Designing a Learning Health Organization for Collective Impact using REACH

33 %
67 %
Information about Designing a Learning Health Organization for Collective Impact using REACH
Health & Medicine

Published on March 7, 2014

Author: TomsJAragn

Source: slideshare.net

Description

Designing a Learning Health Organization for Collective Impact using REACH. REACH is Results, Equity, Accountability for Community Health. REACH is an integrated approach to population health improvement and performance excellence.

Designing a Learning Health Organization for Collective Impact—An Integrated Approach using REACH Tom´s J. Arag´n, MD, DrPH a o Health Officer, City & County of San Francisco Director, Population Health Division (PHD) San Francisco Department of Public Health Adjunct Faculty, Division of Epidemiology UC Berkeley School of Public Health Email: tomas.aragon@sfdph.org Works: http://medepi.com March 10, 2014 Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Designing a Learning Health Organization March 10, 2014 1 / 28

Acknowledgments “Leadership is getting results in a way that inspires trust.” . . . Stephen M.R. Covey “Continuous improvement must not be considered or conducted separately from our work . . . continuous improvement is the work.” . . . Iman Nazeeri-Simmons, SF General Hospital Population Health Division staff SFGH Quality Improvement Program COPC and CBHS Quality Improvement Programs Deitre L. Epps, Partner, Results Leadership Group, LLC Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Designing a Learning Health Organization March 10, 2014 2 / 28

Overview 1 What is REACH and why? 2 What is 4SQ? (4 Strategic Questions) 3 What is RBM? (Results-based Management) 4 What is HEX? (Health Equity X model) 5 What is CPE? (Criteria for Performance Excellence) Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Designing a Learning Health Organization March 10, 2014 3 / 28

What is REACH and why? Challenges and Opportunities Challenges Aging population Public Health Accreditation Health and socioeconomic inequities Epidemic of childhood chronic diseases Patient Protection and Affordable Care Act Opportunities Public Health Accreditation Patient Protection and Affordable Care Act “Collective impact” for community transformation Integration of epidemiology, quality improvement, decision, and complexity science approaches Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Designing a Learning Health Organization March 10, 2014 4 / 28

What is REACH and why? Population Health Division Health Model* Equity PUBLIC HEALTH SYSTEMS Health Protection Health Promotion Disease & Injury Prevention Disaster Preparedness MEDICAL CARE SYSTEMS Life Course Processes Cultural Belief Systems Behavioral Factors Socioeconomic Factors Genetic Endowment Social & Economic Policy Physical Environment Disease & Injury Well-Being Mortality Spirituality Upstream Factors Physiologic Factors Health and Function Resilience Individual / Home / Family / Neighborhoood / Community Factors Intermediate Outcomes States of Health Quality of Life * More than the health status of a population, population health is also a systems framework for studying and improving the distribution of health and quality of life states and their determinants through collective action. Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Designing a Learning Health Organization March 10, 2014 5 / 28

What is REACH and why? Organization Design Stakeholder General Themes Lead SFDPH efforts in health protection, health promotion, disease prevention, and disaster preparedness Be community-centered (“healthy people”)—not pathogen-centric Promote healthy, sustainable environments (“healthy places”) Operationalize division-wide focus on health equity Become agile, adaptive, and responsive to emerging challenges Strengthen service excellence to communities, clients, and providers Become a learning organization with a culture of trust, innovation, and continuous improvement Strengthen culture of discovery and world class research Achieve and maintain Public Health Accreditation Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Designing a Learning Health Organization March 10, 2014 6 / 28

What is REACH and why? Population Health Division Strategic Map Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Designing a Learning Health Organization March 10, 2014 7 / 28

What is REACH and why? PHD Strategic Organization Framework (“physiology”) Population Health Division SFDPH Cross-cutting Efforts Discovery & Knowledge Management: ARCHES, CPHR, & Bridge HIV CASPER Strategic Alignment: Office of Equity and Quality Improvement Policy and Planning Healthy Places (protection) Healthy People (promotion) Diseases (prevention) Disasters (preparedness) Environmental Health Branch Community Health Equity & Promotion Disease Prevention & Control SF Health Network Emergency Preparedness & Medical Services City & Community Organizations Kaiser Perm, UCSF, SFSU, DCYF, CBOs. 1. Black/African American Health 2. Mother, Child, and Adolescent Health 3. Health for People at Risk or Living with HIV 4. Safe and Healthy Living Environments (CHIP) 5. Healthy Eating and Physical Activity (CHIP) 6. Access to Quality Care and Services (CHIP) Operations: Office of Operations, Finance, and Grants Management Finance Professional Development: Center for Learning and Innovation Workforce Development ARCHES, Applied Research, Community Health Epidemiology, & Surveillance; CPHR, Center for Public Health Research; CASPER, Community Assessments, Systems/Program Evaluation, & Research; CHIP, Community Health Improvement Plan Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Designing a Learning Health Organization March 10, 2014 . 8 / 28

