Tulsa System Assessment Report by fuk43069

VIEWS: 42 PAGES: 43

									Tulsa Health Department


       Tulsa
    Public Health
 System Assessment

       Final Report
         June 2008




                          1
                     Table of Contents

Executive Summary                           3

Background                                  5

Methodology
 Preliminary Work                           6
 The Assessment                             6
 Scoring Process                            7

Results
 Limitations in Interpretation of Results   7
 Performance Measurement Results            8

Recommendations                             9

Conclusions                                 10

Appendices
I.   Assessment Meeting Agenda              12
II.  Participant List                       13
III. The Essential Public Health Services   15
IV. Parking Lot Issues and Next Steps       16
V.   CDC Report of Assessment               27
VI. Evaluation                              42




                                                 2
                               Executive Summary

Public health activities are framed by a set of Ten Essential Public Health Services
which, when provided within a public health system, provide the basis for effective
public health practice. Performance assessment tools for state and local level public
health systems, and for local public health governing boards, were released by the
Centers for Disease Control and Prevention (CDC) in 2002. The Tulsa Health
Department contracted with Milne & Associates, LLC (M&A) to facilitate completion of
the local system performance assessment tool.

The assessments were facilitated by M&A over one day June 10 th, 2008. Approximately
sixty people, including Department staff and representatives from a broad range of
partner organizations, participated in the assessment. Participants rated each system
activity, framed in the essential services and described by standards and indicators in
the tool, as to the level of system performance. A standardized scale was used,
describing the degree to which each activity is fulfilled. Ratings included “Optimal” (75-
100%), “Significant” (50-74%), “Moderate” (25-49%), “Minimal” (1-24%) and “No” (0).
M&A entered data from the assessment into a CDC-maintained database and received
reports summarizing and graphing results.

The assessment results identify areas of relative strength and areas in need of
improvement in the local public health system. The overall average score for all
standards across the ten essential services was 69, which falls in the “Significant”
range. Scores for the ten essential services ranged from a high of 94 (Essential Service
#1, Monitor Health Status) to a low of 39 (Essential Service #7, Lind People to Needed
Services). The following table summarizes the distribution of standards and essential
services scores.

                Rating              No.          Pct         No.        Pct.
                                 Standards                   ES
          Optimal                    15          50%          5         50%
          Significant                 7          23%          2         20%
          Moderate                    8          27%          3         30%
          Minimal                     0          0%           0          0%
          No Activity                 0          0%           0          0%


The scoring of the performance assessment instrument was, by its very nature,
subjective and was a reflection of the make-up of the participants and the structure of
the instrument itself. Moreover, the standards against which the public health system
was measured are “Gold Standards,” representing the ideal levels of system
performance. Nevertheless, the comparison between ratings given to the indicators
and to the corresponding essential services do give some idea of relative areas of
strength and areas that might be considered for strengthening the local public health

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system. The report summarizes areas of relative strength and weakness for the local
public health system in Tulsa County. During the assessment of each standard,
themetakers recorded issues requiring more information or suggested for further
consideration; the issues were recorded in the “parking lot.” At the conclusion of each
essential service review, participants in the discussion suggested next steps that might
be taken toward improvement. Parking lot and next steps suggestions are recorded in
Appendix IV.

Based on the results of the performance assessment and the comments from and
interactions between participants, this report makes the following recommendations:

   1. Disseminate results of the assessment to participants and other key partners
   2. Initiate a local public health system planning and improvement process
   3. Consider the THD contributions to system performance and strengthen those
      crucial to community involvement




                                                                                           4
Background

The landmark report The Future of Public Health, issued by the Institute of Medicine in
1988, defines public health as “what we as a society do collectively to assure the
conditions in which people can be healthy.” That definition is built around the construct
of a population-level focus, and generally is not construed to include specific illnesses or
behaviors of individuals, but rather the effect of group decisions, values, and policies on
overall health status. The principal focus of public health is on the health of populations,
rather than on individuals, and on prevention of illness and injury rather than on their
treatment.

State and local health departments traditionally deliver public health services. Many of
the services provided by local health departments are targeted to individuals as
opposed to populations. The organization, size, resourcing, and portfolio of services
vary widely from state- to-state and, within states, from locale-to-locale. The more
progressive local health departments are beginning to replace personal health services
with activities targeted to populations and delivered in partnership with local partners.

Increasingly, communities are recognizing that the effective delivery of services
depends upon collaboration among community agencies and organizations. This
approach reflects the inability of any one organization to generate the resources,
approaches, and commitment required to address the wide range of health related
issues in the community. The emerging approach, then, relies on a public health
system at the national, state and local levels. At the local level, the local public health
system comprises all of the organizations that contribute and/or have the potential to
contribute to the health of the community. In Tulsa, as in most local communities in the
country, the public health system is not clearly defined and does not exist at a formal
level.

In 1994, a national work group chaired by the Surgeon General elucidated Ten Essential
Services of Public Health as an operational framework defining the responsibilities of
public health systems at all levels. (Appendices III and IV) In 2002, the Centers for
Disease Control and Prevention released the National Public Health Performance System
Program (NPHPSP), including three performance assessment tools for work with state
and local public health systems, and for public health governing boards. The NPHPSP
includes a set of “gold standards” within each of the essential services, and provides a
means for improvement of public health systems at the state and local levels.

The National Association of County and City Health Officials (NACCHO) developed a
system to combine measurement of the local system performance, using NPHPSP, with
three other assessments to help guide a strategic planning process. The system is
named Mobilizing Action through Planning and Partnership; the Tulsa Health
Department has actively engaged in the MAPP process, and completion of the NPHPSP
system performance assessment helps move that process.



                                                                                            5
Methodology: The assessment was performed using CDC’s National Public Health
Performance Standards Program (NPHPSP) instrument for local public health systems.
The NPHPSP tool was designed to measure performance in two to four standards for
each of the ten Essential Public Health Services.

Preliminary Work: M&A worked with THD staff in advance of the assessment to:
    Define the tool to be used. It was agreed to use CDC’s Local Public Health
       System Performance Assessment Instrument.
    Identify local public health system partners to be invited. The Department
       agreed to define the public health system broadly. Invitations were sent to
       approximately 65 individuals representing more than 45 organizations.
    The assessment approach to be used.
    Define the materials needed. M&A worked with the THD to identify, prepare and
       organize materials for the assessment, some of which were sent to participants
       in advance of the assessment sessions. Materials included the following:
           1. Session Agenda
           2. NPHPSP Local Assessment Instrument
           3. Health in America (describing the mission of public health and listing the
              essential public health services.)
           4. The Essential Services: “English” version

The Assessment: Four representatives from M&A (Susan Andresen, Paul Newell, Tom
Milne and Casey Milne) provided on-site facilitation services. Approximately 52
individuals representing 40 organizations attended the assessment. M&A provided the
following services:
           1. Orientation and overview for the work including the Ten Essential Services
           2. Orientation to the assessment process
           3. Coordination and work with the “Theme Takers” who recorded the scores,
              responses and parking lot issues during each of the assessment sessions

  The following describes the approach used to complete the assessment (see Appendix
I for the meeting agenda):

   1. After the opening sessions and orientation to the process and tool, a plenary
      session was facilitated to complete review of the essential service (Essential
      Service #7). The plenary session was designed to allow all participants to
      experience the process together as a strategy to help build comfort and
      consistency among subsequent concurrent sessions.
   2. Reviews of all remaining essential services were completed in facilitated breakout
      groups. Each breakout included approximately one-third of the group to
      complete the standards and indicators for a single essential service. Individual
      participants were pre-assigned to specific breakouts to help assure a good
      mixture of expertise and perspectives for each of the essential service reviews.




                                                                                       6
   3. At the conclusion of the last set of three breakout sessions, participants
      reconvened. Themetakers reported next steps identified by the breakout groups
      and an evaluation of the assessment process was completed.

After the assessment was completed, M&A entered the assessment results into the CDC
database, received a copy of the results from CDC (including graphs and raw scores),
conducted analysis and completed this report. The final CDC report is included in
Appendix V beginning on page 27.

Scoring Process: Through a facilitated process, participants in the assessment reached
consensus on a rating of the degree to which the system successfully addresses each of
the questions comprising the instrument. The ratings include the following:

      Measure                                      Definition
Optimal Activity         Greater than 75 percent of the activity described within the
                         question is met within the local public health system.

