Development of Public Health Standards and Protocols in Nova

Scotia

PHPC CPD DayJune 9th, 2013

Dr. Robert StrangDr. Brent Moloughney

2013

CompleteProtocols

Public Health Vision• Shift upstream, focus the determinants of health

and populations at greatest risk

• Capitalize on Public Health’s unique position to:• improve the sustainability of the health system • understand health inequities• change the conditions in which people live (physical and

social environments)• address the determinants of health

• Commitment to a public health system approach

Population Focus

Municipalities

Community Services

Planning Agencies

Tertiary Prevention:

Preventing the worst outcomes from disease and injury (death and disability).

Primary Prevention:

Preventing disease and injury by modifying existing risk factors.

Secondary Prevention:

Early detection and treatment of disease and injury.

Public H

ealth

Individual Focus

Education System

Police and Justice

Primordial Prevention:Preventing the risk factors from ever

existing

Tertiary Prevention:

Preventing the worst outcomes from disease and injury (death and disability).

Primary Prevention:

Preventing disease and injury by modifying existing risk factors.

Secondary Prevention:

Early detection and treatment of disease and injury.

Public Health

Municipalities

Community Services

Planning Agencies

Education System

Police and Justice

Primordial Prevention:Preventing the risk factors from ever

existing

Population Focus Individual Focus

Counselingand Education

ClinicalInterventions

Long Lasting ProtectiveInterventions

Changing the Context to MakeIndividuals’ Default Decisions

Healthier

Socioeconomic Factors

From: Thomas R. Frieden, MD, MPH. American Journal of Public Health April 2010, Vol 100, No. 4

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dHealth Impact Pyramid

Public Health Standards

• Establish the expectations for public health at the provincial and DHA level.

Structure of Standards

Protocols• Complement the Standards providing greater detail

to assist in addressing some key system challenges:• Achieving a shift in emphasis more upstream• Lack of clarity regarding roles and responsibilities• Need for greater accountability

• Need to first be clear about ‘what is the work’, then can address:• Who does it• How it gets done (from a system perspective)• And, what we’re going to stop doing• (Even greater detail (i.e. strategies, business processes,

procedures, manuals etc.) to be included in appendices)

• Balancing consistency with flexibility

Protocol Development• Started Spring 2012:

– Pan-system teams developed raw protocol content (note: had recently developed Standards)

• Fall 2012:– Protocols drafted – Presented to System Leadership Team and VPs Community

• January 2013– Feedback that mostly right – editing and tweaking occurring

iteratively since then

• Spring 2013– Final reviews of protocols– Engage system staff for implementation planning

Protocol OrganizationCross-Cutting Protocols Content-Specific Protocols

• Understanding (assessment & surveillance)• Priority setting & planning• Partnership• Policy• Health equity

• Communicable Disease Prevention & Control • Environmental Health• Healthy Communities• Healthy Development

• Protocols are ‘a package’• Are not sole responsibility of a specific team (e.g., upstream prevention in CDPC not sole responsibility of a CD team)

Protocols – Going Forward• Managing transition issues: primary care and public

health must work together on transition issues• No ‘dump and run’• Alignment with primary care initiatives

(comprehensiveness, continuity, collaborative care)• May need to be assessed and managed on a community-

by-community basis• Addressing design implications to achieve an

effective and efficient public health system• Who and how work gets done in context of 9 DHAs with

varying capacity and population contexts• Requires sharing, working together, and structural

changes – grounded in achieving ‘the work’ in effective, efficient and quality manner

Summary• Development of Public Health Standards and

Protocols key part of collective journey of system renewal

• Unless clear about ‘the work’, difficult to address system design, roles, accountabilities, etc.

• Considerable change management requirements:• Transition for what will stop doing• Leading/mentoring new practices• Workforce development• Potential structural change• Establishing accountabilities