2014 National Network of Public Health Institutes Open Forum: The Launch of Healthy Chicago and Our Accreditation Journey
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Commissioner Choucair at the 2014 National Network of Public Health Institutes Open Forum for Quality Improvement in Public Health presentation on "Perfect Timing! The Launch of Healthy Chicago and Our Accreditation Journey" in Kansas City.
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2014 National Network of Public Health Institutes Open Forum: The Launch of Healthy Chicago and Our Accreditation Journey
- 1. Chicago Department of Public Health Commissioner Bechara Choucair, M.D. City of Chicago Mayor Rahm Emanuel
- 2. Challenges to Change • Dwindling local health department resources – 12% overall decrease in personnel since 2008 for all LHDs – Large jurisdictions hit the hardest • Infrastructure developed over 100 years ago – Tradition creates inertia that impedes change efforts • Political environments – One of several City agencies – Accountable to both Mayor and City Council • Interest groups
- 5. Evolution of Healthy Chicago February – May 2011 August 20112010
- 12. Communication
- 16. Chicago Department of Public Health Commissioner Bechara Choucair, M.D. City of Chicago Mayor Rahm Emanuel
- 17. "By having a clear mission with clear priorities and having a way to measure them and make sure we are not only setting goals but achieving them … we will have the greatest impact on our public health.” Mayor Rahm Emanuel
- 18. Chicago Department of Public Health Commissioner Bechara Choucair, M.D. City of Chicago Mayor Rahm Emanuel IT’S NOT JUST ABOUT INDIVIDUAL BEHAVIOR IT’S ABOUT HOW WE BEHAVE AS A CITY HEALTHY CHICAGO Chicago Department of Public Health
- 19. 1 9
- 23. Tobacco Use Victories • Increased Cigarette Tax • Banned Flavored Tobacco Sales Near Schools • Regulated E-Cigarettes Domain 5: Develop Policies and Plans
- 33. Obesity Prevention Successes • Increased access to healthy & affordable food • Increased opportunities for physical activity • Focus on CPS students
- 38. .
- 51. Advancing Healthy Chicago through Technology
Notes de l'éditeur
- These are just some of our current challenges to change: In its most recent study of about 2,500 local health departments, the National Association of County and City Health Officials found that since 2010, the median number of employees and FTEs has decreased in LHDs, especially in among LHDs serving large populations, with median numbers of employees and FTEs decreasing by more than 10 percent for LHDs serving 500,000 people or more. In Chicago, we face a public health infrastructure that was developed over 100 years ago. There is a long history and lots of tradition. But with that can come a “That’s the way we’ve always done it” attitude, and inertia gets in the way of change efforts. In Chicago, like anywhere else, you have to consider the political landscape. CDPH is just one of more than 30 agencies demanding resources and support from City Hall. And just like anywhere else in the country, it takes more than just business as usual to keep public health in the spotlight. Also, while I report directly to the Mayor, I also am accountable to 50 City Council members. They are all elected officials and their positions are not always aligned with that of the administration, so this can be somewhat of a balancing act. Finally, we also have to balance the demands of multiple interest groups against what’s in the best interest of public health. ------ For these types of challenges – sound management is not enough. I can’t just have a department that’s doing a more efficient job at what we’ve done in the past. It’s just not enough. We need to be able to manage change and drive innovation. And to do that, a framework is required. I have been applying two lenses in efforts to move CDPH from our organizational structure and the delivery of routine health services to agency that innovates.
