Achieving Measurable Health Outcomes for Clients and Communities

Transcription

1 1 Achieving Measurable Health Outcomes for Clients and Communities Outcomes and Impact 2016 Presented by Deitre Epps, Clear Impact and Ruth Jordan, Cardiff and Vale University Health Board

2 The questions we will answer. 2 Who are we? What is OBA / RBA? Where has this worked? How do you implement OBA / RBA? How do you measure success? Any further questions you have?

3 Who are we? Ruth Jordan

4 Ruth Jordan Head of Continuous Service Improvement in Cardiff 4 and Vale University Health Board About Ruth is the Head of Continuous Service Improvement in Cardiff and Vale University Health Board; a large integrated Health Board with responsibility for planning and providing primary, community, mental health and hospital services in South Wales. health and across the wider partnerships. Ruth has an MSc in Leadership for Health Service Improvement from the University of Birmingham and is Education trained in a wide range of service improvement methodologies including Results Based Accountability, Lean, Six Sigma and the Theory of Constraints

5 Deitre Epps Partner, Clear Impact 5 About Deitre is a partner and senior consultant with Clear Impact. She provides coaching, training, facilitation and technical assistance to senior management and professional staff on achieving local community outcomes, performance accountability and program improvement. Education Deitre holds a bachelor s of science degree in microbiology and a master s of science degree in human services administration.

6 Now it s your turn! Speak to your neighbour and find out Who they are What experience they have of OBA Any RBA successes? Any challenges/questions about OBA? 6 Write one challenge/question on a post-it note.

7 Outcome / Result: Indicator or Performance Measure Baseline What is OBA / RBA? Turn-the-Curve Thinking : Talk to Action Story behind the baseline Partners (with a role to play in turning the curve) Research Agenda What Works Research Agenda Criteria: Leverage; Feasible; Specific; Values Propose to do? Our Strategies to Improve the Outcome 7

8 Where has this worked? Case studies

9 Building a Movement COLLABORATIVE LEADERSHIP FOR POPULATION HEALTH IMPROVEMENT 9

10 Maryland Results for Child Well-Being For more than 15 years, the Governor s Office for Children and other children serving agencies have utilized RBA for focused planning, decision-making and budgeting on desired results and outcomes ( Babies Born Healthy Healthy Children Children Enter School Ready to Learn Children are Successful in School Youth Will Complete School Youth Have Opportunities for Employment or Career Readiness Communities are Safe for Children, Youth and Families Families are Safe and Economically Stable

11 Percent of Children in Maryland Entering School Fully Ready 82% 11 49%

12 Building a Movement with Results-based Accountability Maryland, USA Annie E. Casey Foundation Leadership in Action Program From State to City to Neighborhood ( ) Maryland Leadership in Action Program (school readiness) => Baltimore City Leadership in Action Program (school readiness)=> Babies Born Healthy Leadership in Action Program (healthy babies) Promise Heights (Southwest Baltimore) United States Department of Education Promise Neighborhood 2012 report - 100% of babies born to women enrolled in program were full term and healthy weight

13 Babies Born Healthy- Leadership in Action Program Baltimore, MD, United States Robert Wood Johnson Foundation and Annie E Casey Foundation Result: Babies Born Healthy Indicators: Pre-Term Delivery, Infant Mortality. Institutionalized in Baltimore neighborhoods as Bmore for Healthy Babies 13

14 1. What is the end that we seek? 2. How are we doing? 3. What is the story behind the data? 4. Who are our partners with a role to play? 5. What works? 6. What do we propose to do? 14

15 Building a Movement with Results-based Accountability Florida, United States ConnectFamilias Little Havana Community (2009) Wraparound Services Introduction to Results Based Accountability => Result: Keeping Families Safe, Healthy, Engaged and Connected Children s Trust, Miami, Florida ( ) Results-based Strategic Plan for Investments ($100M annually for Children s Services) Oral Health Coalition ( ) Results-based Strategic Plan for Investments ($100M annually for Children s Services) Oral Health Alliance ( ) Results-based Strategic Plan for Investments ($100M annually for Children s Services) Health Foundation of South Florida - Healthy Community Partnerships ( ) Results-based Planning and Implementation for Community Health in Little Havana and Miami Gardens

16 FPSI/RLG 16

17 Healthy Communities Partnership Florida, United States Health Foundation of South Florida Initiative 10 year and $8 million investment in two communities Focus: Community partners identify, plan & implement strategies for health improvement in each community Leveraging community resources and other stakeholders from health, education, employment, social services 17

18 Oral Health Outcomes Florida, United States Oral Health Coalition ( ) Result: All people in Florida have optimal oral health and well-being Focus area #1: Improved access to quality oral health care Focus area #2: Increased community water system fluoridation 18

19 Florida Oral Health Alliance ( ) All Florida children, youth and families have good oral health and well-being, especially those that are vulnerable. 9/19/

20 Headline Indicator: Percentage of Medicaid-eligible Children Ages 1-20 Receiving Preventive Dental Services 50% 41.50% 42.40% 43.10% 44.20% 45.00% 38% 33% 25% 13% 14% 19% 25% 27% 0% Florida National average Source: Florida Form CMS-416 line 12b minus <1 data retrieved in August 2016 from the Florida Institute for Health Innovation.

