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Public HealthPerformance Management

Turning PointPerformance Management

National Excellence Collaborative

[meeting name]

[location][date]

Public Health Performance Management CurriculumPrepared by Center for Public Health Practice, UIC School of Public Health

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Genesis• Turning Point Performance Management

National Excellence Collaborative States (AK, IL, MO, MT, NH, NY, WV)– “..to move the field of public health from

simply measuring performance of individual programs to actively measuring and managing the performance of an entire agency or system.”

– “..from managing silos to managing a system”

Source: Silos to Systems: Using Performance Management to Improve the Public’s Health. Turning Point Performance Management National Excellence Collaborative: Seattle WA; Turning Point National Program, 2003.

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Learning ObjectivesLearners will be able to:1. Define and describe the key concepts and

components of performance management2. Identify performance management concepts and

components in a variety of public health organization and system applications

3. Describe potential benefits of performance management across a range of public health organization and system applications

4. Assess and enhance performance management practices and opportunities in public health work settings

5. Advocate for the use of performance management in public health practice settings

6. Identify and access resources to support performance management applications

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Today’s ProgramI. IntroductionII. Pre-TestIII. Performance Management 101IV. Applications of Performance

Management in Public Health PracticeV. Case StudiesVI. Review and SummaryVII. Post-Test/Course Evaluation

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Part II

Pre-Test

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Part III

Performance Management 101

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The Words

“Performance”– Execution, Accomplishment,

Completion, Effectuation

“Management”– Supervision, Direction, Control,

Manipulation

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Basic Concepts

“Performance Management”– Control/Manipulation towards

Accomplishment– Key considerations = the context

• Who or what performs? • What is performed?

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Focus on Performance1. Marathon Runner2. Not Your Father’s Oldsmobile3. Unit Supervisor4. Program (and Mega-Program) Manager5. National Health Priority Initiative6. National Public Health System7. State Health Agency8. State-Local Public Agency Network9. Community Health Improvement Process10. Public Health Workforce Development

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Managing Performance (Ex 1)

Marathon Runner• trains 5x per week at various

distances• records times• seeks to better last year’s time

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Your Father’s Oldsmobile?• Performance dimensions include fuel

economy, comfort, safety, etc.• Raw materials include steel, plastic, rubber• Tire air pressure measurements• Dashboard instruments assist operators in

making some adjustments; onboard computer chips also monitor performance

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Unit Supervisor• meets with employees annually to

review job performance and set expectations for next year

• next year’s salary increment is tied to this year’s job performance?

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Program Manager• establishes objectives• reports quarterly• seeks continuation funding year

after year

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Common Elementsfrom These Simple

Examples?• Context (who or what is to perform and

what is to be accomplished) • Goals or targets (form & level of

accomplishment)• Information about performance• Collection of information• Modifications/Change possible

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Key Components of Performance Management

• Applying Appropriate Standards

• Measuring Key Aspects of Performance

• Reporting and Interpreting Measurements

• Making Changes Based on Measures of Performance

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Criticalcomponents ofperformance management


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In the performance management cycle...

• All components should be driven by the public health mission and organizational strategy

• Activities should be integrated into routine public health practices

• The goal is continuous performance and quality improvement


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Is Performance Managementthe Same Thing as

Performance Measurement?

[Maybe Yes / Maybe No]

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• Performance Measurement is the regular collection and reporting of data to track work produced and results achieved.

• Performance Management is what you do with information you’ve developed from measuring performance. – Set agreed-upon performance goals– Allocate or prioritize resources– Inform management decisions– Report on progress

• Caution! Some view Performance Measurement as only the first 3 components of Performance Management

Source: lichiello P. Guidebook for Performance Measurement. Seattle WA: Turning Point National Program Office, 1999:48. Based on Hatry HP et al, Monitoring the Outcomes of Economic Development Programs. Washington DC: The Urban Institute Press, 1990.

