1. Overview of Performance Management Systems
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Overview of Performance Management Systems
Pooja Verma, MPH
Program Analyst
Accreditation & QI
NACCHO

2. Objectives Define performance management and related terms
Identify the key steps in building a performance management system
Provide tips and examples for developing performance measures
Identify performance management resources

3. Defining Terminology

4. What is a performance management system?
Source: Turning Point Performance Management Collaborative, 2003.

5. Performance Standards
“Generally accepted, objective standards of measurement such as a rule or guideline against which an organization’s level of performance can be compared.”
- Turning Point Management Collaborative, 2003
Public Health Standards:
Public Health Accreditation Board (PHAB)
National Public Health Performance Standards (CDC)
80% of clients rate health department services as “good” or “excellent.”

6. Performance Measures
Performance Measures
“A specific quantitative representation of a capacity, process, or outcome deemed relevant to assessment against a performance standard.”
- Turning Point Management Collaborative, 2003
% of clients that rate health department services as “good” or “excellent.”

7. Internal and external stakeholders
Reporting of Progress
Includes performance against meeting standards and progress toward strategic goals and objectives
Internal and external stakeholders
Foundation for identifying QI efforts
Reporting of
Progress

8. Quality Improvement
The use of a deliberate and defined improvement process focused on activities that are responsive to community needs and improving population health. It refers to a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality in services or processes which achieve equity and improve the health of the community. *
* Definition developed by the Accreditation Coalition Workgroup and approved by the Accreditation Coalition on June 2009
Quality
Improvement

10. Establish a Performance Management Committee/Team
What are the first steps in building a PM system?
Establish a Performance Management Committee/Team
Conduct a Performance Management self-assessment
Turning Point Self-Assessment Tool
Baldrige Performance Excellence Program
Train staff!

11. Performance Measurement

12. Why is performance measurement important?
Foundation for decision making
Alignment of efforts with agency strategic direction
Shift in focus from individuals/activities to results
Meaningful feedback to employees
Promotes learning and improvement culture
*Adapted from MarMason Consulting

13. What do we measure in public health?
Outcomes
Efficiency
Effectiveness
Healthy People
Processes
10 Essential Public Health Services
Structures
Information Technology
Human Resources
Fiscal Resources

14. Types of Performance Measures
Capacity/Input:
Human/capital resources
Process/Output:
Intermediate steps in developing product or providing service
Short-Term Outcome:
Immediate results of the product or service provided
Long-Term Outcome:
Intended, desired, or actual long-term results

15. Linking Performance Measures
Input and Process
(Program level)
Short/
Intermediate term
(Division level)
Long-term
(Organization level)
Strategic
Direction
2-3 years
1-2 years
Monthly/Quarterly

16. Logic Model: Infant Mortality Performance Measures
Long-term Outcome
Intermediate Outcome
Process/Output
Short-term Outcome
Input
# of health educators
# of nurses
$$ for education materials, clinics, etc.
# of education classes
# of women in Pre-Natal Program
# Pre-natal clinics
% of women that understand risk factors
% of low income pregnant women w/access to Pre-natal care
% high risk pregnant women that smoke
% of high risk pregnant women with adequate nutrition
% premature births
% newborns w/low birth weight
Infant mortality rate

17. Feasibility of data collection Measurable over time
Considerations for Developing Performance Measures
Do not select too many
Feasibility of data collection
Measurable over time
Collectively represent major strategic goals and objectives
Customer and stakeholder support

18. Frameworks for Performance Measurement
Balanced Scorecard
Financial
Internal Business Processes
Learning and Growth
Customer
Malcolm Baldrige National Quality Award Criteria:
Leadership
Strategic Planning
Customer Focus
Measurement and Analysis
Workforce/HR Focus
Operations Focus
Results

19. Who is the target population? What is your numerator?
Developing Performance Measures
What are you measuring?
Who is the target population?
What is your numerator?
What is your denominator?
What is your data source?
Who is responsible?
Rate of positive CT test at clinics
Clients tested for Chlamydia
# clients tested positive CT
# of total CT tests at clinics
DOH records
Jane Doe

20. Establish Performance Targets/Benchmarks
Use a method to establish thresholds for performance:
Industry benchmarks (e.g. HP2020, County Health Rankings)
Regulatory requirements
Other health department’s data
Past performance
*Adapted from MarMason Consulting

21. SMART Objectives
Decrease the rate of CT positivity at clinic sites from 8.1% to 6.5% by the end of
Specific
Measurable
Attainable
Relevant
Time specific