Substantial Activity     Greater than 50 percent, but no more than 75 percent of the
                         activity described within the question is met within the local
                         public health system.
Moderate Activity        Greater than 25 percent, but no more than 50 percent of the
                         activity described within the question is met within the local
                         public health system.

Minimal Activity         No more than 25 percent of the activity described within the
                         question is met within the local public health system.

No Activity              No activity at all, 0%


Results
The local public health system performance assessment instrument includes a number
of questions designed to measure the degree to which the ten Essential Public Health
Services are met. This section summarizes the results of the assessment.

Limitations in Interpretation of Results: Before considering the results of the
assessment, it is important to consider a number of factors related to the instrument
and to the assessment process that limit interpretation and the degree to which
conclusions can be drawn.

   1. The standards are intended to describe the optimal level of performance. It
      is not expected that any system would fully meet the standards; lower scores
      can be seen as identifying opportunities for improvement.




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   2. The “scoring” system is subjective. Although the University of Kentucky has
      validated the tool, actual “scores” are relative and should not be construed as a
      precise quantitative measurement of performance.
   3. The “scoring process” can create some distortion in scores, as individual leaders
      can influence the perceptions of other participants.
   4. “Scoring” of the instrument is somewhat dependent on the number of
      participants, their collective experience and level of knowledge about the content
      material, and their consistent participation in the assessment.

Nevertheless, the results are useful and do provide a beginning framework for
determining areas in need of improvement and for measuring progress of
improvement efforts.

Overall Performance: The assessment results identify areas of relative strength and
areas in need of improvement in the local public health system. The overall average
score for all standards across the ten essential services was 69, which falls in the
“Significant” range. Scores for the ten essential services ranged from a high of 94
(Essential Service #1, Monitor Health Status) to a low of 39 (Essential Service #7, Link
People to Needed Services). The following table summarizes the distribution of
standards and essential services scores.

                 Rating              No.           Pct        No.       Pct.
                                  Standards                   ES
          Optimal                     15        50%            5        50%
          Significant                  7        23%            2        20%
          Moderate                     8        27%            3        30%
          Minimal                      0        0%             0         0%
          No Activity                  0        0%             0         0%

The scores for each of the essential services are displayed in the table on the next
page.

              Essential Service No.>   1   2   3     4    5     6   7    8     9   10
   Overall Essential Service Score
    Optimal Activity                   √   √              √    √                       √
    Significant Activity                       √                         √
    Moderate Activity                                √              √          √
    Minimal Activity
    No Activity

The comparison between ratings given to the indicators and to the corresponding
essential services give some idea of relative areas of strength and areas that might be
considered for further strengthening the local public health system. The results of the
assessment suggest that areas of system strength as reflected by the Standards scoring
include:


                                                                                           8
          Community profile (Standard 1.1)
          Current technology (Standard 1.2)
          Registries (Standard 1.3)
          Emergency response (Standard 2.2)
          Laboratories (Standard 2.3)
          Risk communication (Standard 3.3)
          Governmental presence (Standard 5.1)
          Community health improvement plan/strategic planning (Standard 5.3)
          Emergency plan (Standard 5.4)
          Review laws (Standard 6.1)
          Improve laws (Standard 6.2)
          Enforce laws (Standard 6.3)
          Workforce standards (Standard 8.2)
          Continuing education (Standard 8.3)
          Foster innovation (Standard 10.1)
          Academic linkages (Standard 10.2)

Areas of weakness in the system, reflecting standards the performance scores for which
were in the “Minimal” range, include:
        Health education/promotion (Standard 3.1)
        Health communication (Standard 3.2)
        Community partnerships (Standard 4.2)
        Policy development (Standard 5.2)
        Personal health service needs (Standard 7.1)
        Assure linkages (Standard 7.2)
        Evaluation of population health (Standard 9.1)
        Evaluation of the local public health system (Standard 9.3)

During the assessment of each standard, issues requiring more information or
suggested for further consideration were recorded in the “parking lot.” At the
conclusion of each essential service review, participants in the discussion suggested
next steps that might be taken toward improvement. Parking lot and next steps
suggestions are recorded in Appendix IV.


Recommendations:
Based on analysis of the assessment findings and the comments and observations of
the participants, M&A offers the following recommendations to the Tulsa Health
Department. The first three recommendations should be considered with a sense of
urgency, given their implications for public health practice across the local public health
system.

   1. Disseminate results of the assessment: It is recommended that THD follow up
      the assessment with a written summary of the results sent to the external
      partners who participated in the assessment. THD may consider inviting the


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      participants to a follow-up meeting where the results would be presented, and
      where interest in further work to make system improvements could be explored.

      It is recommended that this action take place within 4-6 weeks if possible to
      maintain interest and momentum.

   2. Initiate a local public health system planning and improvement process: As a
      direct follow-up to the first recommendation, THD should consider leading a
      process to plan for over-all system improvement. Several ideas were generated
      during the NPHPSP assessment for “next steps” to be taken and they may form
      the beginning point for a local improvement plan. Further, the “parking lot”
      issues should help identify areas for dialogue and improvement focus. Finally,
      the Appendix of the CDC Report on the Tulsa Assessment (Appendix V, page 41)
      offers resources for next steps in the improvement process.

   3. Consider the THD contributions to system performance: As is the case for most
      communities presently, the local health department plays a critical and probably
      central role in assuring that the ten essential services are addressed and that the
      local public health system is on a track for improvement. Therefore, it is
      essential that THD has a clear picture of its role in the local system, and that it
      strengthen its capacities in that context.

      The system is strong in the areas of traditional public health practice and that is
      most likely a reflection of the health department’s strengths (e.g. Essential
      Services 1 & 2, Monitoring Health Status and Diagnosing & Investigating).
      However, the system is weaker in areas which will require leadership from the
      health department (e.g. Essential Service 3 and 4, Educating & Empowering the
      Community and Mobilizing Partnerships). It is recommended that THD consider
      the need for strengthening its capacities and presence in work of the essential
      services that depend on the convening, mobilizing, and leadership capacities of
      the health department.

Conclusion:

The general scores of the assessment are higher than are found in many local system
assessments. That is most likely a reflection of the leadership and general presence of
THD. Further, it was apparent that a number of coalitions and partnership activities are
in place in Tulsa County, reflecting strongly on the vision and interests of the health
department and its many partners. However, there is evidence of need for
improvement in several of the essential services, and for a continuing shift to a
population health focus on the part of the health department and its partners.

The participation of nearly50 external partners in the community assessment
demonstrates that many of the needed connections are already well established and
that there is a will to work on strengthening the public health system.


                                                                                        10
Appendices




             11
                                      APPENDIX I
                               Assessment Meeting Agenda
  Intended Results:
         Completion of the National Public Health Performance Standards Assessment
            Process
         Deepened understanding of the Tulsa County Local Public Health System, the
            various roles partners play, and the importance of collaboration to the health of
            county residents
         Initiation of a local system improvement process

  Time                                   Topic                                     Room
8:00 am     Registration, Refreshments                                        Main Auditorium

8:30 am     Welcome, Introductions & Overview of the Day                      Main Auditorium

8:45 am     Orientation                                                       Main Auditorium

9:15 am     Plenary of Essential Service #7                                   Main Auditorium
                  Link People to Needed Personal Health Services

10:45 am    Breakout Sessions
            Essential Service #4 (Blue)                                       Room 231
                                Mobilize Partnerships
            Essential Service #9 (Green)                                      Room 300
                     Evaluate Effectiveness, Accessibility, Quality
            Essential Service #2 (Yellow)                                     Main Auditorium
                       Diagnose & Investigate Health Problems
Noon        Lunch                                                             Main Auditorium
12:40 pm    Breakout Sessions
            Essential Service #3 (Blue)                                       Room 231
                              Planning & Implementation
            Essential Service #8 (Green)                                      Room 300
                            Assure Competent Workforce
            Essential Service #5 (Yellow)                                     Main Auditorium
                               Develop Policies & Plans
2:40 pm     Break
2:55 pm     Breakout Sessions
            Essential Service #10 (Blue)                                      Room 231
                                       Research
            Essential Service #6 (Green)                                      Room 300
                             Enforce Laws & Regulations
            Essential Service #1 (Yellow)                                     Main Auditorium
                                    Monitor Health
4:15 pm     Reconvene; Brief review of Breakout Sessions                      Main Auditorium
4:45 pm     Evaluation and adjourn