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Jargon Alert![Terms may be used

differently]• Performance Measure• A specific quantitative representation of something

deemed relevant to the assessment of progress toward a goal or objective

• Performance Standard• Standards are one form of performance measure; they

are objective measures or guidelines that are commonly used to assess performance (“standard” here means a standard way of measuring rather than something specific to achieve)

• Performance Target• The planned or expected level of performance (generally

expressed in standard terms)

• Performance Indicator• Indicators are another form of performance measure;

they are the data or information that is used to assess progress toward a performance standard or target

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Different Indicators Used to Measure Performance (Workforce

Competency)Self

Assessment --------->

--------->

--------->

--------->

Self ImprovementApplication

Course Instructor

Assessment

Competency Acquisition Application

Workplace Assessment

Personnel Mgt/ Competency Demo

Application

External Certifying

Body Assessment

Credentialing Application

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Performance MeasuresAre Useful to …

• Identify aspects of the work that have and have not resulted in satisfactory results

• Identify trends• Further investigate the nature of particular

problems• Set targets for future periods• Motivate managers and staff to improve

performance• Hold managers and staff accountable• Develop and improve programs and policies• Help design policies and budgets and explain

these to stakeholdersSource: lichiello P. Guidebook for Performance Measurement. Seattle WA: Turning Point National Program Office, 1999:48. Based on Hatry HP et al, Monitoring the Outcomes of Economic Development Programs. Washington DC: The Urban Institute Press, 1990.

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Applying Appropriate Standards

• Identify and apply relevant standards (what will be measured)

• Standards are one form of performance measure; they are generally objective standards or guidelines that are used to assess performance (“standard” here means a standard way of measuring rather than something specific to achieve).

• Identify appropriate indicators (how it will be measured)

• Indicators are another form of performance measure; they are the data or information that is used to assess progress toward a performance standard.

• Set goals and targets• The planned or expected level of performance

• Communicate expectations

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Is there a Performance Standards component?

• Have performance goals and targets been established, and appropriate indicators identified?

• Do these benchmark against similar organizations or use national, state, or scientific guidelines?

• Are expectations communicated?

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Measuring Performance

• Relies on indicators that document where performance is in relation to the target established for a standard

• Develop data systems• Collect data

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Is there a Performance Measurement component?

• Have the indicators been refined?

• Have data systems been developed?

• Are data being collected?

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Reporting Progress

• Analyze data• Convert data into useable

information• Feedback to managers, staff,

policy makers, and constituents• Develop a regular reporting cycle

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Reporting Progress

• Provide context for the report– How do the performance measures

relate to mission and goals• Create clear, easy to read, report

designs– Use simple charts and tables

• Determine Reporting Frequency– When and how often

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Is there a Reporting of Progress component?

• Are data analyzed?• Are data fed back to managers,

staff, constituents, etc. in useable and understandable format?

• Is there a regular reporting cycle in place?

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Improving Quality

Establish a program or process to manage change and achieve quality improvement in public health policies, practice and infrastructure based on what is learned through performance measures

• Use data for decisions to improve policies, programs, and outcomes

• Manage change• Create a learning organization

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A Few Words about Change

• Results are properties of systems: every system is perfectly designed to achieve exactly the results it gets– Results do not occur by new goals or targets, but

through systemic change– Improvement comes only with change; but change

doesn’t always improve results– Smart improvement relies on understanding how

systems work– Systems rely on interdependencies which are as

important as the system’s elements– Change is more difficult than setting goals,

measuring or holding people accountable. “I would rather (measure, complain, blame, accept good enough, fight) than change!”

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Is there a Quality Improvement component?

• Where is the change process?

• Is there a process to manage changes being made?

• Is there a learning organization?

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For SuccessfulPerformance Management

All four Performance Management components should be present!

And they should be integrated into the organization’s or system’s core operations!

