Creating Alignment Across Systems to Equitably Advance Health and Maintain PHAB Accreditation

This case study was developed using content from the webinar, The Very Best Results-Based Accountability Implementation Examples, hosted by Clear Impact in partnership with clients. You can watch a recording of this webinar, as well as access helpful materials here.

Summary of Client Results:

• Enhanced commitment to collective impact.
• Created alignment of staff and activities across the entire organization.
• Increased ability to tell the story of health to the community and staff.
• Data is more accessible, allowing them to set targets and drive continuous improvement activities.
• Increased alignment with national and statewide efforts, like Healthy People 2020.
• Implemented an ongoing improvement process, helping them to achieve and maintain PHAB accreditation.

Sample Measurable Results:

• Improved month-over-previous-month and exceeded Q3 FY 19/20 targets for the measure, “% of clients who present with business or entrepreneurial needs who receive technical assistance or training.”
• Exceeded FY 18/19 targets for the measure, “% of goals achieved in the Older Adults Healthy Results Individualized Care Plans.”
• Improved month-over-previous-month and exceeded FY2 2019 targets for the measure, “% of parents who screened at risk for depression, were referred, AND received mental health supports/treatment.”

Alameda County enjoys a varied geography ranging from urban marinas to rolling open spaces to hillside lakes and streams. It is the seventh most populous county in California, with a total population of around 1,671,329 in 2019, representing a 10.7% increase over nine years. Alameda County characterizes itself as one rich in diversity and culture. Immigration has been substantial, and the county is now one of the nation’s most diverse regions. Whites maintain a slight population majority, but certain ethnicities (especially Hawaiian/Pacific Islanders and Latinos) continue to fare worse proportionately on many health indicators, resulting in a focus on health equity.

In many ways, the Alameda County Public Health Department (ACPHD) is a typical health department. Its mission is to work in partnership with the community to ensure optimal health. It’s a robust and committed health department with some great core values around healthy people, equity, accountability, innovation, transparency, and respect. They recognize that residents are more than consumers of public health services and that health is complex and dependent on a wide range of factors across systems. Therefore, they engage in various community-based activities that engage both residents and community partners in planning, evaluating, and implementing health activities.

ACPHD has worked with Clear Impact since 2013 to improve health equity and other goals through Results-Based Accountability and the Clear Impact Scorecard to support it. At first, the initial PHAB Accreditation process drove this work, and they elected to go with RBA and the Scorecard to fulfill the continuous improvement process requirements for accreditation. They identified early the importance of dedicating lead staff to this effort, and Clear Impact provided training and technical assistance to dedicated teams and managers.

As ACPHD continued their RBA journey, they needed to train front-line staff if they genuinely wanted to succeed. In 2019, they once again selected Clear Impact to provide training to all staff with seven separate one-day onsite training sessions. Everybody had an opportunity to understand RBA and the Scorecard so that the tools could embed into the organization further.

In addition, ACPHD started an RBA learning community that met monthly and quarterly to learn about RBA and use the Scorecard to develop performance measures. These community convenings were so successful that they transformed them into a continuous improvement process for the organization. Currently, the department pays for more than 100 active Scorecard users, which helps the entire organization remain engaged.

Some of the benefits that ACPHD staff have identified through their work with Clear Impact and usage of the Clear Impact Scorecard include:

• “It demonstrates and supports their commitment to collective impact, understanding that they can’t do it alone, and understanding that it requires partnerships and working with the community to do the work effectively.”
• “It helps them enhance their alignment across the entire organization.”
• “It’s a strong communication tool so they can tell their story to the community and to their staff around what they’re doing.
• “It keeps all their key data in one place that is accessible and allows them to help set targets and drive continuous improvement activities using Turn the Curve thinking and driving toward their targets.”
• “It helps them align their work with national and statewide efforts like Healthy People 2020.”
• “It helped with their re-accreditation process with PHAB.”

Many county agencies and several departments within ACPHD are using the Scorecard to drive continuous improvement. These include, but are not limited to, Building Blocks for Health Equity, Brighter Beginnings, and Older Adults/ Healthy Results.

Building Blocks for Health Equity (BBHE) is an initiative designed to increase health equity by focusing on intersectionality. This approach supports that health is not just about healthcare services, nor is it solely the public health department’s responsibility — it’s also about finances, poverty, and other factors. ACPHD engages in collaboratives like the Best Babies Zone to do neighborhood work around births, health equity, and resource advocacy.

In the scorecard below, ACPHD manages data on critical activities for BBHE. Part of this work includes workshops to help people increase their income. ACPHD is a leader in health equity by digging deeper into the performance of its programs and services with Clear Impact Scorecard. One thing that they’re tracking is the percentage of clients referred to the program who complete the workshops. To their detriment, programs don’t often look at these types of measures even though they ensure people commit to fidelity and get the “full dose.” In the scorecard measure below, you can see how ACPHD looks at the data and the “story behind the curve” to identify its action plan and ensure program completion for optimal results (see Fig. 1 below). With the scorecard embed function, ACPHD easily shares this data with partners and the community. You can view this data at the link below. (*TIP use the scroll bar underneath the graph to see the full range of data)

https://embed.resultsscorecard.com/Measure/Embed?id=311141

Fig.1. ACPHD Building Blocks for Health Equity scorecard measure page depicting % of clients who attend workshops who complete the entire workshop series.

Another program scorecard using the embed function is the Brighter Beginnings Scorecard. This program focuses on pregnant women up to 25 years old. The department uses this data to see if young women and their children are getting what they need to have a great start in life. Scorecard allows ACPHD to disaggregate the data by race and ethnicity to maintain the focus on health equity. Anyone can access the scorecard below:

https://embed.resultsscorecard.com/Scorecard/Embed/34488

Finally, for Older Adults, Healthy Results (OA/HR), ACPHD works with older adults to make sure they have the support they need. Clear Impact Scorecard houses this data, which you can access below. Through their work, the county found that the vulnerable older adult patient population has complex care needs and is under-resourced with inadequate caregiving support and challenging healthcare system barriers. The department deemed these challenges so insurmountable that they projected only 50% of goals to be achievable within the review timeframe. However, through careful planning and their commitment to using data-based decision-making, ACPHD was able to exceed their FY 18/19 targets for the percentage of goals achieved in the Older Adults Healthy Results Individualized Care Plans.

https://embed.resultsscorecard.com/Scorecard/Embed/34999

This case study was developed using content from the webinar, The Very Best Results-Based Accountability Implementation Examples, hosted by Clear Impact in partnership with clients. You can watch a recording of this webinar, as well as access helpful materials here.

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