                                                                                                12
                          APPENDIX II
                          Participants

Name                     Organization
Richard Bales            Parks Department
Barbara Barca            Community Action Project
Monica Basu              George Kaiser Family Foundation
Russell Burkhart         Indian Health Care Resouce Center
Pam Butler               School Superintendents
Sam Carroll              YMCA
Sr. M. Felicidad
Chavez                   St. Johns Medical Center
Melanie Christian        Tulsa Health Department
Dr. Gerry Clancy         OU School of Medicine
Tracy Colmanero          Oklahoma Turning Point
Dave Cox                 Tulsa Health Department
Gary Cox                 Tulsa Health Department
Karen Davis              Tulsa Community Foundation
Linda Drumm              St. Johns Medical Center
Jan Figart               Community Service Council
Greg Foland              Morningside Foundation
Reuben Gant              Greenwood Chamber
William Geffen           Tulsa County Medical Society
John Gogets              Tulsa Health Department
Melissa Graham           Tulsa Housing Authority
Emily Patterson Harris   Langston University
Charlotte Harp           Tulsa Technology Center
Mike Harris              Tulsa Fire Department
Reggie Ivey              Tulsa Health Department
Jim Jakobovitz           Tulsa Jewish Retirement and Health Care Center
Nancy Kachel             Planned Parenthood
L'Toya Knighten          Office of the Governor
Sandra Langenkamp        DHS Board
Jeannie McDaniels        Oklahoma House of Representatives
Kim Nave                 YWCA
Tom Neff                 St. Francis Medical Center
Elizabeth Nutt           Tulsa Health Department
Mary Ogle                American Red Cross
Laurie Paul              Community Health Connection
Fred Perry               Tulsa County
Jim Pickens              Tulsa Community College
Eric Polak               OSU School of Medicine
Proxy                    City of Tulsa


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Proxy                Family & Childrens Services
Proxy                Tulsa Metro Chamber
Proxy                Tulsa Metropolitan Ministries
Doug Ressler         Tulsa Health Department
Bob Rohloff          Police
Martha Rupp-Carter   Tulsa Health Department
Robert Sanders       Morton Clinic
Jabar Shumate        Oklahoma House of Representatives
Carmelita Skeeter    Indian Health Care Resouce Center
Eli Smith            St. Francis Medical Center
Susie Stonis         Hispanic Chamber
Jennifer Summers     LIFE Sr. Services
Pleas Thompson       NAACP
Gail Van Dalsem      Metropolitan Tulsa Transit Authority
Sabrina Ware         Goodwill Industries
Gary Woodruff        Tulsa Health Department




                                                            14
                                          Appendix III

                    The Essential Public Health Services
The Essential Public Health Services provide the fundamental framework for the NPHPSP
instruments, by describing the public health activities that should be undertaken in all
communities. The Core Public Health Functions Steering Committee developed the
framework for the Essential Services in 1994. This steering committee included
representatives from US Public Health Service agencies and other major public health
organizations. The Essential Services provide a working definition of public health and a
guiding framework for the responsibilities of local public health systems.

   1. Monitor health status to identify and solve community health problems.

   2. Diagnose and investigate health problems and health hazards in the community.

   1. Inform, educate, and empower people about health issues.

   2. Mobilize community partnerships and action to identify and solve health problems.

   3. Develop policies and plans that support individual and community health efforts.

   4. Enforce laws and regulations that protect health and ensure safety.

   5. Link people to needed personal health services and assure the provision of health
      care when otherwise unavailable.

   6. Assure competent public and personal health care workforce.

   7. Evaluate effectiveness, accessibility, and quality of personal and population-based
      health services.

   8. Research for new insights and innovative solutions to health problems.




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                                     Appendix IV
                           Parking Lot issues and Next Steps
Essential Service #1 - Monitor health status to identify health problems

       Standard 1.1               1. Not including Tulsa area data to be reflected in State‘s reporting,
                                     MEPS, N-HANES; set of national data that does not include
Population-Based                     Oklahoma or Tulsa. Operate with ―shot-gun‖ approaches since
Community Health Profile             data is not always shared
                                  2. Partners are not aware of the Community Health Profile
                                  3. Mental Health is not a component the Community Health Profile
                                  4. Thought that some components from (1.1.2.1- 1.1.2.1 ) should be
                                     separated out.
                                  5. (1.2.12) – would recommend the addition of insurance companies
                                     and evidence-based medicine.
                                  6. Can you Google Tulsa Health Data? Do you get the Community
                                     Health Profile?
                                  7. Need a more aggressive media strategy to promote the CHP?
       Standard 1.2
                                 (none)
Current Technology to
Manage and Communicate
Population Health Data

       Standard 1.3
                                 1. Addition of FIMR and Child Death Registry- examine need of other
Maintenance of Population        standards
Health Registries                2. Accuracy and timeliness is not always trusted. Improvement can
                                 be made in this area for final report.
                                 3. Study of controlled substances and tracking registry; track by
                                 doctor- not client. Individuals are using multiple doctors and multiple
                                 prescriptions. (Josh Cantwell to lead if identified as next step)


             Next 4 Steps to Take                                 Who Leads?
1. Establish Community Measurement with             1.Community Service Council & Alicia Plati
   methodical media strategy to enhance and
   promote Pathways to Health program and
   community report card.

2. Inclusion of nursing home facilities that is a   2. (Undesignated)
   major medical problem for mental and
   physical health. Inclusion in the Community
   Health Profile/ report card.
3. Offer a regional approach through the Tulsa      3. Tulsa City-County Health Department
   City-County Health Department to
   surrounding Northeastern Oklahoma
   counties.

4. Increase the capacity to analyze data            4.Counterpart to creating indicators (THD &
                                                       Community Service Council)




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Essential Service #2 - Diagnose and investigate health problems and health
                     hazards

   Standard 2.1

Identification and       1. There are standardized national expectations/ standards.
Surveillance of          2. Environmental Standards are unknown
Health Threats           (2.1.3)
                         3. Depends on what the definition of ―is‖ is….
                         4. Need consistent reporting procedures


   Standard 2.2

Investigation and        1. Need of volunteer coordinator for large-scale events
Response to Public       2. Depends on size of event to designate sufficient numbers of staffing
Health Threats and
Emergencies
   Standard 2.3

Laboratory Support       1.  Monitored by state that can leave us vulnerable
for Investigation of     2. Effort to build partnerships with other agencies?
Health Threats           3.  Need more information on labs for routine diagnostics.
                         4.  Unsure and lack of information
                         5.  Some procedures in physician‘s labs are CLIA-waived. Labs are licensed.
                            (Question on placement of actual question)
                         6. Partnerships needed: Doctors, Physicians, Clinics, & Schools
                         7. Core Agencies involved in emergency procedures: Emergency Medical, First
                            Responder Groups, Red Cross, Oklahoma Blood Institute


              Next 3 Steps to Take                                       Who Leads?
1. Creation and administration of web-site to       1. Dr. Bill Geffen
show antibiotics sensitivity, activity of disease
(public and private practices), single resource
for infectious diseases in the community. Free
and collected on a ―real-time‖ basis

2. Stay focused on the tribes, Creek,
Cherokee, and Osage. Need to be more                2.Carmellita Skeeter
inclusive and they are not that far away. Clinics
are located close or within the Tulsa area.
Note: Any individual that is a member of a
federally recognized tribe, can access care
through tribal clinics.

