Future of Public Health Intervention: Three Cold Hard Numbers

Friday, Week 3. Future of Public Health Intervention: Three Cold Hard Numbers

I’ve been in a lot of meetings lately. I’m getting grumpy about discussions that are ‘hand wavy’ and never go anywhere. People are full of ideas, but how do we harness discussions about population health interventions and move them rapidly into real-world thinking and planning? Thinking through complex problems is hard, so we often defer this necessary activity until it is too late to even attempt it before a decision needs making!

I have been considering how I and my Public Health Intelligence colleagues might usefully influence the “Future of Public Health Interventions” when this future has never looked so uncertain. System complexity clouds our ability to see clearly how to intervene, declining intervention resources limit our flexibility, while demand for health services increases the pressure for immediate prevention results  — we live in a mad world.

What can we do to help colleagues with their increasingly tough and demanding decision making?

Let’s start with the basics, and have a better conversation.

Three Cold Hard Numbers: Reach, Compliance and Efficacy.

I wonder if we can begin to develop a better shared-understanding of the challenge of prevention with the use of a very simple, but incredibly scary equation — it’s maybe the most frightening maths in public health!

Number of successful interventions = population@risk * reach * compliance * efficacy

population@risk = the target group within the overall population that could benefit from our intervention

reach = % of the population@risk that we can reach each year in an STP area. This is really down to the design and implementation of the intervention programme. And funding of course!

compliance = % of the population we were able to reach who then took up our offer of an intervention. This seems to vary from locality to locality, the effectiveness of the intervention programme and intrinsic nature of what we are asking people to do.

efficacy = % of the population who complied with the intervention AND for whom the intervention worked as intended. You’d have to look this number up for most interventions — maybe NICE or somewhere in the peer reviewed literature, where researchers have studied this under controlled conditions.

What if you could sit down with colleagues and model your intervention at the project planning stage and could visualise the intervention’s impact over its planned life and threw in some basic financial information?

Three cold hard numbers. Not the entire future of public health interventions. But an important place to start.

Here’s the beginnings of a useful model, let me know what you think — just have a play. I’ve noticed it works well using the Chrome browser, but not so well with the Microsoft Explorer/Edge browsers. I have no idea why. I’ve used InsightMaker.com. It is a System Modelling tool, you can set up an account for free to build and share your own thinking — and if this is useful, you can just make your own copy and modify.

Public Health Intelligence: What we are delivering?

Friday, Week 2.

Second week of 2019. This year still holds promise! I have only been in a grump once thus far… in a meeting. I was mad at myself, really, for going to a meeting when I didn’t know why I was invited nor what value I could add, and I didn’t add value, I just consumed oxygen. Don’t be me. Although this doesn’t happen very often any more, this one meeting slipped through… Grumpy with myself.

Transformation

I talked about our 3 years of transformation in my Week 1 blog. This week I thought I’d talk about what, in addition to all that ‘transforming’ (hard work to be sure!) we are delivering. Mostly because a smart-arsed colleague thought that might be a good idea… Go figure, but happy to oblige.

We have three ‘outcome’ areas against which all of our outputs/deliverables aim to make a difference: (1) developing shared-understanding across our Integrated Care System, (2) delivering reliable data and robust evidence, and (3) creating compelling narrative.

Delivery

Here are a few of the big and/or innovative and/or interesting areas where we are delivering results (not comprehensive), and there is no space in this short blog to talk about all the business as usual but great stuff that goes on in data and system management behind the scenes and upon which so many others are dependent — including public health commissioning, drug and alcohol programme management, not to mention data and information sharing. And of course in line with the ‘no programme’ (see Week 1 blog), I won’t talk about our many and varied client requests in this blog. Maybe sometime when levity is called for!

Joint Strategic Needs Assessment: Redesigned from a systems insight perspective combining a top-down systems mapping approach and a bottom-up interviewing of public facing staff. Transformational. Signed off by our Health and Wellbeing Board, steering group structure now being sorted, 17 interviews conducted thus far, going online in the next couple weeks. Progress.

Population health modelling: Population Health Management (I so hate this label) is the new game in town and a requirement for progressing the development of our Integrated Care System. It is however largely focussed on data analytics used to provide clinicians with timely patient level risk data to move practice towards earlier more proactive interventions. A bigger aspiration, at least at the strategic level, is to ensure that the social conditions in which our population live can be taken directly into consideration when commissioning or restructuring health and care pathways. We have a first model that we’ll be consulting with colleagues on over the next three months.

