Demystifying Domain 9: Performance Management Strategies and Resources Micaela Kirshy, MPH, LICSW Project Manager, Performance Management and Quality Improvement

Roundtable Session Overview Explanation of Performance Management and Public Health Accreditation Board (PHAB) Domain 9 Public Health Performance Management Framework The Public Health Performance Management Self-Assessment Tool Performance Management Tools and Resources Closing the loop: Meeting Domain 9 Standards

What is Performance Management? “Performance management is the practice of actively using performance data to improve the public's health. This practice involves the strategic use of performance measures and standards to establish performance targets and goals.” Source: From Silos to Systems: Using Performance Management to Improve Public Health Systems – prepared by the Public Health Foundation for the Performance Management National Excellence Collaborative, 2003 Performance management uses a set of management and analytic processes supported by technology that enables an organization to define strategic goals and then measure and manage performance against those goals.

PHAB Accreditation: Domain 9 Standards Standard 9.1 Use a Performance Management System to Monitor Achievement of Organizational Objectives Standard 9.2 Develop and Implement Quality Improvement Processes Integrated Into Organizational Practice, Programs, Processes, and Interventions

PHAB Accreditation: Domain 9 For the health department to most effectively and efficiently improve the health of the population, it is important to monitor the quality of performance of public health processes, programs, interventions and other activities. A fully functioning performance management system that is completely integrated into health department daily practice at all levels includes: 1) setting organizational objectives across all levels of the department, 2) identifying indicators to measure progress toward achieving objectives on a regular basis 3) identifying responsibility for monitoring progress and reporting, 4) identifying areas where achieving objectives requires focused quality improvement processes.

Developed in 2013, adapted from the 2003 Turning Point Most have seen this Turning Point Model – the 30,000 foot view of what we’re talking about today. Turning Point Performance Management National Excellence Collaborative convened about a decade ago. Four year collaborative funded by RWJF established in 2000. Turning Point Performance Management Collaborative (PMC) – seven states (AK, IL, MO, MT, NH, NY, WV) and five national partners (ASTHO, NACCHO, CDC, HRSA, PHF) working to study and promote systems to manage public health performance 20+ years ago where we started seeing literature and observation about performance management working in other industries. We began asking questions, what does performance management look like in public health? Managing performance is what you do at the program, organization (local/state), or system level to ensure you get results. It’s the opposite of leaving things to chance. Developed in 2013, adapted from the 2003 Turning Point Performance Management System Framework

Performance Standards Identify relevant standards Select indicators Set goals and targets Communicate expectations Think about: Do you set or use standards, targets or goals for your organization or program? How do you communicate the expectations and strategic direction for your organization or program?

Performance Management Successes/Barriers: Performance Standards Success Factors Risk Factors Choose standards by themes to be cross-cutting Training Scrutinize regularly Use QI tools/methods to align and prioritize Align standards with policies Strategic plan alignment Difficult to develop standards Lack of meaningful vision Lack of program goals Tension between goals vs. program focus Funder driven standards vs. department driven standards Poor decision making Measurement becomes the standard

Performance Measurement Refine indicators and define measures Develop data systems Collect data Think about: How do you measure capacity, process or outcomes? What tools exist to support the efforts?

Performance Management Successes/Barriers: Performance Measurement Success Factors Risk Factors Results focus Mission  Data Routine part of work Leadership interest Experience teaches Training internally SMART measures developed through collaborating and listening Lack of clarity about what and how to measure Measures not connected to objectives Difficult to capture in one place Data overload – too much data gathering without prioritization

Reporting of Progress Analyze and interpret data Report results broadly Develop a regular reporting cycle Think about: Do you document or report your unit / program’s progress? Is this information regularly available? To whom? What is the frequency of analysis and reporting?

Performance Management Successes/Barriers: Reporting Progress Success Factors Risk Factors IT Infrastructure Standardized reporting Training on data interpretation Leadership investment in IT University partnerships Transparency and access to data Visible and useable data Tied to business plan Systems are siloed Community-level not integrated Data outdated Bias in favor of financial needs Internal reports too long External reports too brief Limited investment in time/people No follow-up action No sense of “why” No analysis Lack of infrastructure

Quality Improvement Use data for decisions to improve policies, programs and outcomes Manage changes Create a learning organization Think about: Do you have a quality improvement process? What do you do with information gathered through reports? Do you have the capacity to take action for improvement when needed?