3. Develop Plan to coordinate volunteer             3. (Undesignated)
services and community needs




                                                                                                   17
Essential Service #3 – Inform, educate and empower people about health issues

     Standard 3.1             1. Gold Standard – Consistency, Empowerment, Accessible, across
                                 all communities, across all cultures, racial, ethnic groups
Health Education and          2. Make media responsible for providing information to meet citizens
                                 needs for understanding
Promotion                     3. Messages people can hear/find out about and act on
                              4. Gold Standard – Bigger, louder voice to marshal at the State level
                                 for funding – no single voice – comprehensive one voice for health
                                 care – in order to do this need better information center
                              5. Smoking campaign This is a muscle that we have exercised that
                                 can be replicated (media campaigns)
                              6. Use four cornerstones (education, marketing, policy development,
                                 and community) and replicate what was used in the tobacco
                                 campaign.
                              7. Include other agencies in the invitation to future meetings (Heart
                                 Assoc, Lung Assoc, Diabetes Assoc) to participate in more
                                 community health planning sessions

     Standard 3.2
                              1. Using PSA‘s to communicate
Health Communication          2. Required to run PSA‘s throughout the day
                              3. Not necessarily gold standard but do have some media policies in
                                 place, but not for system – we do have media policies in place for
                                 emergency preparedness

     Standard 3.3             1. Have Doppler weather warning system for communication of risk
                              2. The ability to learn from history about what is necessary to improve
Risk Communication               rapid communications response.
                              3. Determine other mechanisms when all other mechanisms
                                 exhausted, e.g., no electricity.
                              4. Debriefing with all involved in emergency – expand those involved
                                 in debriefing (hotwash)
                              5. As a follow-up identifying toolkits as a strength for the special
                                 populations
                              6. Had discussion about the definition of a 638 facility – need to create
                                 awareness about this system approach and what benefits exist. 638
                                 facility - Self-determined 37 tribes, 30,000 native Americans in
                                 Tulsa, largest native American population in US


              Next 3 Steps to Take                               Who Leads?
1. Need a comprehensive single voice to          1. (Not designated)
   advocate for health care issues at the
   legislative level.
2. Running PSA‘s throughout the day -            2. Reuben Gant
3. Meet again, strategize and review – don‘t     3. (Not designated)
   stop at this meeting

4. Create an awareness about 638 facility and    4. (Not designated)
   benefits that would serve the whole
   population




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Essential Service #4 - Mobilize community partnerships to identify and solve
health Problems

         Standard 4.1              1. Acknowledgement of the need for municipalities, education
                                      system, social service, stakeholders needing to stay
Constituency Development              connected with the health system. Residents need to also
                                      be at the table when we seek resolutions to health
                                      problems.
                                   2. Dissemination of information
                                         1) Comprehensive network for providing health access
                                            across the board; is process in place
                                         2) Know about agencies not all that they do
                                         3) Providers and recipients not in symbiotic relationship
                                   3. Recurring theme of services available not being marketed
                                   4. Answers to questions being asked today does not take into
                                      account what the answers would be from the consumers
                                      we serve
                                   5. Providers are here today, but not recipients to the services
                                   6. Small pieces of the pie but room for improvement
                                   7. Need more coordination
                                   8. Have more chambers than we have businesses – need
                                      connection with Greenwood Chamber
                                   9. Need to expand and be more inclusive of organizations
                                      that are in the LPHS

         Standard 4.2

Community Partnerships             (none)




              Next 3 Steps to Take                                     Who Leads?
1.   Meet again                                    1.   THD
2.   Review results                                2.   All participants
3.   Strategize                                    3.   All participants
4.   Possible expansion of current directory       4.   (Not designated)




                                                                                                     19
Essential Service #5 - Develop policies and plans that support individual and
community health efforts

      Standard 5.1

Governmental Presence at    1. Adequate?
the Local Level             2. *Not sure of what this Assessment Process is; don‘t have
                               appropriate information to answer this question
                            3. Do not have this information


      Standard 5.2

Public Health Policy        1. Starting this process now, being done consistently
Development                 2. Partnerships have been established through hospitals to
                               inform THD if there is medical information that needs to be
                               considered.
                            3. Hospitals are seen as ―self-sufficient‖ cities that many only
                               have communications through Emergency Room procedures.
                            4. Past Chamber Meeting had same discussions that hospital
                               administration is not ―coming to the table‖.
                            5. Policies are being set forth by hospitals that don‘t relate or
                               support the Local Public health Policies. ―The issue is getting
                               us all together; hospitals don‘t have to come to the table as it
                               pertains to community health issues just be there.‖
                            6. Insurance companies need to also be a part of the system and
                               part of the public health policy.
                            7. There are groups out there that are making strides and
                               changes through legislature.
                            8. For profits are responsible to their share-holders; they look at
                               their own financial policies than public health policy.
                            9. Philanthropists are looking at public health issues and are very
                               health oriented in their mission.
                           10. We are doing more than we give ourselves credit for
                           11. Needs joint review for policy and internal operating policies

      Standard 5.3

Community Health            1. We are missing legislature; i.e. Mayor‘s office and legislature,
Improvement Process and        also missing insurance companies and faith community (Good
Strategic Planning             Samaritan-Lynn Hersey), and Tulsa Mental Health
                               Association, Day Center for the Homeless, Tulsa County
                               Pharmacy, Coalition of Free Clinic Managers, Neighbor for
                               Neighbor, Cornerstone Assistance Network (Anna Falling).
                               Who was invited?
                            2. Do we answer for the community?
                            3. What is the ―process‖ definition? Voted by intention

                            (5.3.1.5- 5.3.2.1) all voted ―green‖ based on Intention

      Standard 5.4

Plan for Public Health      (none)
Emergencies




                                                                                                  20
             Next 3 Steps to Take                                Who Leads?
1. Including individuals from Emergency          1. Doug Ressler to take to Gary Cox
management Agency in upcoming ―mock‘ drills
for emergency preparedness

2. Indentify ―who‖ do we refer to as community   2. (Undesignated)




                                                                                       21
Essential Service #6 - Enforce laws and regulations that protect health and
ensure safety

       Standard 6.1

 Review and Evaluation of Laws,   1. There is some ambiguity around review of laws etc…
 Regulations, and Ordinances         deliberate, intent)




       Standard 6.2
                                  (None)
 Involvement in the improvement
 of Laws, Regulations, and
 Ordinances

       Standard 6.3

 Enforcement of Laws,             (None)
 Regulations, and Ordinances




           Next 3 Steps to Take                                  Who Leads?
1. (None Designated)




                                                                                          22
  Essential Service #7 - Link people to needed personal health services and assure the
                  provision of health care when otherwise unavailable

  Standard 7.1       1. People know that they need service, don‘t know where to go or can‘t take
                        advantage of it. Not enough ―action‘ going on.
Identification of    2. Healthcare Authority policy not communicated and followed within Oklahoma.
Personal Health         Insurance brokers don‘t sell or support the program. (OEPIC). With current
Service Needs of        administration, waivers cannot be acquired. Needed support to make eligibility
Populations             requirements more supportive. Lack of political will
                     3. No separate funds to offer transportation assistance. Not always reliable for
                        clients needing service.
                     4. Focus on using ‗we‖ not ―they‖
                     5. Education and support is needed in schools
                     6. Insurance does not ensure usage/ action
                     7. Some points of access: Emergency Rooms
                     8. Regional Health Organizations need to be established
                     9. Personal health and transportation systems need to be established
                    10. Shortage of providers that limits access and services provided
                    11. Point of access for non-emergent care remains at the ER
                    12. Not everyone at the table today
                    13. Barriers have not adequately been accessed
                    14. Timeline: We may have accessed, have we continued to access?
                    15. Need a ‗sense‖ of hope that we get results and implement a program of support.
                        Not all ―players‖ are at the table. Those that are passionate are here.

 Standard 7.2        1. Tulsa County/ City have not stepped up to the table to work through legislature
                     to bring health care to the top of funding priorities
Assuring the         2. THD does good job translating all English information into Spanish and Chinese
Linkage of           3. Customer-service is poor by not supporting cultural competence.
 People to
Personal Health
Services

            Next 3 Steps to Take
1. Developing base of funding and data           (Undetermined)
    research for Indian health Services.
    Uniform electronic medical records across
    network from provider to specialists

2. Consistent procedure for intake across all
   agencies                                      Latoya Knight- consistent best practices
                                                 coordination of project for consistent reporting
                                                 and network

    3. Proportional funding from State for       (Undetermined)
       Tulsa similar to OKC
    4.




                                                                                                      23
Essential Service #8 - Assure a competent public health and personal health care
workforce

       Standard 8.1

Workforce Assessment,           1. Entities providing Health Care Ed. Have to meet annual
Planning, and Development          standards for accreditation
                                2. Oklahoma HC Workforce Council—focus is to attract and
                                   attain healthcare workers to grow faculty—beginning with
                                   Nursing. Looking also at Electronic Records as an issue
                                3. OU‘s inaugural Community Medicine Program
                                4. ASTHO.org

       Standard 8.2

Public Health Workforce         (None)
Standards

       Standard 8.3

Life-Long Learning Through      (None)
Continuing Education,
Training, and Mentoring

       Standard 8.4

Public Health Leadership        (None)
Development


            Next 3 Steps to Take                               Who Leads?
1. Funding needed for Instructors                  1. (Not designated)

2. Coordinating Leadership Development             2. (Not designated)
   For PH System
3. Advocacy Training 101                           3. (Not designated)




                                                                                              24
Essential Service #9 - Evaluate effectiveness, accessibility, and quality of
personal and population-based health services

