A New Way of Thinking About Health: Changing How We Change Bruce - PowerPoint PPT Presentation

A New Way of Thinking About Health: Changing How We Change Bruce Behringer, MPH June 1, 2017 Deputy Commissioner for Continuous Improvement and Training Tennessee Department of Health (Retired)

Initial comments • Your regional challenge • Your selected priorities • The wording you choose

Your regional challenge • Advantages and disadvantages of being Tri-State • Strength of sense of regional community • Different policies, people, priorities and portions • Ability to feed ideas across lines

Your selected priorities are troubling issues that require: • Continuing and continuous care • Coordination of effort between patients and providers and among providers • Focus on risk reduction • Really hard behavior change • Broader more comprehensive public interventions

Clarify your language: Differentiate between health problems and solution • Regional health • Strategies address issues issues – Behavioral and – Access to care substance abuse – Data and technology – Chronic Disease • Learn from lack of clarity in nation health care reform debate  Health, health care, or health insurance?  Which essential benefits? • Access to what?  Treatment, coordinated care, preventive services, knowledge and skills to adopt healthy behaviors

Five ideas for your consideration • Units of practice to expand who could be involved with regional population health improvement • Working together strategies to reconsider steps in process toward change and success • Give-Get Grid to identify and value contributions and benefits of the many • Aspects of community health to record, track and evaluate regional population health issues • Strategic maps to display visible outcomes of effort

TOOL 1 Units of practice, Units of solution • Helps to consider “who else” contributes to health? • What is your organization’s traditional unit of practice? • How could effectiveness be improved with broader units of solution? • Engages and involves From: Stewart G. (1993). Social and Behavioral Change more in the solution Theory. Health Education Quarterly. Supplement 1: S113 ‐ S135.

TOOL 2 Working Together Strategies • Networking : Exchanging information for mutual benefit • Coordinating : Exchanging information for mutual benefit and altering activities for a common purpose • Cooperating : Exchanging information for mutual benefit, and altering activities, and sharing resources for a common purpose • Collaborating : Exchanging information for mutual benefit, and altering activities, sharing resources, and enhancing each other’s capacity for a Arthur Turovh Himmelman. 2007 CDC Cancer conference. common purpose

Working Together Strategies • Provides framework for planning • Classify each opportunity for working together • Consider requirements to move to next step • Cooperating becomes a regional goal for change • Incidents of collaborating should be identified, documented, evaluated, and awarded • Important to recognize common purpose and how organizations increase each other’s capacity

TOOL 3 Behringer, 1992 (multiple references)

Explanation of cells in model • Each partner to defines own “Give” and “Get” cells • Cell contents – Gives – promised contributions – Gets – expected benefits • Negotiate relationship together to … – Learn each other’s missions, values and resources (and limitations) – Discover value of own resources (not necessarily money) as contributions – State expected benefits to hold partners publicly accountable to process and shared outcomes

What the Give ‐ Get Grid is not • “Giver and receiver” relationship between those of greater and lesser power and resources • Set of short ‐ term promises just to get a grant or express support for a program • Traditional “win ‐ lose” approach or even “win ‐ win” thinking

What the Give-Get Grid is • Focuses on development of long term, continuing relationship • Provides framework for dual and shared and benefits • Promotes a sense of accountability among partners • Framework to share new external sources support that address community-identified issues and open doors to community • Used for formative evaluation of a planned collaborative program

Background beliefs • Partnerships defined as redistributed power brought about through negotiations (Arnstein) • Equality of partners achieved through recognizing assets, not just needs (Kretzman and McNight) • Value participation and development of relationships based upon contributions seen as meaningful, challenging (Depree) • Define own and others’ interests leading to stating expectations of benefits (Fisher and Ury)

Give ‐ Get Grid Example 1992: Community Partnerships for Health Professions Education University gave: University got: -New curriculum - Rural training location -Student time in community - Expanded service area -Faculty expertise - National rural reputation -New health service site - Recruit new faculty/students Community gave: Community got: - Permission, time and energy - More doctors and nurses - Use of practice and services - New preventive services - Space, homes - Strengthen health - Teaching “Small Town 101” system - Their children in college

Example 2007: Appalachian Communities and Comprehensive Cancer Control Coalitions Communities gave: Communities got: - Volunteer community time - State recognition of local - Local knowledge of cancer needs and accomplishments - Ally for advocacy - Connection for cancer - Local credibility and leaders information and resources - More programs and services - Address cancer problems CCCs got: CCCs gave: - Help to complete and - Appreciation and recognition implement state plan - Materials, services, paid field - New partners and members staff to support local efforts - Local evidences of success - State cancer plans, data and - Reduce state burden of cancer coalition infrastructure - Statewide interconnectedness - Support health policy change

Example 2009: Bradford (PA) Center for Rural Health with multiple partners U Pittsburgh-Oakland Get Give Center for Rural Health as a regional collaborative group project Get Give Give Get U Pittsburgh-Bradford Bradford community organizations

Value of the Give-Get Grid • For planning across multiple parties – Level of participation – Time commitment – Expertise • For evaluation of cooperative efforts – Repeat use of grid every year and compare promises with reality – Count number of contributions and benefits cumulatively over time

How to address typical frustrating dilemma Health care Patients and providers community and systems These common attitudes just do not serve a region well or promote cooperation to improve region’s health.

Model of Health Care Access, Anderson and Aday (1981) Health Policy Financing and Organization Population Structural Needs Availability of care Measured by Measured by Utilization of consumer services satisfaction

TOOL 4 Aspects of Community Health Model Population Health Outcomes Characteristic Characteristics s of health of population services and and community systems Behringer Adapted from: Model of Health Care Access, Aday and Anderson (1981)

Aspects of Community Health Model Population Health Outcomes Characteristics Characteristics of of health population and services and Providers  Patients community systems Interactions System  Community

One successful use 2014: TDH Focused Community Assessment Model Variables Health Status and Part of Community Outcomes Assessment Health Assessment and process identified Risk • Improvement Plan eleven variables Morbidity • process Mortality • Characteristics of Characteristics of the Health Services and Population and System Community • Use of services • Demographics • Cost • Cultural Interaction • Workforce • Environmental • Satisfaction • Evaluation findings

Aspects of Community Health Model Data Collection Tool Health issue problem statements Health services and system Population and factors community factors Interaction factors

Use of Aspects model - HOW • Use sheets to collect data and ideas for topic problem statements, population and systems factors. • Create central visible repository to accept and integrate input • Key questions – Who will collect data? – How will it be shared in a timely manner? – What participatory processes can interpret it? – Who will be responsible for acting on findings?

Use of Aspects model - WHY • “No numbers without stories, nor stories without numbers” • Root solution in community’s lived experience and collective impact • Data is valuable regional asset IF collected, shared and interpreted together • Repository as regional asset to: – Explain reasons why the problem exists and factors that contribute to problem change theory – Guide development of interventions from assessment to concepts to strategies to evaluation