Performance Improvement Processes

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Performance Improvement Processes

• Survey of Tools and Approaches

Heidi Deutsch, MA, MSDM MAPP Program Manager
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Overview

• Defining Terms
• APEXPH
• MAPP
• Performance Standards
• PACE EH
• PATCH
• Performance Measurement

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Terms

• Performance Standards
• Performance Measurement
• Vs. Community Health Assessment
• Performance Monitoring
• Performance Management

4
Terms

• Performance Standards Generally accepted,
  objective standard of measurement against which
  an organizations level of performance can be
  compared.
• Performance Measures Analyzes the success by
  comparing data on what actually happened to what
  was planned or intended.
• Community Health Assessment type of performance
  measure.

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Terms

• Performance Monitoring Quantifying progress over
  time.
• Performance Management or Performance
  Improvement The process of using standards,
  measures, monitoring progress, towards
  performance improvement.

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APEXPH - Overview

• Part 1 Organizational Capacity Assessment
• Part 2 The Community Process
• Part 3 Completing the Cycle

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APEXPH - Benefits

• Assess organization and management of LHD
• Provide framework for working with community
• Link internal assessment with communitys
  priority areas
• Establish the leadership role of
• the LHD

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APEXPH Limitations

• LHD focused
• Measures may be out of date
• Part 3 not well developed
• Did not provide adequate attention to EH

Part 3
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MAPP - Origins
APEXPH MAPP
Build LHD leadership Build LHD leadership, AND promote community responsibility for Public Health
Assess LHD capacity for delivering public health services Assess capacity of entire local public health system
Operational planning Strategic planning
Focus on health status Focus on health status, community perceptions, forces of change, and system capacities
Develop plans to address needs Strategically match needs, resources, ideas, and actions
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MAPP - Overview
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The MAPP Assessments
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Local Public Health System
Police
MCOs
LHD
EMS
Laboratory Facilities
Parks
Schools
Elected Officials
Mass Transit
Hospitals
Environmental Health
Civic Groups
Urban Planners
Fire
Tribal Health
Drug Treatment
Corrections
Mental Health
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MAPP - Challenges

• Time
• Investment
• System Approach

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MAPP - Benefits

• Increases visibility of public health.
• Creates advocates for public health.
• Anticipates and manages change.
• Creates a stronger public health infrastructure.
• Builds stronger partnerships.
• Builds public health leadership.

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NPHPS/LPHSA - Overview

• 3 instruments - local, state and governance
• Measures the capacity of the local public health
  system to conduct essential public health services

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Four Concepts Applied in NPHPS

• 1. Based on the ten Essential Public Health
  Services
• 2. Focus on the overall public health system
• 3. Describe an optimal level of performance
• 4. Support a process of quality improvement

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NPHPS/LPHSAThe Instrument
Essential Service
Indicator
Model Standard
Measures
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NPHPS/LPHSA - Limitations

• Time
• Systems focused
• Not a complete performance improvement tool

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NPHPS/LPHSA - Benefits

• Improves organizational and
• community communication
• Brings partners to same table
• Promotes cohesion and collaborative
• Provides a systems view of public health services
  delivery
• Provides a benchmark for improvements

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PACE EH - Overview
Protocol for Assessing Community Excellence in
Environmental Health
A tool offering local health officials guidance
in conducting a community-based environmental
health assessment and creating an accurate
profile of a communitys environmental health
status
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Key Objectives of PACE EH

• Evaluate Environmental Health Conditions
• Target Populations at Risk
• Set Priorities
• Support Health Equity and Social Justice

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PACE EH - Outcomes

• Constituency-building
• Assessment function
• Match resources to needs
• Power-sharing with the community
• Focus on local situations and solutions
• Ground-up policy development process
• Database development

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PACE EH - Limitations

• EH focused
• Time/investment
• Does not use the 10 EPHS framework

Know your limitations
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PACE EH - Benefits

• Improved environmental health
• New and improved leadership role in community
  regarding EH issues
• Fosters new professional partnerships
• Fosters confidence to take on other large
  initiatives
• New relationship between LHD and community, from
  clients to partners
• Fosters local EH database development
• community members increased sense of ownership
  for the EH of their community

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PATCHPlanned Approach to Community Health

• Community planning model to assess and improve
  the health and quality of life in their
  communities.

www.cdc.gov/nccdphp/patch
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PATCH How It Compares

• Differences
• Focus on health promotion and traditional health
• Not systems based
• Uses a typical health assessment approach
• Not based on 10 EPHS

• Similarities
• Community-based
• Data driven
• Looks to increase community capacity

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Performance Measurement

• Is progress being made toward desired goals?
• Are appropriate activities being undertaken to
  promote achieving those goals?

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Performance Measurement

• What are our priority issues?
• What are the existing reporting requirements?
• What measures do other local agencies have to
  report on?

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What to Measure

• Capacities
• Processes
• Outcomes

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Design Criteria forPerformance Measurement

• Public contact information?
• Community/ stakeholder involvement process?
• Governance process?
• Policies/ protocols/ procedures for services?
• Program Plan/ goals/ objectives/ evaluation?
• Key indicators of performance, tracking,
  reporting?
• Workforce development/ credentials/ training?
• Quality improvement plan?

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Tools for Performance Measurement

• Sterling Criteria for Organizational Performance
  Excellence www.floridasterling.com
• Public Health Infrastructure Resource Center
  (PHIRC) www.phf.org
• Virginia Excels www.vaexcels.governor.virginia.gov
  , click on agency performance information.

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Performance MeasurementPitfalls

• Too many measures
• Measurement time frames too long (the
  population-based health outcome measure)
• Measure process rather than outcome (plan to
  plan)
• Applied in silos rather than systems
• Marginal approach, not related to core business

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Performance MeasurementLimitations

• Need long-term vision, objectives, and indicators
  of performance in order to provide appropriate
  direction for agency plans and measures.

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Key Differences
APEXPH / PATCH MAPP/ PACE-EH NPHPS PM
System x x
Strategic Planning x
PI/QI tool x x 1/2 1/2
Traditional x x
Measures for LHD x x
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Key Differences Cont.

• APEXPH Internal LHD and Community Health
  Assessments
• PACE EH Environmental health improvement process
  with a broad definition of environmental health
• MAPP A community health improvement process with
  a broad definition of public health
• NPHSP A performance measurement tool for the
  local public health system
• Performance Measures Internal LHD performance
  linked with health outcomes.

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Resources

• APEXPH, MAPP, NPHPSP www.naccho.org/topics/infrast
  ructure/MAPP.cfm
• PACE EH www.naccho.org/topics/environmental/CEHA.c
  fm
• Performance Measurement www.phf.org/infrastructure
  / , click on Performance Management

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Questions
MAPP/NPHPSP Heidi Deutsch 202-783-5550
x252 hdeutsch_at_naccho.org PACE EH Jonathan
Schwartz 202-783-5550 x250 jschwartz_at_naccho.org P
erformance Management Stacey Baker 202-218
-4416 sbaker_at_phf.org
Importance of Planning