         Standard 9.1

Evaluation of Population-        1, Core: OHCA, University Med. Schools, Nursing Schools,
 Based Health Services           2. Competition results in inaction
                                 3. Statewide obesity plan—to be implemented at local level
                                 4. Splintered approach felt in the school system—not
                                    coordinated--to impact program development
                                 5. Local assist info vs. info for other levels.
                                 6. Data insufficient to get validity


         Standard 9.2
Evaluation of Personal Health    1. Legislative issues—fear of retaliation by constiuents
                                 2. Not enough slots…but there are providers in place
Services
                                 3. Several layers of surveys within OSU
                                 4. SFH does survey their patients..which is reported to public
                                 5. JACCO surveys/eval. All the hospitals

         Standard 9.3
                                 (none)
Evaluation of the Local Public
 Health System



            Next 3 Steps to Take
1. Consider a food tax                           1. Not easily feasible

2. More cooperative agreements—sharing           2. State Health Insurance Commissioner,
   faculty, programs r/t health education,          Chancellors for Higher Ed.
   fields‘Tech system already work closely

3. Info. r/t surveys not easily accessed—if      3. Governor‘s Office –formally—but go to Mark
   knew what was lacking—could convey this          Jones—Talequah (Pam Rask know his
   to students in the classroom—LPN‘s, lab          contact info.
   techs, etc..Formal link for information
   (clearing house), data sharing needs for
   sharing eval/assessement information.




                                                                                                  25
Essential Service #10 – Research for new insights and innovative solutions to
health problems

     Standard 10.1

Fostering Innovation           1. Neighborhood specific health planning - Tapping into having
                                  more connections with communities and neighborhoods –
                                  different approach to research
                               2. We know the problems and we have it drilled down to zip codes
                               3. We can‘t use a one size fits all approach to implementing the
                                  resolution
                               4. THD, CSC, OU (College of Public Health) OSU (Rural Health
                                  Program) work together to improve communities health
                               5. Data collection for research and being HIPAA compliant


     Standard 10.2
                               (None)
Linkage with Institutions of
Higher Learning and/or
Research

     Standard 10.3

Capacity to Initiate or        1. Information and data sharing of research in compliance of HIPPA
Participate in Research        2. Disseminate information do not wait for publishing rights




         Next 3 Steps to Take                            Who Leads?
1. Collaboration across various zip         1. (Undesignated)
codes that are at high risk of certain
diseases for specific health planning

2. Development of community driven          2. (Undesignated)
research

3. Continue collaboration, ―make better     3. (Undesignated)
choices‖
“All public health systems must work
together for a healthy community”




                                                                                                    26
                               Appendix V
                 CDC Report for Tulsa System Assessment

                               Table of Contents
A. The NPHPSP Report of Results

      I.     Introduction
      II.    About the Report
      III.   Tips for Interpreting and Using NPHPSP Assessment Results
      IV.    Final Remarks

B. Performance Assessment Instrument Results

      I.     How well did the system perform the ten Essential Public Health Services
      II.    How well did the system perform on specific model standards?
      III.   Overall, how well is the system achieving optimal activity levels?

C. Optional Priority Rating Results

      What are potential areas for attention, based on the priority ratings and performance
      scores?

D. Optional Agency Contribution Results

      How much does the Local Health Department contribute to the system's performance, as
      perceived by assessment participants?

Appendix

      Resources for Next Steps




                                                                                              27
   The National Public Health Performance Standards
                        Program
           Local Public Health System Performance Assessment
                             Report of Results

A. The NPHPSP Report of Results

I. INTRODUCTION

The National Public Health Performance Standards Program (NPHPSP) assessments are
intended to help users answer questions such as "What are the activities and capacities of our
public health system?" and "How well are we providing the Essential Public Health Services in
our jurisdiction?" The dialogue that occurs in answering these questions can help to identify
strengths and weaknesses and determine opportunities for improvement.

The NPHPSP is a partnership effort to
improve the practice of public health and           The NPHPSP is a collaborative effort of
the performance of public health systems.           seven national partners:
The NPHPSP assessment instruments                   • Centers for Disease Control and
guide state and local jurisdictions in                Prevention, Office of Chief of Public Health
evaluating their current performance against          Practice (CDC/OCPHP)
a set of optimal standards. Through these           • American Public Health Association
assessments, responding sites consider the            (APHA)
activities of all public health system              • Association of State and Territorial Health
partners, thus addressing the activities of all       Officials (ASTHO)
public, private and voluntary entities that
                                                    • National Association of County and City
contribute to public health within the                Health Officials (NACCHO)
community.
                                                    • National Association of Local Boards of
                                                      Health (NALBOH)
Three assessment instruments have been
designed to assist state and local partners         • National Network of Public Health
in assessing and improving their public               Institutes (NNPHI)
health systems or boards of health. These           • Public Health Foundation (PHF)
instruments are the:

       • State Public Health System Performance Assessment Instrument,
       • Local Public Health System Performance Assessment Instrument, and
       • Local Public Health Governance Performance Assessment Instrument.

This report provides a summary of results from the NPHPSP Local Public Health System
Assessment (OMB Control number 0920-0555, expiration date: August 31, 2010). The report,
including the charts, graphs, and scores, are intended to help sites gain a good understanding
of their performance and move on to the next step in strengthening their public system.




                                                                                                     28
II. ABOUT THE REPORT

Calculating the scores
   The NPHPSP assessment instruments are constructed using the Essential Public Health
   Services (EPHS) as a framework. Within the Local Instrument, each EPHS includes
   between 2-4 model standards that describe the key aspects of an optimally performing
   public health system. Each model standard is followed by assessment questions that serve
   as measures of performance. Each site's responses to these questions should indicate how
   well the model standard – which portrays the highest level of performance or "gold standard"
   – is being met.

   Sites responded to assessment questions using the following response options below.
   These same categories are used in this report to characterize levels of activity for Essential
   Services and model standards.

       NO ACTIVITY               0% or absolutely no activity.

       MINIMAL                   Greater than zero, but no more than 25% of the activity
       ACTIVITY                  described within the question is met.

       MODERATE                  Greater than 25%, but no more than 50% of the activity
       ACTIVITY                  described within the question is met.

       SIGNIFICANT               Greater than 50%, but no more than 75% of the activity
       ACTIVITY                  described within the question is met.

       OPTIMAL                   Greater than 75% of the activity described within the
       ACTIVITY                  question is met.

   Using the responses to all of the assessment questions, a scoring process generates scores
   for each first-tier or "stem" question, model standard, Essential Service, and one overall
   score. The scoring methodology is available from CDC or can be accessed on-line at
   http://www.cdc.gov/od/ocphp/nphpsp/Conducting.htm.

Understanding data limitations
  Respondents to the self-assessment should understand what the performance scores
  represent and potential data limitations. All performance scores are a composite; stem
  question scores represent a composite of the stem question and subquestion responses;
  model standard scores are a composite of the question scores within that area, and so on.
  The responses to the questions within the assessment are based upon processes that utilize
  input from diverse system participants with different experiences and perspectives. The
  gathering of these inputs and the development of a response for each question incorporates
  an element of subjectivity, which can be minimized through the use of particular assessment
  methods. Additionally, while certain assessment methods are recommended, processes
  can differ among sites. The assessment methods are not fully standardized and these
  differences in administration of the self-assessment may introduce an element of
  measurement error. In addition, there are differences in knowledge about the public health
  system among assessment participants. This may lead to some interpretation differences
  and issues for some questions, potentially introducing a degree of random non-sampling
  error.



                                                                                                29
   Because of the limitations noted, the results and recommendations associated with these
   reported data should be used for quality improvement purposes. More specifically, results
   should be utilized for guiding an overall public health infrastructure and performance
   improvement process for the public health system. These data represent the collective
   performance of all organizational participants in the assessment of the local public health
   system. The data and results should not be interpreted to reflect the capacity or
   performance of any single agency or organization.

Presentation of results
   The NPHPSP has attempted to present results – through a variety of figures and tables – in
   a user-friendly and clear manner. Results are presented in Rich Text Format (RTF), which
   allows users to easily copy and paste or edit the report for their own customized purposes.
   Original responses to all questions are also available.

   For ease of use, many figures in tables use short titles to refer to Essential Services, model
   standards, and questions. If in doubt of the meaning, please refer to the full text in the
   assessment instruments.

