1. GOOD MORNING! We will be starting shortly.  Please orient yourself to Live Meeting including use of Q and A  Please mute your microphones and/or telephone  Please email Tegan Ruland at tegan.ruland@wisconsin.gov if you are having any difficulties tegan.ruland@wisconsin.gov

2. Performance Improvement in Public Health Learning Session #2: Performance Management in Public Health 101

3. Welcome and Introductions  Brief description of Learning Sessions  Brief introduction of those participating  Overview of Live Meeting process including muting, accessing handouts, and asking questions

4. Learning Sessions Planned:  Previously: Wisconsin PH Improvement Initiative 101  Today: PH Performance Management 101  5/16/2011: PH Quality Improvement 101  5/23/2011: PH Accreditation 101

5. By the end of this session you should be able to:  Describe public health performance management model and how this fits existing practice.  Access additional information and resources for learning.

6. Performance Management

7. Learning Objectives  Gain understanding of the components of a performance management system (is there a reason why the acronym for this is PMS??)  Identify at least three benefits of performance management  Provide examples of how public health is using PM to better health outcomes in WI

8. What is Performance Management?

9. What Is Performance Management?  The practice of actively using performance data to improve the public’s health.  Can be carried out at any level simultaneously (e.g. individual, program, organization, community, state)  It sound complex, but it’s actually quite simple

10. Don’t look now but… If you are establishing or identifying performance standards (aka targets, goals), measuring and tracking performance (aka progress), reporting progress, and using quality improvement to manage change and improve you are practicing performance management!!!

11. Examples SHP 2020, Grant Requirements, National Performance Standards, PHAB, Etc. Quarterly Reports, Annual Reports, Grant Reports, CHIP Updates, etc. 5 Whys, PDSA, CQI, QI Plan, etc. Work Plan Operations Based (Performance Goals and Measures, Specific Outputs) Internal to Org Level: Program / Function Strategic Plan Strategy Based (Mission, Vision, Core Values, Strategic Goals and Objectives) Internal to Org Level: Agency CHIP Strategy Based (e.g. Goals, Strategies, Objectives) External to Org Level: Community Workforc e Plan Operations Based Internal to Org Level: Individual Improved Health Outcomes Conceptually, this is what PM looks like?

12. Examples of PM in PH  Community Health Improvement Plans (CHIP)  Strategic Plans  Workforce Development Plans  Program Work Plans  Restaurant Inspections  Customer Satisfaction  PHAB  GAC

13. Why PM in PH?  To make better informed decisions.  To allocate and prioritize resources.  To improve policies and processes.  To increase accountability and responsibility.  To reduce duplication of efforts.  To clearly communicate to the public and partners through clear reporting.  To get to outcomes!

14. Why do we need it?

15. A Public Health Tour of the Four Components of PM

16. Performance Standards  … is a generally accepted, objective standard of measurement against which an organization's level of performance can be compared.  Can be descriptive (e.g. LPHA is actively involved in review of policies) or numerical (e.g. at least 80% of…)  Answers the question, “where should we be?”

17. Performance Standards in PH  National standards –PHAB Standards –Preparedness Performance Measures  State specific standards –HW2020, Grant or contract objectives  Benchmarking against others –County Health Rankings  Agency specific targets –Typically when no industry benchmark exists, LPHA will establish a target.

18. Performance Measurement (where are we?)  …is the regular collection and reporting of data to track work produced and results achieved.  … measures something! Identifies what we are going to measure and the process for which to collect the data (e.g. SMART objectives)  Answers the question, “where are we?” – you are systematically tracking and measuring something!!!

19. Examples of Performance Measurements  Systems Level –HW2020 objectives –PHAB Measures –TRAIN  Organizational Level –Strategic plan scorecards –CHA –Department wide database  Program Level –HealthSpace, SPHERE, WIR, ROSIE, etc.

