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  • The expectations of National Excellence Collaboratives
  • The five Collaboratives, each working on tools to improve public health systems.
  • The Performance Management Collaborative’s participating states
  • The Performance Management Collaborative’s national partners
  • We would like to see the field move in this direction in the next five years
  • We believe these goals, if achieved, have significant implications for public health practice and workforce development.
  • The key words here for us are not “performance data”; they are “actively using”. Data mean nothing if they are not applied and used effectively. We’re working towards a very flexible model—a balanced management model for public health, not just measurement. The Collaborative’s preference is to carry out performance management at the systems level.
  • Deming changed industrial thinking about quality control with an emphasis on employee empowerment , performance feedback and measurement based management Can’t just look at the end of the production line for defects but need to look at the root cause or processes that may have caused a defect Continuous quality improvement is often referred as the Plan, Do Check Act process.
  • This is another view of our model. Note that the mission and strategy drive into all components of the performance management system . Each component of our framework interacts together as an integrated process to improve performance.
  • Why have we spent four years on this? What is the compelling reason for thinking about and changing the practice of performance management? The key is to integrate the four components into a continuous system.
  • Public health, like other sectors, needs management results in – READ ALL FOUR ALOUD These are the outputs of managerial action—what we are keeping our eyes on.
  • We wanted to increase our knowledge and better understand the scope and usefulness of current state practices. The baseline assessment conducted by the Public Health Foundation achieved an extremely high response rate.
  • What we learned is that nearly all states have some performance management efforts, but only about half of these are statewide efforts. We defined statewide very broadly, to encompass state-level efforts, state plus local health department efforts and local health department efforts only. The other (approximately) half are targeted at categorical programs only or had no PM effort at all.
  • Yes: 76% said PM improved their performance This positive view of the usefulness of PM efforts, combined with the fact that most state conduct some form of PM, is a very strong base to build on. A state may have a few of the pieces in place that can be the starting points to transition into a system-wide PM effort.
  • To what areas of public health practice is performance management applied? We found the components of performance management were most likely to be in place for health status (not surprising, since there are a number of tools available to assist users in health status assessment) More interesting, perhaps, is that our four components were least likely to be in place for human resource development or management of public health capacity.
  • State health agencies were very different in the array of performance management components they have in place. Overall, they were least likely to have a process for quality improvement or change. They were most likely to have performance measures or standards.
  • Sixty-three (63) percent don’t use incentives or disincentives to manage performance. Very small percentage of states use incentives and disincentives use PM in outside contracts, while even less use incentives or disincentives with staff.
  • We asked what would help states the most to improve their PM efforts. Not surprisingly, the top “vote-getter” for assistance needed to improve states’ performance management efforts was funding. It’s interesting to look at other factors, too. For example, A number of states want to understand what their colleagues in other states are doing in this area and would like technical consultations. Also receiving a large number of votes were a “toolkit” and national public health performance standards to ground their work.

performancesummit.ppt performancesummit.ppt Presentation Transcript

  • Performance Management Using Information to Improve Public Health Practice February 13, 2003
  • Learning Objectives
    • Gain understanding of the components of a performance management system
    • Identify potential benefits of performance management
    • Advance where we are in performance management
    • Learn from one another
  • Turning Point’s National Excellence Collaboratives, 2000-2004
    • Funded by Robt. Wood Johnson Foundation
    • - States, communities, national partners
      • Combine collective experience, skills
      • Take next steps in transforming public health
        • Review of literature & current practice; analysis
        • Development of innovative models
        • Testing and disseminating innovation
        • Evaluation
  • Turning Point: National Excellence Collaboratives
    • Public Health Statute Modernization
    • Performance Management
    • Information Technology
    • Social Marketing
    • Leadership Development
  • Performance Management Collaborative (PMC)
    • Illinois*
    • New York
    • Montana
    • Alaska
      • New Hampshire
      • Missouri
      • West Virginia
      • * Lead State
    7 Turning Point States
  • More PMC Members
    • TP National Program Office at Univ. of WA/School of Public Health
    • National Partners
      • ASTHO
      • NACCHO
      • CDC
      • HRSA
      • ASTHLHLO
  • PMC Vision
    • Widespread use of dynamic and accountable public health performance management
  • PMC Goals
    • To develop useful and feasible performance management models for states
    • To stimulate national dialogue and consensus on performance management in public health
    • To support the application of performance management as a core discipline of public health practice
  • What Is Performance Management?
    • The practice of actively using performance data to improve the public’s health.