Performance Management Successes/Barriers Quality Improvement Success Factors Risk Factors Mandated use of QI Formal QI office or staff providing TA Visibility of successes HC partners Leadership devoting time for sharing Open team for PM Standing discussion/agenda item No experience in QI QI vs. QA Lack of time and resources Lack of collaboration between and among departments Fear of consequences Disconnect with reporting No expectation of need for QI “Little QI” vs. “Big QI”

Visible Leadership Engage leadership in performance management Align performance management with organizational priorities Track and incentivize progress Think about: Does senior management take a visible role in performance management? Is performance management emphasized as a priority and goal for your work?

Performance Management Successes/Barriers: Visible Leadership Success Factors Risk Factors Learn from successes Outspoken proponents Reward success Looking for small wins Educate leaders “Silo busting” Building a culture Lack of clarity about what QI culture is and requires Lack of common priorities Use of data to penalize Risk averse and resistant to change Failing to ask tough questions Status quo/culture takes time to change Political Considerations Turnover

Public Health Performance Management Self-Assessment Tool “How well does your public health team, organization, or system manage performance? Use this assessment to find out if you have the necessary components in place to achieve results and continually improve performance. This self-assessment tool is a guide that was designed to be completed as a group, and can be adapted to fit an organization or system’s specific needs.”

Using the Performance Management Self-Assessment Tool Teams or programs can use this tool to assess relative performance management strengths and weaknesses in their areas of work Organizations can use this tool to assess relative performance management strengths and weaknesses across divisions and programs Systems composed more than one organization can use this tool to assess how well they are managing across the different parts of the system

Tips for Using the Performance Management Self-Assessment Preview the entire tool and definitions before you begin. The detailed questions in Sections II - V may help you better understand performance management and more accurately complete Section I, Visible Leadership. Be honest about what you are currently doing or not doing to manage performance. If you are doing very little in an area, it is better to say "Never" or “Sometimes” than to overstate the attention and resources allocated to it. For questions marked "Never," decision makers can determine the activity’s relevance, and if appropriate, choose to shift priorities or invest resources. Using information for such decision making is a basic tenet of performance management. If you are unsure how to answer a question, the leave it blank until you can find the answer. Use the Notes section at the bottom of each page. Write down improvement ideas, insights, or any qualifications to self- assessment answers. Your individual or group responses will help you interpret the results and choose follow-up actions to the assessment.

Snapshot of the Performance Management Self-Assessment

Public Health Performance Management Self-Assessment As you complete this assessment, or as a next step, your team should also discuss other important questions: What are examples of work that fall within a performance management system? Do we call them performance management? For those components of performance management we are doing, how well are we doing them? In which areas do we need to invest more time and resources to manage performance more successfully? What can leadership and staff do to make the performance management system work? What steps could we try out this month (or this week) to improve our performance management system?

Closing the Loop: Tackling Domain 9 Standard 9.1 Use a Performance Management System to Monitor Achievement of Organizational Objectives Public Health Performance Management Self- Assessment Tool Standard 9.2 Develop and Implement Quality Improvement Processes Integrated Into Organizational Practice, Programs, Processes, and Interventions QI activities based on identified needs of the program or organization

Resources and Tools Stories: Performance Management Examples From the Field Tool: Performance Management PDCA (Plan-Do-Check-Act) Self-Assessment Tool Whitepaper: Performance Management and Cultural Transformation Using PDCA Approach Technical Assistance: PHF’s Performance Management Workshop

Performance Standards Resources Healthy People 2020 Resources Provides performance standards for health departments and other organizations National Public Health Performance Standards Program (NPHPS) Which has developed a set of standardized goals for state and local public health systems and boards of health. The Program defines performance in each of the 10 Essential Public Health Services

Performance Standards Resources Healthy People 2020 Resources Provides performance standards for health departments and other organizations National Public Health Performance Standards Program (NPHPS) Which has developed a set of standardized goals for state and local public health systems and boards of health. The Program defines performance in each of the 10 Essential Public Health Services

COMING SOON: PHF Performance Management Toolkit One stop shop for all of your Performance Management needs Search for resources by Framework component Performance Management stories from others in the field Link to the Performance Management Self- Assessment Additional tools and resources

Public Health Foundation www.phf.org Micaela Kirshy MKirshy@phf.org