22. *Adapted from MarMason Consulting
Performance measure:
The rate of Chlamydia (CT) positivity at provider clinic sites.
Target population:
People being tested for Chlamydia
Numerator:
Positive CT tests at clinic sites
Denominator:
All CT tests at clinic sites
Which are you using—a target or benchmark?
Target
What is the target/benchmark?
6.5% (goals based on past performance)
SMART objective:
Decrease the rate of CT positivity at clinic sites from 8.1% to 6.5% by the end of 2013.
Source of data:
DOH records
Who will collect the information?
Jim Smith
How often will the data be analyzed and reported?
quarterly
Baseline measurement data and date(s):
2005: 10.1% : 8.6%
2006: 9.3% : 8.2%
2007: 10.5% : 8.1%
Definitions and other comments:
Provider clinics, Planned parenthood sites and others.
*Adapted from MarMason Consulting

23. Linking Performance Measures: Example
Intermediate Outcome
% of patients w/adequate blood glucose
Decrease morbidity rates of Diabetes patients by 20% by 2014.
Impact
Short-Term Outcome
-# of patients seen by provider
Improve quality of life among Diabetics
Process/Output
- Length of time b/w request of service and meeting w/provider
Performance Measures
Input/Capacity
- # of service providers on staff

24. Reduce childhood obesity
Linking Performance Measures: Example
Intermediate Outcome
% of low income children w/60 mins of moderately active daily
Decrease % of obese/overweight youth to 25% by 2014.
Impact
Short-Term Outcome
- % of low income children that access parks/playgrounds
Reduce childhood obesity
Process/Output
- # parks/playgrounds in low income neighborhoods
Performance Measures
Input/Capacity
- $$/partnerships for new playgrounds/green space

25. Collecting & Storing Data
Database, Spreadsheets
Excel
Access
Performance Management Software
My Strategic Plan, M3 Planning
Results Scorecard, Results Leadership Group

26. Example Performance Dashboard
Objective
Performance Measure
Baseline (2010)
Baseline (2011)
Current Status
Target
Infant Mortality
Decrease % of women who smoke during pregnancy enrolled in Pre-Natal Partnership Program (PNPP)
% of women who smoke during pregnancy in PNPP
32%
28%
25%
20%
Increase % of low income women who receive prenatal care in the 1st four months of pregnancy
% low income women receiving prenatal care w/in 1st four months of pregnancy
85%
87%
92%
90%
Immunizations
Increase % of mo. olds adequately immunized
% of month old children adequately immunized
59%
60%
66%
75%

27. Turning Data Into Knowledge: Data Analysis
Questions to consider:
How does actual performance compare to a standard or target?
Is corrective action necessary?
Are new goals, objectives, or measures necessary?
How have existing conditions changed?

28. Analyze Measurement Data
Analysis Tools
Analyze Measurement Data
Identify Root Causes
Run chart
Statistical analysis
Control chart
Matrices
Flow chart
Scatter plots
Decision tree
Affinity diagram
Brainstorming
Fishbone
Histogram
Pareto chart
Story boarding
5-whys technique

29. Reporting Structure Frequency Program measures – monthly/quarterly
Division measures – semiannual/annual
Department measures – every 2-3 years
Communicate to:
Management
PM team and/or QI Council
Board of health
Staff

30. Reporting and Presenting
Questions to consider:
Who is the audience?
What is the intended use of the information?
What is the basic message to be communicated?
What is the presentation format? (brochure, oral presentation, report, etc.)

31. Quality Improvement

32. Performance Management Process
Select performance measures
Collect data
Store data
Analyze data
Report and present findings
Apply knowledge

33. “Maybe I’m lucky to be going so slowly, because I may be going in the wrong direction.”
~ Anonymous

34. Performance Management Resources
Performance Management Self-Assessment Tool:
Turning Point Resources:
PHF’s Performance Management & QI Website:
Public Health Performance Management Centers for Excellence:
Developing, Monitoring, and Using Performance Measures:

35. References
Turning Point Performance Management Collaborative:
• Public Health Performance Management Centers for Excellence:
The Performance Based Management Handbook, U.S. Dept. of Energy:
The Quality Improvement Handbook:

36. Pooja Verma Accreditation & QI NACCHO (202) 507-4206 pverma@naccho.org
Thank You!
Pooja Verma
Accreditation & QI
NACCHO
(202)