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State Public Health Infrastructure and
Performance: Insights from Recent ASTHO
SurveysJim Pearsol, Chief Program OfficerAssociation of State and Territorial Health
OfficialsSeptember 16, 2008
Outline
Describe performance context Describe baseline survey and results Describe branding research and results Relate to STHA performance and voluntary
national accreditation Consider next steps
Deconstructing “performance”
Performance management seeks to more closely link employee activities to organizational activities. A performance management system supports and contributes to the creation of high-performance work and work systems by translating behavioral principles into procedures. (ASQ).
Design and use performance measures to drive and monitor organizational performance, and evaluate the results in relation a plan (ASQ).
Performance improvement is a process for achieving desired institutional and individual results. The goal of Performance Improvement is the provision of high quality, sustainable health services. Results are achieved through a process that considers the institutional context, describes desired performance, identifies gaps between desired and actual performance, identifies root causes, selects interventions to close the gaps and measures changes in performance.
Funding support
ASTHO’s Baseline Survey and Marketing Projects are supported through funding from:
Robert Wood Johnson Foundation
&
Centers for Disease Control and Prevention
ASTHO baseline survey: BackgroundSurvey Partners:
Robert Wood Johnson Foundation (RWJF)Centers for Disease Control and Prevention (CDC)Public Health Foundation (PHF)
Goal: Define the purposes, functions, roles and responsibilities of state public health agencies.
Results: 47 responses (46 states and District of Columbia, 82% response rate) (NOW 50)
Survey Purposes
Describe State and Territorial Health Agency (STHA) structure and function
Contribute to development of Accreditation Standards & Measures
Inform STHA marketing “message” to policy makers and general public
Populate a Public Health Information and Analysis System at ASTHO
Inform Public Health Systems & Services Research
Survey Subheadings
Respondent Information Activities Organization for Federal
Initiatives STHA Descriptors STHA Personnel State Organizational
Structure Agency Mission STHA Scope of Work 75 + survey questions Web survey tool
Planning and Quality Improvement
Relationship with Local Public Health Agencies
STHA Training Emergency Preparedness
Infrastructure Partnership and
Collaboration STHA Performance
Activities STHO Qualifications and
Experience
Organizational Structure & Relationship with Local Health Agencies
Structure of state health agencies:58% Free-standing independent agency
40% Under a larger agency
Organizational relationship between state healthagencies and local health departments:40% Decentralized control (local services provided through local gov’t or boards)
18% Mixed control (some local services provided by state and some by locals)
17% Shared control (local services are subject to shared authority of state and local entities)
15% Centralized control (local services provided through units of state)
10% No local health departments
Collaboration (relate to NPHPSP state tool – section on state-local collaboration)More than 83% reported collaboration on the following with local public healthagencies:
Exchanging informationWorking together on activities or projectsProviding financial resources
Over 90% reported working together on projectsor activities with:
HospitalsCommunity health centersOther health care providersRegional cancer societyEmergency respondersSchoolsCommunity based organizationsFaith communitiesUniversities
0
10
20
30
40
50
60
70
Business Health Insurers Health Centers Community-basedOrganizations
Other Health CareProviders
Increased Collaboration & Information Exchange (%)
50
60
70
80
90
100
CommunicationSystem
Epidemiology &Surveillance
Planning &Surge Capacity
Workforce &Relationships
Lab Services Legal Basis forPH Action
Stronger Infrastructure Due to Emergency Preparedness Efforts (%)
30
40
50
60
70
80
90
100
Food & SafetyEducation
EnvironmentalEpidemiology
Toxicology RadiationControl
Radon Control Private WaterSafety Supply& Indoor Air
Environmental Protection Activities (%)
Population-based Primary Prevention Services
Population-based Primary Prevention Services
State Public Health Agency # (%)
Local Public Health Agency # (%)
Tobacco control and prevention 44 (91.7) 37 (77.1) Obesity 41 (85.4) 32 (66.7) Injury control and prevention 39 (81.3) 32 (66.7) STD counseling/partner notification
38 (79.2) 37 (77.1)
HIV 37 (77.1) 38 (79.2) Diabetes 34 (70.8) 29 (60.4) Substance abuse 20 (41.7) 18 (37.5)
Enforce public health laws & regulations
Educate about laws and regulations 77% Local health departments 56% Hospitals
75% Emergency responders 50% Community-based organizations
67% Laboratories
Regulation, inspection or licensing 77% Laboratories 65% Hospice and long term care
73% Hospitals 61% Lead inspection
71% Food service establishment 54% Campgrounds/RVs
69% Swimming pools 50% Public drinking water
Other activities73% Veterinarian PH activities; 70% trauma system; and 67% Institutional Review Board
Help people receive health services
