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Pioneering a New Frontier In Public Health

Pioneering a New Frontier In Public Health. Kansas Public Health Association Annual Fall Conference September 21 st and 22 nd , 2011 Gina Frack RN, BS Norton County Health Department. Preparing for Accreditation.

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Pioneering a New Frontier In Public Health

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  1. Pioneering a New Frontier In Public Health Kansas Public Health Association Annual Fall Conference September 21st and 22nd, 2011 Gina Frack RN, BS Norton County Health Department

  2. Preparing for Accreditation “Do not go where the path may lead. Go instead where there is no path and leave a trail.” - Emerson

  3. Norton County Health Department “Where” we are and “Who” we are Why we applied to be a Beta Site Challenges for small LHDs Challenges for Kansas Thoughts on thriving!!

  4. Kansas Public Health System Decentralized Governance = “home rule” (26 states) LHD jurisdiction is most often by county County Commissioners are also often the Board of Health 105 counties with a LHD in nearly every county

  5. Who We Are and What We Do Norton Co. Health Dept. (est. in 1975) PRN Home Health Agency (est. in 1977) WIC Family Planning KS Breast & Cervical Cancer Program Immunizations Maternal & Infant Program Healthy Start Home Visitor Certified Breastfeeding Educators and breast pumps Disease Surveillance & Epi (dog bites, head lice, “housing authority”) Health lifestyle promotion Public health response for disasters Only Medicare certified home health agency in county Nurse level care – wounds, IV therapy, teaching of new disease/conditions Physical Therapy Home health aide care – housekeeping, personal care, food prep and errands Newborn teaching and assessment for high risk infants Serve Norton and surrounding Kansas Counties CARE assessments Medication management Two agencies = one department w/ 8.2 FTE

  6. Finances for 2010 CY Local 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.

  7. Norton County Health Department 1930’s (county population of 11,701)

  8. Norton County In The Present…… County population of 5,353 (2010 US Census Bureau) Nearly 20% of the population is > 65 y/o 93.3% white 3.3% are non-English speaking 2 School Districts Economic base is 47% agriculture with remaining coming from KDOC, KDOT, private business’ corporate offices and manufacturing

  9. Why Be A Beta Site? Reactive = Fear Proactive = Control How 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 local” We had been asked to be an alpha site so it was logical to then apply to be a beta Addressing challenges of providing public health in rural America may provide infrastructure model for the future

  10. Just Did It!!!

  11. Files and Folders Are Your Friends! Use what is: feasible logical familiar and accessible to all necessary staff.

  12. Beta Lessons Learned • Meeting 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 LHD’s culture, but it takes time

  13. Progression of QI • First – QI Projects • Second – Build the Bridge towards a QI Culture QI “Projects” QI Culture “Bridging” will involve local, state and federal level efforts.

  14. “Bar” of Accreditation #1 #2 #3 #4 #5 #6 #7 #8 #9 10 State Inform & Educate Local Health Department Engage Access Workforce Investigations Evidence Based Develop P&P QI CHA Enforce

  15. Our Next Steps: Accreditation Standards Concentrating on these biggest “building blocks” to get us closer to meeting the “bar” set by the standards. Required to Apply for National Accreditation Strategic Plan Community Health Improvement Plan (CHIP) Community Health Assessment

  16. Accreditation’s Effect on the Perception of Public Health The “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. WIC Preparedness Family Planning MCH

  17. WIC New Way of “Seeing” Public Health #7: Access to Healthcare #2: Investigate Health Problems #3: Health Education What we “do” no longer defines us.

  18. 10 Essential Services • Domain #1: Conduct assessments • Domain #2: Investigate health problems • Domain #3: Inform and educate • Domain #4: Engage the community • Domain #5: Develop policies and plans • Domain #6: Enforce public health laws and regulations • Domain #7: Improve access to health care services • Domain #8: Maintain competent workforce • Domain #9: Continuously improve • Domain #10: Apply evidence base of public health

  19. Survival 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, it’s nearly impossible to prioritize something as long-term, time intensive and broad spectrum as accreditation.

  20. Challenges to “Smalls” Lack of time, skills, training and resources (people and/or things) Sustainability Money State to local relationship Level of understanding and/or support of accreditation varies greatly within public health Small LHDs wear so many, many hats……

  21. Accreditation Coordinator (AC) • Consider designating one person to oversee the overall process • Dive into the Accreditation Version 1.0 • For our LHD, the AC was the Administrator who is also the • Chief Financial Officer • Public Information Officer • Human Resources Director • RN • Disease Investigator • “Float Nurse” and resident expert for those questions and situations no one else knows the answer or wants to deal with 

  22. Effects 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 health • May 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

  23. NCHD and PRN Home Health Agency Crew March 2011

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

  25. Thank You!! Gina Frack 785-877-5745 prnhome@ruraltel.net

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