Public%20Health%20Performance%20Management

1
Public HealthPerformance Management

• Turning Point
• Performance Management National Excellence
  Collaborative
• meeting name
• location
• date

Public Health Performance Management
Curriculum Prepared by Center for Public Health
Practice, UIC School of Public Health
2
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 Publics Health.
Turning Point Performance Management National
Excellence Collaborative Seattle WA Turning
Point National Program, 2003.
3
Learning Objectives

• Learners will be able to
• 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
• Advocate for the use of performance management in
  public health practice settings
• Identify and access resources to support
  performance management applications

4
Todays Program

1. Introduction
2. Pre-Test
3. Performance Management 101
4. Applications of Performance Management in Public
   Health Practice
5. Case Studies
6. Review and Summary
7. Post-Test/Course Evaluation

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Part IIPre-Test
6
Part IIIPerformance Management 101
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The Words

• Performance
• Execution, Accomplishment, Completion,
  Effectuation
• Management
• Supervision, Direction, Control, Manipulation

8
Basic Concepts

• Performance Management
• Control/Manipulation towards Accomplishment
• Key considerations the context
• Who or what performs?
• What is performed?

9
Focus on Performance

1. Marathon Runner
2. Not Your Fathers Oldsmobile
3. Unit Supervisor
4. Program (and Mega-Program) Manager
5. National Health Priority Initiative
6. National Public Health System
7. State Health Agency
8. State-Local Public Agency Network
9. Community Health Improvement Process
10. Public Health Workforce Development

10
Managing Performance (Ex 1)

• Marathon Runner
• trains 5x per week at various distances
• records times
• seeks to better last years time

11
Managing Performance (Ex 2)

• Your Fathers 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

12
Managing Performance (Ex 3)

• Unit Supervisor
• meets with employees annually to review job
  performance and set expectations for next year
• next years salary increment is tied to this
  years job performance?

13
Managing Performance (Ex 4)

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

14
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

15
Key Components of Performance Management

• Applying Appropriate Standards
• Measuring Key Aspects of Performance
• Reporting and Interpreting Measurements
• Making Changes Based on Measures of Performance

16
Critical components of performance management
Source Silos to Systems Using Performance
Management to Improve the Publics Health.
Turning Point Performance Management National
Excellence Collaborative Seattle WA Turning
Point National Program, 2003.
17

• 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 Publics Health.
Turning Point Performance Management National
Excellence Collaborative Seattle WA Turning
Point National Program, 2003.
18
Is Performance Managementthe Same Thing
asPerformance Measurement?Maybe Yes /
Maybe No
19

• 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 youve 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, 199948. 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 ---------gt ---------gt ---------gt ---------gt Self Improvement Application
Course Instructor Assessment ---------gt ---------gt ---------gt ---------gt Competency Acquisition Application
Workplace Assessment ---------gt ---------gt ---------gt ---------gt Personnel Mgt/ Competency Demo Application
External Certifying Body Assessment ---------gt ---------gt ---------gt ---------gt 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 stakeholders

Source lichiello P. Guidebook for Performance
Measurement. Seattle WA Turning Point National
Program Office, 199948. Based on Hatry HP et al,
Monitoring the Outcomes of Economic Development
Programs. Washington DC The Urban Institute
Press, 1990.
23
Critical components of performance management
Source Silos to Systems Using Performance
Management to Improve the Publics Health.
Turning Point Performance Management National
Excellence Collaborative Seattle WA Turning
Point National Program, 2003.
24
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
  doesnt always improve results
• Smart improvement relies on understanding how
  systems work
• Systems rely on interdependencies which are as
  important as the systems 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
  organizations or systems 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 Fathers 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 ?
39
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 IVApplications of Performance
Management in Public Health Practice
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Examples 4A, 4B, 4C
HD Program Ex 4A Community Ex 4B Statewide Ex 4C
Context Program program goals Program 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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Managing Performance (Ex 5)

• 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

44
Components PresentIn These 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 5
National Childhood Obesity (Ex 5)
Context ?
Standards ?
Measuring ?
Reporting ?
Improvement ?
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Summary Example 5
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
47
Managing Performance (Ex 6)

• 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
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Components PresentIn This Example?

