and papers
www.phf.org/qiservices
www.phf.org/resourcestools
ACADEMIC PRACTICE LINKAGES
Furthering academic/practice collaboration to
assure a well-trained, competent workforce and
strong, evidence-based public health
infrastructure
• Council on Linkages Between Academia and
Public Health Practice
• Core Competencies for Public Health
Professionals
• Academic Health Department Learning
Community
www.phf.org/councilonlinkages
www.phf.org/corecompetencies