- I’m sure you’re familiar with this graphic of the three core functions of public health and how they relate to the 10 essential services, and serve as the foundation for PHAB standards and measures. It has often been said that “public health is everything.” But if it’s everything then its really nothing. You have to be grounded in what’s distinctive about public health and how public health adds value. How we do things that nobody else does. So our vision is grounded in the essential services, which allows us to focus our work on what’s important I am always challenging my staff to be innovative, but if someone proposes an initiative and it doesn’t logically fit within this framework, then I probably won’t support it. But even with this model, the story is not fully told. For example, there are many ways one can “monitor health.” We have traditionally done this passively by waiting to receive data from birth and death records or on reportable conditions. But we are currently waiting over 3 years to get death data from the State and historical infant mortality rates do little to inform future interventions and improve public health. In the past two years we have become much more proactive in strengthening relationships with other providers and identifying new and more timely data. For example, this year we gained access to over 80,000 student health records from the Chicago Public Schools – from this we have developed the most comprehensive report to date on childhood obesity in Chicago. Just as important, through this partnership we have established a strong foundation for future collaboration on our shared priority of children’s health.
- The second lens that has influenced my role as a leader, comes from Tom Frieden at the CDC. This graphic builds on the Essential Services and underscores the need to focus public health efforts more broadly – not just on the health and behaviors of individuals. This framework shifts us from the old public health model of delivering services to building and monitoring system performance. By calling on public health practitioners to change the context in which decisions are made and to address socio-economic factors, this framework demands that we focus on systems, policy and environmental changes. I want to focus on this for a moment because this thinking has really re-defined the way we’re doing business at the Chicago Department of Public Health.
- Focus on politics here….
- Healthy Chicago was developed using local health data to determine the 12 priorities. Each priority has multiple measures and targets that we monitor and report on annually. Staff are held responsible for implementing the strategies to achieve the outcomes. Every CDPH program collects and reports data on both process and outcome measures that align with Healthy Chicago. We knew the only way to achieve the goals we set forth in Healthy Chicago was to advance the quality and performance of our work, and PHAB standards and measures are the basis for how we have been and will continue to operate. Finally, none of our work could be fully realized without the help and contributions of our numerous partners. As you know, collaboration is another benefit of Accreditation.
- Partnerships play an immensely important role in all of the Department’s work. We currently are actively engaged with hundreds of different organizations.
- And the list just keeps growing…. In a time of limited resources at the local, state, and federal levels, partnerships are especially critical to keeping our work progressing.
- Another component of our framework for success of Healthy Chicago, is our focus on performance and quality improvement, and accountability at the department. When I was appointed by Mayor Daley in December 2009, the performance management system in place was directed by City Hall and consisted of a small team at CDPH who reported department-wide measures monthly. Only a few programs at CDPH were reporting data at this time. One of my first actions as Commissioner was to establish a formal performance management system at CDPH in the beginning of 2010 that would involve the participation of ALL programs in the department. After receiving funding through CDC’s National Public Health Infrastructure grant, we established a formal Office of Performance & Quality Improvement and hired a Deputy Commissioner to lead PQI efforts through out the department. The Office of PQI continues to evolve with the addition of full time staff on the PQI TEAM in addition to team members who volunteer their time towards the effort. Most importantly, for the past few years, QI has been the focus. We’ve provided QI training to staff, some of our PQI Team has received Lean Six Sigma and Kaizen training, and all programs in the department have an annual QI project in addition to large scale, cross-cutting, department-wide QI projects lead by the PQI Team.
- The backbone of our PQI system at CDPH is the Balanced Scorecard. It gives managers and executives at CDPH a balanced overview of how each program is doing. We use the four quadrants of public health interventions, outcomes, resource management and community & customer engagement to ensure our programmatic activities are aligned with our organization’s vision and strategies in Healthy Chicago. Every program at CDPH has performance measures in each of these quadrants. These measures are a mix of process and outcome measures, and together they make up the “dashboard” for each program.