Access to health care
87% Health disparities 40% Emergency Medical Services
81% Minority health 29% SCHIP, pharmacy and substance
65% Rural health 25% Tribal health & Faith-based
46% Certifying authority for federal reimbursement
& Outreach and enrollment for medical insurance
Maternal and Child Health services67% CSHCN 27% Non-WIC nutrition counseling
48% WIC 29% School health (non-clinical)
42% Early intervention 23% EPSDT
30% Family planning/prenatal care
Scope and Source of State Health Agency Authority
Source of Authority Scope of Authority Number/Percent State Statute Gubernatorial
Order Rules/Regulation
Collect data 48 (100) 48 (100) 4 (8.3) 32 (66.7) Manage vital statistics
47 (97.7) 47 (97.7) 3 (6.3) 30 (62.5)
Declare health emergency 38 (79.3) 33 (68.8) 18 (37.5) 15 (31.3)
Conduct health planning
37 (77.1) 35 (72.9) 2 (4.2) 18 (37.5)
License health professionals
30 (62.5) 30 (62.5) 0 (0) 23 (47.9)
Issue certificates of need
27 (56.3) 26 (54.2) 1 (2.1) 20 (41.7)
Operate health facilities
22 (45.8) 21 (43.8) 2 (4.2) 13 (27.1)
Develop Public Health Policies and Plans
Developed Health Improvement Plan (HIP):56% within 3 years 22% 3 years ago21% no
56% created a state HIP using a State Health Assessment
81% plan to update HIP in next 3 years
State HIP linked to local health department HIP:25% yes 27% some 15% no
STHA has a strategic plan (73%)
Within past year, STHA adopted new public health regulation (83%)
Maintain Competent Workforce
Sources of STHA workforce development (rank order)STHA in-house training
Universities
Federal Government
National associations
Other state agencies
Health professional agencies
PH institutes
STHA has a designated training coordinator (62%)
STHA provides workforce technical assistance 74% Local health departments 43% Community-based organizations
70% EMR 30% Laboratories
47% Hospitals
STHA oversees professional licensing 26% Nurses; 24% Physicians and Physician Assistants; and 22% Dentists
Sources of Revenue
Federal (direct) 45%
State Sources 24%
Medicaid/Medicare 15%
Other 9%
Federal (Indirect) 3%
Fees/Fines 4%
*State Health Agency expenditures: Non-clinical prevention (67%), clinical (31%)
Top priorities for STHA for current fiscal year
Health system reform Assuring preparedness for a health emergency Assuring a local public health presence throughout the
state Developing effective health policy Developing innovations in any area Focusing on early detection or population protection
measures Monitoring the state’s population health Implementing quality improvement programs Attaining workforce stability
Marketing State Public Health
The Association of State and Territorial Health Officials
Project Goal
Develop tested, proven messages about state public health that, when communicated to the public, will result in a better understanding of the role, activities, and value of state public health.
Why Market Public Health?
Improve public health visibility
Mitigate the public health workforce shortage
Enhance the public’s health advocacy power
Create public support for public health activities
Improve policymaker support for public health
Barriers to communicating “public health”
Misconceptions about “Branding”
Public health fails to celebrate
We don’t know our audience and they don’t know us
Don’t know how to talk about public health….to the public
Cost of marketing
Public health is many things – hard to synthesize
Objectives and Approach
Objective: Treat the public health branding project like a major consumer branding issue
Quantify: Understand current national perceptions of State Public Health Determine Public Health’s relationship to healthcare in people’s minds Learn about the importance of the various Public Health functions to the nation’s
citizens
Generate: Develop powerful conceptual positioning platform options for Public Health Create some compelling taglines for use with state Public Health logos
Evaluate: Measure the appeal, believability, and power of the various platform options and
taglines
Refine: Deepen our understanding of the winning communication platforms
Recommend Recommend the optimal communication platform - Positioning and Tagline
World Class Marketing Partners
Quantitative Research Lead: Copernicus Cause marketing: Cone Inc. Creative Horsepower: Red Black Design Qualitative Research Lead: Quest Consulting Project Lead: Green Planet Partners
Recent projects of this branding team
Starbucks, 3M, P&G, Banana Republic, Toyota, Johnson & Johnson, Target, Proctor & Gamble, Pepsi, ….. and State Public Health
Brand Strength
Although the public feels the various functions of stateand local public health services are important, there islittle awareness that these are, in fact, the functions performed by these organizations.
Methodology
Quantitative: 1,059 interviews were conducted between April 16 and April 23, 2008.
Interviews were conducted on-line, using an established survey panel, and averaged 15 minutes in duration.
The sample was demographically representative of the US population age 18-64, with respect to: Age and Sex Geography (Northeast, South, Midwest and West) Household income Race and ethnicity (African-American and Hispanics)
Qualitative: 8 qualitative sessions were conducted in 4 US cities comprised of over 80 U.S. adults (L.A., Nashville, Minneapolis and Jackson MS.)
