QUALITY IMPROVEMENT ROADMAP: POPULATION AND PUBLIC HEALTH FISCAL YEARS: 2014-2016 DRAFT PROGRAM NAME: Population & Public Health OF SUBMISSION: Feb10, 2014 Last reviewed by MOH/Dir. Group on December 23, 2014 QUALITY TEAM CHAIR: Sheryl Bates Dancho, Horst Backé QUALITY ISSUE 1. Information Systems Development The program is unable to generate required reports to funders. Surveillance systems are highly labor intensive, manual, not timely, and inadequate. There is no standardized data collection for some types of infection. Data analysis requires duplication of effort. Workload management and utilization analysis is not happening in great part because of the lack of automated systems. The possibility of multiple client records across service areas creates potential for non-integrated client service and risks to staff. Outbreaks are managed using systems that are not integrated into iphis. The region has limited funding for electronic information technology systems (IT Sx) and selected PPH services have been prioritized regionally based on standardized criteria. The timeline to begin work on a full HPECD health record is slated for 2017. Many electronic information systems are grand-parented as PHIA exceptions. They do not meet privacy requirements of current systems. Population focus, Safety, Client-centred services, Continuity of Services, Effectiveness, Efficiency Champion for Initiative: PPH Information Management Group (Horst Backé, Chair) Implement full IT Sx for selected PPH services. Systems will include as appropriate: billing, scheduling, tracking and reporting on deliverables, health record, workload management, utilization analysis and surveillance. All systems are PHIA compliant. Service Area Details HPECD Database - The new HPECD database will be developed and implemented in 2014. Panorama used for public health immunization, vaccine inventory, communicable disease control (all reportable diseases including public health tuberculosis management & STBBI), & outbreaks. HPECD Client Record A full IT solution for HPECD is prioritized by the end of 2014 after experience with Panorama. Generic Implementation Plan Map processes for all IT systems to be implemented. Gather detailed requirements for each service area that has not already been addressed Develop implementation plan Implement information systems Develop a surveillance and evaluation plan Development will occur over the next four years contingent on Community Services Information Technology Roadmap and Manitoba E-Health prioritization and funding. Explore mechanisms to routinely or episodically track resources required to achieve equitable outcomes. Service Area Details HPECD Database Final change requests are being completed. Implement database in 2014 (Horst Backé) Panorama implementation as per provincial schedule through 2016 Lead is Public Health Manitoba. WRHA Coordination (Alex Henteleff and Helena Wall) HPECD Client Record Development will occur starting 2017 (PPH Information Management Committee) How will you measure? No Generic Performance Measures Databases are used for outbreak management, surveillance, and tracking client services, and the extent possible for client documentation. Decreased referral-related occurrences, tracking within electronic systems and then reporting on them. Generation of reports o meaningful to funders o for program management at all levels o for regional surveillance o for immunization inventory management o for program monitoring All documentation systems are PHIA compliant without relying on the grandparenting provision. Decreased fragmented care by sharing client health records across service areas. Efficient referral & documentation systems, as well as consistent processes across all community areas. Processes improvements that support workload management and staffing allocation that support health equity Improved service rates new technologies will allow for efficiencies and opportunities to identify & target inequity affected populations. Complete: Date:
2. Communication Strategy Development Extend and improve our communication strategy. Accreditation Canada Standards: 1.9 The organization shares the results of its community assessment with key stakeholders and the general population using a variety of methods.(the second part of this is the role of PPH) 5.3 The organization and partners communicate essential public health information at multiple levels using appropriate language and different media. 5.5 The organization regularly assesses the effectiveness of its communication strategy and uses this information to make improvements. Efficiency Effectiveness Champion for Initiative: Population Health Initiatives Leader Horst Backé 1. PPH internet available in French 2. Keep our internet and extranet current. 3. Initiate use of social media for public health messaging 3.1. Secure email 3.2. Secure video conferencing 4. Increase use of typical social media 5. Print materials for essential health issues are translated into a variety of languages. 6. Health of Winnipeg section on the WRHA website 7. Public and staff understand health equity concepts and status and related implications on service. 8. Regular assessment of our communication strategy. 9. Dedicated communication EFT for PPH 1. Translation complete by June 2014. (Horst Backé) 2. Procedure approved by CHSLT in Early 2014 - All Centralized Team Managers or Specialists ongoing. (Horst Backé) 3.1 Participate in secure email pilot based on ehealth initiative - (Horst Backé) 3.2 Participate in secure video conferencing opportunities as they arise based on ehealth initiative - (Horst Backé) 4. Each Centralized team considers and documents opportunities for use of social media to enhance their communication efforts (Centralized Team Managers and Program Specialists) 5.1 Identify the five most common languages in Winnipeg other than French and English - Horst 5.2 Develop criteria for determining essential public health information - Horst then to PPHLT 5.3 Approach Joint Information Management Committee and Manitoba Public Health to help translate relevant information into the five most common languages. Darlene Girard 6. Coordinating development of the Health of Winnipeg section. Public friendly versions of important CHA information - Lawrence Elliot & Salah Mahmud are on Advisory Committee of the CHA. * Requires partnership with Community Health Assessment Unit and others. * Posting a more robust Health of Winnipeg site in partnership with Communications * Will require public friendly versions of important CHA information on the Health of Winnipeg Site. Horst Backe 7. Communicate the health equity aspects of population health assessments and interventions 8. Create logic model for communication strategy as a starting point for evaluation (include literacy level, measures of use and effectiveness) April 2014 9. Medical & Program Director discussion with No How will you measure? 