Program Essentials: Resources, Metrics, and Partnerships Decoded

In this episode of the Community Health Management Design Podcast, Dr. Tami Moser delves into the critical components of designing successful community health programs. The podcast emphasizes the importance of identifying and evaluating key resources, metrics, and partnerships, outlining how these elements can substantially influence program effectiveness. The hosts outline essential resources, highlighting the need for appropriate staffing, funding, technology, and facilities that align with a program's objectives. This is illustrated with a scenario involving a telehealth initiative, where a diverse skill set beyond medical professionals is necessary. Metrics are described as vital tools for evaluating program performance, measuring success, and guiding improvements. The podcast introduces the Institute for Healthcare Improvement's Whole System Measures and elaborates on four types of healthcare quality measures: outcome, process, balancing, and structural. Each type is crucial for gaining a comprehensive understanding of a program's impact and for preventing unintended consequences. Partnerships are also a key focus, with strategic collaborations with healthcare providers, community organizations, and government agencies seen as pivotal in maximizing impact and overcoming capability gaps. Listeners are encouraged to apply these concepts by listing resources, metrics, and potential partners for their programs, ensuring alignment with their program’s mission and strategic approach. Overall, this episode provides a roadmap for developing well-rounded, effective community health management programs that are resourceful, data-driven, and collaborative.

Tami Moser [00:00:00]:
Welcome back to the community health management design podcast. I'm doctor Tami Moser. And in this episode, we're diving into a crucial aspect of program development, identifying and evaluating key resources, metrics, and partnerships. Stay tuned to learn how these elements can make or break your community health management program. When designing a community health program, it's easy to get caught up in the big picture and overlook the nuts and bolts that make it all work. But the success of your program hinges on 3 critical elements, resources, metrics, and partnerships. So let's break these down. First up, resources.

Tami Moser [00:00:40]:
These are the tools, people, and assets you need to make your program run. Think staff, funding, technology, and facilities. But here's the catch. It's not just about having resources. It's about having the right resources. For example, if you're launching a telehealth initiative, you'll need more than just doctors. You'll need IT specialists, user experience designers, and maybe even a digital marketing team. Identifying these needs early can save you headaches down the road, and it also allows you an opportunity to think through who you have available for use within your organization.

Tami Moser [00:01:18]:
This doesn't always mean external people. It can mean internal that you have available. Although, you may have to go looking for them to figure out who would be the best fit for what you're wanting to launch. Now let's talk metrics. As the old saying goes, what gets measured gets managed. But in health care, choosing the right metrics can be tricky. This is where the Institute For Healthcare Improvements whole system measures come in handy. When designing a community health program, it's easy to get caught up in the day to day operations and lose sight of our overall impact.

Tami Moser [00:01:59]:
That's where measurement comes in. It's not just about collecting data. It's about telling the story of your program's effectiveness and identifying areas for improvement. So So let's start by breaking down the 4 main types of measurements we use in healthcare quality improvement. Outcome measures, process measures, balancing measures, and structural measures. First up, outcome measures. These are the big picture results we're aiming for. They answer the question what ultimately happened to our patients or community.

Tami Moser [00:02:31]:
For example, in our Healthy Kids Millbrook obesity program prevention, an outcome measure might be the percentage of children who achieve a healthy BMI for the steps we're taking to achieve our outcomes. They answer the question, are we doing what we said we would do? In our program, a process measure could be the percentage of families attending all scheduled nutrition education sessions. This helps us understand if we're successfully delivering our interventions as planned. Now let's look about balancing measures. These are crucial for catching unintended consequences of our interventions. They answer the question, are we accidentally causing problems while trying to fix others? And unfortunately, this is something we often overlook, but often is an outcome of what we're doing. Those unintended consequences of our interventions can create barriers for us moving forward and being successful. So for Healthy Kid Millbrook, a balancing measure might be tracking the incidence of disordered eating behaviors among participants.