What is REACH and why? New PHD Organization Chart (“anatomy”) Population Health Division (PHD) Tomás J. Aragón, MD, DrPH Health Officer & Director Office of Equity and Quality Improvement Israel Nieves-Rivera Applied Research, Community Health Epidemiology, & Surveillance Kyle Bernstein, PhD, ScM Office of Operations, Finance, and Grants Management Christine Siador, MPH Center for Public Health Research Willi McFarland, MD, PhD, MPH&TM Center for Learning & Innovation Jonathan Fuchs, MD, MPH BridgeHIV (Research) Susan Buchbinder, MD Environmental Health Branch Richard Lee, MPH, CIH, REHS (A) Community Health Equity and Promotion Tracey Packer, MPH Disease Prevention and Control Susan Philip, MD, MPH Public Health Emergency Preparedness and Response Naveena Bobba, MD Emergency Medical Services John Brown, MD, MPA Public Health Accreditation Domains Governance, Administration, and Systems Management Tom´s J. Arag´n, MD, DrPH (SFDPH) a o ASSESSMENT / RESEARCH POLICY DEVELOPMENT Designing a Learning Health Organization ASSURANCE March 10, 2014 9 / 28

What is REACH and why? Strategic Plan Focus Areas Cross-cutting, PHD Priorities 1 2 3 4 5 6 Black / African-American Health Mother, Child and Adolescent Health Health for People At Risk or Living with HIV Safe and Healthy Living Environments* Healthy Eating and Physical Activity* Access to Quality Care and Services* Branch Priorities (in progress) a) b) c) d) e) Environmental Health Branch (4) Community Health Equity and Promotion (5) Disease Prevention and Control (6) Public Health Preparedness and Response Emergency Medical Services/DEM *From Community Health Improvement Plan (CHIP) Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Designing a Learning Health Organization March 10, 2014 10 / 28

What is REACH and why? What is REACH? REACH is an aspirational, comprehensive, and integrated framework for continuous population health improvement and organizational performance excellence. REACH is Results, Equity, and Accountability for Community Health R esults = Focused on achieving results (impacts, outcomes, outputs) E quity = Focused on health equity with a social justice lens A ccountability = Focused on performance excellence & accountability C ommunity = Focused on community-based evidence (voice, etc.) H ealth = Focused on population health & wellness Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Designing a Learning Health Organization March 10, 2014 11 / 28

What is REACH and why? REACH is Results, Equity, and Accountability for Community Health REACH leverages established frameworks used nationally and internationally, and moves from simple, everyday objectives to complex organizational and community challenges. (see Figure): Policy 1 4 Strategic Questionsa 2 Results-based managementb 3 Health Equity X (HEX) modelc 4 Criteria for Performance Excellenced People 4 Strategic Questions Public Health Health Collective Triple Aim ResultsBased Management Impact Equity a Adapted from Strategic Project Management Made Simple [1] United Nations Development Group (http://www.undg.org/?P=224) c Inspired by BARHII (http://www.barhii.org) and Dr. Tony Iton d Malcolm Baldrige Criteria (http://www.nist.gov/baldrige) Note: At SFDPH/PHD, we also use Results-Based AccountabilityTM as presented in the book Trying Hard Is Not Good Enough, by Mark Friedman. RBA is not part of REACH, and should not be confused with results-based management (RBM). Essential Services b Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Place Population Health & Equity Patron Designing a Learning Health Organization Funding & Costs Criteria for Performance Excellence Program Provider March 10, 2014 12 / 28

What is REACH and why? REACH uses public health sciences and community voice REACH promotes and uses public health sciences with a social justice lens: Policy Health equity People Root cause analysis 4 Strategic Questions Shared decision making Impact Equity Collective impact approach Health economics concepts Essential Services Patron Funding & Costs Criteria for Performance Excellence Epidemiology and knowledge integration Tom´s J. Arag´n, MD, DrPH (SFDPH) a o ResultsBased Management Public Health Health Collective Triple Aim Continuous improvement Complexity and systems thinking Place Population Health & Equity Program Provider Designing a Learning Health Organization March 10, 2014 13 / 28

