PHD Update Stratetgic Planning Using RBA 1

Transcription

1 PHD Update Stratetgic Planning Using RBA 1 Tomás J. Aragón, M.D., Dr.P.H. Health Officer, City & County of San Francisco Director,, SFDPH 213 October 15 The San Francisco Health Commission has identified three strategic priorities for the Department of Public Health which aligns with the nationally recognized Triple Aim (Figure 1). 1. Public Health Accreditation (Health) 2. Integrated Delivery System (Care) 3. Financial & Operational Efficiency (Cost) The purpose of public health accreditation is to create a high performing learning organization that is agile, responsive, and accountable to community stakeholders. We are currently in the preapplication step. The application process begins once we submit a completed application form and required supporting material (see Table ). This material includes, but is not limited to, three prerequisite documents, updated in the last 5 years: 1. Community Health Assessment and Profile (CHA); 2. Community Health Improvement Plan (CHIP), 3. Public Health Strategic Plan (focus of this update) In this update, we report on the progress from our Strategic Planning Retreat held on September 24 25, 213. Here are the PHD priorities: 1 Results-Based Accountability Figure 1: The Public Health Triple Aim Table 1: Accreditation Timeline Step Date Prerequisites December 213 Application December 213 Documentation September 214 PHAB Site Visit January 215 Accreditation March Community Health Improvement Plan 2 2 In partnership with San Francisco Health Improvement Partnership Safe and healthy living environments (SFHIP) Healthy eating and physical activity Access to quality care and services 2. African American/Black health 3. Maternal, child, and adolescent health 4. Optimal health for people at risk or living with HIV Attachments (6) 1. Strategic Plan Table of Contents 2. Strategic map 3. Organization design framework 4. Organization chart 5. Headline indicators and curves 6. Example of a story behind the curve 7. Strategic project management dashboard

2 POPULATION HEALTH DIVISION SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH PROTECTING AND PROMOTING HEALTH AND EQUITY I. Letters from Directors: STRATEGIC PLAN TABLE OF CONTENTS Barbara Garcia, MPA, Director of Health Tomás J. Aragón, MD, DrPH, Health Officer, Director, II. Introduction III. About the City and County of San Francisco IV. The Planning Process V. The Planning Context VI. Vision, Mission and Values VII. Population and Result Statement VIII. Strategic Focus Areas and Headline Indicators Focus Area 1: Safe and Healthy Living Environments Percent exposed to air pollution Percent exposed to second hand smoke Number of severe and fatal pedestrian injuries Focus Area 2: Healthy Eating and Physical Activity Percent of residents who have food security (resource, access, consumption) Percent of residents who maintain a healthy weight Percent of residents who have adequate physical activity Focus Area 3: Access to Quality Care and Services Percent of San Francisco residents enrolled in either health insurance or Healthy San Francisco Focus Area 4: African-American/Black Health Percent of African-American men who abuse alcohol or other drugs Percent of African-Americans with heart disease Mortality rate of African-American women with breast cancer Rates of Chlamydia and Gonorrhea among young African-American women Focus Area 5: Mother, Child and Adolescent Health Percent of pre-term and low birth weight infants Rate of substantiated child maltreatment Percent of adolescents who binge drink Percent of adolescents who use any drugs Focus Area 6: Optimal Health for People At Risk or Living with HIV Number of new HIV infections Percent of newly diagnosed with HIV who receive care Percent of HIV infected who are virally suppressed IX. Acknowledgments