- Our PQI system at CDPH is multi-faceted. It’s truly a blend of performance and quality improvement, all with a basis in data. In addition to the Balanced Scorecard, each program reports monthly on their successes, challenges, support needs and new ideas or activities to the Executive Team. The PQI Team reviews the monthly reports, and quarterly themes the challenges and support needs for the Executive Team to review and develop action items to address each one. The bi-annual performance sessions give programs the opportunity to have one on one time with me and other members of the Executive Team to discuss their work, challenges, what’s going well, where they need support. The annual QI presentation allows the programs to share their annual QI project methods and results with the rest of the department, it is a great opportunity for other programs to learn about what’s going on in the department and how other programs are addressing areas of improvement. The success of our PQI system at CDPH is largely due to the communication and training components, which have allowed us to build a culture of QI across all levels of the department. In my weekly email update to staff, I always include a paragraph or 2 about our ongoing PQI efforts, most often highlighting a program. Also, each month program managers discuss their PQI work with staff at their meetings. CDPH provides ongoing training to our managers and supervisors at least every other month, the PQI Office offers QI training bi-annually as part of the QI Learning Collaborative and soon we’ll be launching an annual online PQI training for every staff member.
- CDPH is building culture of quality improvement by infusing QI through all levels of the department from frontline staff to the top. Every person in the department is touched by PQI in some capacity.
- Our accreditation journey began in May 2011 as we assessed our accreditation readiness. After we determined, we were ready to being pursuing accreditation, we then started to build our team. We used an inclusive process to form the Accreditation Team by establishing an application process and asking all staff to apply who were interested. From the beginning, we framed accreditation as a leadership and development opportunity and a means to further infuse QI through the department, which required all level of staff participation. In fact only one member of our Executive team serves on the Accreditation Team, we have food sanitarians, public health nurses, nutritionists, epidemiologists, public health educators and program/project managers. A large part of our journey was spent braining storming examples of documentation to submit, collecting those documents, reviewing documents and filling in gaps of documentation. Through out the process, we learned a lot about what we were doing well, and what we needed to do better. A key component in our Accreditation process was the mock reviews we held both internally and externally. So although, there was a small team of people focused on accreditation at CDPH, it was truly a department project as staff from all programs and levels participated in some ways. In addition, our partners from other public health agencies, academic institutions and others participated in our external mock review. Both of these reviews were immensely helpful in preparing our documentation. During the accreditation process, the Accreditation Team spent a lot of time communicating the importance of meeting national standards and making this relevant to individual staff. The process also allowed for cross program collaboration and has started to break down silos across programs at CDPH.
- CDPH was accredited by PHAB in August of 2013. This is an outstanding achievement for our department but our work has just begun. Being accredited means that we continue to strive to improve our work and to ensure we are always meeting PHAB standards. In fact, our Accreditation Team is still going strong, making sure that we are meeting the standards and measures, and ensuring that the opportunities for improvement identified during the accreditation process are being addressed.
- Leadership, communication and teamwork are CDPH’s greatest asset in achieving and maintaining accreditation, and making us a high performing local health department. As Commissioner I was completely supportive and understood the reasons why we needed to pursue accreditation, and the significant commitment of time and resources that would be required. I knew, and made clear, that accreditation was and is a top priority for CDPH. The identification and selection of a dedicated cross-disciplinary team and a strong team leader are also important contributors to our success. Lastly, communication to staff about accreditation, what it is, why it’s important, how their work is related to the standards and domains was critical to being accredited. Communication to the Executive Team from the Accreditation Team also facilitates our being able to help where needed, so nothing impedes our progress.
- Mayor buy-in….HUGE!
- At the core of Healthy Chicago is the recognition that the choices and behaviors of individuals are heavily influenced by their environments. We can’t direct people to eat healthier foods when their neighborhoods lack a large grocery store and their corner stores are only selling junk foods and sugar-sweetened beverages. These are burdens that the City must take on.
- As many of you know, our Healthy Chicago agenda identifies 12 priority areas. We started out with 193 strategies, but have added more as we have created opportunities to improve the health of Chicagoans. We now have 241 Healthy Chicago strategies and 92% of them have either been fully implemented or are currently in progress.
- We also have 17 outcome measures with 2020 targets that align with the 12 priority areas.
- Now, I’m going to spend some time sharing our success in implementing Healthy Chicago strategies and how this work aligns with the 12 domains of accreditation. At the bottom of this and upcoming slides, you’ll notice multi-colored bars, which reflect the accreditation domains connected to our work. For example, our work in tobacco use touches on 7 different domains: assessment, informing & educating, engaging the community, developing policies & plans, enforcing public health laws, promoting access to care and engaging the governance.