• 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 6
National Public Health System (Ex 6)
Context ?
Standards ?
Measuring ?
Reporting ?
Improvement ?
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Summary Example 6
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 publics 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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Conceptual Framework of the Public Health
System as a Basis for
Measuring Public Health System Performance
Source Handler A, Issel M, and Turnock B. 2001.
A conceptual framework to measure performance of
the public health system. Am J Public Health,
911235-1239.
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Public Health Performance Measures Capacity,
Process, and Outcomes
Process (Essential Public Health Services)
Capacity
Outcomes
Outputs
Key Processes
Improved organizational performance Improved
program performance
Develop Policy
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.
56
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.

58
SHAs Most Likely to Have Components of
Performance Management for Health StatusLeast
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 (N25)
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.
59
Nearly All SHAs Have Some PerformanceManagement
EffortsHowever, only about half apply
performance management efforts statewide beyond
categorical programs

• Figure 1. Agencies or programs to which SHAs
  apply performance management efforts (N47)

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.
60
Most SHAs Have Performance Measures, Targets, and
Reports, While Fewer States HaveProcess for
Quality Improvement or Change
Figure 15. Percentage of SHAs that have
specified components of performance management
for public health capacity (N25)
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.
61
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 (N40)
Note Respondents could choose more than one
response, so total does not equal 100.
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.
62
Performance Measure Sources
Capacity Process Outcome
Healthy People 2010 (1) ? ?
Core Functions (2) ?
EPHS (3) ?
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.
63
Managing Performance (Ex 7)

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

64
Components PresentIn This Example?

• 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?

65
Summary Example 7
State Health Agency (Ex 7)
Context ?
Standards ?
Measuring ?
Reporting ?
Improvement ?
66
Summary Example 7
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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Managing Performance (Ex 8)

• 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?

• 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 8
State-Local PH Network (Ex 8)
Context ?
Standards ?
Measuring ?
Reporting ?
Improvement ?
70
Summary Example 8
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

• Marathon Runner
• Not Your Fathers Oldsmobile
• Unit Supervisor
• Program (and Mega-Program) Manager
• National Health Priority Initiative
• National Public Health System
• State Health Agency
• State-Local Public Agency Network
• Community Health Improvement Process
• Public Health Workforce Development

Indicates number of case studies available for
various PM applications
72
Part VCase Studies
73
Part V Example 9 Case Study Moose
County Community Health Improvement Process Using
MAPP
74
Community
The CHIP Process
Health Needs
Assessment
Community
Health Plan
Evaluation
Program Development
Implementation
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The MAPP Model
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Another View of MAPP Model
Evaluate
Community Health Status Assessment
Community Generated Themes
Organize For Success
Review Mandates, Mission, Stakeholder
Expectations, and Goals
Identify Strategic Issues
Vision For Success
Formulate Strategies
Implement Strategies
Local Public Health System Assessment
Contextual Environment Assessment
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Community Health Plan
Health Problem
Outcome Objective
By 2004, reduce stroke deaths to no more than 70
per 100,000 (Baseline 1997 crude rate 76.5 per
100,000).
Cerebrovascular Disease (Stroke)
Risk Factor
Impact Objective
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).
Tobacco Use
Contributing Factors
Proven Intervention Strategies
Addiction Sedentary Lifestyle Hypertension Adverti
sing (Indirect)
Coalition will implement CDCs community-based
tobacco control program, focusing on delaying
initiation, cessation programs, and advertising
control.
Barriers
Resources Available
Limited number smokers seeking counseling. Media
messages promote smoking. Peer pressure.
Coalition will provide support to LHD with
in-kind donations, staff, and clinical counseling
space.
78
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.
79
Components PresentIn This Example?

• 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?

80
Summary Example 9
Moose County CHIP Using MAPP
Context ?
Standards ?
Measuring ?
Reporting ?
Improvement ?
81
Summary Example 9
Moose County CHIP Using MAPP
Context 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?
82
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.

83
Part VExample 10 Case Study PH Workforce
Development in Grey State/Coyote County
84
Public HealthWorkforce Preparedness
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
Core Public Health Practice BT/ER Competencies
2
3
85
Different Indicators Used to Measure Performance
(Workforce Competency)
Self Assessment ---------gt ---------gt ---------gt ---------gt Self Improvement Application
Course Instructor Assessment ---------gt ---------gt ---------gt ---------gt Competency Acquisition Application
Workplace Assessment ---------gt ---------gt ---------gt ---------gt Personnel Mgt/ Competency Demo Application
External Certifying Body Assessment ---------gt ---------gt ---------gt ---------gt Credentialing Application
86

• 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

87
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88
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

89
CCHD Workers Before After
90
Components PresentIn This Example?

• 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?