1. Yes/No 2. Procedure approved by CHSLT in Early 2014 - All Centralized Team Managers or Specialists ongoing. Horst to lead 3.1 Participate in secure email pilot based on ehealth initiative. 3.2 Participate in secure video conferencing opportunities as they arise based on ehealth initiative. 4. Each Centralized team considers and documents opportunities for use of social media to enhance their communication efforts, develops and implementation plan, develops an evaluation plan - Centralized Team Managers and Program Specialists End of 2014 5.1 Identify the five most common languages other than French and English 5.2 Develop criteria for determining essential public health information. PPHLT by Summer 2014 5.3 Approach Manitoba Public Health to help translate relevant information into the five most common languages. Lynda Tjaden, Lawrence Ellliot 6. Coordinating development of the Health of Winnipeg section. Public friendly versions of important CHA information - Lawrence Elliot, Salah Mahmud. 7. Create logic model for communication strategy as a starting point for evaluation (include literacy level, measures of use and effectiveness) Horst by early fall 2014 8. A resource has been allocated to complete PH work.
Director of Communication. 10. Strike PPH Communications group to guide the strategy. Horst Backe How will you measure? 3. Improve information Transfer. A majority of PPH occurrence reports are related to transfer of information (an Accreditation Canada Required Organizational Practice). There is a need to respond to ongoing occurrences including: missed referrals, incorrect and missed information on referrals that originate at significant transfer points within the health system as HPECD referrals are made to us from external sources (e.g., Womens Program, Midwifery, Child Health Program, physicians) and within our program (e.g., central distribution, weekend services, inter-office). Some CDC referrals are late (e.g., syphilis). We anticipate that our new information system, Panorama, will allow us to track these late referrals and allow us to correct referral errors between WRHA and Manitoba Health as well as other provincial jurisdictions. Safety Client centred services Effectiveness HPECD referrals will be tracked in one database and a clear and consistent referral process will be implemented within PPH. We will escalate our issues to decision makers external to PPH to avoid missed information and referrals as well as incorrect information on referrals. Communicable Disease Control Referrals that are late or missed will be tracked to identify preventable delays. Issues will be routed and escalated as necessary. HPECD - A new HPECD database and related referral management and tracking process will be developed, implemented and evaluated to minimize internal referral errors (Horst Backe) Continue our formal and informal processes for addressing HPECD information transfer problems that originate from sources external to PPH (i.e. Child Health Program, Women s Program, Midwifery) (Darlene Girard) Continue to track all external and internal HPECD information transfer occurrences using RL6 (Horst Backe) Wait on implementation of the CDC module in Panorama to determine how we can track preventable referral delays - Kris Hastie, Kim Bailey, Diana Heywood Yes A new HPECD database has been implemented and related referral management and tracking processes have been developed and implemented 2014 We have ongoing documentation of our efforts to engage Child Health Program, Women s Program, Midwifery in resolution of the problem. Develop baseline measures of timeliness upon which we can improve. Champion for Initiative: Darlene Girard
4. Program Evaluation Accreditation Canada Standards: 11.8 The organization regularly assesses the impacts of its health promotion activities on the intended outcomes. 17.3 When evaluating its services the team involves clients, families and other organizations. (Evaluation is not consistent across programs. Clients and partners are not consistently involved in the evaluation process. The organization is encouraged to review its program evaluation and establish framework and priorities for review including feedback from clients, families and community partners) 17.1 The team regularly evaluates and improves the quality of its services. 17.4 At least every three years, the organization evaluates the outcomes and impacts of its public health programs and services. Effectiveness Population focus Champion for Initiative: Horst Backé Logic models are developed and used to plan, communicate about and evaluate all service areas, all major services and all strategic priorities Logic models include periods of evaluation not exceeding 3 years. More time may be needed if the indicators are not collected within the 3 year window Measurable outcomes include feedback opportunities from clients, families and community partners. Measurable outcomes include intended outcomes and health status indicators Health equity focus threaded throughout all logic models. 1. Complete logic models for all service areas and for most strategic priorities (Lawrence Elliot Applied Public Health Research, Lynda Tjaden & Louis Sorin Health Equity, Horst Backe Health Communication, Lisa Richards Healthy Build Environments, MOH / Director group to be consulted about who will develop a logic model for Healthy Public Policy, Horst Backe Public Health Information Systems, Centralized Team Managers 2. Each major service area and strategic priority by late 2014 3. Each major service by spring 2015. 4. Aim for one complete cycle of evaluation by spring 2016. 5. Health equity considerations will be prominent in all logic models and evaluationslook for examples of best practice in other jurisdictions to use as a model from which to work. How will you measure? No Logic models: include feedback opportunities from clients, families and community partners; include intended outcomes and health status indicators; and include indicators that measure health equity Logic models clearly indicate an evaluation cycle.