   Sites may choose to complete two optional questionnaires – one which asks about priority of
   each model standard and the second which assesses the local health department's
   contribution to achieving the model standard. Sites that submit responses for these
   questionnaires will see the results included as an additional component of their reports.
   Recipients of the priority results section may find that the scatter plot figures include data
   points that overlap. This is unavoidable when presenting results that represent similar data;
   in these cases, sites may find that the table listing of results will more clearly show the
   results found in each quadrant.

III. TIPS FOR INTERPRETING AND USING NPHPSP ASSESSMENT RESULTS

   The use of these results by respondents to strengthen the public health system is the most
   important part of the performance improvement process that the NPHPSP is intended to
   promote. Report data may be used to identify strengths and weaknesses within the local
   public health system and pinpoint areas of performance that need improvement. The
   NPHPSP User Guide describes steps for using these results to develop and implement
   public health system performance improvement plans. Implementation of these plans is
   critical to achieving a higher performing public health system. Suggested steps in
   developing such improvement plans are:
                1. Organize Participation for Performance Improvement
                2. Prioritize Areas for Action
                3. Explore "Root Causes" of Performance Problems
                4. Develop and Implement Improvement Plans
                5. Regularly Monitor and Report Progress

   Refer to the User Guide section, "After We Complete the Assessment, What Next?" for
   details on the above steps.

   Assessment results represent the collective performance of all entities in the local public
   health system and not any one organization. Therefore, system partners should be involved
   in the discussion of results and improvement strategies to assure that this information is
   appropriately used. The assessment results can drive improvement planning within each
   organization as well as system-wide. In addition, coordinated use of the Local Instrument
   with the Governance Instrument or state-wide use of the Local Instrument can lead to more


                                                                                                 30
   successful and comprehensive improvement plans to address more systemic statewide
   issues.

   Although respondents will ultimately want to review these results with stakeholders in the
   context of their overall performance improvement process, they may initially find it helpful to
   review the results either individually or in a small group. The following tips may be helpful
   when initially reviewing the results, or preparing to present the results to performance
   improvement stakeholders.

Examine performance scores
   First, sites should take a look at the overall or composite performance scores for Essential
   Services and model standards. These scores are presented visually in order by Essential
   Service (Figure 1) and in descending order (Figure 2). Additionally, Figures 3 and 5 use
   color designations to indicate performance level categories. Examination of these scores
   can immediately give a sense of the local public health system's greatest strengths and
   weaknesses.

Review the range of scores within each Essential Service and model standard
   The Essential Service score is an average of the model standard scores within that service,
   and, in turn, the model standard scores represent the average of stem question scores for
   that standard. If there is great range or difference in scores, focusing attention on the model
   standard(s) or questions with the lower scores will help to identify where performance
   inconsistency or weakness may be. Some figures, such as the bar charts in Figure 4,
   provide "range bars" which indicate the variation in scores. Looking for long range bars will
   help to easily identify these opportunities.

   Also, refer back to the original question responses to determine where weaknesses or
   inconsistencies in performance may be occurring. By examining the assessment questions,
   including the subquestions and discussion toolbox items, participants will be reminded of
   particular areas of concern that may most need attention.

Consider the context
   The NPHPSP User Guide and other technical assistance resources strongly encourage
   responding jurisdictions to gather and record qualitative input from participants throughout
   the assessment process. Such information can include insights that shaped group
   responses, gaps that were uncovered, solutions to identified problems, and impressions or
   early ideas for improving system performance. This information should have emerged from
   the general discussion of the model standards and assessment questions, as well as the
   responses to discussion toolbox topics.

   The results viewed in this report should be considered within the context of this qualitative
   information, as well as with other information. The assessment report, by itself, is not
   intended to be the sole "roadmap" to answer the question of what a local public health
   system's performance improvement priorities should be. The original purpose of the
   assessment, current issues being addressed by the community, and the needs and interests
   for all stakeholders should be considered.

   Some sites have used a process such as Mobilizing for Action through Planning and
   Partnerships (MAPP) to address their NPHPSP data within the context of other community
   issues. In the MAPP process, local users consider the NPHPSP results in addition to three
   other assessments – community health status, community themes and strengths, and forces
   of change – before determining strategic issues, setting priorities, and developing action


                                                                                                  31
   plans. See "Resources for Next Steps" for more about MAPP.

Use the optional priority rating and agency contribution questionnaire results
   Sites may choose to complete two optional questionnaires – one which asks about priority of
   each model standard and the second which assesses the local health department's
   contribution to achieving of the model standard. The supplemental priority questionnaire,
   which asks about the priority of each model standard to the public health system, should
   guide sites in considering their performance scores in relationship to their own system's
   priorities. The use of this questionnaire can guide sites in targeting their limited attention
   and resources to areas of high priority but low performance. This information should serve
   to catalyze or strengthen the performance improvement activities resulting from the
   assessment process.

   The second questionnaire, which asks about the contribution of the public health agency to
   each model standard, can assist sites in considering the role of the agency in performance
   improvement efforts. Sites that use this component will see a list of questions to consider
   regarding the agency role and as it relates to the results for each model standard. These
   results may assist the local health department in its own strategic planning and quality
   improvement activities.

IV. FINAL REMARKS

The challenge of preventing illness and improving health is ongoing and complex. The ability to
meet this challenge rests on the capacity and performance of public health systems. Through
well equipped, high-performing public health systems, this challenge can be addressed. Public
health performance standards are intended to guide the development of stronger public health
systems capable of improving the health of populations. The development of high-performing
public health systems will increase the likelihood that all citizens have access to a defined
optimal level of public health services. Through periodic assessment guided by model
performance standards, public health leaders can improve collaboration and integration among
the many components of a public health system, and more effectively and efficiently use
resources while improving health intervention services.




                                                                                              32
B. Performance Assessment Instrument Results

I. How well did the system perform the ten Essential Public Health Services (EPHS)?

Table 1: Summary of performance scores by Essential Public Health Service (EPHS)

  EPHS                                                                                     Score
  1       Monitor Health Status to Identify Community Health Problems                       94
  2       Diagnose and Investigate Health Problems and Health Hazards                       87
  3       Inform, Educate, and Empower People about Health Issues                           58
  4       Mobilize Community Partnerships to Identify and Solve Health Problems             47
  5       Develop Policies and Plans that Support Individual and Community Health           82
          Efforts
  6       Enforce Laws and Regulations that Protect Health and Ensure Safety                90
  7       Link People to Needed Personal Health Services and Assure the Provision of        39
          Health Care when Otherwise Unavailable
  8       Assure a Competent Public and Personal Health Care Workforce                      71
  9       Evaluate Effectiveness, Accessibility, and Quality of Personal and Population-    44
          Based Health Services
  10      Research for New Insights and Innovative Solutions to Health Problems             82
  Overall Performance Score                                                                 69

Figure 1: Summary of EPHS performance scores and overall score (with range)




Table 1 (above) provides a quick overview of the system's performance in each of the 10 Essential Public
Health Services (EPHS). Each EPHS score is a composite value determined by the scores given to
those activities that contribute to each Essential Service. These scores range from a minimum value of
0% (absolutely no activity is performed pursuant to the standards) to a maximum of 100% (all activities
associated with the standards are performed at optimal levels).

Figure 1 (above) displays performance scores for each Essential Service along with an overall score that
indicates the average performance level across all 10 Essential Services. The range bars show the
minimum and maximum values of responses within the Essential Service and an overall score. Areas of
wide range may warrant a closer look in Figure 4 or the raw data.



                                                                                                      33
Figure 2: Rank ordered performance scores for each Essential Service




Figure 3: Rank ordered performance scores for each Essential Service, by level of activity




Figure 2 (above) displays each composite score from low to high, allowing easy identification of service
domains where performance is relatively strong or weak.

Figure 3 (above) provides a composite picture of the previous two graphs. The range lines show the
range of responses within an Essential Service. The color coded bars make it easier to identify which of
the Essential Services fall in the five categories of performance activity.

Figure 4 (next page) shows scores for each model standard. Sites can use these graphs to pinpoint
specific activities within the Essential Service that may need a closer look. Note these scores also have
range bars, showing sub-areas that comprise the model standard.




