Performance standards program leading to health improvements: strengthening public health services.

Health leaders across the country are finding that taking a closer look at their public health systems can have positive results, leading to strengthened partnerships, new lines of communication and most importantly, health improvements.

The accomplishments are being realized thanks to the National Public Health Performance Standards Program, a performance assessment tool that helps health system stakeholders assess how well they are meeting the needs of residents. Launched in 2002, the program allows health leaders to compile and evaluate data on their health systems and provides a framework for improvement. More than 20 states, 800 local health systems and hundreds of local boards of health have conducted assessments using the standards program as of September 2006.

"It's wonderful to see that so many communities have embraced the program, and even better, that they are using the process to make a difference in the health of their residents," said Karlene Baddy, MEd, APHA's director of public health systems and partnerships.

Among those that are seeing results through the program is El Paso County, Colo., home to Colorado Springs. The county conducted an assessment of its public health system in 2003 using the National Public Health Performance Standards Program, finding that the county was performing well in areas such as surveillance, disease management and linking residents to health care. Health leaders found that they weren't doing quite as well in public health research, which spurred them into action, according to Kandi Buckland, MPA, RN, deputy public health administrator for the El Paso County Department of Health and Environment.

Building on partnerships made through the assessment process, the El Paso County Department of Health and Environment developed a relationship with a local university to booster public health research. The new alliance is having a positive impact: When El Paso County health officials found they were lacking local information on immunizations--specifically, on why schools, day care centers and physicians weren't keeping their immunization data up to date--health officials were able to link up with researchers at the university. The researchers are now in the process of conducting focus groups, which are expected to yield important insights for the health department.

"We have just found it to be a really good relationship," Buckland told The Nation's Health. "It's been a win-win."

El Paso's success was made possible through an assessment instrument provided through the National Public Health Performance Standards Program. The program centers around three assessment tools: a state-level instrument for evaluating state public health systems, a local instrument for local systems and a governance instrument for local governing bodies such as local boards of health. Based on the essential functions of public health--such as surveillance, research and health promotion--the instruments query users on their systems' ability to offer public health services.

Among those using results from the standards program to improve quality is the New Hampshire Department of Health and Human Services in Concord, N.H. The department led an assessment of its public health system in 2005 and followed up with a summit this year.

Based on the results of the assessment, the health department is using work groups to explore six strategic priorities: improving policy and planning, informing and educating the public, strengthening the work force, developing a public health communication plan, mobilizing partnerships and monitoring health status.

Now carrying out their work, the New Hampshire work groups are expected to issue recommendations that can be used to create a public health improvement plan with specific measures, according to Joan Ascheim, MSN, chief of the Bureau of Policy and Performance Improvement within the New Hampshire Department of Health and Human Services. For example, on the issue of work force development, New Hampshire health leaders hope to come up with tools that can be used for performance evaluation of health workers as well as create a database of public health education offerings.

"It's really a plan for the whole public health system, not just the division of public health," Ascheim told The Nation's Health. "It's really helped us define the areas we know that we have been able to work on but hadn't moved forward."

Progress already being achieved

In Polk County, Iowa, home to Des Moines, health officials are realizing success through the use of the National Public Health Performance Standards' governance instrument. With the assistance of staff from the Polk County Health Department, the county's Board of Health Advisory Committee has been working since January 2006 to make its way through the governance instrument. The committee has been setting aside time at each of its monthly meetings to examine health services addressed in the instrument.

Even before the committee's work was complete, the county began making changes based on its results, said APHA member Scott Slater, MPH, a planning specialist for the Polk County Health Department.

For example, a discussion on how the Polk County Health Department ratifies contracts has led to new monthly updates to the Board of Health Advisory Committee on contracts the health department has entered into. County health officials will have a better idea of what other improvements to make once they've finished their assessment, Slater said, and are planning to create a plan of action based on their findings. Overall, the experience has been beneficial for both parties, he said.

"It opens a dialogue between the board of health and the health department," Slater told The Nation's Health. "They are getting a better picture of what we do, and what they can be doing."

Polk County resident Jean Phillips, vice chair of the Board of Health Advisory Committee, said she found the assessment process "extremely helpful," noting that group discussions have helped to create "a common understanding of department functions and to underscore areas we do well and other areas in need of improvement."

Based on the positive experience with the governance instrument, Polk County plans to begin another assessment using the local instrument in 2007, Slater said.

In coming years, health leaders will have updated instruments available to them as they undertake their assessments through the National Public Health Performance Standards Program. Based on feedback received during the past four years of use, officials with the Centers for Disease Control and Prevention officials are working on improvements to the instruments, making them more user-friendly and streamlining many of their questions.

Health leaders looking for tools that they can use immediately to help them in their health improvement work can find them online now via the National Public Health Performance Standards Program Online Resource Center. Developed through the Public Health Foundation, the center is a searchable database of technical assistance resources that can help public health systems improve performance in each essential public health service. Information on the site, online at <www.phf. org/nphpsp>, includes state, local and governance resource guides.

APHA is one of six national partners working on the National Public Health Performance Standards Program with CDC, which is leading the effort.

A scientific session on the National Public Health Performance Standards Program that was held at APHA's 134th Annual Meeting in Boston in November will be available for viewing online as a webcast in January through the Alabama Public Health Training Network, <www. adph.org/alphtn/>.

For more information on the National Public Health Performance Standards Program, visit <www.cdc.gov/ od/ocphp/nphpsp> or call [phone].