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Concepts and Componentsto Assess in Examples

• Context for “improvement” (is/is not) clear?• Goals or targets for improvement (are/are

not) established?• Appropriate measures of performance

(are/are not) collected?• Reports of measurements (do/do not) reach

the proper parties?• Information from measurements (are/are

not) used to make improvements?

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Summary - Example 1

Marathon Runner (Ex 1)Context Runner; complete race in shortest possible time

Standards Previous time

Measuring “Splits”

Reporting Log

Improvement

Strategy

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Summary - Example 2

Not Your Father’s Oldsmobile (Ex 2)Context An automobile: safe, reliable, efficient personal

transportation

Standards Miles per gallon, cost

Measuring Tire air pressure; oil, water, battery, speed

Reporting Dashboard and other instruments

Improvement

Adjustments as indicated

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Summary - Example 3

Supervisor (Ex 3)Context Worker; job duties

Standards Set annually

Measuring Work prods

Reporting Performance appraisal

Improvement

New objectives, more $ ?

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Summary – Example 4

Program Manager (Ex 4)Context Program; program goals

Standards Approved objectives

Measuring Info on activities

Reporting Quarterly reports

Improvement

Revised workplan

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OK, Sounds Simple Enough!

But How Does This Workfor More Complex Examples?

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Part IV

Applicationsof Performance Management

in Public Health Practice

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Examples 4A, 4B, 4CHD Program

Ex 4ACommunity

Ex 4BStatewide

Ex 4CContext Program;

program goalsProgram; program goals

Program; program goals

Standards Approved objectives

Approved objectives

Approved objectives

Measuring Info on activities

Info on activities

Info on activities

Reporting Quarterly reports

Quarterly reports

Quarterly reports

Improvement

Revised workplan

Revised workplan

Revised workplan

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• Congress appropriates $1 billion annually x5 years for state-based efforts to respond to childhood obesity epidemic

• States must: – Appoint State Coordinators– Establish broadly based advisory committee– Prepare timelines for state and local plans,

information and surveillance systems, lab services, professional training, media strategies, etc.

– Renewal funding available to continue and extend these activities

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Components PresentIn These Examples?






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National Childhood Obesity (Ex 5)Context ?

Standards ?

Measuring ?

Reporting ?

Improvement ?

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National Childhood Obesity (Ex 5)Context Who or what unclear; performance task clear

Standards Standard approaches certainly exist

Measuring Data and data collection systems in place

Reporting Since who or what is unclear, reporting target?

Improvement Mechanisms for change poorly defined

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National Public Health System• Healthy People 2000 Objective 8.14 calls

for 90% of population to be served by LHD effectively carrying out IOM core functions

• Core functions further described in Essential Public Health Services framework

• Replaced by Infrastructure Chapter in Healthy People 2010

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Comparison of Performance Measures Aggregated by Core Function

0

10

20

30

40

50

60

70

80

90

100

1992Mystate

1994Mystate

1999Mystate

1993National

1995National

Assessment

Policy Development

Assurance

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Components PresentIn This Example?






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National Public Health System (Ex 6)

Context ?

Standards ?

Measuring ?

Reporting ?

Improvement ?

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National Public Health System (Ex 6)

Context System components/participants unclear;“effectively carry out core functions” = ?

Standards Core function related measures not widely used

Measuring No consensus as to how to collect information

Reporting Not clear since system components not specified

Improvement Not driven by performance measurement

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Performance Management in Public Health Practice

• Active and strategic use of performance measures to improve the public’s health– Ex: Achieving Healthy People 2010

national health goals and objectives– Ex: Improving public health organization

and system performance (core functions, essential public health services, capacity, preparedness, etc.)

