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Public Health Performance Management

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    Public Health Performance Management Public Health Performance Management Presentation Transcript

    • Public Health Performance Management Turning Point Performance Management National Excellence Collaborative April 2004 Public Health Performance Management Curriculum Turning Point Prepared by Center for Public Health Practice, UIC School of Public Health PM 1 Collaborative
    • 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 Turning Point Collaborative: Seattle WA; Turning Point National Program, 2003. PM 2 Collaborative
    • 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 Turning Point PM 3 Collaborative
    • Today’s Program I. 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) Turning Point PM 4 Collaborative
    • Part II Pre-Test Turning Point PM 5 Collaborative
    • Part III Performance Management 101 Turning Point PM 6 Collaborative
    • The Words “Performance” – Execution, Accomplishment, Completion, Effectuation “Management” – Supervision, Direction, Control, Manipulation Turning Point PM 7 Collaborative
    • Basic Concepts “Performance Management” – Control/Manipulation towards Accomplishment – Key considerations • Who or what performs? (subject = “who/what”) • What is performed? (object = “do what”) Turning Point PM 8 Collaborative
    • Focus on Performance 1. Marathon Runner 2. Unit Supervisor 3. Program Manager 4. State Health Agency 5. State-Local Public Agency Network 6. National Health Priority Initiative 7. National Public Health System 8. Community Health Improvement Process 9. Public Health Workforce Development Turning Point PM 9 Collaborative
    • Managing Performance (Ex 1) Marathon Runner • trains 5x per week at various distances • records times • seeks to better last year’s time Turning Point PM 10 Collaborative
    • 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? Turning Point PM 11 Collaborative
    • Managing Performance (Ex 3) Program Manager • establishes objectives • reports quarterly • seeks continuation funding year after year Turning Point PM 12 Collaborative
    • Common Elements from 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 Turning Point PM 13 Collaborative
    • Key Components of Performance Management • Applying Appropriate Standards • Measuring Key Aspects of Performance • Reporting and Interpreting Measurements • Making Changes Based on Measures of Performance Turning Point PM 14 Collaborative
    • Critical components of performance management Source: Silos to Systems: Using Performance Management to Improve the Public’s Turning Point Health. Turning Point Performance Management National Excellence Collaborative: 15 Seattle WA; Turning Point National Program, 2003. PM Collaborative
    • 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 Turning Point Health. Turning Point Performance Management National Excellence Collaborative: 16 Seattle WA; Turning Point National Program, 2003. PM Collaborative
    • Aren’t Performance Management and Performance Measurement the Same Thing? Turning Point PM 17 Collaborative
    • 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 Turning Point Economic Development Programs. Washington DC: The Urban Institute Press, 1990. PM 18 Collaborative
    • 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 Turning Point PM 19 Collaborative
    • Different Indicators Used to Measure Performance (Staff Competency) Self Assessment ---------> Self Improvement Application Course Competency Acquisition Instructor Application Assessment ---------> Workplace Personnel Mgt/ Assessment Competency Demo ---------> Application External Certifying Credentialing Body Application Assessment ---------> Turning Point PM 20 Collaborative
    • Managers Can Use Performance 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 stakeholders 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 Turning Point Economic Development Programs. Washington DC: The Urban Institute Press, 1990. PM 21 Collaborative
    • 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 Turning Point National Program Office, 1999. PM 22 Collaborative
    • Critical components of performance management Source: Silos to Systems: Using Performance Management to Improve the Public’s Turning Point Health. Turning Point Performance Management National Excellence Collaborative: 23 Seattle WA; Turning Point National Program, 2003. PM Collaborative
    • 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 Turning Point PM 24 Collaborative
    • 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? Turning Point PM 25 Collaborative
    • Measuring Performance • Relies on indicators that document where performance is in relation to the target or standard • Develop data systems • Collect data Turning Point PM 26 Collaborative
    • Is there a Performance Measurement component? • Have the indicators been refined? • Have data systems been developed? • Has data been collected? Turning Point PM 27 Collaborative
    • Reporting Progress • Analyze data • Convert data into useable information • Feedback to managers, staff, policy makers, and constituents • Develop a regular reporting cycle Turning Point PM 28 Collaborative
    • 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 Turning Point PM 29 Collaborative
    • 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? Turning Point PM 30 Collaborative
    • 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 Turning Point PM 31 Collaborative
    • 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? Turning Point PM 32 Collaborative