21 Performance Accountability a Case Study in Epilepsy

22 The Welsh Epilepsy Unit The Welsh Epilepsy Unit is a tertiary referral centre for specialist epilepsy services in South Wales. The immediate catchment population covered is 700,000, but many referrals are also taken from elsewhere in Wales. The Unit offers a multidisciplinary approach to epilepsy care and offers a very broad range of services to people with epilepsy, their families and carers.

23 The Dilemma... How do we know that the patient is better off just because we have achieved the targets? How do we keep their outcomes at the centre of what we do rather than just focus on achievement of the process?

24 What do the experts say? All individuals with a recent onset suspected seizure should be seen within 2 weeks by a specialist. This is to ensure precise and early diagnosis and initiation of therapy appropriate to their needs. NICE, October 2004 Epilepsy Service Development Directive, WAG, March 2009

25 First seizure patients

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28 Old Pathway WAIT Discharge WAIT WAIT 1 st Seizure A&E Review Faxed Referral Waiting List Appt 1st Seizure Clinic Refer Investigations Follow Up clinic Diagnosis Treatment Refer on New Pathway Discharge WAIT 1 st Seizure A&E Review ESN Review Referral Investigations Clinic Diagnosis Cardiology

29 Impact UCL = 95.5% UCL = 104.5% Mean = 60.9% Mean = 35.4% LCL = 17.3% LCL = -24.7%

30 UCL = Mean = UCL = Mean = LCL = 0.44 LCL = -1.55

31 UCL = 9.97 Outcomes Mean = 5.05 UCL = 3.01 Mean = 2 LCL = 0.13 LCL = 0.99

32 Comparison of Pathway Length for Patients on the New and Old First Seizure Pathway No. Days Average Old Pathway Average New Pathway Patients on Old Pathway No. Days Until Seen by No. Days Until Confirme Patients on New Pathway

33 How do you implement OBA / RBA?

34 Our step by step process Step 1. Determine whether population or performance accountability is appropriate. It is not always easy to do this and it is worth taking time at the beginning to make sure the decision you make is correct.

35 Our step by step process Step 2. Decide who needs to be involved and invite them to the OBA/ RBA sessions. Try and identify all of the partners that need to be involved at this point as it is easier to have everyone included at the beginning rather than have people join mid-way through the process.

36 Our step by step process Step 3. If the group is new to OBA / RBA provide an Introduction to OBA / RBA training session in advance. This can either be at the start of the first session or in a dedicated session before hand.

37 Our step by step process Step 4. Facilitate the group through the development of the OBA / RBA framework. Start at step 1 of the 7 OBA / RBA Questions and work through the questions in order. Don t underestimate how long it takes to agree on the customer group in performance accountability. It isn t always as straight forward as you anticipate.

38 Our step by step process Step 5 Identify your measures. Don t forget to create a data development agenda to cover this. Including information analysts in the group from the start may be beneficial when determining which measures are possible.

39 Our step by step process Step 6. Ask the group to use their experience to best guess the baseline and then collect the real data later. The best guess baselines are generally very accurate.

40 Our step by step process Step 7. Ensure the action plan strategies and actions are clear with determined actions, timescales and ownership. Strategy: a coherent set of action with a reasonable chance of improving the data (Criteria: specificity, leverage, values and reach)

41 Our step by step process Step 8. Develop a report card for the framework. The report cards can be used to highlight the area that is being considered, demonstrate and explain the data, promote the work plan and provide an update on progress. The Clear Impact Scorecard offers a web based software for measuring and reporting outcomes for population and performance accountability

42 Our step by step process Step 9. Collect and baseline the data for the measures. It can be difficult to do this when the information is held in various different information systems. Be prepared for this when choosing measures and don t let it hold up the rest of the work.

43 Our step by step process Step 10. Schedule meetings to review any additional data and progress against the action plan. Be prepared to re-visit aspects of the framework if things change e.g. if data is unavailable, if curves are not turned as predicted or if the story behind the baseline changes.

44 What have we learnt from evaluation? RBA training contributed to overall understanding. However, it was only when participating in RBA did stakeholders fully understand the methodology. Some stakeholders who have participated in an RBA framework suggested they would benefit from booster training sessions. Stakeholders feel that the RBA framework is not a difficult method to implement. However, they feel that RBA frameworks are easier to implement and manage in smaller organisations, particularly in the Third Sector

45 What have we learnt from evaluation? Stakeholders are less confident about implementing population frameworks. Experienced facilitation is required to a greater extent. The composition of an RBA group is the most commented upon lesson learned. Stakeholders suggested that inclusivity is a major issue and that patient/service users and managers/practitioners should be involved. Standardising the collection of data across organisations was viewed as one of the major future challenges and something that needs to be improved to see RBA become a mainstream approach in the future.

46 How do you measure success?

47 Turning Curves How have the community s headline indicators improved? How have the program, agency or services system headline performance measures improved? How have partners come together: to align their strategies and actions shared accountability to a common outcome? implementation of OBA /RBA

48 Q&A