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Public HealthPerformance Measures

• Quantitative measures of capacities, processes, or outcomes relevant to the assessment of public health performance– Ex: The number of trained epidemiologists available

to investigate outbreaks (capacity measure)– Ex: The percentage of notifiable diseases reports

submitted within the required time lines (process measure)

– Ex: The annual incidence of selected infectious diseases in the community (outcome measure)

– Ex: Percentage of clients who rate health department communicable disease services as “good” or “excellent” (outcome measure)

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PHS Missionand Purpose

PhilosophyGoals

"Core Functions"

Structural Capacity-----------------

Information ResourcesOrganizational Resources

Physical ResourcesHuman ResourcesFiscal Resources

Outcomes---------------Effectiveness

EfficiencyEquity

Conceptual Framework of the Public Health System as a Basis for Measuring Public Health System Performance

Processes-------------------The 10 Essential

Public HealthServices

Source: Handler A, Issel M, and Turnock B. 2001. A conceptual framework to measure performance of the public health system. Am J Public Health, 91:1235-1239.

MACRO

CONTEXT

PUBLIC

HEALTH

SYSTEM

Public Health Performance Measures: Public Health Performance Measures: Capacity, Process, and OutcomesCapacity, Process, and OutcomesPublic Health Performance Measures: Public Health Performance Measures: Capacity, Process, and OutcomesCapacity, Process, and Outcomes

CapacityCapacity Process(Essential Public Health Services)

Process(Essential Public Health Services)

OutputsOutputs

OutcomesOutcomes

System InputsSystem Inputs

WorkforceWorkforce

InformationInformation

Organization & Organization & RelationshipsRelationships

FacilitiesFacilities

FundingFunding

WorkforceWorkforce

InformationInformation

Organization & Organization & RelationshipsRelationships

FacilitiesFacilities

FundingFunding

Improved Improved organizational organizational performanceperformance

Improved Improved program program performanceperformance

Improved Improved organizational organizational performanceperformance

Improved Improved program program performanceperformance

AssessAssess AssureAssure

Programs and Programs and Services Services consistent consistent with with mandates and mandates and community community prioritiespriorities

Programs and Programs and Services Services consistent consistent with with mandates and mandates and community community prioritiespriorities

Key Processes Key Processes

Improved Outcomes& Customer Satisfaction

Improved Outcomes& Customer Satisfaction

Increased Value& Public Support

Develop Policy

Source: Turnock BJ. Public Health: What It Is and How It Works, 3rd Edition. Boston MA; Jones & Bartlett, 2004.

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Public Health PM Applications

• Public Health Infrastructure Capacity– Human resource development– Data and information systems

• Public Health Processes– Essential Public Health Services– Management practices

• Public Health Outcomes– Health status– Customer focus and satisfaction

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Lessons Learned• State performance management practices are

widespread, although often not system-wide or with processes leading to quality improvement or changes.

• States generally report their efforts result in improved performance, with positive outcomes broadly defined.

• No single or composite framework is used in most states, and there are insufficient data to inform choices in performance management approach.

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SHAs Most Likely to Have Components of Performance Management for Health Status;

Least Likely for Human Resource Development

Figure 8. Areas most and least likely to have performance targets, measures or standards, reports, and processes for quality improvement (QI)/change, of SHAs that apply performance management efforts SHA wide, SHA wide and to local public health agencies, or to local public health agencies only (N=25)

Most Likely Least Likely

Performance Targets Health Status Data & Information Systems

Human Resource Development Public Health Capacity

Performance Measures orStandards

Health Status Data & Information Systems

Human Resource Development Customer Focus and Satisfaction

Performance Reports Health Status Data & Information Systems Management Practices


Process for QI/Change Health Status Customer Focus and Satisfaction Management Practices


Source: Turning Point Survey on Performance Management Practices in States: Results of a Baseline Survey of State Health Agencies. Seattle WA; Turning Point National Program Office, 2002.

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Nearly All SHAs Have Some PerformanceManagement Efforts

However, only about half apply performance management efforts statewide beyond categorical programs

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

Categorical programs

only43% (20)

None4% (2)

SHA wide32% (15)

Local public health

agencies only4% (2)

SHA wide and local

public health agencies17% (8)Source: Turning Point Survey on Performance Management Practices in

States: Results of a Baseline Survey of State Health Agencies. Seattle WA; Turning Point National Program Office, 2002.

