The National Public Health Performance Standards

101Jennifer McKeever

Trina Pyron

This session will help you. . .• Describe the NPHPS and how it can be

used to drive performance improvement at state and local levels;

• Discuss how NPHPS and PHAB accreditation complement each other; and

• Discuss the opportunities and plans for the NPHPS in the future.

History of the NPHPS• Key Dates

– Began in 1998– Version 1 instruments released in 2002– 2002-2007 – Version 1 instruments used in more

than 30 states– Development of Version 2 instruments – 2005-2007– Release of Version 2 instruments – Fall 2007-

present– Re-engineering efforts underway – 2011

• CDC – Overall lead for coordination• ASTHO – Develop and support state

instrument; SHIP• NACCHO – Develop and support local

instrument; MAPP• NALBOH – Develop and support governance

instrument• APHA – Marketing and communications• PHF – Performance improvement; data

collection and reporting system• NNPHI – Co-coordination of partnership,

support through institutes, training workshop and bi-monthly webinars

NPHPS National Partnership

NPHPS Vision

A partnership effort to improve the

quality of public health practice

and performance of

public health systems

Four Concepts Applied in NPHPS1. Based on the ten Essential Public

Health Services

2. Focus on the overall public health system

3. Describe an optimal level of performance

4. Support a process of quality improvement

Assessment Instruments• State public health system• Local public health system• Local public health governance

NPHPS

Comprehensive Development of Instruments

• Practice-driven development by CDC and ASTHO, NACCHO and NALBOH Work Groups

• Field testing• Validation studies

Based on Ten Essential Services

NPHPS State Instrument Use (Through April 2012, n = 29 states + DC)

*Also includes sites using field test versions of the NPHPS State Public Health System Performance Assessment.

NH

WA

OR

NV

CA

ID

MT

AK

UT

AZ

WY

CO

NM

ND

SD

NE

KS

TX

OK

LA

AR

MO

IA

MN

MS

OH

WI

INIL

MI

ME

KY

NY

PA

WVVA

NC

GA

TN

AL

FL

SC

VT

MA

RI

CT

HI

NJ

DE

MD

NH

MA

RI

CT

NPHPS Local Instrument Use (Through April 2012)

Moderate Use(33% - 66%)

Significant Use (67% or greater)

Limited Use(1% - 32%)

*Also includes sites using field test versions of the NPHPS Local Public Health System Performance Assessment.

WA

OR

NV

CA

ID

MT

AK

UT

AZ

WY

CO

NM

ND

SD

NE

KS

TX

OK

LA

AR

MO

IA

MN

MS

OH

WI

INIL

MI

ME

KY

NY

PA

WVVA

NC

GA

TN

AL

FL

SC

VT

NJ

DE

MD

NH

MA

RI

CT

HI

NPHPS Governance Instrument Use (Through April 2012)

No Boards of Health

*Also includes sites using field test versions of the NPHPS Local Public Health Governance Performance Assessment.

WA

OR

NV

CA

ID

MT

AK

UT

AZ

WY

CO

NM

ND

SD

NE

KS

TX

OK

LA

AR

MO

IA

MN

MS

OH

WI

INIL

MI

ME

KY

NY

PA

WVVA

NC

GA

TN

AL

FL

SC

VT

NJ

DE

MD

NH

MA

RI

CT

HI

Moderate Use(33% - 66%)

Significant Use (67% or greater)

Limited Use(1% - 32%)

NPHPS Vision and GoalsTo improve the quality of public health practice

and performance of public health systems by:

1. Providing performance standards for public health systems and encouraging their widespread use;

2. Engaging and leveraging national, state, and local partnerships to build a stronger foundation for public health preparedness;

3. Promoting continuous quality improvement of public health systems; and

4. Strengthening the science base for public health practice improvement.

NPHPS Use in the Field(What the evaluation data tell us)

• Reasons for Using NPHPS – State and Local– Establish a baseline measure of performance– Wanted a nationally developed & recognized assessment

tool to help improve performance – NPHPS the best tool available for improving public health

system effectiveness– Was part of the MAPP process (local users only)

State evaluation data gathered through ASTHO survey 10/05-1/06 – 80% response rate (9 respondents reporting completion of State NPHPS). Local evaluation data gathered through NACCHO survey to known NPHPS and MAPP users in 01/06 – 05/06; 212 total respondents (149 respondents reporting completion of Local NPHPS).

