From Standards to Improvement: Laura B. Landrum, Illinois Public Health Institute NWCPHP Hot Topics Forum, August 11, 2005 Steps to Managing Effective Public Health Organizations

Learning Objectives  Define key concepts and components of performance management  Identify a variety of public health organizational and programmatic applications of performance management  Describe potential benefits of performance management

A Basic Definition “Performance Management” Control towards accomplishment In public health, the active and strategic use of performance data to improve the public’s health

Source: Silos to Systems: Using Performance Management to Improve the Public’s Health. Turning Point Performance Management National Excellence Collaborative: Seattle, WA; Turning Point National Program, Turning Point Performance Management Model

Seeks to better last year’s time Trains 5 x per week at various distances Records times + variables Makes adjustments Pace, workout, shoes, etc. Everyday Example: Marathon Runner

 Individual Process (e.g., disease reporting)  Unit or Team  Program or Division  Public Health Workforce Development  National Health Priority Initiative  State Health Agency  State-Local Public Agency Network  Community Health Improvement Process  National Public Health System Performance Management Scenarios at Many Levels

Question A.Identify relevant standards B.Select indicators for those standards C.Set goals and objectives D.Communicate expectations In planning for bioterrorism preparedness, which of the following has your jurisdiction done best?

Identify and apply relevant standards of performance (what will be measured) Objective standards or guidelines that describe optimal or required performance Typically from external sources: National or state organizations, funders, scientific data, benchmarking, etc. Use existing standards wherever possible 1. Applying Appropriate Standards

Set goals and targets. The planned or expected level of performance May be the same as, higher, or lower than the standard What must be achieved, by whom, and when Communicate expectations.

Question A.Refine selected indicators of performance B.Define specific measures for those indicators C.Develop data systems that capture the measures D. Collect the data In responding to a potential bioterrorism event, which of the following measurement functions has your jurisdiction done best?

Specific data or information used to assess progress toward a performance standard Regular collection and reporting of data to track work produced and results achieved Source: Lichiello, P. Guidebook for Performance Measurement. Seattle, WA: Turning Point National Program Office, 1999:48. Based on Hatry, H.P. et al., Monitoring the Outcomes of Economic Development Programs. Washington D.C.: The Urban Institute Press, Performance Measurement

Quantitative measures of capacities, processes, or outcomes relevant to the assessment of public health performance For example: The number of trained epidemiologists available to investigate outbreaks (capacity measure) The percentage of notifiable diseases reports submitted within the required time lines (process measure) Percentage of food-borne outbreaks controlled in time to prevent serious health complications in the jurisdiction (outcome measure) 2. Performance Measurement

Requires detailed data definitions and sources Trained epidemiologists = Persons whose job role is identified as “Epidemiologist” and have received formal epidemiology training through one of the following, as reported in the state learning management system: (a) a masters or doctorate program (b) a graduate public health certificate program (c) completion of the CDC “Fundamentals of Epidemiology” course in the past three years with an 80% score or higher 2. Performance Measurement

Is performance measurement the same thing as performance management? A. Yes B. No Question

Performance Management is what you do with information you’ve developed from measuring performance. Caution! It’s not performance management if… It addresses only the first three components (missing QI) Use of data stops after measurement or achievement at one point in time (Ex: an audit, some accreditation programs) Source: Lichiello P. Guidebook for Performance Measurement. Seattle, WA: Turning Point National Program Office, 1999:48. Based on Hatry, H.P. et al., Monitoring the Outcomes of Economic Development Programs. Washington D.C.: The Urban Institute Press, Performance Management

Analyze data Convert data into useable information Feedback to managers, staff, policy makers, and constituents Develop a regular reporting cycle 3. Reporting of 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 frequency When and how often 3. Reporting of Progress

Question A.Involving external partners in public health work B. Setting priorities for action (paralysis by analysis) C. Deploying people and dollars to implement the organization’s priorities D. Helping staff understand the organization’s mission, priorities, and strategies In your jurisdiction, what are the most difficult challenges to establishing a good quality improvement process?

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 4. Quality Improvement Process Use data for decisions to improve policies, programs, and outcomes Manage change Create a learning organization Q

Managerial Action Quality improvement techniques Policy change Resource allocation change Program change Using Performance Data for Improvement

Process (Essential Public Health Services) Outputs Outcomes System Inputs Workforce Information Organization & Relation- ships Facilities Funding AssessAssure Key Processes Improved Outcomes & Customer Satisfaction Develop Policy Source: Turnock B.J. Public Health: What It Is and How It Works, 3 rd Edition. Boston, MA; Jones & Bartlett, Programs and Services consistent with mandates and community priorities Capacity The Public Health “Production Model”: Capacity, Process, and Outcomes Improved organizational performance Improved program performance Increased Value & Public Support

1. Identify gaps between actual and desired performance 2. Establish priorities 3. Analyze root causes of performance problems in the system 4. Develop improvement plans 5. Manage implementation Steps in Performance Improvement Plan DoCheck Act

Lessons Learned from Turning Point Survey… State health agency performance management practices are widespread, although often not system-wide or with processes leading to quality improvement. Three-quarters (76%) of states that manage performance report that their efforts result in improved performance, with positive outcomes broadly defined.

States most frequently manage performance related to health status, overlooking many factors in performance. Less frequently managed in public health: Human resource development Public health capacity Customer focus and satisfaction Lessons Learned from Turning Point Survey…

Question A.Increased effectiveness and accountability in public health practice B. Motivation of staff to investigate problems and find solutions C. Better alignment of resources and efforts with the public health mission D. More informed decision making with clearer targets In your opinion, what are the most important reasons to use Performance Management?

Where to Begin… How well does your public health organization or partnership manage performance within its jurisdiction? Use the assessment to find out if you have the necessary systems in place to achieve results and continually improve performance. Performance Management Self-Assessment Tool

Guidebooks for public health Real-life examples, tools, and case stories from practice Self-assessment tool Evidence from literature Training curriculum Performance Improvement Resources

Public Health Infrastructure Resource Center: Case studies Searchable tools Publications Performance Improvement Resources PHF’s Alliance for Achieving Results and Outcomes (“AARO”)

Share Your Thoughts What are your “take away” messages? What will you apply or do differently? ? Thank You!