3 GOVERNANCE, ADMINISTRATION, AND SYSTEMS MANAGEMENT PUBLIC HEALTH ACCREDITATION (PHA) DOMAINS CATEGORIES ASSURANCE POLICY DEVELOPMENT ASSESSMENT / RESEARCH POPULATION HEALTH DIVISION SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH PROTECTING AND PROMOTING HEALTH AND EQUITY OUR MISSION OUR VISION Drawing upon community wisdom and science, we support, develop, implement evidence-based policies, practices, and partnerships that protect and promote health, prevent disease and injury, and create sustainable environments and resilient communities. To be a community-centered leader in public health practice and innovation. STRATEGIC DIRECTIONS PHD STRATEGIES AND PERFORMANCE MEASURES Superb knowledge management systems and empowered users STRATEGY 1 : Build an integrated information and knowledge management infrastructure that enables us to monitor health, to inform and guide activities, and to improve staff and systems performance. PERFORMANCE MEASURES: 1.1.Build a strong, highly functional information technology (IT) and technical assistance infrastructure in alignment with Department of Public Health IT strategy. 1.2 Establish a highly functional, integrated infectious disease system to collect and report data, and to deliver and monitor public health actions. 2. Assessment and research aligned with our vision and priorities STRATEGY 2: Integrate, innovate, improve, and expand efforts in community and environmental assessments, research, and translation. PERFORMANCE MEASURES: 2.1 Create an action plan that supports division priorities. 2.2 Build cross-section interdisciplinary teams to improve health outcomes and programmatic activities. 3. Policy development with collective impact 4. Assurance of healthy places and healthy people 5. Sustainable funding and maximize collective resources 6. Learning organization with a culture of trust and innovation. STRATEGY 3: Conduct effective policy & planning that achieves collective impact to improve health and well-being for all San Franciscans. PERFORMANCE MEASURES: 3.1 Establish a division-wide Performance Management, Equity & Quality Improvement Program. 3.2 Establish systems and partnerships to achieve and maintain Public Health Accreditation. 3.3 Develop a prioritized legislative agenda and strategic implementation plan to address health status and inequities. STRATEGY 4: Lead public health systems efforts to ensure healthy people and healthy places PERFORMANCE MEASURES: 4.1 Establish community-centered approaches that address the social determinants of health and increase population well-being. 4.2 Sustain and improve the infrastructure and capacity to support core public health functions, including legally mandated public health activities. STRATEGY 5: Increase administrative, financial and human resources efficiencies within the division. PERFORMANCE MEASURES: 5.1 Establish a centralized business office for the division. 5.2 Appropriately address the human resource issues regarding civil service and contract employees. 5.3 Establish a centralized grants management and development system for the division. STRATEGY 6: Build a division-wide learning environment that supports public health efforts. PERFORMANCE MEASURES: 6.1 Establish a division-wide Workforce Development program.

4 (PHD) Design Framework Updated PH Accreditation Domain Categories (PHD) Assessment KNOWLEDGE MANAGEMENT & DISCOVERY: ARCHES*, CPHR, and BridgeHIV Policy Development STRATEGIC ALIGNMENT: Office of Equity and Quality Improvement HEALTHY PLACES Environmental Health Protection, Equity, and Sustainability HEALTHY PEOPLE Community Health Promotion DISEASES Disease Prevention and Control DISASTERS Emergency Preparedness and Medical Services DPH Community Health Programs - MCAH** - COPC - CBHS - HUH COMMUNITY ORGANIZATIONS - Kaiser Perm., - UCSF / SFSU - SF Planning, DCYF, MTA, etc. High priority, interdisciplinary, cross-branch initiatives, programs, task forces, teams, projects, etc. Assurance Examples: HIV/STD Prevention, Community Health Improvement Plan, African American Health Initiative, etc. High-priority initiatives may be led or coordinated by a PHD Branch, community partner, or community coalition. SF General Hosp. Lagunda Honda Hospital Governance, Administration, & Systems Management OPERATIONS FOCUS: Operations, Finance, and Grants Management PROFESSIONAL DEVELOPMENT: Center for Learning and Innovation * ARCHES = Applied Research, Community Health Epidemiology, and Surveillance; CPHR = Center for Public Health Research **MCAH = Maternal, Child & Adolescent Health; COPC = Comm. Oriented Primary Care; CBHS = Comm. Behaviorial Health Services; HUH = Housing and Urban Health; DCYF = Dept of Children, Youth, & their Families; MTA = Muni. Transportation Agency; SFSU = SF State University; Version