    • For Successful Performance Management All four Performance Management components must be present! And they must be integrated into the organization’s or system’s core operations! Turning Point PM 33 Collaborative
    • Concepts and Components to 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 Turning Point PM 34 Collaborative
    • Summary - Example 1 Marathon (1) Who/What Runner Do What Run fast Standards Previous time Indicators “Splits” Reporting Log Improvement Strategy Turning Point PM 35 Collaborative
    • Summary - Example 2 Supervisor (2) Who/What Worker Do What Job duties Standards Set annually Indicators Work prods Reporting Perf Appraisal Improvement New Objs, More $ ? Turning Point PM 36 Collaborative
    • Summary – Example 3 Program Mgr (3) Who/What Program Do What Program Goals Standards Approved Objectives Indicators Info on Activities Reporting Quarterly Reports Improvement Revised Workplan Turning Point PM 37 Collaborative
    • Summary - Examples 1-3 Marathon (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 Turning Point PM 38 Collaborative
    • OK, Sounds Simple Enough! But How Does This Work for More Complex Examples? Turning Point PM 39 Collaborative
    • Part IV Applications of Performance Management in Public Health Practice Turning Point PM 40 Collaborative
    • Public Health Performance 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) Turning Point PM 41 Collaborative
    • Conceptual Framework of the Public Health System as a Basis for Measuring Public Health System Performance P U B Structural Capacity L ----------------- M I Information Resources A C Organizational Resources C Physical Resources Human Resources R H Fiscal Resources O E A PHS Mission C L and Purpose O T ---------------- N H Philosophy Goals T "Core Functions" E S Processes Outcomes X Y ------------------- --------------- T S The 10 Essential Effectiveness Public Health Efficiency T Services Equity E M Source: Handler A, Issel M, and Turnock B. 2001. A conceptual framework to measure Turning Point performance of the public health system. Am J Public Health, 91:1235-1239. PM 42 Collaborative
    • Conceptual Framework of the Public Health System as a Basis for Measuring Public Health System Performance P U B Structural Capacity L ----------------- M I Information Resources A C Organizational Resources C Physical Resources Human Resources R H Fiscal Resources O E PHS Mission A and Purpose C L O T Philosophy N H Goals "Core Functions" T E S Processes Outcomes X Y ------------------- --------------- T S The 10 Essential Effectiveness Public Health Efficiency T Services Equity E M Source: Handler A, Issel M, and Turnock B. 2001. A conceptual framework to measure Turning Point performance of the public health system. Am J Public Health, 91:1235-1239. 43 PM Collaborative
    • Public Health Performance Measures: Capacity, Process, and Outcomes Process Capacity (Essential Public Health Services) Outcomes Outputs System Inputs Key Processes Improved Programs and organizational Workforce Services performance Assess Develop Assure Information Policy consistent with Improved Organization & mandates and program Relationships community performance Facilities priorities Funding Improved Outcomes & Customer Satisfaction Increased Value & Public Support Source: Turnock BJ. Public Health: What It Is and How It Works, 3rd Edition. Boston MA; Jones & Bartlett, 2004.
    • 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.) Turning Point PM 45 Collaborative
    • Public Health Applications • Human resource development • Data and information systems • Customer focus and satisfaction • Financial systems • Management practices • Public Health capacity • Health status Turning Point PM 46 Collaborative
    • 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) None 4% (2) SHA wide 32% (15) Categorical programs only 43% (20) Local public SHA wide health and local agencies only public health 4% (2) agencies Source: Turning Point Survey on Performance Management Practices in 17% (8) States: Results of a Baseline Survey of State Health Agencies. Seattle Turning Point WA; Turning Point National Program Office, 2002. PM 47 Collaborative
    • 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) 100 Percentage of States (N=25) 90 80 70 60 (15) 60 44 (11) 50 40 (10) 36 (9) 40 30 20 10 0 Performance Targets Performance Measures Performance Reports Process for QI/Change or Standards *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 Turning Point Agencies. Seattle WA; Turning Point National Program Office, PM 48 2002. Collaborative
    • 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) 100 90 80 Percentage of States (N=40) 70 63 (25) 60 50 40 30 (12) 30 20 (8) 20 13 (5) 8 (3) 10 0 Incentives for Incentives for Staff Disincentives for Disincentives for Staff None Agencies, Programs, Agencies, Programs, Divisions Divisions Note: Respondents could choose more than one response, so total does not equal 100. Turning Point Source: Turning Point Survey on Performance Management Practices in States: Results of a 49 Baseline Survey of State Health Agencies. Seattle WA; Turning Point National Program Office, PM 2002. Collaborative
    • 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 Human Resource Development Data & Information Systems Public Health Capacity Performance Measures or Health Status Human Resource Development Standards Data & Information Systems Customer Focus and Satisfaction Performance Reports Health Status Human Resource Development Data & Information Systems Public Health Capacity Management Practices Process for QI/Change Health Status Human Resource Development Customer Focus and Satisfaction Public Health Capacity Management Practices Source: Turning Point Survey on Performance Management Practices in States: Results of a Turning Point Baseline Survey of State Health Agencies. Seattle WA; Turning Point National Program PM 50 Office, 2002. Collaborative
