Community Balanced Scorecards to Make MAPP Partnerships More Effective
NACCHO (www.NACCHO.org)
Results That Matter Team (www.RTMteam.net)
Webinar Presenters
Paul Epstein, Leader, Results That Matter Team, Epstein & Fass Associates.
Belinda Johnson-Cornett, Administrator, Osceola County, Florida, Health Department, who has been leading Osceola County’s CBSC approach toimprove access to health care.
Karen van Caulil, Executive Director, Health Council of East Central Florida, a key participant in Osceola County’s MAPP planning process and CBSC efforts.
Mark Peters, Director of Community Health, St. Clair County, Illinois, Health Department, St. Clair County MAPP Coordinator, lead of CBSC efforts, and co-chair of the County’s Get Up & Go partnership for improving fitness and nutrition.
2Results That Matter Team (www.RTMteam.net)
About the RTM Team
Epstein & Fass Associates: Results That Matter Teamwww.RTMteam.net
• Measuring & improving public and nonprofit performance since 1985
• Public Health Foundation & ASTHO Consulting Teams
• Featured in The Public Health Quality Improvement Handbook
• Working with Insightformation, Inc. (www.insightformation.com) to bring Community Balanced Scorecards to Public Health Partnerships
3Results That Matter Team (www.RTMteam.net)
4
Execution Gap
Strategy Maps and Community Balanced Scorecards to improve the Alignment and Execution of Strategies
No Strategic Alignment
High Level Goals
Power of Strategic Alignment
Public Health
Outcomes
Other PublicAgencies
Hospitals
Schools CommunityGroups
FaithCommunities
NonprofitsHealth Dept
Families & Individuals
• Is an integrated strategic planning and management system traditionally focused on one organization
• Communicates vision, mission, and strategy to stakeholders and employees
• Maps strategies based on cause & effect assumptions across different perspectives or “views.”
• Aligns day-to-day work to the strategy
• Provides a disciplined framework for measuring strategic performance as viewed from those different perspectives.
The Balanced Scorecard (BSC) …
5Results That Matter Team (www.RTMteam.net)
Community Balanced Scorecard (CBSC)
• Combines the community building power of effective collaborations with the strategy alignment of balanced scorecards
– Pulls the community together around common outcomes
– Leverages assets from all sectors
– Aligns key community collaborators behind a common strategy for faster, measurable results
– Creates mutual accountability for results
• Intended for the many important issues in communities and regions that cannot be resolved by one organization or sector.
6Results That Matter Team (www.RTMteam.net)
Community Balanced Scorecard Components
Performance Measures, Targets, &
Initiatives
Perspectives
Community Vision, Overall or by Issue or
“Theme”Community
Priorities
Strategy MapStrategic Objectives
Could be a “Strategic Goal” or
“AIM Statement”
7Results That Matter Team (www.RTMteam.net)
Perspectives in Current Practice for Public Health Community Balanced Scorecards
Community Health Status
Community Implementation
Community Process & Learning
Community Assets
9Results That Matter Team (www.RTMteam.net)
Quick Guides to Relating Community Balanced Scorecards & MAPP at RTMteam.net
10Results That Matter Team (www.RTMteam.net)
MAPP Phase
1. Organize/Partner-ship Development
2. MAPP Vision
3. Four Assessments
CBSC Element
• Building Community Assets
• CBSC Vision
• Four Perspectives
11Results That Matter Team (www.RTMteam.net)
MAPP Phase
1. Organize/Partner-ship Development
2. MAPP Vision
3. Four Assessments
4. Identify Strategic Issues
5. Formulate Goals & Strategies
6. Action Cycle
CBSC Element
• Building Community Assets
• CBSC Vision
• Four Perspectives
• Select Issues for Strategy Mapping
• Strategic Objectives & Strategy Maps
• Initiatives, Performance Measures, & Targets
12Results That Matter Team (www.RTMteam.net)
# 2Investigate, Respond to
Emergencies & Threats
Minimize Risks
# 6Enforce Laws & Regulations
Potential Public Health Community Balanced Scorecard Strategy MapBased on the Ten Essential Services of Public Health
STRATEGIC OBJECTIVESPerspectives
Improve Health
Outcomes & Eliminate
Disparities
# 3Inform, Educate,
& Empower People (Promote Health)
# 7Help People
Receive Services
# 4Engage & Develop
Community Members & PH
Partners
# 5Develop Policies &
Plans
# 1Monitor Health
Status
# 9Evaluate & Improve
Services & Interventions
# 10Support
Research & Innovation
# 8Assure
Competent Health
Workforces
Community Assets
Community Health Status
Community Implemen-
tation
Community Process & Learning
H2. Increase Active Living & Healthy Eating
STRATEGIC OBJECTIVESPerspective
Com
mun
ity
Ass
ets
Com
mun
ity
Hea
lth
Stat
us
Com
mun
ity
Impl
emen
-ta
tion
Com
mun
ity
Proc
ess
&
Lear
ning
Vision: A creative collaboration between public health, community leaders, community organizations and institutions, business, and government eliminates cultural and economic health disparities by focusing on prevention through behavior and lifestyle changes.
