Development of Public Health
Standards and Protocols in Nova
Scotia
PHPC CPD Day
June 9th, 2013
Dr. Robert Strang
Dr. Brent Moloughney
2013
Complete
Protocols
Public Health Vision
• Shift upstream, focus the determinants of health and
populations at greatest risk
• Capitalize on Public Health’s unique position to:
• improve the sustainability of the health system
• understand health inequities
• change the conditions in which people live (physical and
social environments)
• address the determinants of health
• Commitment to a public health system approach
Population Focus
Individual Focus
Primary Prevention:
Primordial Prevention:
Preventing the risk
factors from ever existing
Preventing disease
and injury by
modifying existing
risk factors.
Secondary Prevention:
Early detection and
treatment of disease and
injury.
Tertiary Prevention:
Community Police and
Services
Justice
Education
System
Planning
Agencies
Municipalities
Preventing the worst
outcomes from
disease and injury
(death and disability).
Population Focus
Public Health
Primordial Prevention:
Preventing the risk
factors from ever existing
Individual Focus
Primary Prevention:
Preventing disease and
injury by modifying existing
risk factors.
Secondary Prevention:
Early detection and treatment of
disease and injury.
Tertiary Prevention:
Community Police and
Services
Justice
Education
System
Planning
Agencies
Municipalities
Preventing the worst
outcomes from disease and
injury (death and disability).
Counseling
and Education
Clinical
Interventions
Long Lasting Protective
Interventions
Changing the Context to Make
Individuals’ Default Decisions
Healthier
Socioeconomic Factors
From: Thomas R. Frieden, MD, MPH. American Journal of Public Health April 2010, Vol 100, No. 4
Increasing Individual Effort Needed
Increasing Population Impact
Health Impact Pyramid
Public Health Standards
• Establish the
expectations
for public
health at the
provincial and
DHA level.
Structure of Standards
Protocols
• Complement the Standards providing greater detail
to assist in addressing some key system challenges:
• Achieving a shift in emphasis more upstream
• Lack of clarity regarding roles and responsibilities
• Need for greater accountability
• Need to first be clear about ‘what is the work’, then
can address:
•
•
•
•
Who does it
How it gets done (from a system perspective)
And, what we’re going to stop doing
(Even greater detail (i.e. strategies, business processes,
procedures, manuals etc.) to be included in appendices)
• Balancing consistency with flexibility
Protocol Development
• Started Spring 2012:
– Pan-system teams developed raw protocol content (note: had
recently developed Standards)
• Fall 2012:
– Protocols drafted
– Presented to System Leadership Team and VPs Community
• January 2013
– Feedback that mostly right – editing and tweaking occurring
iteratively since then
• Spring 2013
– Final reviews of protocols
– Engage system staff for implementation planning
Protocol Organization
Cross-Cutting Protocols
• Understanding (assessment &
surveillance)
• Priority setting & planning
• Partnership
• Policy
• Health equity
Content-Specific Protocols
• Communicable Disease
Prevention & Control
• Environmental Health
• Healthy Communities
• Healthy Development
• Protocols are ‘a package’
• Are not sole responsibility of a specific team (e.g., upstream
prevention in CDPC not sole responsibility of a CD team)
Protocols – Going Forward
• Managing transition issues: primary care and public
health must work together on transition issues
• No ‘dump and run’
• Alignment with primary care initiatives
(comprehensiveness, continuity, collaborative care)
• May need to be assessed and managed on a communityby-community basis
• Addressing design implications to achieve an
effective and efficient public health system
• Who and how work gets done in context of 9 DHAs with
varying capacity and population contexts
• Requires sharing, working together, and structural
changes – grounded in achieving ‘the work’ in effective,
efficient and quality manner
Summary
• Development of Public Health Standards and
Protocols key part of collective journey of system
renewal
• Unless clear about ‘the work’, difficult to address
system design, roles, accountabilities, etc.
• Considerable change management requirements:
•
•
•
•
•
Transition for what will stop doing
Leading/mentoring new practices
Workforce development
Potential structural change
Establishing accountabilities