    • Performance Measure Sources Capacity Process Outcome Healthy 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 Turning Point Agencies. Seattle WA; Turning Point National Program Office, 2002. PM 51 Collaborative
    • 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. Turning Point PM 52 Collaborative
    • 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 Turning Point PM 53 Collaborative
    • Components Present In 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 54 Collaborative
    • Summary – Example 4 State Health Agency (4) Who/What ? Do What ? Standards ? Indicators ? Reporting ? Improvement ? Turning Point PM 55 Collaborative
    • 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 Turning Point PM 56 Collaborative
    • Components Present In 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 57 Collaborative
    • Summary – Example 5 State-Local Public Health Network (5) Who/What ? Do What ? Standards ? Indicators ? Reporting ? Improvement ? Turning Point PM 58 Collaborative
    • 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 Turning Point PM 59 Collaborative
    • Components Present In 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 60 Collaborative
    • Summary – Example 6 National Epidemic of Childhood Obesity (6) Who/What ? Do What ? Standards ? Indicators ? Reporting ? Improvement ? Turning Point PM 61 Collaborative
    • Summary - Examples 4-6 SHA (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 Turning Point PM 62 Collaborative
    • 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 Turning Point PM 63 Collaborative
    • Comparison of Performance Measures Aggregated by Core Function 100 Assessment 90 Policy Development 80 Assurance 70 60 50 40 30 20 10 0 1992 1994 1999 1993 1995 Turning Point PM 64 Mystate Mystate Mystate National National Collaborative
    • Components Present In 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 65 Collaborative
    • Summary – Example 7 National Public Health Network (7) Who/What ? Do What ? Standards ? Indicators ? Reporting ? Improvement ? Turning Point PM 66 Collaborative
    • 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? Turning Point PM 67 Collaborative
    • Examples and Case Studies 1. Marathon Runner 2. Agency Supervisor 3. Program Manager 4. State Health Agency (C) 5. State-Local Public Agency Network (D,E) 6. National Health Priority Initiative 7. National Public Health System 8. Community Health Improvement Process (A) 9. Public Health Workforce Development (B) Turning Point PM 68 Collaborative
    • Part V Case Studies Turning Point PM 69 Collaborative
    • Part VI Review and Summary Turning Point PM 70 Collaborative
    • Critical components of performance management Source: From Silos to Systems: Using Performance Management to Improve the Turning Point Public’s Health. Turning Point Performance Management National Excellence 71 Collaborative: Seattle WA; Turning Point National Program, 2003. PM Collaborative
    • 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 Objectives Process - National Public Health Performance Standards State-Local Public Outcomes – Healthy People 2010 Objectives Agency Network Process - National Public Health Performance Standards National Health Priority Target established for childhood obesity prevalence National Public Health Outcomes – Healthy People 2010 Objectives System Process - National Public Health Performance Standards Community Health Outcomes – Healthy People 2010 Objectives Improvement Process Process - National Public Health Performance Standards Public Health Workforce Core public health practice competencies Development Turning Point PM 72 Collaborative
    • Measure Performance Marathon 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 Turning Point PM 73 Collaborative
    • Report Information Marathon 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 Turning Point PM 74 Collaborative
    • Quality Improvement Marathon 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 Turning Point PM 75 Collaborative
    • 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 Turning Point Public’s Health. Turning Point Performance Management National Excellence 76 Collaborative: Seattle WA; Turning Point National Program, 2003. PM Collaborative
    • For Successful Performance Management All four Performance Management components must be continuously integrated into the core operations of the agency or system Turning Point PM 77 Collaborative
    • Capacity & Accountability Marathon 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 Turning Point PM 78 Collaborative
    • Public Health Agency as a Learning Organization: Core Organizational Competencies Support Strategic Planning / Change Processes < Strategy Formation > < Implementation > Forces / Health Stakeholders Trends System MANDATES External Core Functions Environment & Opportunities / Essential Public Threats Actions Results Health Services Organizational Planning Strategic Systems Design Strategies & Development to Plan Issues Vision Strengths / Weaknesses Mission Internal Values Environment Capacity Competencies Barriers Turning Point 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. PM 79 Collaborative
