Performance Improvement Processes Survey of Tools and Approaches Heidi Deutsch, MA, MSDM MAPP Program Manager

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

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

Terms Performance Standards: Generally accepted, objective standard of measurement against which an organization’s 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.

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

APEXPH - Overview Part 1 – Organizational Capacity Assessment Part 2 – The Community Process Part 3 – Completing the Cycle

APEXPH - Benefits Assess organization and management of LHD Provide framework for working with community Link internal assessment with community’s priority areas Establish the leadership role of the LHD

APEXPH – Limitations LHD focused Measures may be out of date Part 3 not well developed Did not provide adequate attention to EH Part 3

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

MAPP - Overview

The MAPP Assessments

Local Public Health System Home Health Police Community Centers Churches MCOs EMS LHD Laboratory Facilities Parks Schools Doctors Elected Officials Nursing Homes Philanthropist Hospitals Mass Transit Environmental Health Civic Groups Urban Planners Fire Economic Development Tribal Health Employers Drug Treatment Corrections Mental Health

MAPP - Challenges Time Investment System Approach

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.

NPHPS/LPHSA - Overview 3 instruments - local, state and governance Measures the capacity of the local public health system to conduct essential public health services

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

NPHPS/LPHSA The Instrument Essential Service Indicator Model Standard Measures

NPHPS/LPHSA - Limitations Time Systems focused Not a complete performance improvement tool

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

Protocol for Assessing Community Excellence in Environmental Health 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 community’s environmental health status

Key Objectives of PACE EH Evaluate Environmental Health Conditions Target Populations at Risk Set Priorities Support Health Equity and Social Justice

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

PACE EH - Limitations EH focused Time/investment Know your limitations EH focused Time/investment Does not use the 10 EPHS framework

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

PATCH Planned 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

PATCH – How It Compares Similarities: Differences: Community-based Data driven Looks to increase community capacity Differences: Focus on health promotion and traditional health Not systems based Uses a typical health assessment approach Not based on 10 EPHS

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

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

What to Measure Capacities Processes Outcomes

Design Criteria for Performance 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?

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”.

Performance Measurement Pitfalls 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

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

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

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.

Resources APEXPH, MAPP, NPHPSP www.naccho.org/topics/infrastructure/MAPP.cfm PACE EH www.naccho.org/topics/environmental/CEHA.cfm Performance Measurement www.phf.org/infrastructure/ , click on “Performance Management”

Importance of Planning Questions: MAPP/NPHPSP Heidi Deutsch 202-783-5550 x252 hdeutsch@naccho.org PACE EH Jonathan Schwartz 202-783-5550 x250 jschwartz@naccho.org Performance Management Stacey Baker 202-218 -4416 sbaker@phf.org Importance of Planning