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Most SHAs Have Performance Measures, Targets, and Reports, While Fewer States Have

Process for Quality Improvement or Change*

Figure 15. Percentage of SHAs that have specified components of performance management for public health capacity (N=25)

36 (9)

44 (11)

60 (15)

40 (10)

0

10

20

30

40

50

60

70

80

90

100

Performance Targets Performance Measuresor Standards

Performance Reports Process for QI/Change

Pe

rce

nta

ge

of

Sta

tes

(N

=2

5)

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


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Most States Use Neither Incentives nor Disincentives to Improve Performance

Figure 18. Percentage of SHA performance efforts that include incentives or disincentives to improve performance (N=40)

Note: Respondents could choose more than one response, so total does not equal 100.

63 (25)

8 (3)

20 (8)

13 (5)

30 (12)

0

10

20

30

40

50

60

70

80

90

100

Incentives forAgencies, Programs,

Divisions

Incentives for Staff Disincentives forAgencies, Programs,

Divisions

Disincentives for Staff None

Pe

rce

nta

ge

of

Sta

tes

(N

=4

0)


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Performance Measure SourcesCapacity Process Outcom

eHealthy People 2010 (#1)

✔ ✔

Core Functions (#2) ✔ EPHS (#3) ✔ NPHPS (based on EPHS and CF)

✔ ✔

APEX-PH ✔ ✔ ✔ MAPP ✔ ✔ ✔


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State Health Agency• Mission: to protect and promote the health of

the state’s population• Local public health agencies are units of

state health agency and work under its direction

• Health status & other info (including activity counts, costs, staffing, etc.) collected

• Resources deployed to local units based on progress toward pre-established targets

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State Health Agency (Ex 7)Context ?

Standards ?

Measuring ?

Reporting ?

Improvement ?

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State Health Agency (Ex 7)Context State agency/local unites;

promote/protect public health

Standards HP 2010, Baldridge Quality Stds

Measuring Outcomes, costs, satisfaction, etc.

Reporting Agency management

Improvement Incentives for progress; info for resource allocation

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State-Local Public Health Agency Network• Mission to protect and promote• State certifies local public health

agencies• Core function based standards applied• Annual grants made to local agencies

meeting standards via formula based on population and need

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State-Local PH Network (Ex 8)Context ?

Standards ?

Measuring ?

Reporting ?

Improvement ?

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State-Local PH Network (Ex 8)Context State and LHDs (+ partners?);

promote/protect public health

Standards HP 2010, core function based LHD stds

Measuring Outcomes, LHD stds, activities?

Reporting State agency?

Improvement Decisions/resource allocations based on info?

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Examples and Case Studies*1. Marathon Runner2. Not Your Father’s Oldsmobile3. Unit Supervisor4. Program (and Mega-Program) Manager5. National Health Priority Initiative6. National Public Health System7. State Health Agency*8. State-Local Public Agency Network**9. Community Health Improvement Process*10. Public Health Workforce Development**

* Indicates number of case studies available for various PM applications

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Part V

Case Studies

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Part V

Example 9 Case Study

Moose CountyCommunity Health

Improvement Process Using MAPP

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The CHIP

Process

CommunityHealth NeedsAssessment

CommunityHealth Plan

Program Development

Implementation

Evaluation

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The MAPP Model

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Another View of MAPP Model

Community Health Status

Assessment

Local Public Health System Assessment

Organize For

Success

Review Mandates, Mission,

Stakeholder Expectations,

and Goals

Vision For Success

Identify Strategic Issues

Formulate Strategies

Implement Strategies

Evaluate

Community Generated

Themes

Contextual Environment Assessment

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Tobacco Use By 2002, reduce cigarette smoking to a prevalence of no more than 24 percent among people aged 18 and older. (Baseline: 1996 BRFS percentage 27.3).