What is REACH and why? REACH and expected public health staff competencies Table : Expected competency level for public health professionals Tier 1 Tier 2 Tier 3a Tier 3b 4SQ HEX RBM 4 3 2 4 4 3 4 4 4 4 4 4 CPE 1 2 3 4 Primary purpose simple project management health equity framework strategic continuous improvement (process, results, health equity) organizational performance Tier definitions (adapted from Public Health Foundation http://www.phf.org): 1 2 3a 3b Those Those Those Those who carry out the day-to-day tasks and are not in management positions. with program management or supervisory responsibilities. at the senior/management level of public health organizations. at the leadership level of public health organizations. Competency levels: 1 2 3 4 None: Unaware, or have very little knowledge of the item Aware: Have heard of it; limited knowledge and/or ability to apply the skill Knowledgeable: Comfortable with knowledge or ability to apply the skill Proficient: Very comfortable, an expert; could teach this to others Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Designing a Learning Health Organization March 10, 2014 14 / 28

What is 4SQ? (4 Strategic Questions) What is 4SQ? (4 Strategic Questions) 4SQ is the daily practice of asking four strategic questions with all important activities (daily objectives, planning for meetings, simple projects, etc.). All key activities should be fulfilling a strategic intent. The idea is to promote a culture of strategy awareness and results-based accountability, but in a supportive environment that values staff engagement, empowerment, creativity, learning, and innovation. 1 What are we trying to Accomplish and why? (strategic intent) 2 How do we measure Success? (metrics) 3 What other conditions must exist? (Assumptions / risks) 4 How do we get there? (PDSA1 project management) ASAP = Accomplish → Success → Assumptions → PDSA 1 Plan–Do–Study–Act Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Designing a Learning Health Organization March 10, 2014 15 / 28

What is 4SQ? (4 Strategic Questions) What is PDSA project management? PDSA is a continuous improvement method to test process improvements for learning, implementing, and spreading change. However, we also use it for basic project management (Table). PDSA empowers staff to learn basic project management and practice scientific thinking. This becomes a foundation for quality improvement and advanced project management. PDSA Description Alignment with PMI2 Process Groups Plan Do Study Act Plan Implement and monitor Evaluate and learn Adjust (adopt, adapt, or abandon) Initiating,3 Planning Executing, Controlling – Controlling, Closing 2 3 Project Management Institute This is actually accomplished with the first three questions of 4SQ. Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Designing a Learning Health Organization March 10, 2014 16 / 28

What is RBM? (Results-based Management) What is RBM? (results-based management) Building upon 4SQ, RBM is a results-based management strategy for equity and quality improvement. We believe health equity must move beyond core values and guiding principles and be operationalized into continuous improvement activities. RBM looks like the familiar logic model because it is an updated variant of the logical framework approach [1, 2]. However, RBM provides the following: Results chain ensures alignment from strategic goal to process activities Results matrix ensures systems approach to performance accountability: Causal links from strategic goal to process activities that incorporate assumptions and risk management; Performance monitoring built in Continuous improvement built in, aligning nicely with the Model for Improvement (MFI) [3] used by the Institute for Healthcare Improvement Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Designing a Learning Health Organization March 10, 2014 17 / 28

What is RBM? (Results-based Management) What is RBM? Results Chain and Results Matrix 1 What are we trying to Accomplish and why? (continuous improvement with equity focus) 2 How do we measure Success? (measurements) 3 What other conditions must exist? (Assumptions / risks) 4 How do we get there? (PDSA project management) Clients or Community Goal & Impacts Impact indicators (a) ENDS Clients or Community Outcomes Staff es) Outputs Programs or organizations Processes* (activities) High priority population, and program / process Future State (b) Performance measures: Current State MEANS Outcome indicators (c) Output indicaators RBM (d) Inputs * Processes are coordinated activities that create value (outputs and outcomes). Outputs are services or products; Outcomes are changes in a state or condition. RBM = Results-based Management; See Results Chain and Results Matrix in the UNDG RBM Handbook, available from http://www.undg.org/?P=224 Tom´s J. Arag´n, MD, DrPH (SFDPH) a o 4SQ Plan working from ends to means Plan-Do-Study-Act (PDSA) 1. Project management 2. Continuous improvement 3. Test, Learn, Implement, Spread Designing a Learning Health Organization March 10, 2014 18 / 28