- In 2013, we had some of our greatest successes in the area of tobacco use and many examples of how partnerships, policy, public awareness can come together to create change. Lets talk about the historic tobacco tax increase.
- In 2013, we had some of our greatest successes in the area of tobacco use and many examples of how partnerships, policy, public awareness can come together to create change. Lets talk about the historic tobacco tax increase.
- In late 2013, the City Council passed a 50 cent tax increase on a pack of cigarettes. With local, state and federal taxes considered, Chicago now has the highest cigarette tax in the nation at $7.17 a pack. This is just one area where our partners – many of you here today – came together in a powerful way to fight for groundbreaking change.
- Healthy Chicago partners also came together to successfully advocate to address the challenge of flavored tobacco including menthol – In August, Mayor Emanuel directed the Board of Health to convene town hall meetings to identify solutions to reduce menthol cigarette use among our youth. Led by our Board president, Dr. Carolyn Lopez, 4 town hall meetings were convened and recommendations were forwarded to the Mayor. And at it’s December meeting, the Chicago City Council passed an ordinance which banned the sale of flavored tobacco – including menthol – within 500 feet of a school. This was a groundbreaking ordinance - the first of its kind anywhere – federal, state, or local.
- Our third tobacco policy success and most hard fought battle concerned e-cigarettes. Following two contentious committee meetings, in early January, the City Council voted to “stand with public health” and “be on the right side of history,” by regulating electronic cigarettes. The ordinance will protect Chicago youth by Requiring e-cigarettes to be placed behind sales counters, Prohibiting sales to minors And requiring e-cigarette retailers to obtain a tobacco retail license. The Council also voted to restrict e-cigarette use by including these devices under Chicago’s Clear Indoor Air Act.
- We are increasingly using media not only to reinforce the need to behavior change among our residents, but also to generate support for our policy efforts. We had two targeted campaigns last year – “Burned by Menthol Cigarettes” and “Take Pride, Leave Cigarettes” which addressed the LGBT community.
- More Smokers are seeking cessation All of our tobacco campaigns promote the State-funded Tobacco Quitline and as you can see in this slide, calls for cessation support from Chicagoans have increased recently. Over 24,000 calls came from Chicagoans last year, an increase of about 10,000 from 2012.
- Finally, work continued in 2013 to increase smoke-free environments. In July, the University of Illinois at Chicago enacted a smoke-free campus policy affecting their 27,000 students, as well a faculty, staff, and hospital patients and visitors. This latest policy brings the total number of smoke-free institutions of higher education to 5 and the number of smoke-free hospital campuses to seven. CHA continued its important smoke free work, designating the Dearborn Homes and Sullivan Station smoke-free bringing the total number of smoke-free CHA developments to 6 with 610 smoke-free public housing units.
- As you can see from this list of policy changes currently only being considered at the federal level, in 2013 Chicago established itself as a clear leader in tobacco control efforts. None of these accomplishments would have been possible without the significant efforts of so many partners.
- Work to expand access to healthy and affordable food continued in 2013 – let me share just 4 examples. In January, Chicago’s food plan – A Recipe for Healthy Places – was approved by the City’s Plan Commission. With 6 community-based strategies to support healthy eating, the plan is our official roadmap for city planning and policymaking around food access. The Plan was developed with significant community input, the leadership of critical partners Department of Planning and Development, Family and Support Services, CDPH, and CLOCC – the Consortium to Lower Obesity in Chicago children. Also last year, the City joined CPS and the Park District by implementing a Healthy Vending policy affecting machines in all City owned and operated buildings. The Park District – strengthened their healthy vending policy by offering only low- or no-calorie options in their beverage machines.
- The work of Neighbor Capitol and Streetwise continued and in 2013 there were 15 licensed produce carts in the city, with another 15 planned for 2014 . 20 related jobs were created and over 40 people were also trained in retail sales. And the 4th example of food access work, also includes a job development component. the City’s Farmers for Chicago initiative will initially making available 5 more acres of land for farming. Growing Power will then train local farmers and help them install needed equipment.
