Future Leading

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Future Leading Lagging Indicators of Community
Health

• Paul Epstein epstein_at_epsteinandfass.com
• Results That Matter Team (www.resultsthatmatter.ne
  t)
• Epstein Fass Associates [phone]
• Community Indicators Consortium Conference
• Arlington, Virginia
• June 27, 2008

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PH Essential Services Operational Standards

• Ten Essential Services of PH
• Monitor health status to identify community
  health problems.
• Diagnose and investigate health problems and
  health hazards in the community.
• Inform, educate, and empower people about health
  issues.
• Mobilize community partnerships to identify and
  solve health problems.
• Develop policies and plans that support
  individual and community health efforts.

• Ten Standards of the Operational
• Definition of a Local Health
• Department (LHD)
• Monitor health status and understand health
  issues facing the community.
• Protect people from health problems and health
  hazards.
• Give people information they need to make healthy
  choices.
• Engage the community to identify and solve health
  problems.
• Develop public health policies and plans.

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PH Essential Services Operational Standards

• Ten Essential Services of PH
• Enforce laws regulations that protect health
  ensure safety.
• Link people to needed personal health services
  and assure the provision of health care when
  otherwise unavailable.
• Assure a competent public and personal health
  care workforce.
• Evaluate effectiveness, accessibility and quality
  of personal and population-based health services.
• Research for new insights and innovative
  solutions to health problems.

• Ten Standards of the Operational
• Definition of a Local Health
• Department (LHD)
• Enforce public health laws and regulations.
• Help people receive health services.
• Maintain a competent public health workforce.
• Evaluate and improve programs and interventions.
• Contribute to and apply the evidence base of
  public health.

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Sample Health System Model Standards LHD
Operational Standards

• Local Health System Model
• Standards for
• 3. Inform, educate, and
• empower people about health
• issues.
• 3.1 Health Education and Promotion
• 3.2 Health Communication
• 3.3 Risk Communication

• NACCHO LHD Accreditation
• Focus Standards for
• III. Give people information they
• need to make healthy choices.
• III-A. Develop and Implement Media Strategies
• III-B. Data and Information Exchange on Issues
  Affecting Population Health
• III-C. Provide Health Information to Individuals
  for Behavior Change
• III-D. Health Promotion Programs For Behavior
  Environ-mental/Community Change

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LHD STANDARD IIIC Provide targeted, culturally
appropriate information to help individuals
understand what decisions they can make to be
healthy.

• There are 225 indicators covering all LHD
  Standards.

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Scoring Scales

• Both the Local Health System LHD Assessments
  use 5-point scales
• Scale definitions from the LHD Assessment Tool
• 0 No capacity There is no capacity, planning,
  staff, resources, activities to fulfill the
  indicator
• 1 Minimal capacity minimal planning and
  staffing capacity but no implementation
  activity or documentation
• 2 Moderate capacity There is moderate
  planning, staffing and other resources but only
  minimal activity and/or documentation
• 3 Significant capacity significant planning,
  staffing, and other resources and a moderate
  amount of activity and/or documentation
• 4 Optimal capacity There is significant
  planning, staffing and resources and significant
  to optimal activity and/or documentation

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Effective Community Governance Model from
Results that Matter (Jossey-Bass, 2006)
Align 2 or 3 Core Skills
to Get 4 Advanced Governance Practices
1
3
4
2
7
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Performance Feedback Cycles to Keep Improving
Suggested Triple Loop Learning from Accreditation
Quality Improve-ment for One LHD
LHD Mission, Strategic Plan, Resource
Allocation Incorporation of NACCHO Operational
Definition Accreditation Standards
Redesign Programs Revise Service Plans Based on
Measured Results Accreditation Assessment
Improve Program Delivery
Build Performance Measurement Learning
Capability
Deliver Programs and Services

• Cycles for
• LHD Organizational
• Learning

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Performance Feedback Cycles to Keep Improving
Triple Loop Learning from Accreditation Quality
Improvement from the Local to National Levels
NAACHO Operational Definition Accreditation
Standards Local Health System Model Standards
Improve Accreditation Standards Based on Best
Practices
Improve Accreditation Standards based on Best
LHD Practices
Revise Service Plans Based on New Programs
Strategies
Redesign Programs Strategies based on Best
Practice Comparisons
Build National Learning Capability Improve How
to Use Standards and Benchmarks
Improve LHD Practices Based on Results
Accreditation Assessment
Deliver Programs and Services
Measure Results Benchmark Practices Against
Accreditation Standards Best Practices

• Cycles for
• Organizational
• Learning
• Collaborative
• Learning
• National
• Learning

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Community Balanced Scorecard

• Combines the results-focused community building
  power of Effective Community Governance with the
  strategy alignment of Balanced Scorecards
• Pulls the community together around common
  outcomes desired by citizens
• Brings together decision makers and leverages
  assets from all sectors for shared results
• 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.
• For more, see the website below.