Creative: Creative teams from around the country were asked to submit positioning platforms and tagline options to be tested
Knowledge of functions of Public Health Services
There is generally little awareness of the functions that State or Local Public Health Services perform.
The most commonly recognized functions are: Conducting sanitation and safety inspections of restaurants Giving vaccines
Less than half of the public realizes that State or Local Public Health Services perform the following functions: Developing public policies that make it easier for people to engage in
healthy behaviors Promoting healthy behaviors Providing the latest information on health hazards Monitoring health care providers Assuring there are no environmental health threats in the wake of natural
disasters
There is generally little awareness of the functions that State or Local Public Health Services perform.
The most commonly recognized functions are: Conducting sanitation and safety inspections of restaurants Giving vaccines
Less than half of the public realizes that State or Local Public Health Services perform the following functions: Developing public policies that make it easier for people to engage in
healthy behaviors Promoting healthy behaviors Providing the latest information on health hazards Monitoring health care providers Assuring there are no environmental health threats in the wake of natural
disasters
Importance of functions ofPublic Health
The most important functions include: Monitoring and controlling the spread of diseases, and alerting people to
these diseases and how to avoid them• These two functions are perceived as more important by respondents who
prefer either Concept 2 (Minimizing health costs) or Concept 5 (Prevent, promote and protect)
Conducting sanitation and safety inspections of restaurants Monitoring air and water quality Assuring there are no environmental health threats in the wake of natural
disasters Providing health care services to the disadvantaged
The least important functions are perceived to be: Developing public policies that make it easier for people to engage in healthy
behaviors Promoting healthy behaviors
Overall, “Promoting health. Reducing costs” is the
most preferred tagline.
% Select each Total
1: Our work is the health of the
population
2: We minimize health costs to individuals and
society by promoting health and preventing
diseases
3: We live on the front lines, fighting new health threats
as they emerge
4: We are working to make the
wealthiest country also the healthiest
5: We prevent disease, promote health and protect
communitiesBase: Total Respondents (1059) (239) (282) (107) (163) (268)
Promoting health. Reducing costs. 19% 10% 32% 12% 17% 16% Prevention is the best defense 16 15 16 12 14 20 In pursuit of a stronger, healthier nation 15 20 11 14 20 13 Healthy people, healthy communities 15 16 12 8 8 23 Because we're only as healthy as the world we live in 12 16 10 16 12 10 Creating a healthier, safer world - Millions at a time 7 6 6 12 11 6 Because health threats never rest 7 8 4 13 5 6 America's immune system 4 3 2 9 4 6 Getting the most for the nation's health dollars 4 2 6 2 6 1 The secret weapon in the battle for health 2 5 2 2 4 0
Favorite Concept
The two most favored concepts (2 and 5) share the ideas of promoting health and preventing disease.
Concept 2, the quantitative “winner” (by a small margin), adds the idea of minimizing health costs.
1: Our work is the health of the population
2: We minimize health costs to individuals and
society by promoting health and preventing
diseases3: We live on the front lines, fighting new
health threats as they emerge
4: We are working to make the wealthiest
country also the healthiest
5: We prevent disease, promote health and protect communities 23%
27%
10%
14%
26%
Positioning Testing
Strategic Communications Linksafety, security, reduced health
costs
“Public health and I care fundamentally about a really important thing and they’re actually doing huge work around it - the safety and well-being of my family.” They then said things like:
“You should tell people about this!”“People should know” “I can’t believe we haven’t been told this before”
Unlike most branding projects, while talking to consumers, nobody ever poked holes in our work or our desire to communicate. They understood the benevolent nature of our practice; they just don’t know very much about us. But once they know, they care, and it matters, they’re like:
“wow, this matters”“This is cool” “You guys rock!, You got our back!”
Next Steps
ASTHO/ASPH Public Health Marketing Meeting
Public Health Language Development
Online Toolkit
Corporate partnership to benefit all of public health
MLC-3 Target Measures
5 Capacity and Process target areas were identified: Community Health Profiles Culturally Appropriate Services Health Improvement Planning Assure Competent Workforce Customer Service
5 Health Outcome target areas were identified: Reduce the incidence of vaccine preventable disease Reduce preventable risk factors that predispose to chronic
disease Reduce infant mortality rates Reduce the burden of tobacco related illness Reduce the burden of alcohol related disease and injury
Performance readiness
ASTHO survey information on structure and function Value - increased awareness and recognition by
professional peers NPHPSP Version 2, MLC-3 and PHAB standards
ASTHO branding research Challenge - Consumers unaware
Implications for “selling” assessments? (whether they be NPHPSP or PHAB)
Accreditation “readiness” toolkits When? Now is probably a good time
Thanks!
For more information, contact:
jpearsol@astho.org mdickey@astho.org jjimenez@astho.org lcaldwell@astho.org bpetersen@astho.org aholland@astho.org