91
Summary Example 10
Coyote County Health Dept. PH Workforce Development
Context ?
Standards ?
Measuring ?
Reporting ?
Improvement ?
92
Summary Example 10
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
93
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.

94
Part VIReview and Summary
95
Critical components of performance management
Source From Silos to Systems Using Performance
Management to Improve the Publics Health.
Turning Point Performance Management National
Excellence Collaborative Seattle WA Turning
Point National Program, 2003.
96
Apply Standards, Set Targets
Marathon Runner Previous personal best time
Your Fathers 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 Objectives Process - National Public Health Performance Standards
State Health Agency Outcomes Healthy People 2010 Objectives, Baldridge Quality Criteria Process - National Public Health Performance Standards
State-Local Public Agency Network Outcomes Healthy People 2010 Objectives Process - National Public Health Performance Standards
Community Health Improvement Process Outcomes Healthy People 2010 Objectives Process - National Public Health Performance Standards
PH Workforce Development Core public health practice competencies
97
Measure Performance
Marathon Runner Training times for specific distances
Fathers 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
National Public Health System Surveillance of core function or EPHS performance
State Health Agency Outcomes, activities, costs, satisfaction, etc
State-Local Public Agency Network Outcomes, compliance with standards, activities?
Community Health Improvement Process Outcomes and contributing factors in community
PH Workforce Development Various views of individual competency
98
Report Information
Marathon Runner Personal training log
Fathers Oldsmobile Dashboard and other instruments
Unit Supervisor Monthly or quarterly progress reports
Program Manager Quarterly progress reports
National Health Priority Annual review
National Public Health System Annual surveillance
State Health Agency Agency management
State-Local Public Agency Network Unclear
Community Health Improvement Process Community Health Partnership, policy makers, public
PH Workforce Development Individuals, agency management
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Quality Improvement
Marathon Runner Revise race strategy
Fathers Oldsmobile Adjust tire air pressure, oil, water, speed, direction
Unit Supervisor Set new performance expectations
Program Manager Revise program objectives and workplan
National Health Priority Secure new commitments redeploy resources new policies
National Public Health System Incentives redeploy resources
State Health Agency Management decisions incentives resource allocation
State-Local Public Agency Network Incentives resource allocation?
Community Health Improvement Process Secure new commitments redeploy resources
PH Workforce Development 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 Publics Health.
Turning Point Performance Management National
Excellence Collaborative Seattle WA Turning
Point National Program, 2003.
101
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 Accountability
Marathon Runner Commitment Leadership Informed Decision Making Incentives Accountability
Fathers Oldsmobile Commitment Leadership Informed Decision Making Incentives Accountability
Unit Supervisor Commitment Leadership Informed Decision Making Incentives Accountability
Program Manager Commitment Leadership Informed Decision Making Incentives Accountability
National Health Priority Commitment Leadership Informed Decision Making Incentives Accountability
National Public Health System Commitment Leadership Informed Decision Making Incentives Accountability
State Health Agency Commitment Leadership Informed Decision Making Incentives Accountability
State-Local Public Agency Network Commitment Leadership Informed Decision Making Incentives Accountability
Community Health Improvement Process Commitment Leadership Informed Decision Making Incentives Accountability
PH Workforce Development Commitment Leadership Informed Decision Making Incentives Accountability
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Public Health Agency as a Learning
OrganizationCore Organizational Competencies
SupportStrategic Planning / Change Processes
lt Strategy Formation gt
lt Implementation gt
Health System
Forces / Trends
Stakeholders
MANDATES
External Environment
Core Functions Essential Public Health Services
Opportunities / Threats
Actions
Results
Organizational Systems Design Development
Planning to Plan
Strategic Issues
Strategies
Vision Mission Values
Strengths / Weaknesses
Internal Environment
Competencies
Capacity
Barriers
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.
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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 (contd)

• 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 stakeholders

Source lichiello P. Guidebook for Performance
Measurement. Seattle WA Turning Point National
Program Office, 199948. Based on Hatry HP et al,
Monitoring the Outcomes of Economic Development
Programs. Washington DC The Urban Institute
Press, 1990.
107
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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Why Use Performance Management?

• Quality improvement efforts
• Policy change
• Resource allocation change
• Program change

Managerial Action
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Performance Mgt Resources

1. 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 Publics 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 VIIPost-Test Course Evaluation