5 (PHD) Organization Chart, Updated Public Health Accreditation Domains* Department of Public Health Barbara A. Garcia, MPA Director of Health Governance, Administration, and Systems Management ASSESSMENT / RESEARCH DPH Policy and Planning, Colleen Chawla, MPA Director POLICY DEVELOPMENT ASSURANCE ** Tomás J. Aragón, MD, DrPH Health Officer & Director Environmental Health Protection Richard Lee, MPH, CIH, REHS (a) Office of Equity and Quality Improvement Israel Nieves-Rivera Community Health Equity & Promotion Tracey Packer, MPH Operations, Finance, & Grants Management Christine Siador, MPH (Deputy) Disease Prevention & Control Susan Philip, MD, MPH Center for Learning & Innovation Jonathan Fuchs, MD, MPH Public Health Emergency Preparedness & Response Naveena Bobba, MD Applied Research, Community Health Epidemiology, & Surveillance Kyle Bernstein, PhD, ScM Emergency Medical Services/DEM John Brown, MD*** Center for Public Health Research Willi McFarland, MD, PhD, MPH&TM Bridge HIV (Research) Susan Buchbinder, MD * Primary activity; all Branches have activities in all domains. ** PHD works closely with Maternal, Child, & Adolescent Health (MCAH) in the SF Health Network *** Medical Director, EMS, Department of Emergency Management

6 POPULATION HEALTH DIVISION PROTECTING AND PROMOTING HEALTH AND EQUITY P POPULATION & RESULT S ESULT STATEMENTS STRATEGICPLANNING: HEADLINE INDICATORS AND CURVES PopulationHealth Division San Francisco Department of Public Health Population: San Francisco s vulnerable populations Result Statement: San Franciscans have optimal health and wellness at every stage in life September 23, 213 In Preparation for the PHD Strategic Planning Retreat 1 2 Focus Area: Safe and Healthy Living Environments Headline Indicator: Percent exposed to air pollution Headline Indicator: Percent exposed to air pollution (1ug/m3 PM2.5 or Greater than 1 excess cancer cases per million) PM 2.5 CANCER Headline Indicator: Percent exposed to second hand smoke Headline Indicator: Number of severe and fatal pedestrian injuries 3 City Avg. = 1.2% of population Mission Bay = 15.8% FiDi = 7.1% SoMa = 6.1% City Avg. = 3.3% of population Mission Bay = 28% SoMa = 27.8% FiDi = 16.5% Source: BAAQMD/SFDPH, 214

7 Headline Indicator: Percent exposed to second hand smoke 16% Percent of population living i in a home where adult(s) smoke inside, /12 14% Smoke 12% 11.8% present indoors 1% 98% 9.8% 82% 8.2% 8% 8.3% 6.9% 6% 4% 2% % /12 Source: California Health Interview Survey 5 Headline Indicator: numberof severe and fatal pedestrian injuries Injuries/de eaths Number of severe andfatal pedestrian injuries, Severely Injured Killed Source: SWITRS Data, California Highway Patrol 6 Focus Area: Healthy Eating and Physical Activity Headline Indicator: Percent of residents whohave have food security (resource, access, consumption) Headline Indicator: Percent of residents who have food security (resource, access, consumption) 6.% Unable to afford food, for those with incomes <=2% poverty Headline Indicator: Percent of residents who maintain a healthy weight Headline Indicator: Percent of residents who have adequate physical activity 4.% 2.% 3.% 23.3% 27.8% 2.4% 44.3% 33.9%.% Source: Ask CHIS 8

