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Going Beyond the County Health Rankings – Sharing Local Data &
Information Technology
Bill Barberg, President - Insightformation, Inc.
Mark Peters, Director of Community Health – St. Clair County Health Dept.
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Agenda
• Cooperative Assessment and Priority Issue Selection
• The Need for Improved Collective Impact
• Reviewing & Revising a Draft Diabetes Strategy Map
• Gathering Details on Several Objectives
• Developing Strategic Measures
• Next Steps
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• East Side Health District
• Memorial Hospital
• Southern IL Healthcare Foundation
• St. Clair County Health Department
• St. Elizabeth’s Hospital
• Touchette Regional Hospital
Background
2014 Summit Recommendation
“A Commitment to Cooperative Assessments”
Community Best Practice
For Triple Aim
FQHC
IPLAN ACA
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Long Range Goal: Community Oriented
Continuous Quality Improvement
Information Technology
Strategy Maps
Balanced Scorecards
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Step One The Elusive Search for Local Data, Resources and
Information Technology Tools
• Data Use Agreements with the Illinois Department of Public Health
– Case & Community Specific Birth Information
– Case & Community Specific Death Information
– Case & Community Specific Hospital Information
• Community Level Demographic & Socio-economic Indicators
• GIS Layers for Land Use and Outcome Mapping
• ESRI Food Access & Healthy Lifestyle Activities
• Behavioral Risk Factor Surveillance (Youth & Adult)
• Program Implementation and Outcome
1990 - 2013
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Step Two Evaluate Current Community Health Assessments and Plans
• East Side Health District • HIV/AIDS
• Obesity Prevention
• Cancer
• Environment
• Memorial Hospital • Lung Cancer
• COPD
• Diabetes
• Cardiovascular Disease
• Southern IL Healthcare Foundation • Dental/Oral Health
• Behavioral Health
• Cardiovascular Disease
• COPD/Tobacco
• Obesity
• Prenatal Health
• HIV/AIDS
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Step Two Evaluate Current Community Health Assessments and Plans
• St. Clair County Health Department • Risk Factors for Chronic Diseases (Diabetes, Lung Cancer, Heart Disease
• Maternal & Child Health (Infant Mortality, Teen Pregnancy, STD’s/HIV)
• Behavioral Health (Suicide, Substance Abuse)
• Violence Prevention (Homicide, Domestic Abuse, Neighborhood Crime)
• St. Elizabeth’s Hospital • Access to Healthcare
• Diabetes
• Behavioral Health
• Touchette Regional Hospital • Cancer
• Mental Health
• Diabetes
• STIs
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Step Three Select a Starting Place based on a Common Priority Issue
Did you notice any alignment with the six organizational CHAs & CHIPs?
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Premature Mortality Rates*(<65 Years of Age) for Diabetes Mellitus for St. Clair County, Illinois and the United States
2004-2013
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
St. Clair County 18 12.7 16 23.3 15.9 15.7 12.7 11 17.6 15.3
Illinois 6.8 6.9 6.7 6.8 6.5 6.8 6.6 6.6 6.8 7.2
U.S. 7.5 7.7 7.7 7.5 7.4 7.4 7.4 7.9 7.8 8
0
5
10
15
20
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*Rates are calculated per 100,000 population.
Source: CDC Wonder, Compressed mortality file.
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Diabetes Deaths 2008
Legend
85 - 168
26 - 84
< 26
Source: IDPH, Vital Records
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Diabetes Deaths 2009
Legend
85 - 168
26 - 84
< 26
Source: IDPH, Vital Records
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Diabetes Deaths 2010
Legend
85 - 168
26 - 84
< 26
Source: IDPH, Vital Records
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Diabetes Deaths 2011
Legend
26 - 84
< 26
Source: IDPH, Vital Records
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Diabetes Deaths 2012
Legend
85 - 168
26 - 84
< 26
Source: IDPH, Vital Records
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Diabetes Deaths 2013
Legend
85 - 168
26 - 84
< 26
Source: IDPH, Vital Records
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Diabetes Deaths 2008-13
Legend
280 - 446
169 - 279
85 - 168
26 - 84
< 26
Source: IDPH, Vital Records
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Area Diabetes Programs Scott Air Force Base
• 375th MDG uses MERCK Journey for Control Healthy Interactions Diabetes Conversation Maps to educate newly diagnosed patients as well as those needing to refresh their knowledge on management of their diabetes.