    • Performance management can be carried out at the program, organization, community and state levels.
  • Performance Management
    • What you do with the information you’ve developed from measuring performance
    • Using performance measurement to manage public health capacity and processes
      • Review services and programs
      • Assess progress against targets
      • Conduct employee evaluations
      • Formulate and justify budgets
  • Four Components of Performance Management
    • Performance Standards
    • Performance Measures
    • Reporting of Progress
    • Quality Improvement
  • Performance Standard
    • A generally accepted, objective standard of measurement such as a rule or guideline against which an organization’s level of performance can be compared
    • Establishes the level of performance expected
  • Performance Standard
    • Descriptive – capacities or processes
      • A system for communicable disease surveillance and control shall be maintained
      • The information systems in use enable the collection, use and communication of data
  • Performance Standard
    • Numerical – establishes a quantifiable level of achievement
      • At least 80% of community health center clients will be satisfied with the services received
  • Performance Measurement
    • The selection and use of quantitative measures, capacities, processes and outcomes to develop information about critical aspects of activities, including their effect on the public
  • Performance Measurement
    • The regular collection and reporting of data to track work produced and results achieved.
  • Performance Measure
    • The specific quantitative representation of a capacity, process or outcome deemed relevant to the assessment of performance
    • It measures something …usually progress toward an objective or goal
  • Performance Measures
    • Examples
      • Percentage of children with age-appropriate immunization levels at age two
      • Percentage of target audiences that recall content of public service announcements, brochures or presentations
  • Jargon Alert
    • Don’t let the terms goals, objectives, standards, indicators, measures catch you.
    • What’s important is that we use intelligently selected and written measures to assist us in assessing if we are doing the right things in the right way.
  • Reporting of Progress
    • Don’t hoard the data
      • Share with those who provided the data
    • Convert it into useable information
      • So what?
    • Know your audience
      • Is it agencies, lawmakers?
  • Reporting of Progress
    • Provide context for the report
      • How do the measures relate to your mission and goals
    • Create clear,easy to read, report designs
      • Use Simple charts and tables
    • Determine Reporting Frequency
      • When and how often
  • Using Charts
  • Quality Improvement
    • 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
  • Quality Improvement
    • A dynamic and continuous process
    • Doesn’t just look at outcomes – but the process to get there
    • Not a new concept – 1950’s W. Edward Deming
    • Plan–Do-Check-Act
  • Examples of Quality Improvement
    • Florida Dept. of Health performs regular performance management reviews and provides feedback to local county administrators. Jointly develop a plan.
    • In a performance
    • management
    • system...
    • 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: Turning Point Performance Management Collaborative.
  • Why Develop a PM System?
    • To maximize public health’s effectiveness. This requires
      • More than measurement alone
      • More than standards alone
      • All four PM components to be continuously integrated into a system of performance management
    • Quality improvement efforts
    • Policy change
    • Resource allocation change
    • Program change
    Managerial Action Using Data to Achieve Results
  • How Does NH Measure Up
  •                                      
  • Survey of Performance Mgmt. Practices in States
    • Baseline Assessment
      • Conducted by PHF
      • 47 of 50 States Responded
    • Survey Asks About:
      • Use of Performance Targets, Reports
      • Impact on Program and Policy
      • Need for New Tools
  • Nearly All SHAs Have Some Performance Management 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)
    • Reported Positive Outcomes:
    • Improved delivery of services—program services, clinical preventive services, essential services
    • Improved administration/management— contracting, tracking/reporting, coordination
    • Legislation or policy changes
    Performance Management Efforts Result in Improved Performance for Three-Quarters of SHAs Figure 19. Percentage of SHAs that report their performance management efforts resulted in improved performance (N=41)
  • 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)
  • Top Three Models/Frameworks Explicitly Incorporated by SHAs Into Their Performance Management Efforts
    • Healthy People Objectives
    • Core Public Health Functions
    • Ten Essential Public Health Services
    States use a variety of performance management models/frameworks, in a variety of combinations
  • 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) *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 15 illustrates this finding.
  • 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
  • Funding for Performance Management Chosen as Number One Way to Improve States’ Efforts Figure 5. Types of aid identified as most useful to SHAs to improve SHA performance management efforts, in rank order (N=47)
  • Where do we go from here?
    • One step at a time
    • Develop performance measures
    • Develop reports
    • Develop quality improvement processes
    • Look beyond categorical programs
  • Where do we go from here?
    • Look beyond health indicators
    • Look at systems
    • Refine, revise,
    • Learn from one another
    • Keep on Truckin