8 Headline Indicator: Percent of San Francisco Residents who maintain a healthy weight Headline Indicator: Percent of San Francisco Residents who have adequate physical activity Percent of SF residents with iha healthy h weight, ih BMI le 24.9 San Francisco, During the past month, did you participate ii in any physical activities? iii San Francisco, (CI: ) 55.2 (CI: ) 49.2 (CI: ) (CI: ) (CI: ) (CI: ) Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. SMART BRFSS. Atlanta, Georgia: U.S. Department of Health and Human Services, Center for Disease Control and Prevention, Accessed 9/19/213 9 Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. SMART BRFSS. Atlanta, Georgia: U.S. Department of Health and Human Services, Center for Disease Control and Prevention, Accessed 9/19/213 1 Focus Area: Access to Quality Care and Services Headline Indicator: Percent of San Francisco residents enrolled in either insurance or Healthy San Francisco Headline Indicator: Percent of San Francisco residents enrolled in either insurance or Healthy San Francisco Percent of San Franciscans Who Have Insurance or Are Enrolled in a Comprehensive Access Program 1.% 96.% 96.5% 95.% 94.% 94.% 9.% 92.% 85.% 8.% FY 26 7 FY 27 8 FY 28 9 FY 29 1 FY Source: SFHIP Health Matters in San Francisco Indicator&file=indicator&iid=

9 Focus Area: African American/Black A i khealth Headline Indicator: Percent of African American American men who abuse alcohol or other drugs Headline Indicator: Percent of African American men who abuse alcohol or other drugs Headline Indicator: Percent of African Americans with heart disease Headline Indicator: Mortality rate of African American women with breast cancer Male cirrhosis death rates African American Males All Males Headline Indicator: Rates of Chlamydia and Gonorrhea among young African American American women Source: Department of Public Health annual county death files 14 Headline Indicator: Percent of African American American men who abuse alcohol or other drugs Headline Indicator: Percent of African American American men who abuse alcohol or other drugs Ml Male alcohol luse disorder d death rates Ml Male unintentional ti drug poisoning i death rates African American Males All Males African American American Males All Males Source: California Department of Public Health annual county death files 15 Source: California Department of Public Health annual county death files 16

10 Headline Indicator: Percent of African Americans Americans withheart heart disease Headline Indicator: Percent of African Americans Americans withheart heart disease Ml Male ischemic i heart tdisease death rate African American American Males All Males Source: California Department of Public Health annual county death files 17 Female ischemic i heart tdisease death rate African American Females All Females Source: California Department of Public Health annual county death files 18 Headline Indicator: Mortality rate of African American American women with breast cancer Headline Indicator: Rates of Chlamydia and Gonorrhea among young African American American women Female breast cancer death rates African American Females 2 All Females Source: California Department of Public Health annual county death files 19 San Francisco Chlamydia Rates (per 1,) ) Among Adolescent Females (<26) 7, 6,25 6, 5, ,981 5, 5,31 5,456 4, 4,258 AllFemale Adolescents 3, AA Female Adolescents 2, 1,257 1,37 1,29 1, 1,254 1,278 1, Source: STD Surveillance Data 2

11 Headline Indicator: Rates of Chlamydia and Gonorrhea among young African American American women Focus Area: Mother, Child, and Adolescent Health San Francisco Gonorrhea Rates (per 1,) ) Among Adolescent Females (<26) 1,6 1,4 1,459 1,2 1,13 1,174 1, 1,32 8 AllFemale Adolescents 64 6 AA Female Adolescents Source: STD Surveillance Data 21 Headline Indicator: Percent of pre term and low birth weight infants Headline Indicator: Rate of substantiated child maltreatment Headline Indicator: Percent of adolescents who binge di drink Headline Indicator: Percent of adolescents who use any drugs 22 Headline Indicator: Percent of pre term and low birth weight infants Headline Indicator: Rate of substantiated child maltreatment 1% 8% 6% 4% 2% 7.4% Low birth weight and pre term birth rates 9.3% 8.8% 8.6% 7.7% 7.2% 7.3% 7.% 6.7% 7.% Pre term Low birth weight ren, Childr Cases per 1, Rate of substantiatedchildmaltreatment for children 17years % Source: California Department of Public Health annual county birth files Source: UC Berkeley Center for Social Services Research 24