• They also use the University of Pittsburgh's Diabetes Prevention Support Center's "Group Lifestyle Balance Program" for patients who have pre-diabetes and/or the metabolic syndrome.
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Area Diabetes Programs Touchette Regional Hospital
• Diabetes Self-Management program is an outpatient program accredited by the American Association of Diabetes Educators. Participants are educated on Healthy Eating, Being Active, Monitoring, Taking Medications, Problem Solving, Reducing Risks and Healthy Coping.
• Participants are taught in group sessions by an RN who is a Certified Diabetes Educator and a diabetic of 15 years as well as a Registered Dietician, Physical Therapist, and a Certified Wound Care Nurse.
• Classes are hands on, where participants learn to carb count, read labels, and build meals using food models. Participants work on individualized goals and treatment plans.
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Area Diabetes Programs St. Elizabeth’s Hospital
• Diabetes Support Group with Monthly Guest Speakers
• Diabetes Support Group-2x/week Exercise Sessions (1 evening, 1 day)
• ADA Diabetes Self-management Training Program: Individual and group sessions with Certified diabetes educator
• Outpatient Nutrition Counseling: Medical Nutrition Therapy for Diabetes
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Area Diabetes Programs YMCA Diabetes Prevention Program
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Agenda
Cooperative Assessment and Priority Issue Selection
• The Need for Improved Collective Impact
• Reviewing & Revising a Draft Diabetes Strategy Map
• Gathering Details on Several Objectives
• Developing Strategic Measures
• Next Steps
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The Model Behind the County Health Rankings
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The Importance of Addressing Social Needs
Source: online survey of 1,000 American physicians conducted Sept-Oct 2011 on behalf of the Robert Wood Johnson Foundation.
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It Takes Team Approach for Social Needs
Source: online survey of 1,000 American physicians conducted Sept-Oct 2011 on behalf of the Robert Wood Johnson Foundation.
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Priorities for Addressing Social Needs
Source: online survey conducted Sept-Oct 2011 on behalf of the RWJF
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Schools
Community Centers
Employers
Transit
Elected Officials
Doctors
EMS
Law Enforcement
Nursing Homes
EMS
Corrections
Mental Health
Faith Based Orgs
Civic Groups
Non-Profit Organizations
Foundations & Grant Makers
Laboratories
Home Health
Comm. Health Centers
Hospitals
Tribal Health
Drug Treatment Wellness Coalition
Many Organizations Should be Involved
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Execution Gap
No Strategic Alignment Health Goals
© 2014 All Rights Reserved by Insightformation, Inc.
• Wasteful redundancy • Little sharing of information, ideas and resources • Frequent ramp-up and ramp-down of programs
based on funding • Time spent chasing and competing for funding • Frustration among people committed to
improving the environment
Will one more little arrow solve the problem?
Fragmentation Undermines Success
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Execution Gap
No Strategic Alignment
Improve Community
Health Outcomes
Health Depts
Social Service Providers
Schools Community groups
Faith Communities
Medical Practices
Hospitals
Families & individuals
Unmet Health Goals
Employers
© 2014 All Rights Reserved by Insightformation, Inc.
Other Public Agencies & Officials
Opportunity to Collaborate around a Strategy
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People Get Healthier TOGETHER
Create Strategies for Neighborhoods or Other Communities
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What are the New Techniques & Tools
• Collective Impact – Shifting from Isolated Impact to Collective Impact – Five Key Conditions
• Strategy Mapping and Shared Scorecards – A flexible, co-created framework for change – OMTA (Smarter than SMART goals) – Zoomability to tame the complexity
• Appropriate Information Technologies – Efficient information management and sharing – Allows the role of “Backbone Support” to be shared – Simplifies “Continuous Communication”
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Introducing the Term “Collective Impact”
2011
2011
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How is Collective Impact Achieved?
Source::
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Shared Goal – but No Strategy for Teamwork
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Professional Soccer Players Know their Roles…
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…Because They Understand the Strategy
© 2012 All Rights Reserved by Insightformation, Inc.
