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

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

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

4. 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.

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

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

7. 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

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 APEXPH – Limitations LHD focused Measures may be out of date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

9. 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

10. MAPP - Overview

11. The MAPP Assessments

12. 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

13. MAPP - Challenges
Time
Investment
System Approach

14. 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.

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

16. 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

17. NPHPS/LPHSA The Instrument
Essential
Service
Indicator
Model
Standard
Measures

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

19. 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

20. 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

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

22. 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

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

24. 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

25. PATCH Planned Approach to Community Health
Community planning model to assess and improve the health and quality of life in their communities.

26. 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

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

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

29. What to Measure
Capacities
Processes
Outcomes

30. 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?

31. Tools for Performance Measurement
Sterling Criteria for Organizational Performance Excellence
Public Health Infrastructure Resource Center (PHIRC)
Virginia Excels click on “agency performance information”.

32. 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

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

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

35. 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.

36. Resources
APEXPH, MAPP, NPHPSP
PACE EH
Performance Measurement , click on “Performance Management”

37. Importance of Planning
Questions:
MAPP/NPHPSP
Heidi Deutsch
x252
PACE EH
Jonathan Schwartz
x250
Performance Management
Stacey Baker
Importance of Planning