                                                                                                           34
II. How well did the system perform on specific model standards?

Figure 4: Performance scores for each model standard, by Essential Service




                                                                             35
Table 2: Summary of performance scores by Essential Public Health Service (EPHS) and
model standard

 Essential Public Health Service                                                         Score
 EPHS 1. Monitor Health Status To Identify Community Health Problems                       94
  1.1 Population-Based Community Health Profile (CHP)                                      86
     1.1.1 Community health assessment                                                    100
     1.1.2 Community health profile (CHP)                                                 100
     1.1.3 Community-wide use of community health assessment or CHP data                   75
  1.2 Access to and Utilization of Current Technology to Manage, Display, Analyze         100
       and Communicate Population Health Data
     1.2.1 State-of-the-art technology to support health profile databases                100
     1.2.2 Access to geocoded health data                                                 100
     1.2.3 Use of computer-generated graphics                                             100
  1.3 Maintenance of Population Health Registries                                          97
     1.3.1 Maintenance of and/or contribution to population health registries             100
     1.3.2 Use of information from population health registries                           100
 EPHS 2. Diagnose And Investigate Health Problems and Health Hazards                       87
  2.1 Identification and Surveillance of Health Threats                                    64
     2.1.1 Surveillance system(s) to monitor health problems and identify health           75
            threats
     2.1.2 Submission of reportable disease information in a timely manner                 75
     2.1.3 Resources to support surveillance and investigation activities                  50
  2.2 Investigation and Response to Public Health Threats and Emergencies                  99
     2.2.1 Written protocols for case finding, contact tracing, source identification,    100
            and containment
     2.2.2 Current epidemiological case investigation protocols                           100
     2.2.3 Designated Emergency Response Coordinator                                      100
     2.2.4 Rapid response of personnel in emergency / disasters                           100
     2.2.5 Evaluation of public health emergency response                                 100
  2.3 Laboratory Support for Investigation of Health Threats                               97
     2.3.1 Ready access to laboratories for routine diagnostic and surveillance           100
            needs
     2.3.2 Ready access to laboratories for public health threats, hazards, and           75
            emergencies
     2.3.3 Licenses and/or credentialed laboratories                                      100
     2.3.4 Maintenance of guidelines or protocols for handling laboratory samples         100
 EPHS 3. Inform, Educate, And Empower People about Health Issues                           58
  3.1 Health Education and Promotion                                                       48
     3.1.1 Provision of community health information                                       50
     3.1.2 Health education and/or health promotion campaigns                              50
     3.1.3 Collaboration on health communication plans                                     25
  3.2 Health Communication                                                                 42
     3.2.1 Development of health communication plans                                       25
     3.2.2 Relationships with media                                                        50
     3.2.3 Designation of public information officers                                      50
  3.3 Risk Communication                                                                   84
     3.3.1 Emergency communications plan(s)                                               100
     3.3.2 Resources for rapid communications response                                     25
     3.3.3 Crisis and emergency communications training                                   100
     3.3.4 Policies and procedures for public information officer response                100
 EPHS 4. Mobilize Community Partnerships to Identify and Solve Health Problems             47


                                                                                                 36
 4.1 Constituency Development                                                          58
    4.1.1 Identification of key constituents or stakeholders                           50
    4.1.2 Participation of constituents in improving community health                  50
    4.1.3 Directory of organizations that comprise the LPHS                            50
    4.1.4 Communications strategies to build awareness of public health                75
 4.2 Community Partnerships                                                            37
    4.2.1 Partnerships for public health improvement activities                        75
    4.2.2 Community health improvement committee                                       25
    4.2.3 Review of community partnerships and strategic alliances                     25
EPHS 5. Develop Policies and Plans that Support Individual and Community Health        82
        Efforts
 5.1 Government Presence at the Local Level                                             85
    5.1.1 Governmental local public health presence                                    100
    5.1.2 Resources for the local health department                                     25
    5.1.4 LHD work with the state public health agency and other state partners        100
 5.2 Public Health Policy Development                                                   43
    5.2.1 Contribution to development of public health policies                         25
    5.2.2 Alert policymakers/public of public health impacts from policies              75
    5.2.3 Review of public health policies                                              25
 5.3 Community Health Improvement Process                                               99
    5.3.1 Community health improvement process                                         100
    5.3.2 Strategies to address community health objectives                            100
    5.3.3 Local health department (LHD) strategic planning process                     100
 5.4 Plan for Public Health Emergencies                                                100
    5.4.1 Community task force or coalition for emergency preparedness and             100
           response plans
    5.4.2 All-hazards emergency preparedness and response plan                         100
    5.4.3 Review and revision of the all-hazards plan                                  100
EPHS 6. Enforce Laws and Regulations that Protect Health and Ensure Safety              90
 6.1 Review and Evaluate Laws, Regulations, and Ordinances                              81
    6.1.1 Identification of public health issues to be addressed through laws,          75
           regulations, and ordinances
    6.1.2 Knowledge of laws, regulations, and ordinances                               100
    6.1.3 Review of laws, regulations, and ordinances                                   50
    6.1.4 Access to legal counsel                                                      100
 6.2 Involvement in the Improvement of Laws, Regulations, and Ordinances               100
    6.2.1 Identification of public health issues not addressed through existing laws   100
    6.2.2 Development or modification of laws for public health issues                 100
    6.2.3 Technical assistance for drafting proposed legislation, regulations, or      100
           ordinances
 6.3 Enforce Laws, Regulations and Ordinances                                           87
    6.3.1 Authority to enforce laws, regulation, ordinances                            100
    6.3.2 Public health emergency powers                                               100
    6.3.3 Enforcement in accordance with applicable laws, regulations, and             100
           ordinances
    6.3.4 Provision of information about compliance                                     75
    6.3.5 Assessment of compliance                                                     100
EPHS 7. Link People to Needed Personal Health Services and Assure the Provision         39
        of Health Care when Otherwise Unavailable
 7.1 Identification of Populations with Barriers to Personal Health Services           46
    7.1.1 Identification of populations who experience barriers to care                50
    7.1.2 Identification of personal health service needs of populations               50



                                                                                             37
    7.1.3 Assessment of personal health services available to populations who            50
           experience barriers to care
 7.2 Assuring the Linkage of People to Personal Health Services                          33
    7.2.1 Link populations to needed personal health services                            25
    7.2.2 Assistance to vulnerable populations in accessing needed health                25
           services
    7.2.3 Initiatives for enrolling eligible individuals in public benefit programs       50
    7.2.4 Coordination of personal health and social services                             25
EPHS 8. Assure a Competent Public and Personal Health Care Workforce                      71
 8.1 Workforce Assessment Planning, and Development                                       65
    8.1.1 Assessment of the LPHS workforce                                                75
    8.1.2 Identification of shortfalls and/or gaps within the LPHS workforce              75
    8.1.3 Dissemination of results of the workforce assessment / gap analysis             50
 8.2 Public Health Workforce Standards                                                    85
    8.2.1 Awareness of guidelines and/or licensure/certification requirements             75
    8.2.2 Written job standards and/or position descriptions                              75
    8.2.3 Annual performance evaluations                                                  75
    8.2.4 LHD written job standards and/or position descriptions                         100
    8.2.5 LHD performance evaluations                                                    100
 8.3 Life-Long Learning Through Continuing Education, Training, and Mentoring             76
    8.3.1 Identification of education and training needs for workforce development        75
    8.3.2 Opportunities for developing core public health competencies                    50
    8.3.3 Educational and training incentives                                             75
    8.3.4 Interaction between personnel from LPHS and academic organizations             100
 8.4 Public Health Leadership Development                                                 55
    8.4.1 Development of leadership skills                                                75
    8.4.2 Collaborative leadership                                                        50
    8.4.3 Leadership opportunities for individuals and/or organizations                   75
    8.4.4 Recruitment and retention of new and diverse leaders                            25
EPHS 9. Evaluate Effectiveness, Accessibility, and Quality of Personal and                44
        Population-Based Health Services
 9.1 Evaluation of Population-based Health Services                                      38
    9.1.1 Evaluation of population-based health services                                 50
    9.1.2 Assessment of community satisfaction with population-based health              25
           services
    9.1.3 Identification of gaps in the provision of population-based health services    25
    9.1.4 Use of population-based health services evaluation                             50
 9.2 Evaluation of Personal Health Care Services                                         61
    9.2.1. Personal health services evaluation                                           75
    9.2.2 Evaluation of personal health services against established standards           75
    9.2.3 Assessment of client satisfaction with personal health services                75
    9.2.4 Information technology to assure quality of personal health services           25
    9.2.5 Use of personal health services evaluation                                     50
 9.3 Evaluation of the Local Public Health System                                        33
    9.3.1 Identification of community organizations or entities that contribute to the   50
           EPHS
    9.3.2 Periodic evaluation of LPHS                                                     25
    9.3.3 Evaluation of partnership within the LPHS                                       25
    9.3.4 Use of LPHS evaluation to guide community health improvements                   25
EPHS 10. Research for New Insights and Innovative Solutions to Health Problems            82
 10.1 Fostering Innovation                                                                78
    10.1.1 Encouragement of new solutions to health problems                             100
    10.1.2 Proposal of public health issues for inclusion in research agenda             100