20. Reporting of Progress 1.Are we presenting the right information?  Tie it to your performance measurements 2.Are we presenting the information in the right way?  Avoid jargon; create clear, easy to read, understandable reports 3.Are we reporting information at the right time?  Establish frequency; timing is everything!

21. PH Examples of Reporting  Annual Reports  Media efforts  Website  Journals  Stakeholder meetings  CHIP Plan  Year End Contract Reporting

22. Quality Improvement  Is only 1 component of a PM system ... is the purposeful change of a process or program to improve the reliability of achieving an outcome  May focus on one aspect of performance (customer satisfaction) or cut cross entire agency / system (budgeting processes).  Does not need to be complicated!!!

23. PDCA of QI  Plan what to accomplish over a period of time and what needs to be done to get there  Do what is planned  Check the results of what was done to see if objectives were achieved  Act on the information

24. Putting it together  Performance Standard: 1 epidemiologist on staff per 100,000 population served  Performance Measure: # of trained epidemiologists on staff from a 4 year accredited universities  Reporting: A Workforce Report indicates we have 1 epidemiologist per 300,000 population served  Quality Improvement: using a QI technique, we determine that the root-cause analysis for this is … AND we decide to …

25. PCHD Example  Performance Standard 8.2B: Assess staff competencies and address gaps by enabling organizational and individual training and development opportunities  Performance Measure 8.2.1 B: # of staff that have completed annual performance evaluations and develop improvement / training plans  Reporting: annual employee sat survey indicates that 80% of staff have completed PE  Quality Improvement: Conduct root cause analysis to find out why we are not at 100%. Findings: need a software system to help track and remind.

26. Wood County PM Tracking

27. Challenges and Tips  We are still learning and defining  Getting started  Finding the time  Staffing  Getting organized  Collecting the wrong data  Absence of standards and benchmarks  Burnout

28. Examples from the Great One!  Terry Brandenburg, West Allis

29. Quest for the Holy Grail Performance Management X X X

30. Performance Management is not a buitenlands begrip We conduct aspects of performance management in everyday practice:  Consolidated Contracts  Annual Reports to governing body / general public  Community Health Assessments (CHAs), Community Health Improvement Plans (CHIPS)  Justify Annual Budgets (Dutch translation: foreign concept)

31. However: We don’t practice performance management comprehensively We often do it only under duress

32. What do we put on the table?

33. Source: 2009 Community Health Survey

34. Source: 2009 WAWM Community Health Survey

37. Source: 2009 WAWM Community Health Survey, 2009 Chronic Disease Indicators for Wisconsin and U.S. 1

38. Source: Wisconsin Department of Health and Human Services Wisconsin Childhood Lead Poisoning Prevention Program, West Allis Health Department Statistics

39. Source: 2009 WAWM Youth Risk Behavior Survey

41. Source: Wisconsin Interactive Statistics on Health

42. The year shown refers to the fiscal year from July 1 in the preceding year through June 30 of the year shown. The decrease in the six-month continuation rate from 2008 to 2009 reflects a change in the way the number is calculated to improve accuracy. Source: West Allis WIC Statistics

43. Two Examples of Applying Performance Management in a Local Health Department: QI only:Postpartum Newborn Home Visits Performance Management: Reduction in Smoking in Pregnant and Post-partum Women enrolled in WIC

44. Quality Improvement “How can we make it better?” Performance Measurement “How are we doing?” QI Plan Goals Objectives Measures Strategies Performance, Yes Performance, No Act Plan CheckDo Performance Measurement / QI System

45. Post Partum Newborn Visits AIM:By September 1, 2010, the Community Health Services Division will establish protocol for a newborn / postpartum initial visit

46. QI Example – Postpartum Newborn Home Visit QI focus – staff selected and led by staff Practiced using QI tools – 5 whys, flow charts, fishbone diagrams New policies and procedures developed New forms and brochures developed Piloted new procedures Inserviced staff

