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Overview of Performance Management Systems Pooja Verma, MPH Program Analyst Accreditation & QI NACCHO
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?
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
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%
ImmunizationsIncrease % 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