Tami Moser [00:03:46]:
We want to ensure that in our efforts to promote healthy weight, we are not inadvertently encouraging unhealthy relationships with food. Lastly, we have structural measures. These assess the characteristics of the organization or system providing the care. They answer the question, do we have the right resources and systems in place to deliver quality? For our program, a structural measure could be the ratio of nutritionists to program participants, ensuring we have adequate staffing to provide personalized support. This also gets missed a lot when we start talking about program design and that those structural measures aren't necessarily put in place, and instead we think of it as efficiency. Right? We want that ratio to be as high as possible. We're gonna see, you know, 3 times what might be considered appropriate, number of patients or participants per nutritionist, per nurse. But when we really start thinking about how well we can deliver the program, what should that ratio actually look like? If we have outcomes that are not good in our program and we look at a structural measure and go, well, we have twice as many participants per nutritionist than we should.

Tami Moser [00:05:11]:
We set up a ratio that looks different in terms of this being healthy, but that ratio has gotten out of hand. And now when we look at the overall outcomes and we realize we're not delivering the way in which we should or it's not occurring accurately or we have unintended consequences we shouldn't have, we can often look at the structural measures or our structure and go. In this ratio, it looks completely different than it should, and this could be the reason that we're having other measures not look the way that we want them to. In other words, our design is off, and we need to think about, perhaps, it's not the program elements that are leading to an outcome we don't want, but our structural elements are not designed in a way to actually support the outcomes we want. All the other elements of the program are just fine. If I don't have these different measures, I don't necessarily know what's going wrong. So now you might be wondering why do we need all these different types of measures? Isn't 1 or 2 enough? And that's a great question. Each type of measure provides a unique piece of the puzzle, and you may have more than one measure that you want to look at in each part of the puzzle.

Tami Moser [00:06:31]:
So for outcome measures, they show us if we're achieving our ultimate goals. But if they don't tell us they don't tell us why or why not. So why are we achieving them? Why aren't we achieving them? I don't know. I just know if we are or we aren't based on the outcome measure we chose. So that's where process measures come in. They help us understand if we're implementing our program as intended and can point to areas for improvement if outcomes aren't what we hoped. In other words, the elements of our program are fine. Right? But the way in which we're delivering it isn't working well.

Tami Moser [00:07:08]:
And so that process measure helps us to understand why things aren't the way we would like them to be in terms of outcomes. Balancing measures act as our safety net, ensuring we're not solving one problem by creating another. And this can often happen. Right? In terms of the outcome the direct outcome we wanted, things are working well. But in doing that, we've created an another problem altogether. So this balancing measure in the pharmacy world could look like, average time to fill a script. So we're adding this service over here and our average time right now is 12 minutes to fill a script. We've added this other service.

Tami Moser [00:07:53]:
We've started to deliver this other service and an unintended consequence is that it slows down our ability to fill scripts throughout a day. So now our average time to fill is 18 minutes. You have to decide if that's okay or not and have to decide how you're gonna fix it if it's not okay. And the hope is that you don't just go, well, let's just throw our hands up and go, we can't deliver this service or provide this program. No. Instead, we need to think about how we're delivering. So we might go backwards to our process measures and look at the process for delivery and see if there's a way in which we can adjust our process to eliminate or mitigate the issue with the balancing measure. So as you can see, it is a puzzle.

Tami Moser [00:08:40]:
You're you're working with each piece of this puzzle to make sure you're getting the best possible outcomes. Structural measures help us understand if we have the necessary foundation to deliver quality care. Again, we go back to the average number of patients per nurse or average number of patients per pharmacist or average number of patients per. Fill in the blanks depending on what the pharmacist or average number of patients per. Fill in the blanks depending on what you're doing. If our structure is not set up right so that we can deliver quality care, we're always gonna have a problem here. So together, these measures provide a comprehensive view of our program's performance. They allow us to celebrate successes, identify areas for improvement, and make data driven decisions.

Tami Moser [00:09:25]:
So let's look at how this might play out in our Healthy Kids Millbrook program. An outcome measure may be percentage of children achieving a healthy BMI for their age. So the formula, and and actually detailing the formulas are really important in this stage. Because if you can't figure out what numbers to use, you're not gonna be able to look at your measure. And if you can't make sure you can access reports that provide the numbers, then this measure won't work for you. And so you may have to really kind of figure out what you're gonna do from there. So you need your formula and your data source detailed. So the formula for percentage of children achieving a healthy BMI for their age would be number of children with healthy BMI divided by total number of children in the program times 100.

