ASTHO Helps Public Health Agencies Maximize Their Programs with Key Practices and Data
Developing, carrying out, and improving public health programs for maximum impact requires appropriate evaluation methods, measures, and data. ASTHO’s Performance Improvement, Research, and Evaluation (PIRE) team provides these activities to support state and territorial health departments as they carry out and improve high quality public health programs.
ASTHO’s PIRE team collects information to assess the current status of state and territorial public health agencies, providing assistance for achieving accreditation and undertaking business improvements, and evaluating the effectiveness of efforts undertaken to improve the public’s health. PIRE staff direct the highly-regarded Profile Survey of State and Territorial Public Health (Profile Survey) and the Public Health Workforce Interests and Needs Survey (PH WINS), along with other surveys. Additionally, the team assists states and territories in support of achieving and maintaining public health accreditation.
The PIRE team also helps measure ASTHO’s own performance and the effectiveness of projects it undertakes, such as Million Hearts—a high-profile hypertension prevention and treatment initiative. The PIRE team staffs the Chief Financial Officers (CFO) Peer Network, providing a place for CFOs to network with their peers and non-traditional partners, and build needed skills in economics, evaluation and assessment, and financial management. Below is a more detailed look at these important activities.
Performance and Quality
ASTHO is dedicated to continually strengthening the public health infrastructure and improving state and territory health agencies’ performance. ASTHO’s Performance and Quality team works to advance participation in national accreditation, facilitate performance management and quality improvement, increase systems assessments, and strengthen the ability of states and territories to deliver essential public health services. As of March 20, 2017, 21 states and the District of Columbia are accredited and an additional 16 states are in the queue to become accredited. This represents an increase of ten states over the past year. Here’s an overview of ASTHO’s performance and quality products and services:
Facilitate Peer to Peer Learning to support and promote performance improvement activities and advance accreditation preparation through the Accreditation Coordinator Learning Community, Accredited States Learning Community, and Performance Management/Quality Improvement Affinity Group.
Provide Technical Assistance (TA) on performance improvement and accreditation preparation activities. Between 2010 and 2016, ASTHO completed 100 requests for TA from 40 states and 18 requests for TA from 8 territories/freely-associated states. Feedback from the states and territories/freely-associated states indicated that they found the TA beneficial and valuable for their department.
Provide Resources to support performance improvement activities and advance accreditation preparation. ASTHO has developed a comprehensive collection of tools and resources to support accreditation preparation, advance performance management and quality improvement, and increase public health systems assessments. Recently, ASTHO published two strategy guides for public health leaders explaining how they can implement performance management and champion PHAB accreditation efforts within their agency. Both resources were developed based on input and guidance from key informant interviews with current and previous state health officials, as well as an environmental scan of available resources. The guides offer perspectives and approaches to various issues specific to performance management and accreditation as they relate to the unique role of an executive leader, address successes and challenges, and share experiences and lessons learned from various health departments. All of the tools and resources are on ASTHO’s Accreditation and Performance Resources and Tools web page.
Research and Evaluation
ASTHO’s Research and Evaluation team is responsible for collecting information to assess the current status of state and territorial public health agencies and evaluating the effectiveness of efforts undertaken to improve the public’s health. Currently, the team is analyzing and writing up the results of the Profile Survey, which is the only comprehensive source of information about state/territorial public health agency activities, structure, and resources. The information gathered from this survey allows state/territorial health officials, policymakers, and researchers to compare health agency activities, determine funding needs, and advance the field of public health systems and services research.
This spring, ASTHO will also field the Forces of Change survey, which gathers information on rapidly changing topics and immediate challenges within state public health, such as budgets, workforce capacity, accreditation status, opioid addiction, Zika virus, health equity, and communicating the value of public health. Results from this survey help inform ASTHO’s programmatic work, allowing the organization to better serve its members.
Additionally, the PIRE team gathers data to support the public health workforce by leading the Public Health Workforce Interests and Needs Survey (PH WINS). PH WINS, an effort supported by the de Beaumont Foundation, was the first survey to capture nationally representative data of individual state health agency workers. First fielded in 2014, PH WINS provided information on workforce development priorities, the workplace environment, training needs, and job satisfaction. The PIRE team is currently working to revise the PH WINS instrument for a fall 2017 launch. PH WINS 2017 will include an expanded training needs assessment and leadership module.
Another workforce research project supported by PIRE is the Directors Assessment of Workforce Needs Survey (DAWNS), a comprehensive analysis of public health training needs, gaps, and priorities by incorporating perspectives from individual workers, managers, and public health leaders. DAWNS collects important leadership perspectives regarding the capacities and development needs of the state governmental public health workforce.
The PIRE team also leads innovative work in the area of workforce development and support through the Human Resources and Workforce Development Directors Peer Network and the PH WINS: Research to Action Learning Collaborative. Both projects provide an opportunity for workforce personnel to share resources, network, and build relationships as well as identify ways PH WINS can inform workforce development efforts.
U.S. Territories and Freely Associated Nations
In addition to our stateside work, ASTHO also supports its member agencies in the five U.S. territories and three nations with compacts of free association with the United States (collectively referred to as the “insular areas”). ASTHO has a strong history of developing resources, services, and initiatives to meet the unique needs in these jurisdictions and ensures that its resources and networking opportunities are accessible and relevant. ASTHO also provides customized technical assistance to insular areas health agencies and their senior leadership. Projects focus on increasing state health agency capacity to improve the performance and quality of the public health system.
In coordination with regional partners, ASTHO works virtually and on-site to support health agencies across all program areas. Current projects include support of agency strategic planning and internal process mapping of procurement, recruitment, and expenditure tracking and review processes. ASTHO is also supporting health agencies in the insular areas on projects to improve capacity to respond to Zika, to address the public health consequences of climate change, and to develop and enhance informatics capacity. Additionally, insular areas health agencies are participating in ASTHO’s Million Hearts learning collaborative to develop community-clinical linkage systems to improve identification and control of hypertension.
Chief Financial Officers Peer Network
The PIRE team staffs the Chief Financial Officers (CFO) Peer Network, providing a place for CFOs to network with their peers and non-traditional partners, and build needed skills in economics, evaluation and assessment, and financial management. Public health budgets have remained stable or even declined in recent years, even as the complexities of public health have worsened and new challenges have emerged. Drug resistant infections and opioid overdoses and deaths are on the rise even as basic public health challenges have reemerged such as safe drinking water. The call is clear, today’s state and territorial public health agencies must make do with much less and do more than ever. Therefore, these agencies must think and act creatively, and use innovative and cutting edge financing techniques and practices.
During the last two years alone, CFOs have partnered with senior deputies on ways to impact the ways in which the needs of communities are assessed and the ways in which decisions are made about targeting community benefit dollars. They have provided input on methods to develop a uniform chart of accounts that will provide a common framework for defining how public health is best funded. Efforts to define core foundational public health services and their cost are embedded in this effort. They have created a web-based tool designed to estimate the return on investment (ROI) of interventions. The tool has been used by the states of Oklahoma, Utah, Maine, Virginia, Connecticut, by the Republic of Palau, by Spokane, Washington, and by the Iowa State Hygienics Lab. CFOs have partnered with federal officials and staff to streamline and improve communications on financial matters.