Intelligence capability building: We’ve delivered a number of workshops to colleagues on the value and structure of credible programme evaluation over the last two years and will continue this development for another year at least.

Pan-Dorset air quality monitoring network: Designed and installed. Took a lot longer than hoped, but well done EHOs from the Dorset Districts and Bournemouth and Poole! Real time monitors linked to our data warehouse and visualised using Tableau. Not public yet, but available to interested colleagues.

Programme evaluations: We are in year 3 of a 3 year evaluation of Stepping into Nature, which aims to improve the lives of older people and particularly people living with dementia and their carers. The team has delivered the Evaluation Guide and analysis of interviews is well underway — looking forward to an interim report in 3 months or so… Planning of several more programme evaluations for things like ‘healthy homes’, ‘the daily mile’ and other programmes is underway.

Greenspace accessibility model: In collaboration with some extraordinary colleagues at the European Centre for Environment and Human Health, at Exeter University, we have developed a pan-Dorset spatial accessibility model for greenspace. The first data products output from the model include (1) walking distance to the closest greenspace of any type from each postcode and (2) identification of postcodes that do not have a greenspace of at least half a hectare within 300 m, which is the WHO recommended level of access for urban populations.

Healthy Urban Microbiome Initiative: Bournemouth is the first UK city to be included in this International Initiative to explore and understand the population level exposure to healthy environmental microbiomes found in biodiverse urban greenspaces. Fifteen greenspaces across the city have been sampled and results are currently being analysed.

Beyond Q4 and into 2019-2020

As we work toward the completion of this financial year, we begin a momentous 2019-2020 financial year by moving from a shared-service across Bournemouth Borough Council, Borough of Poole and the Dorset County Council to a shared service across two new councils: Bournemouth, Christchurch and Poole unitary council and a Dorset unitary council. This local government reform is critical to the future of health places across our two future councils — it has our full attention as we work with intelligence teams across the patch!

Joint Strategic Needs Assessment: continuing to grow and enable system-wide strategic insights through the twin adoption and use of Systems Thinking from the top-down and qualitative interviewing of public facing staff across the system

Intelligence capability building: ensuring that everyone in a position to employ a systems thinking approach to problem solving anywhere within the Integrated Care System that explores challenges in care pathway planning, commissioning, and other strategically important areas has the ability to access those skills.

Population health modelling: System modelling — we believe that population health modelling is our entry point into Population Health Management, because it provides a learning laboratory that allows us to look in more depth at how the social conditions in which our population lives will impact our health services utilisations and population health outcomes in the future.

Programme evaluation: having developed our capacity and begun to deliver programme evaluations, we are more convinced than ever that credible outcome based programme evaluation is the key to the preservation and growth of public health programmes.

Healthy Places Programme: work in this area on the settings or conditions in which people live, including their access to quality urban greenspace, air quality, healthy homes, will continue as we work to use the population health management paradigm to extend traditional health and care service planning to include ‘health places futures planning’.

Food security and fresh look at socio-economic deprivation are on the cards for the coming year — new collaborations are currently being developed and we will be throwing everything we have at it… systems thinking, data analytics, simulation modelling, futuring.

This futures blog

This blog is about how we create ‘healthy places’ and what our possible ‘futures’ could be given current trends and momentum within society, the economic and political systems, and the environment. I use the plural ‘futures’ intentionally, because our future is not pre-determined (I hope), we can and should work towards the future we want. This blog aims to generate discussion (maybe even some debate) around ‘Healthy places futures’ in the hope that if we all put our minds to it, a collective vision may emerge, which would inform any strategy we might put in place to get us to our preferred future. We’ll be leaning on heavily on futuring tools found on our Shaping Tomorrow hosted website: phd.shapingtomorrow.com.

The future is already here — it’s just not very evenly distributed (William Gibson 1993).

2019 — a year full of promise for Public Health Intelligence

A year full of promise for Public Health Intelligence.

Friday, Week 1.

First week back at work. Week 1 of 2019 is almost done.

This new year of ours holds a lot of promise for Public Health Intelligence, and our ability to add value to the important work that colleagues are delivering across the Integrated Care System.

Over the last 3 years we have transformed the way we work and how we work with colleagues.

At the beginning of 2016 our time and effort was still almost entirely consumed by ‘data’. Numbers. Facts. Figures. Sometimes we biffed out interesting, at least to us, reports, but about 90% of our time went into responding to colleague requests for data. Data was king. Data needs cleaning, formatting, storing, processing, analysing. It is never ending.