    • 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 Turning Point PM 80 Collaborative
    • 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 Turning Point PM 81 Collaborative
    • Why Use Performance 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 Turning Point PM 82 Collaborative
    • Why Use Performance Management? • Quality improvement efforts • Policy change Managerial Action • Resource allocation change • Program change Turning Point PM 83 Collaborative
    • Part VII Post-Test & Course Evaluation Turning Point PM 84 Collaborative
    • Performance Mgt Resources Turning Point PM National Excellence Collaborative 1. 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) Turning Point PM 85 Collaborative
    • Part V Case Study A Community Health Improvement Process Using MAPP Turning Point PM 86 Collaborative
    • Community The Health Needs Assessment CHIP Process Community Health Plan Program Development Evaluation Implementation Turning Point PM 87 Collaborative
    • The MAPP Model Turning Point PM 88 Collaborative
    • Another View of MAPP Model Evaluate Community Health Community Status Generated Assessment Themes Organize Review Identify For Mandates, Vision For Strategic Formulate Implement Success Mission, Success Issues Strategies Strategies Stakeholder Expectations, and Goals Local Public Contextual Environment Health System Assessment Assessment Turning Point PM 89 Collaborative
    • Health Priority A situation or condition of people which is considered undesirable, Indirect Contributing is likely to exist in the future, and Factors Direct Contributing is measured as death, disease, or Factors disability. Risk Factors Health Priority
    • Risk Factor A scientifically established Indirect Contributing factor (determinant) that Direct Contributing Factors relates directly to the level of a Factors health problem. Risk Factors Health Priority
    • Direct Contributing Factor A scientifically established Indirect Contributing factor that directly affects Direct Contributing Factors the level of a risk factor. Factors Risk Factors Health Priority
    • Indirect Contributing Factors A community specific factor that directly affects the level of the direct contributing Indirect Contributing factor. Factors Direct Contributing Factors Risk Factors Health Priority
    • Outcome Objective The level to which a Indirect Contributing health problem Direct Contributing Factors (priority) should be Factors reduced. Risk Factors Health Priority
    • Indirect Contributing Direct Contributing Factors Factors Risk Factors Health Priority Impact Objective The level to which a risk factor should be reduced.
    • Indirect Contributing Direct Contributing Factors Factors Risk Factors Health Priority Intervention Strategy Impact Objective The level to which a Demonstrated to be effective or risk factor should be used as national model and should reduced. address an impact objective.
    • Community Health Plan: Worksheet Health Problem Outcome Objective 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). Risk Factor Impact Objective 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). Contributing Factors Proven Intervention Strategies Addiction Coalition will implement CDC=s Sedentary Lifestyle community-based tobacco control Hypertension program, focusing on delaying initiation, Advertising (Indirect) cessation programs, and advertising control. Resources Available Barriers Limited number smokers seeking Coalition will provide support to counseling. LHD with in-kind donations, staff, Media messages promote smoking. and clinical counseling space. Peer pressure.
    • Community Health Plan Description of the Health Problem, Risk Factors and Contributing Factors 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. Corrective Actions 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. Proposed Community Organizations 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. Evaluation Plan 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.
    • Add Slides for Case Study A Here! Turning Point PM 99 Collaborative
    • Components Present In 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 100 Collaborative
    • Summary – Case Study A Community Health Improvement Process Using MAPP Who/What ? Do What ? Standards ? Indicators ? Reporting ? Improvement ? Turning Point PM 101 Collaborative
    • 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 102 Collaborative
    • Part V Case Study B Workforce Development in a State-Local PH Network Turning Point PM 103 Collaborative
    • Public Health Workforce Development 1 – Assess Competency Using Consistent Methods and Tools 2 – Enhance Specific Competencies Based 1 on Assessment 4 Core Public 3 – Verify Competent Performance in Health Practice Workplace via Human Resource Management & BT/ER Competencies 2 4 – Recognize Competent Performance via System Incentives such as Credentialing 3 Turning Point PM 104 Collaborative
    • Case Study B Turning Point PM 105 Collaborative
    • Case Study B Turning Point PM 106 Collaborative
    • Case Study B Turning Point PM 107 Collaborative
    • Case Study B Turning Point PM 108 Collaborative
    • Case Study B Turning Point PM 109 Collaborative
    • Case Study B Turning Point PM 110 Collaborative
    • Components Present In 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 111 Collaborative
    • Summary – Case Study B Workforce Development in a State-Local PH Network Who/What ? Do What ? Standards ? Indicators ? Reporting ? Improvement ? Turning Point PM 112 Collaborative
    • 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? Turning Point PM 113 Collaborative