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Turning Point PM
Collaborative 1
Public HealthPerformance Management
Turning PointPerformance Management
National Excellence Collaborative
April 2004
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 Objectives• Define and describe the key concepts and
components of performance management• Identify performance management concepts
and components in a variety of public health organization and system applications
• Describe potential benefits of performance management across a range of public health organization and system applications
• Assess and enhance performance management practices and opportunities in public health work settings
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Today’s ProgramI. Introduction (~10 min)
II. Pre-Test (~10 min)
III. Performance Management 101 (50-60 min)
IV. Applications of Performance Management in Public Health Practice (50-60 min)
V. Case Studies (60-240 min)
VI. Review and Summary (~45 min)
VII. Post-Test/Course Evaluation (~15 min)
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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
• Who or what performs? (subject = “who/what”)
• What is performed? (object = “do what”)
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Focus on Performance
1. Marathon Runner2. Unit Supervisor3. Program Manager4. State Health Agency5. State-Local Public Agency Network6. National Health Priority Initiative7. National Public Health System8. Community Health Improvement Process9. 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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Managing Performance (Ex 2)
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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Managing Performance (Ex 3)
Program Manager• establishes objectives• reports quarterly• seeks continuation funding year
after year
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Common Elementsfrom These Simple
Examples?• Subjects (who or what is to perform)
and Objects (what is to be accomplished)
• Goals or targets (level of accomplishment)
• Information about performance• Collection of information• Modifications/Changes 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
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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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: 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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Aren’t Performance Management
and Performance Measurement the Same Thing?
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Performance Measurement
• The regular collection and reporting of data to track work produced and results achieved.
• Caution! Some view Performance Measurement as only the first 3 components of Performance Management
Source: Liachello 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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Terminology• Performance Measure
• A specific quantitative representation of a capacity, process, or outcome deemed relevant to the assessment of performance (a generic term that includes standards, targets, indicators)
• Performance Standard• Standards are one form of performance measure; they
are generally objective standards or guidelines that are used to assess performance.
• Performance Target• The planned or expected level of performance
• 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
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Different Indicators Used to Measure Performance (Staff 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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Managers Can UsePerformance Measures 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: Liachello 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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Performance Management
“Performance Management is what you do with the information you’ve developed from measuring performance.”
Source: Liachello P. Guidebook for Performance Measurement. Seattle WA: Turning Point National Program Office, 1999.
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Criticalcomponents ofperformance management
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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Applying Appropriate Standards
• Identify and apply relevant standards• Standards are one form of performance measure;
they are generally objective standards or guidelines that are used to assess performance.
• Identify appropriate indicators• 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 or 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?
• Has data been 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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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 must be present!
And they must be integrated into the organization’s or system’s core operations!
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Concepts and Componentsto Assess in Examples
• Something needing “improvement” (is/is not) clearly identified
• 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 1Marathon
(1)
Who/What Runner
Do What Run fast
Standards Previous time
Indicators “Splits”
Reporting Log
Improvement
Strategy
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Summary - Example 2Supervisor (2)
Who/What Worker
Do What Job duties
Standards Set annually
Indicators Work prods
Reporting Perf Appraisal
Improvement
New Objs, More $ ?
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Summary – Example 3Program Mgr (3)
Who/What Program
Do What Program Goals
Standards Approved Objectives
Indicators Info on Activities
Reporting Quarterly Reports
Improvement
Revised Workplan
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Summary - Examples 1-3Marathon
(1)Supervisor (2) Program Mgr (3)
Who/What Runner Worker Program
Do What Run fast Job duties Program Goals
Standards Previous time
Set annually Approved Objectives
Indicators “Splits” Work prods Info on Activities
Reporting Log Perf Appraisal Quarterly Reports
Improvement
Strategy New Objs 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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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: Percentage of clients who rate health department services as “good” or “excellent” (outcome measure)
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PHS Missionand Purpose
----------------Philosophy
Goals"Core Functions"
Structural Capacity-----------------
Information ResourcesOrganizational Resources
Physical ResourcesHuman ResourcesFiscal Resources
Processes-------------------The 10 Essential
Public HealthServices
Outcomes---------------Effectiveness
EfficiencyEquity
Conceptual Framework of the Public Health System as a Basis for Measuring Public Health System Performance
MACRO
CONTEXT
PUBLIC
HEALTH
SYSTEM
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.