5. Performance Evaluation 9.6 Team leaders regularly evaluate and document each team member's performance in an objective, interactive, and positive way. Worklife Champion for Initiative: Sheryl Bates Dancho All staff are provided with routine feedback to help recognize and improve performance 1. Monitor compliance All Team Managers as part of PPHOT and PPHLT. Snapshots every six months - March, September 2. Ongoing reminders at PPHOT and PPHLT (Sheryl Bates Dancho & Lynda Tjaden) 3. Clarify regional expectations and tools (SAP) re performance management including Performance Support and Dialogue process - (Sheryl Bates Dancho) 4. Develop a performance assessment tool for PHNs based on competencies (Horst Backé) 5. Develop a performance assessment tool for Home Visitors based on the position description (Horst Backé) 6. Develop a position description and performance assessment tool for Public Health Dietitians based on the competencies (Colleen Rand with Sheryl) 7. Consider implications of the Manitoba Health Promoter Competencies in relation to performance assessments and position descriptions (Horst Backé) 8. Integrate completion of orientation into PA process (Horst Backé) How will you measure? No 100% compliance with performance appraisals at 3 and 6 months as well as every two years thereafter.
6. Healthy Built Environments 11.5 The organization works with its partners to create supportive employment and living environments. Population Focus Champion for Initiative: Lisa Richards Continued involvement in planning the build urban environments to support healthy living and health equity Schools recognize themselves as healthy living environments All staff visiting homes assess, make recommendations for home safety and follow up as required 1. Continued involvement in CLASP initiative locally and nationally 2. Plan to sustain input into city level planning after Sept 2014 (Lisa Richards, Lawrence Elliot) 3. Support criteria that divisions can use for school site selection, school design and school usage agreements (Deanna Betteridge) 4. Safety teleform redeveloped, client handouts developed (Injury Prevention Team) How will you measure? No 1. Continued involvement in CLASP initiative locally and nationally 2. Plan to sustain input into city level planning after Sept 2014 3. Support criteria that divisions can use for school site selection, school design and school usage agreements Safety teleform redeveloped, client handouts developed - Completed 7. Resource Utilization 17.7 The team regularly completes utilization reviews to ensure resources have been used appropriately. Efficiency Champion for Initiative: Lynda Tjaden Human resources are annually allocated to: Minimize health inequities Maximize health benefits for all Maximize opportunities for health gain Meet our funded and legislated obligations Maximize efficiencies Maximize collaboration and scope of practice Based on clearly defined roles and responsibilities 1. Develop logic models (Centralized Team Managers and Specialists) 2. Clarify service standards for all service areas that are applied at the community area level. 3. Review the PHN allocation formula and revise to be consistent with service standards (Lynda Tjaden, Dec 2014) 4. Outline an explicit allocation process for Home Visitors Darlene (Dec 2014) 5. Follow up with HR on admin allocation (Merrilee Sigvaldason, June 2014) No 1. Public Health Nursing Service Model developed by Sept 2014. 2. PHN allocation formula revised to be consistent with service standards 3. An explicit allocation process for Home Visitors developed 4. 95% compliance with all service standards Resources are maintained in service areas unless contrary evidence exists. Resources are allocated based on quantified evidence whenever possible. Use information gathered through the program planning process (logic models) to inform allocation.
8. Health Equity Promotion 1.4 The organization identifies populations at higher risk of poorer health outcomes. 1.5 The organization identifies where health equity gaps exist between and within populations. 1.6 The organization identifies populations that experience barriers to access. 3.6 The organization designs its public health services to address the particular needs of population at higher risk. 3.11 The organization follows a process to identify, address and document ethics related issues. Population Focus Accessibility Effectiveness Champion for Initiative: Lynda Tjaden, Louis Sorin, Sande Harlos Maximize health gains through a focus on targeted universality in PPH. Host the regional Health Equity initiative. 1. Develop, implement and monitor a PPH CA Health Equity plan. 2. Facilitate regional activity in the areas of knowledge, governance, partnerships and health services. 3. Staff training in concepts, directions 4. Identify consistent messaging but use language familiar to our partners 5. Engage all levels of the organization How will you measure? 1. Develp a PPH CA Health Equity Plan 2. Implement a PPH CA Health Equity Plan 3. Monitor the PPH CA Health Equity Plan 4. PPH staff has been trained in Health Equity concepts and directions. 5. Regional activity in the areas of knowledge, governance, partnerships and health services. 6. All levels of the organization are engaged.