What is RBM? (Results-based Management) RBM extends the Model for Improvement (MFI) [3] The Institute for Healthcare Improvement uses the MFI. 4SQ already incorporates MFI questions, and RBM provides a logic model framework. Model for Improvement PHD results-based management (RBM) framework (3 Questions + PDSA) 4 Strategic Questions United Nations RBM What are we trying to accomplish? What are we trying to accomplish and why? (improvement with health equity focus) Results: Impacts, Outcomes, Outputs How will we know that a change is an improvement? How do we measure success? Indicators: Impacts, Outcomes, Outputs, Processes What other conditions must exist? Risk identification using a systems approach How do we get there? PDSA project management What change can we make that will result in improvement? Plan-Do-Study-Act Cycles Tom´s J. Arag´n, MD, DrPH (SFDPH) a o PDSA continuous improvement Designing a Learning Health Organization March 10, 2014 19 / 28

What is RBM? (Results-based Management) Why results-based management? 1 Designed for public sector and non-profit agencies in resource poor environments around the world 2 Designed to engage and empower stakeholders to tackle complex challenges and opportunities (e.g., collective impact) 3 Starts with ends (goal) and uses the results chain and results matrix to design, implement, and monitor means (activities) 4 In collective impact, distinguishes between mutual accountability for collective performance and respective accountability for individual performances; 5 Designed for continous improvement of processes and performance Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Designing a Learning Health Organization March 10, 2014 20 / 28

What is RBM? (Results-based Management) Results-based management and collective impact Results-based management (formal definition)a “RBM is a management strategy by which all actors, contributing directly or indirectly to achieving a set of results, ensure that their processes, products and services contribute to the achievement of desired results (outputs, outcomes and higher level goals or impact). The actors in turn use information and evidence on actual results to inform decision making on the design, resourcing and delivery of programs and activities as well as for accountability and reporting.” Collective impactb “Collective impact is the commitment of a group of actors from different sectors to a common agenda for solving a complex social problem.” a United Nations Development Group, Results-based Management Handbook (http://www.undg.org/?P=224) b FSG (www.fsg.org) Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Designing a Learning Health Organization March 10, 2014 21 / 28

What is RBM? (Results-based Management) RBM as a framework for implementing collective impact Collective impact fulfills five conditions: 1 Common Agenda: All participants have a shared vision for change including a common understanding of the problem and a joint approach to solving it. 2 Shared Measurement: Collecting data and measuring results consistently ensures efforts remain aligned and participants hold each other accountable. 3 Mutually Reinforcing Activities: Participant activities must be differentiated while still being coordinated through a mutually reinforcing plan of action. 4 Continuous Communication: Consistent and open communication is needed across the many players to build trust, and assure mutual objectives. 5 Backbone Organization: Collective impact requires a separate organization(s) with staff and a specific set of skills to serve as the backbone for the entire initiative and coordinate participating organizations and agencies. RBM is a comprehensive United Nations framework that can be used for planning, monitoring, and evaluating collective impact. Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Designing a Learning Health Organization March 10, 2014 22 / 28

What is RBM? (Results-based Management) RBM as a framework for implementing collective impact REACH also provides the Health Equity X (HEX) framework (Figure). HEX can be used for focusing CI common agenda, shared metrics, or mutually-reinforcing activities by people (belief systems, mental models), policy, place, programs (or organizations), providers, and patrons (clients, patients). Policy People Population Health & Equity 4 Strategic Questions Public Health Health Collective Triple Aim Health Equity Impact Equity Essential Services Place ResultsBased Management Funding & Costs Criteria for Performance Excellence Patron Program Provider Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Designing a Learning Health Organization March 10, 2014 23 / 28

What is HEX? (Health Equity X model) What is HEX? (Health Equity X model) HEXa is used for planning and managing efforts to achieve results for challenges and opportunities embedded in complex social systems, including for quality improvement, health inequities, and collective impact. Policy People 1 2 3 Place (neighborhoods, schools, work, open spaces) 4 Program (programs, agencies, or service systems) 5 Provider (teachers, doctors, priests) 6 a Policy (social, organizational) Patron (clients, customers, patients) Place People (mental models, belief systems, cultural norms, “isms”) Health Equity Patron Program Provider A hexateron is a geometric object with 6 vertices, 15 edges, 20 triangle faces, 15 tetrahedral cells Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Designing a Learning Health Organization March 10, 2014 24 / 28

