Public Health Infrastructure & Systems

Kansas Public Health Association Annual Fall ConferenceSeptember 21st and 22nd, 2011Gina Frack RN, BSNorton County Health DepartmentPioneering a New Frontier In Public HealthPreparing for AccreditationDo not go where the path may lead. Go instead where there is no path and leave a trail. - Emerson

Where we are and Who we are Why we applied to be a Beta SiteChallenges for small LHDsChallenges for KansasThoughts on thriving!!

Norton County Health Department3Kansas Public Health SystemDecentralized Governance = home rule (26 states)LHD jurisdiction is most often by countyCounty Commissioners are also often the Board of Health 105 counties with a LHD in nearly every county4Who We Are and What We DoNorton Co. Health Dept. (est. in 1975)PRN Home Health Agency (est. in 1977)WICFamily PlanningKS Breast & Cervical Cancer ProgramImmunizationsMaternal & Infant ProgramHealthy Start Home VisitorCertified Breastfeeding Educators and breast pumpsDisease Surveillance & Epi (dog bites, head lice, housing authority)Health lifestyle promotionPublic health response for disastersOnly Medicare certified home health agency in countyNurse level care wounds, IV therapy, teaching of new disease/conditionsPhysical Therapy Home health aide care housekeeping, personal care, food prep and errandsNewborn teaching and assessment for high risk infantsServe Norton and surrounding Kansas CountiesCARE assessmentsMedication management

Two agencies = one department w/ 8.2 FTE 5Finances for 2010 CYLocal tax support ($68,413) comprises 13%-15% of our total annual revenue.

Of the grants, only $7,000 of the total funds came from state funding (KDHE).

The majority of our revenue comes from direct client services as seen in the fee for service & PRN HH.

6Norton County Health Department1930s (county population of 11,701)

County population of 5,353 (2010 US Census Bureau)Nearly 20% of the population is > 65 y/o93.3% white3.3% are non-English speaking2 School DistrictsEconomic base is 47% agriculture with remaining coming from KDOC, KDOT, private business corporate offices and manufacturing

Norton County In The PresentWhy Be A Beta Site?Reactive = Fear Proactive = ControlHow would a one size fits all approach affect truly small LHDs?Would accreditation really improve what we do or just thin the herd ?Will we be forced to all do the same programs and services?Will funding be affected?Be a vocal localWe had been asked to be an alpha site so it was logical to then apply to be a betaAddressing challenges of providing public health in rural America may provide infrastructure model for the futureJust Did It!!!

10Files and Folders Are Your Friends!Use what is: feasible logicalfamiliar and accessible to all necessary staff.

Beta Lessons LearnedMeeting standards are doable and reasonable Focus in on what is being done to meet a standard/measure, NOT how or by whom The true benefits of accreditation is in striving to achieve it, not just attaining it.Depending on your SHD to LHD relationships, there can be varying gaps that will need to be met before either can achieve accreditation (forces this relationship to strengthen and improve)Document, document, document!! ! QI can become a part of a LHDs culture, but it takes time

12Progression of QIFirst QI ProjectsSecond Build the Bridge towards a QI Culture

QI ProjectsQI CultureBridging will involve local, state and federal level efforts.Bar of Accreditation#1#2#3#4#5#6#7#8#910CHAInvestigationsInform & EducateEngageDevelop P&P EnforceAccessWorkforceQIEvidence BasedStateLocal Health DepartmentOur Next Steps:

Community Health AssessmentCommunity Health Improvement Plan (CHIP)Strategic PlanAccreditation StandardsConcentrating on these biggest building blocks to get us closer to meeting the bar set by the standards. Required to Apply for National AccreditationAccreditations Effect on the Perception of Public HealthThe silos will still exist for funding reasons, but accreditation being based upon the 10 Essential Services is reshaping how we now think of public health in the U.S. Family PlanningWICMCHPreparednessNew Way of Seeing Public HealthWIC#7: Access to Healthcare#3: Health Education#2: Investigate Health ProblemsWhat we do no longer defines us.10 Essential ServicesDomain #1: Conduct assessmentsDomain #2: Investigate health problemsDomain #3: Inform and educateDomain #4: Engage the communityDomain #5: Develop policies and plansDomain #6: Enforce public health laws and regulationsDomain #7: Improve access to health care servicesDomain #8: Maintain competent workforceDomain #9: Continuously improveDomain #10: Apply evidence base of public healthSurvival Mode Existence Due to many factors in Kansas rural/frontier LHDs are at risk to exist in a state of surviving rather than thriving. When your focus is just to get through today, its nearly impossible to prioritize something as long-term, time intensive and broad spectrum as accreditation. Challenges to SmallsLack of time, skills, training and resources (people and/or things)SustainabilityMoney State to local relationshipLevel of understanding and/or support of accreditation varies greatly within public health Small LHDs wear so many, many hats

Accreditation Coordinator (AC)Consider designating one person to oversee the overall processDive into the Accreditation Version 1.0 For our LHD, the AC was the Administrator who is also theChief Financial OfficerPublic Information OfficerHuman Resources DirectorRN Disease InvestigatorFloat Nurse and resident expert for those questions and situations no one else knows the answer or wants to deal with

21Effects of Accreditation Due to the continual depopulation of rural America, accreditation may also be the catalyst for the rural public health infrastructure to be recreated. Provides potential to truly improve public healthMay inadvertently create wider gaps between LHDs that can from those that cannot Key is to NOT focus on accreditation, but rather on the baby steps to get there

22NCHD and PRN Home Health Agency CrewMarch 2011

Accreditation Is A Journey......National accreditation is new to us all, both big and small. Regardless of actually attaining it, its the pursuit of it that will improve what we do.

24Gina Frack785-877-5745prnhome@ruraltel.netThank You!!

NWBT Workplan2009-2010NCCOAODMtg Minutes2/2010NWBT MtgMinutes3/2010Domain 4Domain 3Domain 2Domain 1Part A

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