12 Headline Indicator: Percent of adolescents whobingedrinkor or use any drugs Headline Indicator: Percent of adolescents whobingedrinkor or use any drugs 15.% 1.% Percent of Adolescents Who Binge Drink 12.4% 11.6% 1.4% 11.7% 25.% 2.% % 15.% Percent of Adolescents Who Used dany Drugs 19.8% 5.% 1.% 5.%.% % 211 Source: SFUSD Youth Risk Behavioral Survey yrbstrends/hs%2yrbs%2alcohol%2trends%229.pdf 25 Source: SFUSD Youth Risk Behavioral Survey yrbstrends/hs%2yrbs%2alcohol%2trends%229.pdf 26 Focus Area: Optimal health for people p at risk or living with HIV Headline Indicator: Number Of New HIV Infections Headline Indicator: Number of new HIV infections Headline Indicator: Percent of newly diagnosed with HIV who receive care Headline Indicator: Percent of HIV infected who are virally suppressed Estimated number of new HIV infections, San Francisco, (CI: ) 365 (CI: 22 51) 437 (CI: ) Source: HIV Incidence Surveillance Project 28

13 Headline Indicator: Percent of newly diagnosed with HIV who receive care Headline Indicator: Percent of HIV infected whoare virally suppressed 1% 8% 6% Percent of personsnewly newly diagnosedwith HIVwho were linked to care within 3 months of diagnosis 86% 85% 85% 1% 8% 6% Percent of PLWH who were virally suppressed (<=2 copies/ml) among those with one or more viral load tests in the year 81% 84% 86% 4% 4% 2% 2% % % Source: HIV surveillance data 29 Source: HIV surveillance data 3

14 Focus Area: Access to Quality Care and Services Headline Indicator: Percent of San Francisco residents enrolled in either health insurance or Healthy San Francisco BASELINE CURVE 1.% Percent of San Franciscans Who Have Insurance or Are Enrolled in a Comprehensive Access Program 96.% 96.5% 95.% 9.% 92.% 94.% 94.% 85.% 8.% FY 26-7 FY 27-8 FY 28-9 FY 29-1 FY DATA DEVELOPMENT AGENDA STORY BEHIND THE CURVE Access to comprehensive, high quality health care and other services is essential in preventing illness, promoting wellness, and fostering vibrant communities. While San Francisco often outperforms the state and other California counties in terms of health care resources like primary care doctors, availability does not always equal accessibility; many of San Francisco s more vulnerable residents ranging from low-income persons to nonnative English speakers seeking culturally competent care in their primary language struggle to get the services they need to be healthy and well. As of 21, 94 percent of San Franciscans between the ages of 18 and 64 either had health insurance or were enrolled in Healthy San Francisco, a program that is part of San Francisco s safety net.13 As indicated in Exhibit 13 above, however, San Francisco falls short of the Healthy People 22 target for residents with a usual source of care. Some residents may lack a usual source of care because they do not have insurance and are not enrolled in Healthy San Francisco; others, because providers do not accept their coverage. According to a study conducted in 28, California providers are less likely to serve Medi-Cal beneficiaries compared to those with private insurance or Medicare, likely because of the state s low reimbursement rate.14 Data also suggest that San Franciscans who speak English less than very well as well as English speakers with limited literacy skills may struggle to access the services they need. In focus groups, residents often expressed the importance of the linguistic and cultural competency of service providers in diminishing their anxiety and frustration. The Increase Access to High Quality Health Care + Services priority strives to bridge these gaps, so all residents may access the services they need to support their health and wellbeing.

