Performance Summit

8/8/2019 Performance Summit

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Turning Point1

Performance Management

Using Information to Improve

Public Health Practice February 13, 2003



Turning Point2

Learning Objectives Gain understanding of the components of a

performance management system Identify potential benefits of performancemanagement

Advance where we are in performance

management Learn from one another



Turning Point3

T urning Point·s National

Excellence Collaboratives,2000-2004

Funded by Robt. Wood Johnson Foundation

- States, communities, national partners² Combine collective experience, skills

² Take next steps in transforming public health Review of literature & current practice; analysis

Development of innovative models Testing and disseminating innovation

Evaluation



Turning Point4

T urning Point: National

Excellence Collaboratives

Public Health Statute Modernization

Performance Management Information Technology

Social Marketing

Leadership Development





Turning Point6

More PMC Members TP National Program Office at Univ. of

WA/School of Public Health

National Partners² ASTHO² NACCHO² CDC

² HRSA² ASTHLHLO



Turning Point7

PMC Vision

Widespread use of dynamic andaccountable public health

performance management



Turning Point8

PMC Goals To develop useful and feasible performance

management models for states

To stimulate national dialogue and consensuson performance management in public health

To support the application of performance

management as a core discipline of publichealth practice



Turning Point9

What Is Performance

Management? The practice of actively using performance

data to improve the public·s health. Performance management can be carriedout at the program, organization,community and state levels.



Turning Point10

Performance Management What you do with the information you·ve

developed from measuring performance

Using performance measurement to managepublic health capacity and processes² Review services and programs

² Assess progress against targets

² Conduct employee evaluations

² Formulate and justify budgets



Turning Point11

Four Components of

Performance Management

Performance Standards Performance Measures

Reporting of Progress

Quality Improvement



Turning Point12

Performance Standard A generally accepted, objective

standard of measurement such as arule or guideline against which anorganization·s level of performancecan be compared

Establishes the level of performanceexpected



Turning Point13

Performance StandardDescriptive ² capacities or processes

² A system for communicable diseasesurveillance and control shall bemaintained

² The information systems in use enable

the collection, use and communication ofdata



Turning Point14

Performance Standard Numerical ² establishes a quantifiable

level of achievement² At least 80% of community health

center clients will be satisfied with theservices received



Turning Point15

Performance Measurement The selection and use of quantitative

measures, capacities, processes andoutcomes to develop informationabout critical aspects of activities,including their effect on the public



Turning Point16

Performance Measurement The regular collection and reporting

of data to track work produced andresults achieved.



Turning Point17

Performance Measure The specific quantitative

representation of a capacity, processor outcome deemed relevant to theassessment of performance

It measures something «usuallyprogress toward an objective or goal



Turning Point18

Performance Measures Examples

² Percentage of children with age-appropriate immunization levels at agetwo

² Percentage of target audiences that

recall content of public serviceannouncements, brochures orpresentations



Turning Point19

Jargon Alert Don·t let the terms goals, objectives,

standards, indicators, measures catch you.

What·s important is that we useintelligently selected and written measuresto assist us in assessing if we are doing theright things in the right way.



Turning Point20

Reporting of Progress Don·t hoard the data

² Share with those who provided the data

Convert it into useable information² So what?

Know your audience² Is it agencies, lawmakers?



Turning Point21

Reporting of Progress Provide context for the report

² How do the measures relate to your

mission and goals Create clear,easy to read, report

designs² Use Simple charts and tables

Determine Reporting Frequency² When and how often



Turning Point22

Using Charts

0

2

4

6

8

10

1999 2000

Percent Low Bi rth ei ht

Medi cai d

Non-Medi cai d

State



Turning Point23

Quality Improvement Establish a program or process to

manage change and achieve quality

improvement in public health policies,practice and infrastructure based onwhat is learned through performance

measures



Turning Point24

Quality Improvement A dynamic and continuous process

Doesn·t just look at outcomes ² butthe process to get there

Not a new concept ² 1950·s W.Edward Deming

Plan²Do-Check-Act



Turning Point25

Examples of Quality

Improvement Florida Dept. of Health performs

regular performance management

reviews and provides feedback tolocal county administrators. Jointlydevelop a plan.



Turning Point26

In a performance

managementsystem... All components should

be driven by the publichealth mission and

organizational strategy Activities should be

integrated into routinepublic health practices

The goal is continuousperformance and quality

improvement

Source: Turning Point Performance Management Collaborative.