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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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Performance Management in Public Health Practice
• Active and strategic use of performance measures to improve the public’s health through managing public health capacity and processes– Achieving Healthy People 2010 national health
goals and objectives– Improving public health organization and
system performance (core functions, essential public health services, capacity, preparedness, etc.)
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Public Health Applications• Human resource development• Data and information systems• Customer focus and satisfaction• Financial systems• Management practices• Public Health capacity• Health status
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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.
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 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)
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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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
Human Resource Development Public Health Capacity
Process for QI/Change Health Status Customer Focus and Satisfaction Management Practices
Human Resource Development Public Health Capacity
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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Performance Measure SourcesCapacity Process Outcom
eHealthy People 2010 ✔ ✔ Core Functions ✔ EPHS ✔ NPHPS (based on EPHS and CF)
✔ ✔
APEX-PH ✔ ✔ ✔ MAPP ✔ ✔ ✔
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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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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Managing Performance (Ex 4)
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• Health status & other info collected• Resources deployed to local units based
on progress toward pre-established targets
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Components PresentIn This Example?
• Something needing “improvement” (is/is not) clearly identified
• 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 4State Health Agency (4)
Who/What ?
Do What ?
Standards ?
Indicators ?
Reporting ?
Improvement ?
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Managing Performance (Ex 5)
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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Components PresentIn This Example?
• Something needing “improvement” (is/is not) clearly identified
• 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 5State-Local Public Health Network (5)
Who/What ?
Do What ?
Standards ?
Indicators ?
Reporting ?
Improvement ?
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Managing Performance (Ex 6)
• 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 This Example?
• Something needing “improvement” (is/is not) clearly identified
• 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 6National Epidemic of Childhood Obesity (6)
Who/What ?
Do What ?
Standards ?
Indicators ?
Reporting ?
Improvement ?
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Summary - Examples 4-6SHA (4) State-Local (5) Nat’l Priority (6)
Who/What SHA State-Local PHA PH and Medical Care System
Do What Health PH Practice Obesity Prevalence
Standards Perf target CF standards HP 2010 standards
Indicators S-P-O Assessed Unclear
Reporting Quarterly Limited HP 2010 process
Improvement
$ deployed Not included Not included
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Managing Performance (Ex 7)
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?
• Something needing “improvement” (is/is not) clearly identified
• 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 7National Public Health Network (7)
Who/What ?
Do What ?
Standards ?
Indicators ?
Reporting ?
Improvement ?
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Example 7 to the Next Level
• Which PM components could be enhanced? How?
• For a companion effort at the state (or local) level, describe how the various PM components would be used.
• Have you been (are you now) involved in a similar effort? If so which PM components are in place? How could these be improved?
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Examples and Case Studies
1. Marathon Runner2. Agency Supervisor3. Program Manager4. State Health Agency (C)5. State-Local Public Agency Network (D,E)6. National Health Priority Initiative7. National Public Health System8. Community Health Improvement Process
(A)9. Public Health Workforce Development (B)
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Criticalcomponents ofperformance management
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
Unit Supervisor Expectations established for specific job duties
Program Manager Objectives approved by granting agency
State Health Agency Outcomes – Healthy People 2010 ObjectivesProcess - National Public Health Performance Standards
State-Local Public Agency Network
Outcomes – Healthy People 2010 ObjectivesProcess - National Public Health Performance Standards
National Health Priority Target established for childhood obesity prevalence
National Public Health System
Outcomes – Healthy People 2010 ObjectivesProcess - National Public Health Performance Standards
Community Health Improvement Process
Outcomes – Healthy People 2010 ObjectivesProcess - National Public Health Performance Standards
Public Health Workforce
Development
Core public health practice competencies
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Measure PerformanceMarathon Runner
Unit Supervisor
Program Manager
State Health Agency
State-Local Public Agency Network
National Health Priority
National Public Health System
Community Health Improvement Process
Public Health Workforce
Development
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Report InformationMarathon Runner
Unit Supervisor
Program Manager
State Health Agency
State-Local Public Agency Network
National Health Priority
National Public Health System
Community Health Improvement Process
Public Health Workforce
Development
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Quality ImprovementMarathon Runner
Unit Supervisor
Program Manager
State Health Agency
State-Local Public Agency Network
National Health Priority
National Public Health System
Community Health Improvement Process
Public Health Workforce
Development
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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 must be continuously integrated into the core operations of the agency or system
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Capacity & AccountabilityMarathon Runner
Unit Supervisor
Program Manager
State Health Agency
State-Local Public Agency Network
National Health Priority
National Public Health System
Community Health Improvement Process
Public Health Workforce
Development
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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 meets 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 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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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 must 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 Resources
Turning Point PM National Excellence Collaborative1. Guidebook for Performance Measurement. Seattle WA:
Turning Point National Program Office, 1999.2. Performance Management in Public Health: A Literature
Review. Seattle WA; Turning Point National Program Office, 2002.