Tami Moser [00:10:19]:
That gives me my percentage. Now our data source for this would be BMI measurements taken at program checkups. So I have a point of, a data point that I know I can get because we've detailed where we can access that information or pull it in. And then I've got the actual numbers I need and I should check and make sure. Can I identify total number of children in our program? And the answer should be yes. And what are the number of children with healthy BMI? Now I may not be able to run a report on that. I may have to look, okay, here's our data source. Here's our last BMI measurements that were taken at program checkup.

Tami Moser [00:10:58]:
Here is the number that children need to be under in terms of BMI for their age. So for each age, I would have the healthy BMI number set. And maybe it is a range because it's healthy BMI for their age high end and low end. So within that age, in other words, if they're under, then that means they're underweight. So they don't have a healthy BMI percentage. So we may not just be looking for over the BMI, but under the healthy BMI. Now this brings me to a point before we move to process measures that I just wanna throw in here because it's a pet peeve of mine. Once I understood that average healthy, fill in the blank, number is based on average healthy, fill in the blank number, is based on your particular areas overall numbers and therefore that's where CMS sets the normal range or where the normal ranges are set in general.

Tami Moser [00:11:56]:
I have a real problem with that because if we're looking at an unhealthy society and we look at areas and BMIs are high and then we go, okay, they're high, so let's just take what would be what we could consider a healthy range within this high range. That doesn't necessarily mean it's a good BMI or a healthy BMI. So I would recommend that a little bit like, for something like this, a little more research is done, perhaps looking at European numbers, numbers across the country, and not just looking at, okay, what would be the average what we would consider the average healthy weight in our area based on the BMI of kids in our area. I would go instead, I wanna know what a true healthy BMI should look like. And then that is what I wanna use. Well, that's me. So you might not have that same attitude, but I have a problem with calling it healthy when it's actually unhealthy. We're just adjusting our numbers up and up and up to deal with what they look like at any given time.

Tami Moser [00:12:58]:
In other words, I don't wanna say, well, as a society, BMI, it's 90% or over the healthy BMI. Instead, we're just gonna adjust where that BMI sits. I think I've kinda beat this, dead horse, but consider that. It should be a consideration when you're setting these. Okay. Process measures. Attendance rate at nutrition education sessions. That would be a process measure.

Tami Moser [00:13:23]:
Right? So formula, total sessions attended by all families divided by total sessions offered, time number of families. And then once I've got that divided, then it's times 100. And our data source would be session attendance logs. So now we know we need to have a sign in sheet. It's our attendance logs for every session. We can take those, and that can be where we get our numbers from. A balancing measure might be incidence of disordered eating behaviors. Right? We don't want that to happen.

Tami Moser [00:13:55]:
It's what we wanna pay close attention to because we don't want that unintended consequence, and it could be, if we're not careful. And especially when dealing with adolescents there's a lot we need to consider. So our formula for that would be number of children showing signs of disordered eating divided by total number of children in the program times 100. That gets us our percentage. The data scores would be a screening tool administered by mental health professionals. So now I'm I'm like, okay, we need to screen and perhaps we're gonna do this multiple times. So we're gonna do in the beginning so we have an understanding of if I'm pulling children into this and they already have disordered eating behaviors, then they may not be eligible for my program. They may need to do something else before I would take them into the program because they already have, a disordered view of eating, and therefore this, it could just exacerbate that issue.

Tami Moser [00:14:55]:
Let's let's put it that way. That's for you to decide. Right? That's something I would consider with this program if I was designing it. But I also would wanna know, well, how often do we want that screening tool to be administered by healthcare professionals? This is gonna be a cost. So it's gonna need to be considered in the overall cost, But I don't necessarily need it to happen every time we meet. Maybe it's mid the program. So if this is gonna be a 16 week program, then I may go at week 8. So we're gonna do a pre before we start to make sure that everything looks okay to begin with.

Tami Moser [00:15:35]:
And then 6 weeks or 8 weeks in, we're gonna do it again to make sure that there have been no changes. I could also think about, well, where in our education program might we be discussing disordered eating behaviors or teaching something that if not done well or if children don't receive it appropriately or parents misinterpret something we're teaching, it could result in that shifting from healthy to an unhealthy or disordered eating behavior. And so here we go. Now I also want to identify here. I've got my data source. Right? It says screening tool administered by mental health professionals. So I'm gonna need to find a mental health professional. The screening does it need to be done in person? Can it be done online with a link before they come to an education session? Do we know exactly what screening tool we're gonna use? So I wouldn't just say screening tool.