AddictionSedentary LifestyleHypertensionAdvertising (Indirect)

Coalition will implement CDC=s community-based tobacco control program, focusing on delaying initiation, cessation programs, and advertising control.

Coalition will provide support to LHD with in-kind donations, staff, and clinical counseling space.

Cerebrovascular Disease (Stroke) By 2004, reduce stroke deaths to no more than 70 per 100,000 (Baseline: 1997 crude rate 76.5 per 100,000).

Limited number smokers seeking counseling.Media messages promote smoking.Peer pressure.

Health Problem Outcome Objective

Risk Factor Impact Objective

Contributing Factors

Community Health Plan

Proven Intervention Strategies

Resources Available Barriers

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Description of the Health Problem, Risk Factors and Contributing Factors

Corrective Actions

Proposed Community Organizations

Evaluation Plan

The problem is the high death rate associated with Cerebrovascular disease (county CR = 76.5, state CR =61.7 p/100,000 or 23% above state rate). The major risk factor is cigarette smoking and county has higher percentage of smokers (27.6%) , especially males (31%) than state (24%, 28%, respectively). Addiction appears to be the chief contributing factor.

In order to effectively address this health problem a multi-sited and multi- targeted campaign is required to delay initiation of smoking behavior, assist persons attempting to quit, and provide counter advertising to tobacco promotions.

A coalition of community groups, including the LHD, Cancer Society, Lung Association, General Hospital, Teens Against Butts will collaborate with in- kind donations, staff, and clinical counseling space to assist in meeting objectives.

Coalition will meet quarterly to assess progress in achieving goals. Coalition will use the evaluation tool developed by the CDC to determine effectiveness of programming efforts. Surveys will be conducted amongst coalition members to ascertain stakeholder satisfaction with program.

Community Health Plan

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Moose County CHIP Using MAPPContext ?

Standards ?

Measuring ?

Reporting ?

Improvement ?

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Moose County CHIP Using MAPPContext Moose County Health Partnership;

Improve community health via health priorities

Standards HP 2010, MAPP assessments (incl. NPHPS)

Measuring Outcomes and community contributing factors

Reporting Partnership, policy makers, public

Improvement Not clear, commitment of partners?

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Moose County CHIPCase Study to the Next Level• Have you been (are you now)

involved in a similar effort? If so which PM components are in place? Which PM components are missing or could be enhanced? How?

• For a companion effort at the state level, describe how the various PM components would be used.

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Part V

Example 10 Case Study

PH Workforce Developmentin Grey State/Coyote County

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1 – Assess Competency Using Consistent Methods and Tools

2 – Enhance Specific Competencies Based on Assessment

3 – Document Competent Performance in Workplace via Human Resource Management

4 – Recognize Competent Performance via System Incentives such as Credentialing

1 – Assess Competency Using Consistent Methods and Tools

2 – Enhance Specific Competencies Based on Assessment

3 – Document Competent Performance in Workplace via Human Resource Management

4 – Recognize Competent Performance via System Incentives such as Credentialing

Public HealthWorkforce Preparedness

Public HealthWorkforce Preparedness

44

11

Core PublicHealth Practice

& BT/ERCompetencies

2

33

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Different Indicators Used to Measure Performance (Workforce

Competency)Self

Assessment --------->

--------->

--------->

--------->

Self ImprovementApplication

Course Instructor

Assessment

Competency Acquisition Application

Workplace Assessment

Personnel Mgt/ Competency Demo

Application

External Certifying

Body Assessment

Credentialing Application

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• 9 core competencies for all public health workers

• PLUS Function-specific competencies for 8 emergency response functional roles:– leaders– communicable disease– clinical– environmental health– public health laboratory– medical examiner– public information– other professionals– technical and support

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Coyote County Health Dept Training Plan

• ALL STAFF HRS– Anthrax/BT Primer (150 Staff) – 1.5 hrs 225– Smallpox Primer (125 Staff ) - 1-5 hrs 118– SNS Drill (90 staff) – 8 hrs 720– CERT Training (10 staff) - 21 hrs

