Turning Point 1 Performance Management Using Information to Improve Public Health Practice February 13, 2003

Turning Point 2 Learning Objectives Gain understanding of the components of a performance management system Identify potential benefits of performance management Advance where we are in performance management Learn from one another

Turning Point 3 Turning Point’s National Excellence Collaboratives, Funded by Robt. Wood Johnson Foundation - States, communities, national partners –Combine collective experience, skills –Take next steps in transforming public health Review of literature & current practice; analysis Development of innovative models Testing and disseminating innovation Evaluation

Turning Point 4 Turning Point: National Excellence Collaboratives Public Health Statute Modernization Performance Management Information Technology Social Marketing Leadership Development

Turning Point 5 Performance Management Collaborative (PMC) Illinois* New York Montana Alaska New Hampshire Missouri West Virginia * Lead State 7 Turning Point States

Turning Point 6 More PMC Members TP National Program Office at Univ. of WA/School of Public Health National Partners –ASTHO –NACCHO –CDC –HRSA –ASTHLHLO

Turning Point 7 PMC Vision Widespread use of dynamic and accountable public health performance management

Turning Point 8 PMC Goals To develop useful and feasible performance management models for states To stimulate national dialogue and consensus on performance management in public health To support the application of performance management as a core discipline of public health practice

Turning Point 9 What Is Performance Management? The practice of actively using performance data to improve the public’s health. Performance management can be carried out at the program, organization, community and state levels.

Turning Point 10 Performance Management What you do with the information you’ve developed from measuring performance Using performance measurement to manage public health capacity and processes –Review services and programs –Assess progress against targets –Conduct employee evaluations –Formulate and justify budgets

Turning Point 11 Four Components of Performance Management Performance Standards Performance Measures Reporting of Progress Quality Improvement

Turning Point 12 Performance Standard A generally accepted, objective standard of measurement such as a rule or guideline against which an organization’s level of performance can be compared Establishes the level of performance expected

Turning Point 13 Performance Standard Descriptive – capacities or processes –A system for communicable disease surveillance and control shall be maintained –The information systems in use enable the collection, use and communication of data

Turning Point 14 Performance Standard Numerical – establishes a quantifiable level of achievement –At least 80% of community health center clients will be satisfied with the services received

Turning Point 15 Performance Measurement The selection and use of quantitative measures, capacities, processes and outcomes to develop information about critical aspects of activities, including their effect on the public

Turning Point 16 Performance Measurement The regular collection and reporting of data to track work produced and results achieved.

Turning Point 17 Performance Measure The specific quantitative representation of a capacity, process or outcome deemed relevant to the assessment of performance It measures something …usually progress toward an objective or goal

Turning Point 18 Performance Measures Examples –Percentage of children with age- appropriate immunization levels at age two –Percentage of target audiences that recall content of public service announcements, brochures or presentations

Turning Point 19 Jargon Alert Don’t let the terms goals, objectives, standards, indicators, measures catch you. What’s important is that we use intelligently selected and written measures to assist us in assessing if we are doing the right things in the right way.

Turning Point 20 Reporting of Progress Don’t hoard the data –Share with those who provided the data Convert it into useable information –So what? Know your audience –Is it agencies, lawmakers?

Turning Point 21 Reporting of Progress Provide context for the report –How do the measures relate to your mission and goals Create clear,easy to read, report designs –Use Simple charts and tables Determine Reporting Frequency –When and how often

Turning Point 22 Using Charts

Turning Point 23 Quality Improvement 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

Turning Point 24 Quality Improvement A dynamic and continuous process Doesn’t just look at outcomes – but the process to get there Not a new concept – 1950’s W. Edward Deming Plan–Do-Check-Act

Turning Point 25 Examples of Quality Improvement Florida Dept. of Health performs regular performance management reviews and provides feedback to local county administrators. Jointly develop a plan.

Turning Point 26 In a performance management system... 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: Turning Point Performance Management Collaborative.

Turning Point 27 Why Develop a PM System? To maximize public health’s effectiveness. This requires –More than measurement alone –More than standards alone –All four PM components to be continuously integrated into a system of performance management

Turning Point 28 Managerial Action Quality improvement efforts Policy change Resource allocation change Program change Using Data to Achieve Results

Turning Point 29 How Does NH Measure Up

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Turning Point 31 Survey of Performance Mgmt. Practices in States Baseline Assessment –Conducted by PHF –47 of 50 States Responded Survey Asks About: –Use of Performance Targets, Reports –Impact on Program and Policy –Need for New Tools

Turning Point 32 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)

Turning Point 33 Reported Positive Outcomes: 4Improved delivery of services—program services, clinical preventive services, essential services 4Improved administration/management— contracting, tracking/reporting, coordination 4Legislation or policy changes Performance Management Efforts Result in Improved Performance for Three-Quarters of SHAs Figure 19. Percentage of SHAs that report their performance management efforts resulted in improved performance (N=41)

Turning Point 34 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)

Turning Point 35 Top Three Models/Frameworks Explicitly Incorporated by SHAs Into Their Performance Management Efforts Healthy People Objectives Core Public Health Functions Ten Essential Public Health Services States use a variety of performance management models/frameworks, in a variety of combinations

Turning Point 36 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) *Correlation analysis revealed that there is a comparatively weak relationship between having performance targets, performance measures or performance reports and process for quality improvement (QI)/change. That is, in general, fewer states indicated that they did have a process for change, even though they indicated having performance targets, performance measures, or performance reports. This was the case for all areas of performance management studied (Human Resource Development, Data & Information Systems, Customer Focus and Satisfaction, Financial Systems, Management Practices, Public Health Capacity, and Health Status). Figure 15 illustrates this finding.

Turning Point 37 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) Note: Respondents could choose more than one response, so total does not equal 100

Turning Point 38 Funding for Performance Management Chosen as Number One Way to Improve States’ Efforts Figure 5. Types of aid identified as most useful to SHAs to improve SHA performance management efforts, in rank order (N=47)

Turning Point 39 Where do we go from here? One step at a time Develop performance measures Develop reports Develop quality improvement processes Look beyond categorical programs

Turning Point 40 Where do we go from here? Look beyond health indicators Look at systems Refine, revise, Learn from one another Keep on Truckin