development of public health standards and protocols in nova scotia phpc cpd day june 9th, 2013 dr....
TRANSCRIPT
Development of Public Health Standards and Protocols in Nova
Scotia
PHPC CPD DayJune 9th, 2013
Dr. Robert StrangDr. Brent Moloughney
2013
CompleteProtocols
Public Health Vision• Shift upstream, focus the determinants of health
and populations at greatest risk
• Capitalize on Public Health’s unique position to:• improve the sustainability of the health system • understand health inequities• change the conditions in which people live (physical and
social environments)• address the determinants of health
• Commitment to a public health system approach
Population Focus
Municipalities
Community Services
Planning Agencies
Tertiary Prevention:
Preventing the worst outcomes from disease and injury (death and disability).
Primary Prevention:
Preventing disease and injury by modifying existing risk factors.
Secondary Prevention:
Early detection and treatment of disease and injury.
Public H
ealth
Individual Focus
Education System
Police and Justice
Primordial Prevention:Preventing the risk factors from ever
existing
Tertiary Prevention:
Preventing the worst outcomes from disease and injury (death and disability).
Primary Prevention:
Preventing disease and injury by modifying existing risk factors.
Secondary Prevention:
Early detection and treatment of disease and injury.
Public Health
Municipalities
Community Services
Planning Agencies
Education System
Police and Justice
Primordial Prevention:Preventing the risk factors from ever
existing
Population Focus Individual Focus
Counselingand Education
ClinicalInterventions
Long Lasting ProtectiveInterventions
Changing the Context to MakeIndividuals’ Default Decisions
Healthier
Socioeconomic Factors
From: Thomas R. Frieden, MD, MPH. American Journal of Public Health April 2010, Vol 100, No. 4
Incr
easi
ng P
opul
ation
Impa
ct
Incr
easi
ng In
divi
dual
Effo
rt N
eede
dHealth Impact Pyramid
Public Health Standards
• Establish the expectations for public health at the provincial and DHA level.
Structure of Standards
Protocols• Complement the Standards providing greater detail
to assist in addressing some key system challenges:• Achieving a shift in emphasis more upstream• Lack of clarity regarding roles and responsibilities• Need for greater accountability
• Need to first be clear about ‘what is the work’, then can address:• Who does it• How it gets done (from a system perspective)• And, what we’re going to stop doing• (Even greater detail (i.e. strategies, business processes,
procedures, manuals etc.) to be included in appendices)
• Balancing consistency with flexibility
Protocol Development• Started Spring 2012:
– Pan-system teams developed raw protocol content (note: had recently developed Standards)
• Fall 2012:– Protocols drafted – Presented to System Leadership Team and VPs Community
• January 2013– Feedback that mostly right – editing and tweaking occurring
iteratively since then
• Spring 2013– Final reviews of protocols– Engage system staff for implementation planning
Protocol OrganizationCross-Cutting Protocols Content-Specific Protocols
• Understanding (assessment & surveillance)• Priority setting & planning• Partnership• Policy• Health equity
• Communicable Disease Prevention & Control • Environmental Health• Healthy Communities• Healthy Development
• Protocols are ‘a package’• Are not sole responsibility of a specific team (e.g., upstream prevention in CDPC not sole responsibility of a CD team)
Protocols – Going Forward• Managing transition issues: primary care and public
health must work together on transition issues• No ‘dump and run’• Alignment with primary care initiatives
(comprehensiveness, continuity, collaborative care)• May need to be assessed and managed on a community-
by-community basis• Addressing design implications to achieve an
effective and efficient public health system• Who and how work gets done in context of 9 DHAs with
varying capacity and population contexts• Requires sharing, working together, and structural
changes – grounded in achieving ‘the work’ in effective, efficient and quality manner
Summary• Development of Public Health Standards and
Protocols key part of collective journey of system renewal
• Unless clear about ‘the work’, difficult to address system design, roles, accountabilities, etc.
• Considerable change management requirements:• Transition for what will stop doing• Leading/mentoring new practices• Workforce development• Potential structural change• Establishing accountabilities