Get Up & Go: Top LevelStrategy Map
H1. Minimize Obesity & Eliminate Disparities
H2. Increase Active Living & Healthy Eating
STRATEGIC OBJECTIVESPerspective
Com
mun
ity
Ass
ets
Com
mun
ity
Hea
lth
Stat
us
Com
mun
ity
Impl
emen
-ta
tion
Com
mun
ity
Proc
ess
&
Lear
ning
Vision: A creative collaboration between public health, community leaders, community organizations and institutions, business, and government eliminates cultural and economic health disparities by focusing on prevention through behavior and lifestyle changes.
Get Up & Go: Top LevelStrategy Map
H1. Minimize Obesity & Eliminate Disparities
I1. Promote Nutrition & Fitness
I1. Improve the Environment
I3. Enhance School & Community Nutrition &
Fitness Activities
P1. Develop & Advocate for Better Policies, Plans &
Programs
I3. Enhance School & Community Nutrition &
Fitness Activities
H2. Increase Active Living & Healthy Eating
I2. Improve the Environment
STRATEGIC OBJECTIVESPerspective
Com
mun
ity
Ass
ets
Com
mun
ity
Hea
lth
Stat
us
Com
mun
ity
Impl
emen
-ta
tion
Com
mun
ity
Proc
ess
&
Lear
ning
I1. Promote Nutrition & Fitness
P4. Create Toolkits &Online Resources for
Community Use
P2. Provide Incentives & Support to
Stimulate Change
P3. Increase Health Status Assessment
H1. Minimize Obesity & Eliminate Disparities
16
Vision: A creative collaboration between public health, community leaders, community organizations and institutions, business, and government eliminates cultural and economic health disparities by focusing on prevention through behavior and lifestyle changes.
Get Up & Go: Top LevelStrategy Map
P5. Encourage School -centered
Health & Wellness
A2. Keep Increasing Partnerships & Volunteerism
P1. Develop & Advocate for Better Policies, Plans &
Programs
I3. Enhance School & Community Nutrition &
Fitness Activities
H2. Increase Active Living & Healthy Eating
I2. Improve the Environment
STRATEGIC OBJECTIVESPerspective
Com
mun
ity
Ass
ets
Com
mun
ity
Hea
lth
Stat
us
Com
mun
ity
Impl
emen
-ta
tion
Com
mun
ity
Proc
ess
& L
earn
ing
I1. Promote Nutrition & Fitness
P4. Create Toolkits &On-Line Resources for
Community Use
A1. Leverage funding opportunities
P2. Provide Incentives & Support to
Stimulate ChangeP3. Increase Health Status Assessment
H1. Minimize Obesity & Eliminate Disparities
17
Vision: A creative collaboration between public health, community leaders, community organizations and institutions, business, and government eliminates cultural and economic health disparities by focusing on prevention through behavior and lifestyle changes.
P5. Encourage School -centered
Health & Wellness
Get Up & Go: Top LevelStrategy Map
St. Clair County Healthcare Commission Strategic Goals and IssuesSTRATEGIC GOALS and ISSUESPerspectives
Improve outcomes for priority health status issues selected by the Health Care Commission
Cardiovascular Diseases
Maternal & Child Health
RespiratoryDisease
STD Disparities
Get Up & Go!