NPHPS Outcomes Achieved

0 20 40 60 80 100

ID strengths / weaknesses of PHS

Awareness of interconnectedness of PH

HD plan to make improvements

Better understanding of health issues

Stronger system collaboration

Tangible commitments for improving

PI processes that engage system partners

Initiate a MAPP process

State Local

Percentage of respondents indicating achievement of these outcomes was partial/medium or high

Data based on evaluation conducted by ASTHO and NACCHO in 2005-06. Findings are consistent with Respondent Information Form data, August 2007 – present.

Health Department

+PH System

+Community

Partners+

Workforce

OperationalCapacity

(infrastructure)

EveryCommunity

Program and Public Health

Activity

(Chronic Disease, Inf Disease, EH)

Builds Impacts

Whichleads

to

Investments here Pay big dividends here

Better HealthOutcomes

Reduced Disparities

Better Preparedness

Framework for Improving Performance

NPHPS: Strengthening systemsThe value of strengthening systems • Diminishing resources• Increasing service demands• Complex problems • Collaborative service delivery systems• Policy development • New opportunities (e.g., health reform)• Accountability

Considerations:• Important to strengthen both the agency and the

system

NPHPS and Public Health Agency Accreditation:complementary tools for strengthening public healthNPHPS• Based on the ten Essential

Public Health Services

• Focus on the overall public health system (but acknowledges agency as hub / convener)

• Describe an optimal level of performance

• 4. Support a process of quality improvement

Accreditation•Same – also includes domains about admin / governance

•Focus on agency (but acknowledges importance of the system and agency in building the system)

•Standards / measures that can be met, but also have “stretch” opportunities.

•Support a process of quality improvement

Future Directions

Re-engineering the NPHPS

Reengineering will sustain and continue to enhance the NPHPS as a tool for systems building, assessment and improvement activities

Reengineering guided by. . .• Program evaluation data• User feedback• Opportunities in the field

The Re-engineered NPHPS

• Goal: To sustain and enhance the NPHPS as a tool for systems building, assessment and improvement activities

• Re-engineering priorities:– Streamline assessment tools – Enhance systems building aspects of assessment

process– Strengthen linkages with accreditation– Promote quality and performance improvement

activities

The Re-engineered NPHPS

The Re-engineered NPHPS • Current and more community-

friendly standards • Streamlined assessments • Comprehensive and seamless

package of tools that most effectively promote systems engagement and performance improvement

Re-engineering Timeline Date Activity

Fall 2010 State, Local, and Governance Instrument Update workgroups convened

Jan – May 2011 Draft field test instruments

Jun – Sept 2011 Finalize field test instruments; Identify and confirm field test sites

Sept – Dec 2011 Conduct field test; desktop review; follow up interviews

Jan 2012 – May 2012 Complete final revisions to instruments; revise supporting documents

Summer 2012 Develop new instrument layout/design; revise online materials

Fall 2012 Launch new instruments!

Phases

Four Re-engineering Priorities• Streamline the assessment tools• Enhance systems building aspects of

the assessment process• Strengthen linkages with

accreditation• Promote quality and performance

improvement activities

Streamline Assessment Tools

• Fewer scored questions– Scoring at stem question level only

• Emphasize use of plain language

Enhance Systems Building • Implementation Guide highlights

techniques to build system connections

• List of potential system partners included at Essential Service level in State and Local Instruments

• Revised stem question language to reinforce system orientation– “At what level does the system. . .”

Strengthen Linkages with Accreditation

• Draft cross-walk between accreditation standards and NPHPS– Two potential supplemental

components: 1. Recommendations for ways to

document/act upon NPHPS work for accreditation purposes and

2. Questionnaire/note-taking format for accreditation coordinators.

Promote Quality and Performance Improvement

• Implementation Guide emphasizes improvement orientation throughout the assessment process (pre-, during, and post-assessment)

• Assessment includes a framework to identify improvement opportunities within each Essential Service

• Revised template and guidance for identifying priorities

THANK YOU!