Overview of Performance Management Systems

Pooja Verma, MPHProgram Analyst

Accreditation & QINACCHO

Objectives

• Define performance management and related terms

• Identify the key steps in building a performance

management system

• Provide tips and examples for developing performance

measures

• Identify performance management resources

Defining Terminology

What is a performance management system?

Source: Turning Point Performance Management Collaborative, 2003.

Performance StandardsPerformance Standards

“Generally accepted, objective

standards of measurement such

as a rule or guideline against

which an organization’s level of

performance can be compared.”

- Turning Point Management Collaborative,

2003

Public Health Standards:

• Public Health Accreditation Board (PHAB)

• National Public Health Performance Standards (CDC)

80% of clients rate health department services as “good” or “excellent.”

Performance Measures Performance Measures

“A specific quantitative representation

of a capacity, process, or outcome

deemed relevant to assessment

against a performance standard.”

- Turning Point Management Collaborative,

2003

% of clients that rate health department services as “good” or “excellent.”

Reporting of Progress

Reporting of Progress

• Includes performance against meeting standards and progress toward strategic goals and objectives

• Internal and external stakeholders

• Foundation for identifying QI efforts

Quality Improvement

Quality Improvement

The use of a deliberate and defined improvement process focused on activities that are responsive to community needs and improving population health. It refers to a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality in services or processes which achieve equity and improve the health of the community. *

* Definition developed by the Accreditation Coalition Workgroup and approved by the Accreditation Coalition on June 2009

What are the first steps in building a PM system?

• Establish a Performance Management Committee/Team

• Conduct a Performance Management self-assessment Turning Point Self-Assessment Tool Baldrige Performance Excellence Program

• Train staff!

Performance Measurement

Why is performance measurement important?

• Foundation for decision making

• Alignment of efforts with agency strategic direction

• Shift in focus from individuals/activities to results

• Meaningful feedback to employees

• Promotes learning and improvement culture

*Adapted from MarMason Consulting

What do we measure in public health?

OutcomesEfficiency

Effectiveness

Healthy People

Processes

10 Essential Public Health Services

Structures

Information Technology

Human Resources

Fiscal Resources

Types of Performance Measures

Capacity/Input:

• Human/capital resources

Process/Output:

• Intermediate steps in developing product or providing

service

Short-Term Outcome:

• Immediate results of the product or service provided

Long-Term Outcome:

• Intended, desired, or actual long-term results

Linking Performance Measures

Input and Process

(Program level)

Short/

Intermediate term

(Division level)

Long-term

(Organization level)

Strategic Direction

Monthly/Quarterly

1-2 years

2-3 years

Logic Model: Infant Mortality Performance Measures

Input Process/Output

Short-term Outcome

Intermediate Outcome

Long-term

Outcome

- # of health educators

- # of nurses

- $$ for education materials, clinics, etc.

- # of education classes

- # of women in Pre-Natal Program

- # Pre-natal clinics

- % of women that understand risk factors

- % of low income pregnant women w/access to Pre-natal care

- % high risk pregnant women that smoke

- % of high risk pregnant women with adequate nutrition

- % premature births

- % newborns w/low birth weight

-Infant mortality rate

Considerations for Developing Performance Measures

• Do not select too many

• Feasibility of data collection

• Measurable over time

• Collectively represent major

strategic goals and objectives

• Customer and stakeholder support

Frameworks for Performance Measurement

Balanced Scorecard

1. Financial

2. Internal Business

Processes

3. Learning and Growth

4. Customer

Malcolm Baldrige National

Quality Award Criteria:

1. Leadership

2. Strategic Planning

3. Customer Focus

4. Measurement and

Analysis

5. Workforce/HR Focus

6. Operations Focus

7. Results

Developing Performance Measures

• What are you measuring?

• Who is the target population?

• What is your numerator?

• What is your denominator?

• What is your data source?

• Who is responsible?

Rate of positive CT test at clinics

Clients tested for Chlamydia

# clients tested positive CT

# of total CT tests at clinics

DOH records

Jane Doe

Establish Performance Targets/Benchmarks

Use a method to establish thresholds for performance:

• Industry benchmarks (e.g. HP2020, County Health Rankings)

• Regulatory requirements

• Other health department’s data

• Past performance

*Adapted from MarMason Consulting

SMART Objectives

Decrease the rate of CT positivity at clinic sites from

8.1% to 6.5% by the end of 2013.

SpecificMeasurable AttainableRelevantTime specific

Performance measure: The rate of Chlamydia (CT) positivity at provider clinic sites.

Target population: People being tested for Chlamydia

Numerator: Positive CT tests at clinic sites

Denominator: All CT tests at clinic sites

Which are you using—a target or benchmark?