Our analysts work hard, but they were frustrated back in 2016. The work was very ‘bits and pieces’, and worse yet although they did their best, they knew that in many cases the data handed over, and sometimes turned into information, would make little or no difference to the decision-making process. Mostly our colleagues who were asking for data, didn’t know what they were going to do with it, except maybe drag it along to a meeting to wave at other colleagues. They didn’t often have a good question that they were asking, not that we could find anyway. We do try.

Transformation

How were we going to add value to important work going on to reform local government, develop our Sustainable Transformation Partnership and improve the health and wellbeing of our population?

It looked impossible to ever get on top of all the work.

So we decided to take back control of our work programme (i.e our time) and focus our efforts into fewer bigger pieces of work that we thought would add more value to the work of colleagues.

Step 1: Just say ‘no’. We just said ‘no’ to data requests from colleagues (this was our single most difficult behaviour change — our analysts love to help colleagues! They didn’t want to say no. I was mean for making them say no.), unless they really knew what they were going to do with the data — and had a decent set of questions they were trying to answer. We got away with this 95% of the time and it saved us a massive amount of time.

Step 2: Dethroning our data. The king was dead. We stopped being spreadsheet warriors. We developed a modern and effective business intelligence infrastructure. Nothing fancy — SQL Server data warehouse with a Tableau front end. It works. We now have a single point of truth for all data we use. One truth. We automate many routine data management tasks. We saved more time.

Step 3: Capability Development. We started spending our newly found ‘time’. We did a client centred consulting training course — and we began to change the way worked with colleagues. We stopped owning other people’s problems — we consulted with them where ever we could, helped them to help themselves. Yes, this saved even more time.

We’ve initiated more project management. We took some decent training. We learned to use project management tools more effectively. We deliver what we say we are going to deliver. Everyone knows how we are trying to make a difference as an intelligence team: (1) improving shared-understanding, (2) ensuring reliable data and robust evidence and (3) delivering compelling narrative. Every one of us has an annual logic model that ties their effort to their activities to their deliverables to the difference we are trying to make as a team. Every analyst is a thought leader in some area. This is massive.

We invested in analyst training. Everyone can access the data warehouse, everyone is capable of develop SQL scripts, everyone can use Tableau and we invested in sharing these skills with colleagues throughout the system. The evidence base is everyone’s business. We also invested in a professional data manager. Best stand-alone hire for improving team efficiency. Ever.

But there was more, we developed our narrative and story-telling with data skills to improve engagement. We developed our Health Economics skills so that we speak the language of economics and finance. We developed Programme Evaluation capability, so that we could help colleagues deliver credible evaluations of their programmes that are useful in future decision-making.

We’ve taken tentative steps towards adopting a ‘futuring’ based approach to everything we do. Analytically, we do more forecasting now, but the real change is in how we look at challenges. We can statistically forecast almost anything, but understanding the future context of those forecasts may be even more valuable than our data trends. I think that this is so central to what we try to do in Public Health Intelligence, that I’ve named these blogs our ‘healthy places futures blog’. The future is more relevant to decision-making that the past. More on this later.

However, I believe that our single most impactful investment over the last three years is in developing our Systems Thinking approach to the health of our population. I will talk about this at length in future blogs. This is big. It is a game changing, paradigm shifting, transformation of epic proportions. Joint Strategic Needs Assessment. Integrated Care System. Everything. We timed this one right.

2019

So in 2019, we are a transformed lot, energised, practiced and looking forward to year of helping colleagues effect the change that they come to work to make happen! We were well supported by senior colleagues and that was very encouraging.

Extremely proud of the way we been able to change the nature of our work and the way we interact with colleagues. It was a choice. A good one. Public Health Dorset and indeed the entire Integrated Care System is very lucky to have such a transformational group of analysts. The best bunch I’ve ever worked with — look out 2019!

This futures blog

This blog is about how we create ‘healthy places’ and what our possible ‘futures’ could be given current trends and momentum within society, the economic and political systems, and the environment. I use the plural ‘futures’ intentionally, because our future is not pre-determined (I hope), we can and should work towards the future we want. This blog aims to generate discussion (maybe even some debate) around ‘Healthy places futures’ in the hope that if we all put our minds to it, a collective vision may emerge, which would inform any strategy we might put in place to get us to our preferred future. We’ll be leaning on heavily on futuring tools found on our Shaping Tomorrow hosted website: phd.shapingtomorrow.com.

The future is already here — it’s just not very evenly distributed (William Gibson 1993).