Tami Moser [00:16:36]:
I well, I would say screening tool and then in parentheses, I would put exactly what screening tool we plan on using. Then we've got structural measures. Right? So let's say ratio of nutritionist to program participants. So our formula, number of full time nutritionists attributed to our program divided by number of program participants. And our data source will be program staffing records and enrollment data. And so we're gonna be pulling from those areas. By tracking all these measures, we get a full picture of our program. We can see if we're achieving our goal of helping children reach a healthy weight, if families are engaging with our education sessions, if we're maintaining a healthy approach to food and body image, and if we have enough staff to provide quality care.

Tami Moser [00:17:23]:
That's what those four measures in those four primary areas would help tell us. Now, just as a side note, let's consider the fact that I may have more than one measure and our outcome measure may be broken down into stepping stone measures, if you will, where we can midway check on x and we would expect this kind of progress in that outcome measure to get to the outcome in the end. It's the difference between a overarching milestone and the individual goals or tasks that we need to hit along the way. Right? So thinking through, what do I really wanna know? You you do not want or need too much information. That can actually lead to some paralysis or failure to act on what your the information you're getting because there just is so much. So I don't need 50 measures, but I may need more than 4, and I do need measures in all 4 areas. So something to think about. Now here's your call to action.

Tami Moser [00:18:30]:
Take a look at your community health program. For each type of measure we discussed today, try to identify at least one that would be relevant to your program. Remember, the goal is to create a balanced set of measures that tell the full story of your program's impact. In our next episode, we'll discuss how to use these measures to drive continuous improvement in your program. You'll see how this data can inform decision making and help you make your community health initiative even more effective. Remember, in community health management, what gets measured gets managed. So keep measuring, keep improving, and keep making a difference in your community's health. Now, as one additional element to this, I want you to think about the IHI, Institute For Healthcare Improvement, and they recommend a balanced set of measures that cover different aspects of healthcare quality.

Tami Moser [00:19:24]:
And so these includes rated adverse events, you would define an an adverse event for your program, functional health outcome score, patient satisfaction with care score, hospital readmission percentages, if applicable, and reliability of core measures. But here's the key. Don't just copy these measures blindly, adapt them to fit your specific program and community needs. For instance, if you're running a diabetes prevention program, you might track the HbA 1c levels of participants, which is an outcome measure, percentage of participants attending all education sessions, a process measure, participant satisfaction scores, a balancing measure. Remember, the goal is to create a balanced scorecard, if you will, that gives you a comprehensive view of your program's performance. Now let's talk about partnerships for a moment in community health. No program is an island. Strategic partnerships can amplify your impact and fill gaps in your capabilities.

Tami Moser [00:20:32]:
Think about potential partners in 3 categories. Healthcare providers, hospitals, clinics, and individual practitioners, community organizations, schools, religious institutions, and local businesses, and government agencies, public health departments, and social services. The key is to find partners whose mission aligns with yours and who can bring complementary strengths to the table. For instance, if you're running a childhood obesity prevention program, partnering with local schools can give you access to your target population while a partnership with a grocery store chain could support healthy eating initiatives. Now let's address some common pitfalls in resource metric and partnership management. 1st, don't underestimate your resource needs. It's better to overestimate and be prepared than to run short mid program, and I happen to have the perspective that you should always under promise and over deliver. You're in a much better position when you do that versus overpromising and underdelivering.

Tami Moser [00:21:40]:
And sometimes that overpromising can come from underestimating the actual resource needs and then not being able to deliver because of that. 2nd, avoid the temptation to measure everything. Focus on metrics that directly relate to your program goals and that you can act on. And what this would mean is if I asked you, why would you need that process measure? You should be able to have a rationale for the choice of that. So maybe we go back and I add on, we look at the actual measure, then the formula, then the data source, then we're adding on the rationale. This is why we need to know this. This is what it tells us about what's happening. This is what it helps us do in terms of telling the story of our program.