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Balanced Scorecards

• Balanced Scorecards traditionally map strategies
  based on cause effect assumptions across
  multiple performance perspectives or views that
  relate to strategy.
• Detailed cause-and-effect relationships can be
  complex, but in general they move upward across
  the scorecard perspectives.
• Perspectives can vary by organization, especially
  outside the business sector.

• Suggested for
• Public Health
• Community
• Balanced
• Scorecards
• Community Health Status
• Community Action
• Community Learning Planning
• Community Assets

• Traditional
• Business
• Perspectives
• Financial Performance
• Customer
• Internal Business Process
• Learning Growth

• Hartford
• Public Library
• End Results
• Processes Practices
• Learning and Growth
• Leadership and Development

• City of Charlotte,
• North Carolina
• Serve the Customer
• Run the Business
• Manage Resources
• Develop Employees

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Potential Public Health Community Balanced
Scorecard Strategy MapBased on the Ten Essential
Services Operational Standards of Public Health
STRATEGIC OBJECTIVES
Perspectives
Both Objectives Relate to Essential Service 1
Improve Health Outcomes Eliminate Disparities
Community Health Status
LAGGING INDICATORS
2-Investigate, Respond to Emergencies Threats
LAGGING LEADING INDICATORS
Community Action
6-Enforce Laws Regs
LEADING INDICATORS
Community Learning Planning
Community Assets
4-Engage Develop Community Members PH Partners
LEADING INDICATORS
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Cascading Scorecards to Implement Strategy

• Cascading by organizational sub-unit
• Important for mid-size and large organizations
  using organizational Balanced Scorecards.
• Not critical for Community Balanced Scorecards.
• Cascading by theme
• Used by organizations for cross-cutting issues,
  often involving cross-functional teams from
  several departments.
• Especially important for Community Balanced
  Scorecards on broad issues such as public health.

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Sample Types of Themes for a Public Health
Community Balanced Scorecard
STRATEGIC OBJECTIVES
Perspectives
Mortality or Morbidity Specific Themes
Risk-specific Themes
Demographic Themes
Policy-related Themes
Geographic Themes
Physical Environment Themes
Action-related Themes
Social Environment Themes
Community Health Status
Community Action
Community Learning Planning
Community Assets
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Potential Public Health Community Balanced
Scorecard Sample Leading Lagging
IndicatorsSample Demographic Theme Health of
Our Citys Homeless Population
STRATEGIC OBJECTIVES POSSIBLE
INDICATORS
Leading or Lagging
Perspectives
Community Health Status
Community Action
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Potential Public Health Community Balanced
Scorecard Sample Leading Lagging
IndicatorsSample Demographic Theme Health of
Our Citys Homeless Population
STRATEGIC OBJECTIVES POSSIBLE
INDICATORS
Leading or Lagging
Perspectives
Community Learning Planning
Community Assets
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Sources References

• For Effective Community Governance and Community
  Balanced Scorecards
• www.effectivegovernance.com
• Book on Effective Community Governance Epstein,
  P., Coates, P., Wray, L. with D. Swain. Results
  That Matter, Jossey-Bass, San Francisco, 2006.
• Excellent Portal Source on the National Public
  Health Performance Standards Program
• Public Health Performance Improvement
• Public Health Foundation, Washington, DC
  http//www.phf.org/performance.htm
• For the 10 Essential Services of Public Health
  Local Health System Assessment Standards
• Local Public Health System Performance Assessment
  Instrument, Version 2.0. The National Public
  Health Performance Standards Program, U.S.
  Centers for Disease Control and Prevention,
  Atlanta. Available from http//www.cdc.gov/od/ocp
  hp/nphpsp/NewInstrument.htm
• For the 10 Standards of the Operational
  Definition of a Local Health Department (LHD)
• Operational Definition of a Functional Local
  Health Department. National Association of County
  City Health Officers (NACCHO), Washington, DC,
  November 2005.
• http//www.naccho.org/topics/infrastructure/
  accreditation/operationaldefinition.cfm
• For NACCHO LHD Accreditation Focus Standards,
  Indicators, Scale Definitions
• Local Health Department Self-Assessment Tool
  Operational Definition of a Functional Local
  Health Department Capacity Assessment for
  Accreditation Preparation. NACCHO
• http//www.naccho.org/topics/infrastructure/accre
  ditation/OpDefMetrics.cfm