                                                                                               38
   10.1.3 Identification and monitoring of best practices                       75
   10.1.4 Encouragement of community participation in research                  50
10.2 Linkage with Institutions of Higher Learning and/or Research              100
   10.2.1 Relationships with institutions of higher learning and/or research   100
          organizations
   10.2.2 Partnerships to conduct research                                     100
   10.2.3 Collaboration between the academic and practice communities          100
10.3 Capacity to Initiate or Participate in Research                            68
   10.3.1 Access to researchers                                                100
   10.3.2 Access to resources to facilitate research                            75
   10.3.3 Dissemination of research findings                                    50
   10.3.4 Evaluation of research activities                                     50




                                                                                     39
III. Overall, how well is the system achieving optimal activity levels?

Figure 5: Percentage of Essential Services scored in each level of activity

                                                            Figure 5 displays the percentage of
                                                            the system's Essential Services
                                                            scores that falls within the five activity
                                                            categories. This chart provides the
                                                            site with a high level snapshot of the
                                                            information found in Figure 3.




Figure 6: Percentage of model standards scored in each level of activity

                                                            Figure 6 displays the percentage of
                                                            the system's model standard scores
                                                            that falls within the five activity
                                                            categories.




Figure 7: Percentage of all questions scored in each level of activity

                                                            Figure 7 displays the percentage of
                                                            all scored questions that falls within
                                                            the five activity categories. This
                                                            breakdown provides a closer
                                                            snapshot of the system's
                                                            performance, showing variation that
                                                            may be masked by the scores in
                                                            Figures 5 and 6.




                                                                                                         40
                      APPENDIX: RESOURCES FOR NEXT STEPS

The NPHPSP offers a variety of information, technical assistance, and training resources to assist
in quality improvement activities. Descriptions of these resources are provided below. Other
resources and websites that may be of particular interest to NPHPSP users are also noted below.

• Technical Assistance and Consultation - NPHPSP partners are available for phone and
   email consultation to state and localities as they plan for and conduct NPHPSP assessment
   and performance improvement activities. Contact 1-800-747-7649 or phpsp@cdc.gov.

• NPHPSP User Guide - The NPHPSP User Guide section, "After We Complete the
  Assessment, What Next?" describes five essential steps in a performance improvement
  process following the use of the NPHPSP assessment instruments. The NPHPSP User Guide
  may be found on the NPHPSP website www.cdc.gov/od/ocphp/nphpsp.

• NPHPSP Online Tool Kit - Additional resources that may be found on, or are linked to, the
  NPHPSP website (www.cdc.gov/od/ocphp/nphpsp/) under the "Post Assessment/
  Performance Improvement" link include sample performance improvement plans, quality
  improvement and priority-setting tools, and other technical assistance documents and links.

• NPHPSP Online Resource Center - Designed specifically for NPHPSP users, the Public
  Health Foundation's online resource center (www.phf.org/nphpsp) for public health systems
  performance improvement allows users to search for State, Local, and Governance resources
  by model standard, essential public health service, and keyword. Alternately, users may read
  or print the resource guides available on this site.

• NPHPSP Monthly User Calls - These calls feature speakers and dialogue on topics of interest
  to users. They also provide an opportunity for people from around the country to learn from
  each other about various approaches to the NPHPSP assessment and performance
  improvement process. Calls occur on the third Tuesday of each month, 2:00 – 3:00 ET.
  Contact phpsp@cdc.gov to be added to the email notification list for the call.

• Annual Training Workshop - Individuals responsible for coordinating performance
  assessment and improvement activities may attend an annual two-day workshop held in the
  spring of each year. Visit the NPHPSP website (www.cdc.gov/od/ocphp/nphpsp/) for more
  information.

• Improving Performance Newsletter and the Public Health Infrastructure Resource Center
   at the Public Health Foundation - This website (www.phf.org/performance) presents tools
   and resources that can help organizations streamline efforts and get better results. A five
   minute orientation presentation provides an orientation on how to access quality improvement
   resources on the site. The website also includes information about the Improving Performance
   Newsletter, which contains lessons from the field, resources, and tips designed to help
   NPHPSP users with their performance management efforts. Read past issues or sign up for
   future issues at: www.phf.org/performance.

• Mobilizing for Action through Planning and Partnerships (MAPP) - MAPP has proven to be
  a particularly helpful tool for sites engaged in community-based health improvement planning.
  Systems that have just completed the NPHPSP may consider using the MAPP process as a
  way to launch their performance improvement efforts. Go to
  www.naccho.org/topics/infrastructure/MAPP to link directly to the MAPP website.




                                                                                                41
                                Appendix VI
                  Tulsa Health Department * Visioning Process
                             Verbal Evaluation
                               June 9, 2008
What Worked?
      Heard a lot of new information
      Got connected with several new people I didn’t know
      Increased my understanding of the parts of the public health system
       that is lacking
      Learned a lot about health in Tulsa
      Led me to think that a self-evaluation is needed to see if our
       organization is on the right track
      Reinforced the need to step back to check progress, to evaluate.

What Could Have Been Improved?
      Could have brought more people to the table, including:
             o The City of Tulsa
             o Clients of services
             o Insurers
             o More service providers
             o More from hospitals
      Use technology to get instant results

One Word Describing How I am Leaving Today:

 Delighted                      Enlightened              Energized

 Enthusiastic -2                Powerful                 Ready

 Networking                     Hopeful -2               Tired

 Service                        Opportunity              Educated

 Overwhelmed                    Impressed -3             Optimistic

 Able                           Aw Shit!                 Informed -2

 Appreciative                   Encouraged               Valuable

 Brain is full                  On   the     verge   of  Yes we can!
                                  something big




                                                                             42
                            Tulsa NPHPSP Evaluation 6/10/08



                                                                      Bad                                       Superb
Meeting Arrangements:                                                       1         2             3      4         5
 Advance notice of the meeting                                                                      2      3        13
 Room Accommodations                                                                                       8        11
 Advance materials for meeting                                              1                       6      5         7
   Comments:
  the environment for the meeting is good,. Evidently didn't need to print off manual, unknown (about advanced materials)


                                                                      Bad                                       Superb
Flow of Meeting:                                                            1         2             3      4         5
  Started on time                                                                                          6        13
  Clear objectives for meeting                                                        1             4      5         9
  Agenda followed or appropriately amended                                                          1      4        14
  Facilitation was effective                                                                        1      5        14
  The "right" people were at the meeting                                              4             3      8         4
   Comments:
the inter-change of information & sharing went well. I learned a lot which is helpful to me. Maybe having some consumers
  that are active in policy &/or health issues, thanks for the facilitators, we were missing some key people who did not
  attend-some were invited, would like to see more representation of clients served, 1st responders, need theme taker info
  ahead of time, need more community participation of other PH agencies, PH is a messy topic w/ many conflicting goals
                                                                      Bad                                       Superb
Utility of Meeting:                                                         1         2             3      4         5
  Stated purposes of meeting were met                                                 1             4      2        12
  Dialogue was useful                                                                               1      8        10
  I support the group's recommendations                                                             3      6        10
  Next steps are clear                                                                1             4      8         7
  Meeting was a good use of my time                                                   1             5      7         8
   Comments:
I learned a lot of information about the programs & services in Tulsa, , I have my audit next week & other meetings this
week so for me it would have been nice to have been asked about the timing of the meeting, very insightful-would have had
more community participation
What worked?
content of the discussion, # of participants, diversity of persons here, facilitators were the best-keeping us on topic &
clarifying topics. Thanks to the foundation for the breakfast, lunch & snacks it helped to keep agenda on track, Long &
tiring but eager to see fruits of our labor, break down groups, very good process-loved being part of it, excellent facilitation
a lot got done in a single day, diversity of opinion & organization, facilitators were excellent!
What/How can we do better?
the beginning of the seminar frustrated me, I wasn't clear, especially from beginning-"how tos" of this workshop, get it
going faster, don't let people toot their own horn, indicators in plain English, clarify how the role of this group fits in with
the public and general community citizenry, have meeting on a regular basis




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