- The Divvy bike share program was launched in June with an initial 700 bikes and 65 docking stations. By years end, The fleet had expanded to over 3,000 bikes and 300 docking stations Over 1.4 Million trips were taken coving more than 3.1 Million miles. 21,207 annual memberships and nearly 212,171 24-hour passes were sold. On the right side of this slide you can see the before and after of the Dearborn St. Complete Street where a buffered bike lane was created. Chicago bike riders are now supported by 200 miles of protected, buffered or shared bike lanes, more than 13,000 bike racks, and by 2020, a 645-mile network of biking facilities will provide a bicycle accommodation within one half mile of every Chicagoan.
- There is much to talk about with increased opportunities for physical activity, and a lot of this work has been led by our colleagues at the Chicago Department of Transportation. In April, CDOT released Complete Street design guidelines (part of our Healthy Places initiative) with a primary emphasis on supporting walking, biking, and public transportation. Our Playstreet program expanded in 2013, with 61 events and over 13,000 participants – twice as many as in 2012. I want to recognize our Playstreet partners – Blue Cross Blue Shield, Active Transportation Alliance, LISC Chicago, and World Sport Chicago.
- Finally in the area of obesity prevention I want to talk about our continued focus on CPS students, under the leadership of our shared chief health officer, Dr. Stephanie Whyte. CDPH has recently been enjoying a data-sharing partnership with CPS, resulting in what we believe to be the largest scale look at childhood obesity in Chicago. In February of last year, our first join report was focused on the physical exam records of over 59,000 students, The report – looking at students in kindergarten, 6th and 9th grades, revealed overall obesity prevalence was 25%, with the highest rates among 6th graders. A subsequent report focused on the most recent health records, found slight reductions in kindergarten obesity at 19%.
- CDPH and its partner, Health & Disability Advocates, prepared a report on the uninsured in Chicago to better inform and target efforts at outreach, education and enrollment. In addition to describing the characteristics of newly eligible Chicagoans in this profile, guidance was also presented on how to best use this information to reach these residents. I’ll show you some of those efforts to engage and reach Chicagoans next.
- As of November, 125,000 applications submitted to state for approval. Officials say the expansion will generate $468 million next year for the county’s health programs, reducing the burden on taxpayers.
- Another way CDPH is promoting enrollment is by focusing on children and implementing a Medicaid enrollment program. Through the All Kids program, Illinois children (≤18 years old, ≤ 300% poverty) qualify for Medicaid and can receive comprehensive care. Including: physician visits, hospital stays, prescription drugs, vision care, dental care and medical devices (e.g. glasses, asthma inhalers). However, up to 50,000 CPS students are still uninsured despite CPS efforts. To reach these children, CDPH issued a Request for Proposals (RFP), which will fund a Lead Organization to coordinate outreach and application completion for at least 5,000 CPS students, which wall lead to enrollment in All Kids. The LO will work with community-based organizations to reach these students. Grant period: October 2013 – September 2015 Funding available: $350,000-$1,050,000
- Our Public Health Infrastructure priority area has many strategies. Today, I’ll focus on our innovation in technology strategy.
- We’re at approx 50 health datasets in the open data portal and growing. We are releasing more publicly available data to help spur innovation at the Department as well as in the civic tech and business communities.
- Here is a tweet from a Chicago resident that our app discovered and a report was submitted.
- These are the themes that have been very important in our work: Partnerships, Policy, Technology and Public Awareness. Each of these components plays a distinctive and critical role to the success of our work at the Chicago Department of Public Health. However, one component alone does not provide a success, but it is the sum of all these components working together that has and will continue to help us transform the health of Chicago and attain our goal of making Chicago the healthiest city in the nation.
- Accreditation is working at CDPH because its providing standards that we can measure ourselves against and continually work to improve upon, developing our workforce and focusing on the customer – the residents of Chicago. Each of these factors are critical our success as a local health department.