210– Phase I Training (210 staff) - 2 hrs 420– Phase II Training (211 staff) - 7 hrs 1477

• BT-IC TEAM (Health Department Leaders)– Weapons of Mass Destruction (8 staff) – 12 hrs 96– Forensic Epidemiology (4 staff) – 12 hrs 48– Risk Communications (10 staff) – 11 hrs 110– Community-wide ER Response Drill (6 staff) – 6 hrs 36– Incident Command Drill (10 staff) – 3 hrs 30

• SPECIALIZED STAFF– Smallpox Vaccine Administration (25 RN staff)- 1 hr

25– RN Team Captains (20 RN staff ) – 4 hrs 80– PH Training Network Satellite - (50+ staff/15+ presentations) 1-6 hrs 150

• TRAINING INVESTEMENT (including Phase I and II) • # Staff hours 3800 +• # Trainings – 14• # Estimated cost (including materials, space, prep.) >$98,000

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CCHD Workers Before & After

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Coyote County Health Dept.PH Workforce Development

Context ?

Standards ?

Measuring ?

Reporting ?

Improvement ?

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Coyote County Health Dept.PH Workforce Development

Context CCHD; skilled workforce

Standards Competency expectations

Measuring Multiple views beginning with self-assessment

Reporting Individuals, agency mgt, state

Improvement Individual, group, agency training plans

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CCHD Workforce Development Case Study to

the Next Level• Have you been (are you now)

involved in a similar effort? If so which PM components are in place? Which PM components are missing or could be enhanced? How?

• For a companion effort at the state level, describe how the various PM components would be used.

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Part VI

Review and Summary

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Source: From Silos to Systems: Using Performance Management to Improve the Public’s Health. Turning Point Performance Management National Excellence Collaborative: Seattle WA; Turning Point National Program, 2003.

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Apply Standards, Set Targets

Marathon Runner Previous personal best time

Your Father’s Oldsmobile

Safe, reliable, efficient transportation

Unit Supervisor Expectations established for specific job duties

Program Manager Objectives approved by granting agency

National Health Priority Target established for childhood obesity prevalence

National Public Health System

Outcomes – Healthy People 2010 ObjectivesProcess - National Public Health Performance Standards

State Health Agency Outcomes – Healthy People 2010 Objectives, Baldridge Quality CriteriaProcess - National Public Health Performance Standards

State-Local Public Agency Network


Community Health Improvement Process


PH Workforce Development

Core public health practice competencies

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Measure PerformanceMarathon Runner Training times for specific distances

Father’s Oldsmobile Air, oil, water, battery, speed, direction, etc.

Unit Supervisor Specific performance expectations for employee

Program Manager Program goals and objectives

National Health Priority

Population studies of health status


Surveillance of core function or EPHS performance

State Health Agency Outcomes, activities, costs, satisfaction, etc


Outcomes, compliance with standards, activities?

Community Health Improvement

Process

Outcomes and contributing factors in community


Various views of individual competency

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Report InformationMarathon Runner Personal training log

Father’s Oldsmobile Dashboard and other instruments

Unit Supervisor Monthly or quarterly progress reports

Program Manager Quarterly progress reports


Annual review


Annual surveillance

State Health Agency Agency management


Unclear


Process

Community Health Partnership, policy makers, public


Individuals, agency management

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Quality ImprovementMarathon Runner Revise race strategy

Father’s Oldsmobile Adjust tire air pressure, oil, water, speed, direction

Unit Supervisor Set new performance expectations

Program Manager Revise program objectives and workplan


Secure new commitments; redeploy resources; new policies


Incentives; redeploy resources

State Health Agency Management decisions; incentives; resource allocation


Incentives; resource allocation?


Process

Secure new commitments; redeploy resources


Tailored training plans for individuals and agencies

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In the performance management cycle...