Campaign
Address the Needs of those who
require Behavioral Health Services
Improve Health Services to the
Aging Community
Improve Access to
Care
Strengthen the Public Health Workforce
Create a Broader Sense of Community
Connectedness
Com
mun
ity
Ass
ets
Com
mun
ity
Hea
lth
Stat
us
Com
mun
ity
Impl
emen
-ta
tion
Com
mun
ity
Proc
ess
&
Lear
ning
Behavioral Health
Continually Advance Health Care Commission Processes (e.g., MAPP, QI, Policy Advocacy)
St Clair County MAPP Chronology
• 2006: Phases IV & V:– 6 Strategic Issues
– 13 Overarching Goals
– 47 Strategies
• 2007: Phase VI (Action Cycle) begins:– 35 Action Items for the 6 Strategic Issues
– Get Up & Go! conceived as a countywide Health & Wellness Campaign
19Results That Matter Team (www.RTMteam.net)
St Clair Co MAPP Action Cycle Continues• 2008:
– 7th Strategic issue added– Recognized as a Pioneering Healthier Community
• 2009:– QI Mini-collaborative– Health Policy Summit
• 2010:– Selected by State for CPPW grant application– Piloting Community Balanced Scorecard
20 20Results That Matter Team (www.RTMteam.net)
MAPP in Osceola
Started the process in 1999; updated in 2004 and again in 2009.
MAPP has yielded impressive returns to the community
Data and information on the greatest needs in the county which have been communicated successfully to community partners and to local and national funders
Osceola’s MAPP Process…
Six priority areas were identified: (1) affordable prescriptions (2) specialty physician referral system for
the uninsured(3) inappropriate ER utilization(4) growing numbers of uninsured (5) lack of primary care services in outlying
areas(6) lack of chronic care services.
Tangible Results!
Pharmacy Co-op Developed a voluntary provider network Expanded safety net for uninsured to
include a federally qualified health center and a mobile medical van
Case management forum Cultural competency training
Vision: Osceola County will be a community where all uninsured and underinsured residents have full access to the health care services that they need. (A systemic issue.)
STRATEGIC OBJECTIVESPerspective
Community Assets
Community Health Status
Community Implemen-
tation
Community Process & Learning
Improve outcomes of people with, or at risk of, Diabetes Mellitus and Cardiovascular disease
Target our initiatives to
areas of most need
Increase access to specialty care
Measure our success
Improve the delivery and quality of care by
using evidenced-based best practices
Ensure access to comprehensive
health care
Sustain best practice
programs
Maximize resources and engage new & existing partners in developing solutions
Ensure the public health workforce is skilled to address
health issues
Increase enrollment in a medical home
24
25
You often need to “zoom in” from:• a “top level” strategy map• to maps with more details.
25Results That Matter Team (www.RTMteam.net)
CommunityAssets
“Healthy Living” Themes from Communities of HOPE
Community HealthStatus
Pers
pect
ives
Strategic Themes
CommunityImplementation
CommunityProcess& Learning
Reduce Smoking &
Substance Abuse
Chronic Disease Prevention,
Early Detection, &
Managem
ent
Healthy Eating
Better Exercise
H e a l t h y L i v i n g
26
St. Clair County Healthcare Commission Strategic Goals and IssuesSTRATEGIC GOALS and ISSUESPerspectives
Improve outcomes for priority health status issues selected by the Health Care Commission
Cardiovascular Diseases
Maternal & Child Health
RespiratoryDisease
STD Disparities
Address the Needs of those who
require Behavioral Health Services
Improve Health Services to the
Aging Community
Improve Access to
Care
Strengthen the Public Health Workforce
Create a Broader Sense of Community
Connectedness
Com
mun
ity
Ass
ets
Com
mun
ity
Hea
lth
Stat
us
Com
mun
ity
Impl
emen
-ta
tion
Com
mun
ity
Proc
ess
&
Lear
ning
Behavioral Health
Continually Advance Health Care Commission Processes (e.g., MAPP, QI, Policy Advocacy)
Get Up & Go!Campaign
Theme: Expand with Education & Engagement
Theme: Fitness
Theme: School-based Strategies
Theme: Nutrition
CommunityAssets
“Get Up and Go” Themes from St. Clair County
Community HealthStatus
Pers
pect
ives
Strategic Themes
CommunityImplementation
CommunityProcess& Learning
Engagement and Education
Nutrition
Fitness
GET UP & GO!