Target

What is the target/benchmark? 6.5% (goals based on past performance)

SMART objective: Decrease the rate of CT positivity at clinic sites from 8.1% to 6.5% by the end of 2013.

Source of data: DOH records

Who will collect the information?

Jim Smith

How often will the data be analyzed and reported?

quarterly

Baseline measurement data and date(s):

2005: 10.1% 2008: 8.6%2006: 9.3% 2009: 8.2%2007: 10.5% 2010: 8.1%

Definitions and other comments:

Provider clinics, Planned parenthood sites and others.

*Adapted from MarMason Consulting

Linking Performance Measures: Example

Improve quality of life among Diabetics

Decrease morbidity rates of Diabetes patients by

20% by 2014.

Performance Measures

Intermediate Outcome-% of patients w/adequate blood glucose

Short-Term Outcome-# of patients seen by provider

Process/Output- Length of time b/w request of service and meeting w/provider

Input/Capacity- # of service providers on staff

Impact

Linking Performance Measures: Example

Reduce childhood obesity

Decrease % of obese/overweight youth to 25% by 2014.

Performance Measures

Intermediate Outcome- % of low income children w/60 mins of moderately active daily

Short-Term Outcome- % of low income children that access parks/playgrounds

Process/Output- # parks/playgrounds in low income neighborhoods

Input/Capacity- $$/partnerships for new playgrounds/green space

Impact

Collecting & Storing Data

• Database, Spreadsheets

o Excel

o Access

• Performance Management Software

o My Strategic Plan, M3 Planning

o Results Scorecard, Results Leadership Group

Example Performance Dashboard

Objective Performance Measure

Baseline (2010)

Baseline (2011)

Current Status

Target

Infant Mortality Decrease % of women who smoke during pregnancy enrolled in Pre-Natal Partnership Program (PNPP)

% of women who smoke during pregnancy in PNPP

32% 28% 25% 20%

Increase % of low income women who receive prenatal care in the 1st four months of pregnancy

% low income women receiving prenatal care w/in 1st four months of pregnancy

85% 87% 92% 90%

Immunizations

Increase % of 19-35 mo. olds adequately immunized

% of 19-35 month old children adequately immunized

59% 60% 66% 75%

Turning Data Into Knowledge: Data Analysis

Questions to consider:

• How does actual performance compare to a standard or

target?

• Is corrective action necessary?

• Are new goals, objectives, or measures necessary?

• How have existing conditions changed?

Analysis Tools

Analyze Measurement Data Identify Root Causes

• Run chart• Statistical analysis• Control chart• Matrices• Flow chart• Scatter plots• Decision tree

• Affinity diagram• Brainstorming• Fishbone• Histogram• Pareto chart• Story boarding• 5-whys technique

Reporting Structure

• Frequency

o Program measures – monthly/quarterly

o Division measures – semiannual/annual

o Department measures – every 2-3 years

• Communicate to:

o Management

o PM team and/or QI Council

o Board of health

o Staff

Reporting and Presenting

Questions to consider:

• Who is the audience?

• What is the intended use of the information?

• What is the basic message to be communicated?

• What is the presentation format? (brochure, oral presentation,

report, etc.)

Quality Improvement

Performance Management Process

1. Select performance measures

2. Collect data

3. Store data

4. Analyze data

5. Report and present findings

6. Apply knowledge

“Maybe I’m lucky to be going so slowly, because I may be going in the wrong direction.”

~ Anonymous

Performance Management Resources

• Performance Management Self-Assessment Tool:

http://www.collaborativeleadership.org/pages/pdfs/CL_self-assessments_lores.pdf

• Turning Point Resources:

http://www.turningpointprogram.org/Pages/perfmgt.html

• PHF’s Performance Management & QI Website:

http://www.phf.org/focusareas/PMQI/Pages/default.aspx

• Public Health Performance Management Centers for Excellence:

http://www.doh.wa.gov/PHIP/perfmgtcenters/index.htm

• Developing, Monitoring, and Using Performance Measures:

http://www.doh.wa.gov/PHIP/perfmgtcenters/modules/Year2/11-09-11_PerfMeas_public_main.htm

References

• Turning Point Performance Management Collaborative: http://www.turningpointprogram.org/Pages/perfmgt.html • Public Health Performance Management Centers for Excellence: http://www.doh.wa.gov/PHIP/perfmgtcenters/index.htm

• The Performance Based Management Handbook, U.S. Dept. of Energy: http://www.doh.wa.gov/PHIP/perfmgtcenters/index.htm

• The Quality Improvement Handbook: http://bookstore.phf.org/product_info.php?products_id=660

Thank You!

Pooja VermaAccreditation & QI

NACCHO(202) 507-4206

pverma@naccho.org www.naccho.org/QI