Turning Point27

Why Develop a PM System? To maximize public health·s

effectiveness. This requires² More than measurement alone

² More than standards alone

² All four PM components to be

continuously integrated into a system ofperformance management



Turning Point28

Managerial Action

Quality improvement

efforts

Policy change

Resource

allocation

change

Program change

Using Data to Achieve Results



Turning Point29

How Does NH Measure Up



Turning Point30



Turning Point31

Survey of Performance

Mgmt . Practices in States Base line Assessment

² Con ducte d by PHF

² 47 of 50 States Res pon de d

Survey As ks About:

² Use of Performance T argets , Re ports

² Im pact on Program an d Po licy ² Nee d for Ne w T oo ls



Turning Point32

Nearly All SHAs Have Some Performance

Management EffortsHowever, only about half apply performance management efforts statewide

beyond categorical programs

Figure 1. Agencies or programs to which SH As apply performance management efforts (N=47)

Categorical

programs

only

43% (20)

None

4% (2)

SHA wide32% (15)

Local public

health

agencies only

4% (2)

SHA wide

and local

public health

agencies

17% (8)



Turning Point33

Reported Positive Outcomes:

Improved delivery of services²program

services, clinical preventive services, essential

services

Improved administration/management²

contracting, tracking/reporting, coordination

Legislation or policy changes

Performance Management Efforts Result in Improved

Performance for Three-Quarters of SHAs

Figure 19. Percentage of SH As that report

their performance management efforts

resulted in improved performance (N=41)

o24% (10)

Yes

76% (31)



Turning Point34

SHAs Most Likely to Have Components of Performance

Management for Health Status;

Least Likely for HumanR

esource DevelopmentFigure 8. Areas most and least likely to have performance targets, measures or standards, reports, and

processes for quality improvement (QI)/change, of SH As that apply performance management efforts SH A

wide, SH A wide and to local public health agencies, or to local public health agencies only (N=25)

Most Likely Least Likely

Performance Targets y Health Statusy Data & Information Systems

y Human Resource Developmenty Public Health Capacity

Performance Measures or Standards

y Health Statusy Data & Information Systems

y Human Resource Developmenty Customer Focus and Satisfaction

Performance Reports y Health Statusy Data & Information Systemsy Management Practices


Process for QI/Change y Health Statusy Customer Focus and Satisfactiony Management Practices




Turning Point35

Top Three Models/Frameworks Explicitly Incorporated

by SHAs Into Their Performance Management Efforts

Healthy People Objectives

Core Public HealthFunctions

Ten Essential Public

Health Services

S tates use a variety of

performance management models/frameworks, in a

variety of combinations



Turning Point36

Most SHAs Have Performance Measures, Targets, and

Reports, While Fewer States Have

Process for Quality Improvement or Change*Figure 15. Percentage of SH As that have specified components of performance management for

public health capacity (N=25)

3 (9)

( )

0 ( 5)

0 ( )

0

10

0

30

0

50

0

0

0

0

100

P e rfo rm a n ce T a rg e ts P e rfo rm a n ce M e a su re s

or Standards

Performance Re p orts P ro ce ss fo r Q I C ha n ge

P e

r c e n t a g e

o f S t a t e s

(

*Correlation analysis revealed that there is a comparatively weak relationship between having performance targets,performance measures or performance reports and process for quality improvement (QI)/change. That is, in general,

fewer states indicated that they did have a process for change, even though they indicated having performance targets,performance measures, or performance reports. This was the case for all areas of performance management studied

(Human Resource Development, Data & Information Systems, Customer Focus and Satisfaction, Financial Systems,

Management Practices, Public Health Capacity, and Health Status). Figure 5 illustrates this finding.



Turning Point37

Most States Use Neither Incentives nor Disincentives

to Improve Performance

Figure 18. Percentage of SH A performance efforts that include incentives or disincentives to improve

performance (N=4 )

Note: Respondents could choose more than one response, so total does not equal 1

¡

(¢ £

)

8 ( ¤ )

¥ ¦

(8)

1¡

(£ )

¡ ¦

(1¢ )

1

8

1

Incentives for §

gencies̈

Programs ̈

Divisions

Incentives for Staff Disincentives for §

gencies̈

Programs ̈

Divisions

Disincentives for Staff None

P e r c

e n t a g e

o f S t a t e s

N

)



Turning Point38

Funding for Performance Management Chosen as

Number One Way to Improve States¶ Efforts

Figure 5. Types of aid identified as most useful to SH As to improve SH A performance

management efforts, in rank order (N=47)

Num er of SH As t at ranked eacans er -

st nd rd. unding sources/support 7

. etailed examples/a set of models from ot er states¶performance management systems

4

. onsultation/tec nical assistance 7

4. ³Ho to´ guide/toolkit (tie) 44. A set of voluntary national performance standards for

pu lic ealt systems (tie)6



Turning Point39

Where do we go from here?

On e st ep at a ti me

Develop performan ce meas ures

Develop reports

Develop qua lit y i mprovement process es

Look beyon d cat egori ca l progra ms



Turning Point40

Where do we go from here?

Look beyond health indicators Look at systems

Refine, revise, Learn from one another

Keep on Truckin

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