28
School-based Efforts
Built Theme Objectives from Processes Many Contributed to
From Nov 2009 Health Policy Summit
From the CPPW Grant Application
And from other grant applications and planning documents
29Results That Matter Team (www.RTMteam.net)
STRATEGIC OBJECTIVESPerspective
Community Assets
Community Health Status
Community Implemen-
tation
Community Process & Learning
Minimize Obesity & Eliminate Disparities
Improve planning & advocacy for school
and community nutrition
Identify and target communities at highest risk for food insecurity
Incentivize schools to comply with established nutrition & wellness policies
Overcome cultural & informational barriers to
better nutrition
Create a data mining capability to inform the public and target initiatives
Motivate grassroots demand for better school
nutrition policies
Increase breast feeding support through education
Leverage funding opportunities for improving nutrition
Maximize nutrition value for kids in school, family, & other settings
Increase Healthy Eating
Facilitate the availability of fresh and locally grown
fruits and vegetables
Get Up and Go!Nutrition Theme
A creative collaboration between public health, community leaders, community organizations and institutions, business, and government eliminates cultural and economic health disparities by focusing on prevention through behavior and lifestyle changes.
Vision:
Teach gardening skills & encourage
community gardensCoordinate community and family nutrition education
Promote replacement of sugary and unhealthy snacks
with healthy alternatives
31
Ranking Possible Initiatives for this Objective
32Results That Matter Team (www.RTMteam.net)
* Top ideas that have the highest strategic value and with the highest ability to do
Health Summit – February 18, 2010
Leaders focused on top 5 Strategy Map objectives
1. Sustain best practice programs
2. Improve delivery and quality of care using evidence-based best practices
3. Increase access to specialty care
4. Ensure access to comprehensive care
5. Increased enrollment in a primary medical home
This work becomes the...
Community Balanced Scorecard33
Vision: Osceola County will be a community where all uninsured and underinsured residents have full access to the health care services that they need.
STRATEGIC OBJECTIVESPerspective
Community Assets
Community Health Status
Community Implemen-
tation
Community Process & Learning
Improve outcomes of people with, or at risk of, Diabetes Mellitus and Cardiovascular disease
Target our initiatives
for greatest need
Measure our success
Improve the delivery and quality of care by
using evidenced-based best practices
Ensure access to comprehensive
health care
Sustain best practice
programs
Maximize resources and engage new & existing partners in developing solutions
Ensure the public health workforce is skilled to address health issues
Increase enrollment in a primary care
medical home
Pool and match resources with needs
Use resources at maximum value
Increase & optimize external resources
Increase access to specialty care
Ensure access to comprehensive
health care
Vision: Osceola County will be a community where all uninsured and underinsured residents have full access to the health care services that they need.
STRATEGIC OBJECTIVESPerspective
Community Assets
Community Health Status
Community Implemen-
tation
Community Process & Learning
Improve outcomes of people with, or at risk of, Diabetes Mellitus and Cardiovascular disease
Increase enrollment in a primary care medical homes
Expand Primary Care Capacity for Under-
& Uninsured
Better Leverage Partners to Connect People to Primary
Care Medical Homes
Clearly Define PCMH Role
Co-locate FQHC Clinics & Free Clinics w/ ER
Recruit & Reward PC Professionals
Recruit & Reward Volunteers for Free Clinics
Extend Free Clinics to Operate in Faith Orgs.
Team with Healthcare Schools
Expand County’s FQHC Sites
Enhance Profitability of Serving Underinsured
Enhance ER Diversion Formalize Targeted Referral Processes for HC Orgs
Segment Interventions for Populations & Conditions
Better Coordinate Who Should Do What
School-based programsDevelop
Partner-Specific Programs
Maximize resources and engage new & existing partners in developing solutions
Use resources at maximum value
Pool and match resources with needs
Adopt evidenced-based best practices for increasing medical
home enrollment & use.
Medical Home Enrollment
Setting Implementation Priorities
36Results That Matter Team (www.RTMteam.net)
Low Medium High
Low
Medium
High
Stra
tegi
c Im
port
ance
Difficulty of Implementing
Encourage Others to “Jump In”
Low Medium High
Low
Medium
High
Stra
tegi
c Im
port
ance
Difficulty of Implementing
Programmed Priorities
37Results That Matter Team (www.RTMteam.net)
Next Steps
• In Saint Clair County
• In Osceola County
39Results That Matter Team (www.RTMteam.net)
Next Steps
“The Sequel: Did we get it right?”1. Reconvene Health Summit
2. Give feedback from their initial work
3. Identify what they think is most important
Health Leadership Council1. Present recommendations from “The Sequel”
2. Use Implementation Priority Grid (next slide) to make decisions on 3-5 top objectives
3. Develop timelines for implementation
40
Population & Participant Outcomes
41Results That Matter Team (www.RTMteam.net)
Outcomes & Performance Drivers
Performance Driver
Population Outcomes
Participant Outcomes Performance
Drivers
42Results That Matter Team (www.RTMteam.net)
Vision: Osceola County will be a community where all uninsured and underinsured residents have full access to the health care services that they need.