Tami Moser [00:22:28]:
If you can't provide that kind of rationale, then the question becomes, is it really something you need to measure? So think about adding that 4th element of why. Why would I want to to capture this information and know this? When we sit down with everybody involved in the program and we report on these measures, what could we do if we knew this? So if I couldn't act on it, it doesn't help me tell the story. But I'm just going, well, I can get that information. That's nice, but it's not what you need. So sometimes there can be a temptation to move over to other measures simply because when I'm looking at my data source and the numbers I need, I can get the information for that measure, but I can't on the one I originally laid out. Well, let's look a little deeper into why we can't first if that's the measure we really need. But if I look at this measure over here and go, I can get everything, that's great, but if I can't do anything with it, if it doesn't matter, if it doesn't help tell the story, what's the point? So that's the challenge in this second step. And then finally, don't rush into partnerships without due diligence.

Tami Moser [00:23:38]:
Ensure your potential partners actually share your values and have a track record of reliability with what you're actually wanting to do. Are they easy or hard to work with? And you can define what easy means versus hard. You'll know what I mean by that in your particular area of concern and with your particular program and with the partners you're looking at. If you're looking at a partnership and you're like, they would be a great strategic partner, but we've tried to work with them 4 times in the past past and they never deliver. Then why are you even considering them again? And if you have someone that says, well, it looks good if we have them on the list, then put them on the list if you must. Put your strategic partnership in place if you must, knowing you're not gonna ever get anything you need out of them more than likely. Just look at it as it'll be gravy if they suddenly start them more than likely. Just look at it as it'll be gravy if they suddenly start becoming reliable, but I need other partners that can actually do what we think we want from them because they're not going to deliver.

Tami Moser [00:24:32]:
And so and so, fill in the blank, wants them on the list because it looks good. Do with that what you will, but one thing you don't wanna do is actually rely on that partner for anything if that's been your experience with them. So here's a pro tip. Create a resource map, a metric dashboard, and a partnership roster early in your planning process. And that's why this is in module 2 of our actual micro credential. Because you really do need to know. Here's all the resources I need, and here's where I can get access to them. Here's my metric dashboard.

Tami Moser [00:25:10]:
Here's the formulas. Here's the data source, and here's the rationale for use of those. And then here's the partnership roster and our I would even add kind of the score we're giving them for reliability. And if we've never worked with them before, it's kind of a question in that. If we've worked with them quite a bit, we can go, they're excellent. They're always gonna be on on task and on target, and we can rely on them for whatever we need. And then we may have some questionables, and then we have some they're on the list as a strategic partner, but they're not gonna actually deliver. So you're putting that together early.

Tami Moser [00:25:44]:
You've got this in place, and you understand what what you have available to you. And you do it early enough that you could actually revisit it. So remember resources, metrics, and partnerships are the engines that drive your program. They translate your grand vision into concrete action and measurable impact. So when we get to this point, we should really understand that kind of foundational information, resources, metrics, and partners. Now here's your assignment. I want you to take at least an hour. For some, it may take more, for some less, and it depends on how new your idea is.

Tami Moser [00:26:21]:
If it's something you're already been working on, but just haven't been sure on how to put it all together, or it's just something your organization wants to do but haven't had the time to put something in place, and so this is kind of your start for that. Or it's something that you've already written out and you're now revisiting it to see if you're missing pieces and to check that what you've done will actually work. Whatever and however you're tackling this, I want you to come up with at least 5 key resources you'll need for your program. Where are those resources located at? Who do you have to talk to or get involved with to actually access those resources and why do you need them? 3 or second, I guess I should say, give 3 I'm gonna say 4 to 6 metrics you'll use to measure success. I want one in each of the of the 4 categories, and then you can add others as needed. Remember, you're going to detail the measure and type of measure. You're going to detail the formula of how you're going to actually calculate to get the results for that measure, and then you're gonna detail where you can get the data, the numbers for that, and then you're gonna identify your rationale for use of that measure. And then I want you to identify 3 potential strategic partners.

Tami Moser [00:27:48]:
And it would be good if you could go ahead and score them. You know? And it's not just a score about what they'll deliver to you when you partner with them, but the other thing to detail is this is what you need them for as a strategic partner, and here's your rationale for choosing this particular strategic partner. It gives you just a little bit deeper into that strategic partner roster and what it means for you. In our next episode this week, we'll discuss how to integrate these elements into overall program design and an implementation strategy. Remember in community health management, success lies in the details. Keep planning, keep measuring, and keep building those crucial partnerships. Until next time, this is doctor Tami Moser signing off.