• All components should be driven by the public health mission and organizational strategy

• Activities should be integrated into routine public health practices

• The goal is continuous performance and quality improvement

Source: From Silos to Systems: Using Performance Management to Improve the Public’s Health. Turning Point Performance Management National Excellence Collaborative: Seattle WA; Turning Point National Program, 2003.

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For SuccessfulPerformance Management

All four Performance Management components should be continuously integrated into the core operations of the agency or system

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Capacity & AccountabilityMarathon Runner

Commitment

Leadership

Informed Decision Making

Incentives

Accountability

Father’s Oldsmobile

Unit Supervisor

Program Manager



State Health Agency



Process


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Public Health Agency as a Learning Organization:Core Organizational Competencies Support

Strategic Planning / Change Processes

Forces / Trends

StakeholdersHealth System

Planningto Plan

Internal Environment

Capacity Competencies Barriers

External Environment

StrategicIssues

Strategies

Organizational Systems Design & Development

Actions Results

MANDATES

Vision

Mission

Values

< Strategy Formation > < Implementation >

Adapted from John M. Bryson (c) 1985. In Bryson, J.M. & Roering, W.D. (1988). Initiation of strategic planning by governments. Public Administration Review, Nov.- Dec., 995 -1004.

Opportunities / Threats

Strengths / Weaknesses

Core Functions&

Essential Public Health Services

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Success Factors

• Integrate PM into routine public health processes

• Sustainable PM activities meet state and local needs and political realities

• NPHPS, management models and tools provide a head start

• Early stakeholder involvement increases support and chances of success

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Success Factors (cont’d)

• Align PM measures, activities, and spending with public health priorities

• Trained staff, dedicated resources, and PM culture are essential

• Baseline information and trends important

• New or adapted information and management systems are necessary for cross-program management

• Incentives motivate performance and quality improvement

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Performance MeasuresAre Useful to …

• Identify aspects of the work that have and have not resulted in satisfactory results

• Identify trends• Further investigate the nature of particular

problems• Set targets for future periods• Motivate managers and staff to improve

performance• Hold managers and staff accountable• Develop and improve programs and policies• Help design policies and budgets and explain

these to stakeholdersSource: lichiello P. Guidebook for Performance Measurement. Seattle WA: Turning Point National Program Office, 1999:48. Based on Hatry HP et al, Monitoring the Outcomes of Economic Development Programs. Washington DC: The Urban Institute Press, 1990.

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Why UsePerformance Management?

• To improve public health practice and maximize its effectiveness. This requires– More than setting goals/targets alone;

more than measurement alone. These are necessary, but not sufficient, components

– All four PM components should be continuously integrated into the core operations of the agency/system

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Managerial Action

• Quality improvement efforts

• Policy change

• Resource allocation change

• Program change

Why Use Performance Management?

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Performance Mgt Resources1. Turning Point PM National Excellence Collaborative (online via

www.turningpointprogram.org/Pages/perfmgt.html)2. Guidebook for Performance Measurement. Seattle WA:

Turning Point National Program Office, 1999.3. Performance Management in Public Health: A Literature

Review. Seattle WA; Turning Point National Program Office, 2002.

4. Turning Point Survey on Performance Management Practices in States: Results of a Baseline Survey of State Health Agencies. Seattle WA; Turning Point National Program Office, 2002.

5. From Silos to Systems: Using Performance Management to Improve the Public’s Health. Seattle WA; Turning Point National Program Office, 2003.

6. Performance Management Self-Assessment Tool. Washington DC: Public Health Foundation, 2004.

7. Performance Management Toolkit. Public Health Foundation (online via www.phf.org)

8. Performance Measurement and Improvement. Chapter 18 in Public Health Administration: Principles for Population-Based Management. Sudbury MA; Jones & Bartlett, 2000.

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Part VII

Post-Test &Course Evaluation

Date post:	20-Oct-2014
Category:	Health & Medicine
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