STRATEGIC OBJECTIVESPerspective
Community Assets
Community Health Status
Community Implemen-
tation
Community Process & Learning
Improve outcomes of people with, or at risk of, Diabetes Mellitus and Cardiovascular disease
Target our initiatives
for greatest need
Measure our success
Improve the delivery and quality of care by
using evidenced-based best practices
Ensure access to comprehensive
health care
Sustain best practice
programs
Maximize resources and engage new & existing partners in developing solutions
Ensure the public health workforce is skilled to address health issues
Increase enrollment in a primary care
medical home
Pool and match resources with needs
Use resources at maximum value
Increase & optimize external resources
Increase access to specialty care
Ensure access to comprehensive
health care
Vision: Osceola County will be a community where all uninsured and underinsured residents have full access to the health care services that they need.
STRATEGIC OBJECTIVESPerspective
Community Assets
Community Health Status
Community Implemen-
tation
Community Process & Learning
Improve outcomes of people with, or at risk of, Diabetes Mellitus and Cardiovascular disease
Ensure access to comprehensive
health care
Sustain best practice
programs
Maximize resources and engage new & existing partners in developing solutions
Increase enrollment in a primary care
medical home
Use resources at maximum value
Increase access to specialty care
Ensure access to comprehensive
health care
No. successful programs sustained beyond initial funding period
No. people diverted from emergency room to a medical homeNo. non-urgent ER visits
•Sample Draft Measures
Vision: Osceola County will be a community where all uninsured and underinsured residents have full access to the health care services that they need.
STRATEGIC OBJECTIVESPerspective
Community Assets
Community Health Status
Community Implemen-
tation
Community Process & Learning
Improve outcomes of people with, or at risk of, diabetes mellitus and cardiovascular disease
Sustain best practice
programs
Maximize resources and engage new & existing partners in developing solutions
Increase enrollment in a primary care
medical home
Use resources at maximum value
Increase access to specialty care
Ensure access to comprehensive
health care
No. successful programs sustained beyond initial funding period
No. people diverted from ER to a medical homeNo. non-urgent ER visits
No. physicians in specialty care network (by specialty)
Percent of people who have a usual source of care
•Sample Draft Measures
No. people enrolled in free clinics with access to comprehensive care
Vision: Osceola County will be a community where all uninsured and underinsured residents have full access to the health care services that they need.
STRATEGIC OBJECTIVESPerspective
Community Assets
Community Health Status
Community Implemen-
tation
Community Process & Learning
Improve outcomes of people with, or at risk of, diabetes mellitus and cardiovascular disease
Sustain best practice
programs
Maximize resources and engage new & existing partners in developing solutions
Increase enrollment in a primary care
medical home
Use resources at maximum value
Increase access to specialty care
Ensure access to comprehensive
health care
No. diabetes patients who improve in Hgb A1c levels No. hospitalizations for people with congestive heart failure
No. successful programs sustained beyond initial funding period
No. people diverted from ER to a medical homeNo. non-urgent ER visits
No. physicians in specialty care network (by specialty)
Percent of people who have a usual source of care
•Sample Draft Measures
No. people enrolled in free clinics with access to comprehensive care
Additional Sources
• Documentation posted at www.RTMteam. net
• Recorded Webinars at www.RTMteam.net and www.Insightformation.com
• Chapters 7, 17, & 18 in The Public Health Quality Improvement Handbook of PHF & ASQ (ASQ Quality Press, Milwaukee, 2009)
• Upcoming presentation at NPHPSP training in Dallas (April 14: Day before MAPP training)
• Request a PDF of these slides on evaluation survey
47Results That Matter Team (www.RTMteam.net)
Opportunities for More Communities
• If you have partners, you can get started
• Projects can with one community at a time or groups of communities– Indicate interest on evaluation survey
• Potential for communities at different stages of MAPP or not using MAPP
• Contact Paul Epstein ([email protected]) or 212-349-1719
• Contact Heidi Deutsch ([email protected]) or 202-507-4214
48Results That Matter Team (www.RTMteam.net)