15 Forecast curve will stay the same (flat) No insurance access Providers don t take Medi-Cal Non-native speaker/low literacy Linguistic and cultural competency PARTNERS Outreach/enrollment specialists HSA Prevention staff CBOs TB/STD, all clinics/hospitals Jails Behavioral Health Medi-Cal providers Hospital council Consortium SFUSD School TOP 1-3 STRATEGIES Enrolling clinic patients into care (1. Protocols for initial and ongoing enrollment; 2. Training) Enrolling CBO/program participants into care (1. Protocols for initial and ongoing enrollment; 2. Training) Marketing Covered California

16 Project Cycle Developing Mission, Vision and Values POPULATION HEALTH DIVISION STRATEGIC PLANNING FRAMEWORK* Strategic Project Management Dash Board Action Steps Dash Board Identifying Formal and Informal Organizational Mandates Determining the Type and Level of Stakeholder Engagement Developing Organizational Values Statements Completed In Progress Not Started Progress Tables from Staff Directors retreat and Staff focus groups of formal and informal organizational mandates, August 212 Diagram illustrating the Integration stakeholder engagement process, June 212 Document providing the vision and overview of the of process, January 212 FAQ of the integration process and information on staff focus groups, June 212 Developing Mission Statement Developing Vision Statement Communicating Vision, Mission and Values Mission statement finalized, January 213 Vision statement finalized, January Staff FAQ Introduction, January March 213 Overview of PHD, March 19, 213 Business Case, March 19, Presentations and Town Halls, March-May 213 Products Cycle 1: Vision and Mission Statements for the PHD; Communication Plan, including FAQs, Presentations and Town Halls Compiling Relevant Information: Environmen tal Scan Determining Value of Existing Data Assessment of current quantitative data Collecting Additional Data/Information as Gathering of quantitative data for the Community Health Needed Status Assessment, July 212 Gathering qualitative data from stakeholders (17 community focus groups, 6 staff focus group, 3 Directors retreats and ongoing monthly meetings), Summer 212 Summarizing Data/Information Completed Community Health Assessment (CHA) (quantitative data), September 212 Completed Mind Maps of qualitative data, August 212 Products Cycle 2: Community Health Status Assessment, Community Health Assessment, and graphic illustrations of stakeholder priorities 1 *National Association of County & City Health Officials, Developing a Local Health Department Strategic Plan: A How-To Guide, modified to meet the Results Based Accountability framework

17 Project Cycle Analyzing Results and Selecting Strategic Priorities POPULATION HEALTH DIVISION STRATEGIC PLANNING FRAMEWORK* Strategic Project Management Dash Board Action Steps Dash Board Completing a SWOT/SWOC Analysis Identifying and Framing Cross-cutting Themes, Emerging Issues and Key Strategic Issues Prioritizing and selecting Strategic Issues Completed In Progress Not Started Progress Analysis of quantitative and qualitative data, (see Project Cycle 2) Compiling of data from stakeholder input, December 212 Compiling of data for cross cutting PHD themes, September 213 Identified cross-cutting themes that align with PHD priorities, June 213 Developed a strategic map for the Integration of the Division, March 213 Prioritizing Headline Indicators for the Division, September 213 Products Cycle 3: Community Health Improvement Plan, and PHD Headline Indicators Developing the Strategic Plan Identifying Results Statements and Populations Identifying Headline Indicators and Strategies Creating a Strategic Planning Document Product Cycle 4: PHD Strategic Plan Develop results and populations statements, September 213 Develop Headline Indicators, September 213 Develop strategies to support headline indicators, Pending (due date October 15 th ) Present update to Health Commission Public Health Committee, October 15, 213 Present update to Health Finance Committee, December 5, 213 Finalize Strategic Plan, December 1, 223 Approval of Strategic Plan from Health Commission, December 17, *National Association of County & City Health Officials, Developing a Local Health Department Strategic Plan: A How-To Guide, modified to meet the Results Based Accountability framework