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The Five Conditions of Collective Impact
Condition One: Common Agenda - All participants have a shared vision for change including a common understanding of the problems and a joint approach to solving it through agreed upon actions
Upgraded to, A Shared (Co-Created) Strategy
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Re-Thinking Strategy for Systems
• From: Organizational Mindset of “The few things we will pick to do with our limited resources”
• To: Community System Mindset of “A framework that will enable alignment and success—which we will work with the community to figure out how to do.”
Once the Community Strategic Framework is in place, different organizations can align their organizational strategies and pick the few things they will do with their limited resources.
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Understanding a Strategy Map
These are Strategic Objectives (regardless of the color) Each Strategic Objective also has measures in the Scorecard.
Clicking on this “zoom in” icon allows you to zoom in to see an added layer of strategic objectives that provide more details related to this objective.
Clicking on the “zoom out” icon allows you to zoom out to see the bigger picture.
Expand Use of Care Navigators & Diabetes
Coaches
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Agenda
Cooperative Assessment and Priority Issue Selection
The Need for Improved Collective Impact
• Reviewing & Revising a Draft Diabetes Strategy Map
• Gathering Details on Several Objectives
• Developing Strategic Measures
• Next Steps
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Switch to the Zoomable Strategy Maps
St. Clair County
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Input on the Diabetes Strategy Map
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The Five Conditions of Collective Impact
Condition Three: Mutually Reinforcing Activities - Participant activities must be differentiated while still being coordinated through a mutually reinforcing plan of action
Upgrade to Mutually-Reinforcing and Mutually-Beneficial Activities The Real Source of Power for Collective Impact
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An Important Shift in Thinking
• From: “What do I need to do?” (or my organization)
• To: “How are we going to win as a community—and what is my organization’s role?”
A Copernican Shift in Strategic Thinking
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Who Scored More Career Points than This Guy?
32,292 Points
Michael Jordan
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Who Is This Guy?
36,928 Points
Karl Malone
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What made the Difference for Karl Malone?
36,928 Points
Karl Malone
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The Power of Teamwork!
36,928 Points
15,806 Assists (3,000 more than #2) 9x NBA Assists Leader
Karl Malone John Stockton
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Recommendations for Recruiting Partners
• Focus on engaging the people you’re trying to help—not just as voices, but as key parts of the solution.
• Strategy Ambassadors
• Faith Communities
• Universities and Colleges
• Social Entrepreneurs
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Improve Each Program with “Assists”
© 2015 All Rights Reserved by Insightformation, Inc.
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Agenda
Cooperative Assessment and Priority Issue Selection
The Need for Improved Collective Impact
Reviewing & Revising a Draft Diabetes Strategy Map
• Gathering Details on Several Objectives
• Developing Strategic Measures
• Next Steps
Work Session
•Select an Objective to Work on.
•Develop Draft Descriptions
• Identify current Activities and Plans
•Create a draft “From-To Gap”
• Identify Potential Assists
• List possible Lead Advocate and Action Team
Picking Objectives to Work On
Gathering Information for Objectives
Examples of Supporting Information
• Description An important way to improve demand for local food and to increase consumption of local food by low-income population is to expand the use of EBT and WIC for purchasing local produce. While we don’t have detailed data, there is substantial evidence that EBT (SNAP) and WIC resources are often used to buy packaged, highly-processed and non-local food. Regardless of what the exact numbers are, our strategy is to overcome some of the obstacles that may hinder use of these funds and encourage the desired change. Some of the ways we will work to achieve this objective include: • Education of people who receive SNAP and WIC funds about the importance and benefits
of eating local produce, where to get it, and how to prepare it. This could be done through a variety of organizations where people have relationships and trust.
• Expanding the acceptance of SNAP/EBT and WIC payments at farmers markets and other places that sell local produce.
• Securing funding and support for programs like “Double-up Food Bucks” to incentivize the use of SNAP or WIC funds for purchasing local produce.
• Working with corner store and convenience vendors to support them in offering more local produce and to promote community members buying that produce so the stores can be successful selling it.