48. To help you care for your self, the nurse will talk to you about:  Breast care  Signs and symptoms of illness  Postpartum activity  Sleep needs  Nutrition needs  Birth control methods  Emotional health A Healthy Start for You and Your Baby West Allis Health Department 7120 West National Avenue West Allis, WI 53214 West Allis Health Department Public Health Nursing

50. Reduction in Smoking - WIC Clients AIM 1:By January, 2012, the quit rates for pregnant and post partum women enrolled in the WIC program through WAHD who smoke (tobacco) will be at or below the annual quit rates from the preceding year as reported by the First Breath Program. AIM 2:By January, 2012, the rates of smoking reduction for pregnant and post partum women enrolled in the WIC program through WAHD who smoke (tobacco) will be at or below the annual reported reduction rates from the preceding year as reported by the First Breath Program.

51. How to measure performance for this project? One example: Indicator:Percentage of pregnant women who complete First Breath following referral who report a reduction in smoking tobacco at the last prenatal contact Target:35% Numerator:Count or women who completed First Breath who report a reduction in smoking tobacco Denominator:Count of women who completed First Breath Reporting Frequency:Quarterly (January, April, July, October) Reduction in Smoking - WIC clients (cont.)

52. Why:Using ROSIE, higher than expected levels of tobacco use. Low birth rates & pre-term birth rates Who:WIC staff & public health nurses How:Review data and use QI tool of process mapping The Plan:During WIC enrollment, identify women who self report tobacco use Public health nurse attempts to enroll in First Breath Program Follow up and support occurs each trimester and early post partum period

53. Reduction in Smoking - WIC clients (cont.) Process Data: Staff have already made minor changes to the PHN intervention In the month of April there were more enrollments in the First Breath Program than in all of 2010. Outcome Data:  These measures will be reviewed in early 2012. Program stared in April 2011 – Early Returns!

54. Lessons Learned Training in evaluation and QI is essential. Demonstrate that systems are in place, not just pieces of performance management. Involve your governing body (e.g., Board of Health). Start small and allow your performance measurement and QI plans to grow and evolve. Demonstrate your value to policymakers and the community. “What gets measured, gets done.”

55. National Resources: CDC: http://www.cdc.gov/ostlts/NPHII/index.htmlhttp://www.cdc.gov/ostlts/NPHII/index.html NACCHO: http://www.naccho.org/topics/infrastructure/http://www.naccho.org/topics/infrastructure/ ASTHO: http://www.astho.org/Programs/Accreditation-and- Performance/http://www.astho.org/Programs/Accreditation-and- Performance/ PHAB: http://www.phaboard.org/http://www.phaboard.org/ PHF: http://www.phf.org/focusareas/pmqi/pages/default.aspxhttp://www.phf.org/focusareas/pmqi/pages/default.aspx NALBOH: http://www.nalboh.org/Board_Governance.htm#http://www.nalboh.org/Board_Governance.htm# NIHB: http://www.nihb.org/public_health/accreditation.phphttp://www.nihb.org/public_health/accreditation.php

56. Primary Wisconsin Resources: CDC Infrastructure Grant: Mary Young, DPH Southern Regional Office mary.young@wisconsin.org Prevention Block Grant: Jackie Bremer, DPH Northern Regional Office Jacquelyn.Bremer@wisconsin.org HW 2020 Capacity and Quality Focus Area: Lieske Giese, DPH Western Regional Office elizabeth.giese@wisconsin.gov WIQI: Nancy Young, IWHI grayhorse@mac.com

57. Websites: IWHI http://www.instituteforwihealth.org/project- portal/ http://www.instituteforwihealth.org/project- portal/ DPH http://www.dhs.wisconsin.gov/localhealth/ind ex.htm Accreditation site (contact Tegan Ruland for access) http://www.phawisconsin.com/

58. Tell us what you thought of today’s session: http://4.selectsurvey.net/dhs/TakeSurvey.as px?SurveyID=82M2584K