3. 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.
4. From Silos to Systems: Using Performance Management to Improve the Public’s Health. Seattle WA; Turning Point National Program Office, 2003.
Public Health Foundation– Performance Management Toolkit (online via www.phf.org
)
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Part V
Case Study A
Community Health Improvement Process Using
MAPP
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The CHIP
Process
CommunityHealth NeedsAssessment
CommunityHealth Plan
Program Development
Implementation
Evaluation
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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
Risk Factors
Health Priority
Indirect Contributing FactorsDirect Contributing
Factors
Health Priority
A situation or condition of people which is considered undesirable, is likely to exist in the future, and is measured as death, disease, or
disability.
Risk Factors
Health Priority
Indirect Contributing FactorsDirect Contributing
Factors
Risk Factor
A scientifically established factor (determinant) that
relates directly to the level of a health problem.
Risk Factors
Health Priority
Indirect Contributing FactorsDirect Contributing
Factors
Direct Contributing Factor
A scientifically established factor that directly affects the level of a risk factor.
Indirect Contributing Factors
A community specific factor that directlyaffects the level of the direct contributing
factor.
Risk Factors
Health Priority
Indirect Contributing FactorsDirect Contributing
Factors
Outcome Objective
The level to which a health problem
(priority) should be reduced.
Risk Factors
Health Priority
Indirect Contributing FactorsDirect Contributing
Factors
Risk Factors
Health Priority
Indirect Contributing FactorsDirect Contributing
Factors
Impact Objective
The level to which a risk factor should be
reduced.
Intervention Strategy
Demonstrated to be effective or used as national model and should address an impact
objective.
Risk Factors
Health Priority
Indirect Contributing FactorsDirect Contributing
Factors
Impact Objective
The level to which a risk factor should be
reduced.
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: Worksheet
Proven Intervention Strategies
Resources Available Barriers
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
Turning Point PM
Collaborative 100
Components PresentIn This Example?
• Something needing “improvement” (is/is not) clearly identified
• 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
Turning Point PM
Collaborative 101
Summary – Case Study ACommunity Health Improvement Process Using
MAPP
Who/What ?
Do What ?
Standards ?
Indicators ?
Reporting ?
Improvement ?
Turning Point PM
Collaborative 102
Case Study A to the Next Level
• Which PM components could be enhanced? How?
• For a companion effort at the state (or local) level, describe how the various PM components would be used.
• Have you been (are you now) involved in a similar effort? If so which PM components are in place? How could these be improved?
Turning Point PM
Collaborative 103
Part V
Case Study B
Workforce Developmentin a State-Local PH Network
Turning Point PM
Collaborative 104
1 – Assess Competency Using Consistent Methods and Tools
2 – Enhance Specific Competencies Based on Assessment
3 – Verify 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 – Verify Competent Performance in Workplace via Human Resource Management
4 – Recognize Competent Performance via System Incentives such as Credentialing
Public HealthWorkforce Development
Public HealthWorkforce Development
44
11
Core PublicHealth Practice
& BT/ERCompetencies
2
33
Turning Point PM
Collaborative 111
Components PresentIn This Example?
• Something needing “improvement” (is/is not) clearly identified
• 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
Turning Point PM
Collaborative 112
Summary – Case Study BWorkforce Development in a State-Local PH
Network
Who/What ?
Do What ?
Standards ?
Indicators ?
Reporting ?
Improvement ?
Turning Point PM
Collaborative 113
Case Study B to the Next Level
• Which PM components could be enhanced? How?
• For a companion effort at the state (or local) level, describe how the various PM components would be used.
• Have you been (are you now) involved in a similar effort? If so which PM components are in place? How could these be improved?