• Lead Advocate: John Smith, [email protected] 715-832-4266
• Action Team • Terry Paige, Claire Williams, Ming Tang, and Yolanda Colburn
Expand the Use of EBT/WIC for Local
Produce
Gathering Information for Objectives
Gathering Information for Objectives
Examples of Supporting Information
From – To Gap:
Current State (2014) 1. Many people receiving SNAP and WIC shop at convenience stores that sell mainly
processed food and lack easy access to healthy, local produce. 2. Lack of awareness, habits and skills for cooking local produce reduces the interest
of people to strive to purchase produce of any kind. 3. Transportation difficulties and high costs (actual and perceived) keep many
recipients of SNAP/WIC from purchasing local produce at farmers markets.
Desired State (2018) 1. Convenience stores sell more local produce—sometimes from mini farmers
markets right in the stores or even via CSA-type arrangements. 2. Recipients of SNAP and WIC benefits also receive training and information for how
to purchase, prepare and enjoy fruits and vegetables. Organizations that are involved with people who receive these benefits actively encourage the opportunities for developing these skills and healthy eating habits.
3. Programs to overcome the transportation obstacles have led to increased purchase of local produce. Financial incentives (like Double-Up Food Bucks) help make the purchase of local produce more attractive and overcome perception problems.
Expand the Use of EBT/WIC for Local
Produce
Engaging the Core Collaborators
Local Health Department(s) Non-Profit Hospital(s)
Local United Way Organization
Expanding the Circle
County Social Services
School District(s)
Community Foundation
Faith Communities
FQHCs
Mental Health Providers
Parks & Rec Dept
Chamber of Commerce
Civic Orgs (Rotary, etc.)
Municipal Gov’ts
Health Payers
And Many More…
• Local Media
• Colleges & Universities
• Affordable Housing Providers & Property Managers
• Libraries
• Youth-serving Organizations
• Para-Church organizations
• National Organizations
• Other Local Foundations
• Other Health Care Centers
• Transportation Providers
• City Planners
• Real Estate Developers
• Retirement Communities
• Social Entrepreneurs
Look for Mutually-Beneficial
Opportunities that are also Mutually-Reinforcing to achieve the Common
Agenda
Examples of Supporting Information
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Agenda
Cooperative Assessment and Priority Issue Selection
The Need for Improved Collective Impact
Reviewing & Revising a Draft Diabetes Strategy Map
Gathering Details on Several Objectives
• Developing Strategic Measures
• Next Steps
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The Conventional Approach
– Select a Goal
– Pick things you will do (“What are your strategies?” “Are they evidence-based?”)
– Choose (“How are you going to measure them?”)
• Create a Measurable Objective (SMART)
– Evaluate (“Were you able to hit your target?” “Did your strategies work?”)
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Flipping the Conventional Approach
• Select outcome Objectives
• Collaboratively map out the strategic “driver” Objectives (changes, not activities) that will be key to accomplishing the Outcome Objectives
• Select Measures and Targets for those Objectives
• Plan/Collaborate on what it will take to hit the targets, prioritize initiatives and bring in as many “Mutually-Beneficial and Mutually-Reinforcing” activities as you can to accomplish all the drivers so you accomplish the outcomes.
• Use shared accountability and transparency for monitoring the progress on the activities by many different organizations.
• Use Rapid-cycle QI to make improvements quickly and pull in more assists
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What Strategy Measurement is NOT (esp. CI)
• A Clinical Trial or a Research Experiment – Don’t keep trying to re-prove things that are already
established • Example: Raising my kids
– Keep collaborating and innovating to overcome obstacles
• Six Sigma-like Measurement Practices
– Achieving breakthroughs in community health is very different from refining a repetitive manufacturing process (or any operational process)
– Reducing variance is usually not practical or a wise priority at the strategic level
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What Strategy Measurement is NOT (esp. CI)
• A Journey of Data Analytics and Discovery – Analytics can be valuable to inform strategy selection or
to trouble-shoot and discover potential problems, but it is fundamentally different from strategic measurement.
– A major lesson learned in the business world
• Operational Monitoring – Not a dashboard to monitor operational processes
• Library System example (Come in to look at your dashboard each morning to see if something has changed.)
– Don’t just measure what your organization does – Valuable data rarely comes from operational systems
• Automobile dashboard vs. GPS System