What is CPE? (Criteria for Performance Excellence) What is CPE? (Criteria for Performance Excellence) The Baldrige CPE help organizations assess their improvement efforts, diagnose their overall performance management system, and identify their strengths and opportunities for improvement. The CPE help strengthen competitiveness by improving organizational performance practices, capabilities, and results facilitating communication and sharing of information on best practices among organizations of all types serving as a tool for understanding and managing performance and for guiding planning and opportunities for learning The CPE provide organizations with an integrated approach to performance management that results in delivery of ever-improving value to customers and stakeholders, contributing to organizational sustainability improved organizational effectiveness and capabilities organizational and personal learning Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Designing a Learning Health Organization March 10, 2014 25 / 28

What is CPE? (Criteria for Performance Excellence) What is CPE? (Criteria for Performance Excellence) [4, 5] “Leadership is getting results in a way that inspires trust.” S.M.R. Covey Guided by Strategic Vision and Action Plans Influenced by Challenges and Opportunities 2. Strategic Planning 4. Workforce Focus 1. Leadership 7. Results 3. Customer Focus 5. Process Management 4. Knowledge Integration and Decision Support Supported by Values Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Designing a Learning Health Organization March 10, 2014 26 / 28

What is CPE? (Criteria for Performance Excellence) CPE 7.1 (collective impact) implemented using RBM [1, 2] “Leadership is getting results in a way that inspires trust.” S.M.R. Covey Results-based management 7.1 Population Health Improvement and Performance Excellence Guided by Strategic Vision and Action Plans Influenced by Challenges and Opportunities 2. Strategic Planning 4. Workforce Focus 1. Leadership 7. Results 3. Customer Focus 5. Process Management 4. Knowledge Integration and Decision Support Supported by Values 7.2 Customer 7.3 Workforce 7.4 Leadership and Governance 7.5 Financial and Market Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Designing a Learning Health Organization March 10, 2014 27 / 28

What is CPE? (Criteria for Performance Excellence) Bibliography 1 Terry Schmidt, Strategic Project Management Made Simple: Practical Tools for Leaders and Teams, (4SQ) 2 United Nations Development Group, Results-based Management Handbook: Harmonizing RBM concepts and approaches for improved development results at country level. Available from http://www.undg.org/?P=224 3 Gerald J. Langley, et al. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance, 2nd Ed. (RBM) 4 Baldrige Performance Excellence Program. 2013. 2013–2014 Health Care Criteria for Performance Excellence. Gaithersburg, MD: U.S. Department of Commerce, National Institute of Standards and Technology. Available from http://www.nist.gov/baldrige, (CPE) 5 Kathleen J. Goonan, et al. Journey to Excellence: How Baldrige Health Care Leaders Succeed, (CPE) Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Designing a Learning Health Organization March 10, 2014 28 / 28

Add a comment

Related presentations

Related pages

Designing a Learning Health Organization for Collective Impact

Designing a Learning Health Organization for Collective Impact. ... Collective Impact Using ... In public health practice, collective impact ...
Read more

Mobilizing Communities: Improving Coordinated and ...

Mobilizing Communities: Improving Coordinated and Collective ... Designing a Learning Health Organization for ... for Collective Impact using REACH ...
Read more

Organizational Culture - AF.mil - Home

... influencing or changing an organization's culture? THE IMPACT ... and "health and dental ... of the organization. Without collective ...
Read more

Collective Impact Summit 2015 - Resources | Communities ...

Learn from the experience of building a Mental Health and Addictions Collective Impact ... REACH does work that no one ... Evaluating Collective Impact ...
Read more

Section 5. Collective Impact - Community Tool Box

Learn how to use a collective impact ... Documenting Health Promotion Initiatives Using ... Collective Insights on Collective Impact shares ...
Read more

Collective Impact Summit - Agenda - Upcoming Events

Collective Impact Summit: Join us for ... and receive a certificate recognizing their collective impact learning . ... Collective Impact using ...
Read more

5. Developing Strategic and Action Plans | Community Tool Box

Using Community Sectors to Reach Targets and ... (EXAMPLE FOR ONE COMMUNITY CHANGE IN THE HEALTH ORGANIZATION ... Designing the business model for the ...
Read more

N

Publications of the World Health Organization are ... using validated ... which can have a negative impact on children’s health and ...
Read more