1. Overview of Performance Review Process
U.S. Department of Health and Human Services (DHHS)
Health Resources and Services Administration (HRSA)
Office of Performance Review (OPR)
Chicago Regional Division I

2. OPR Regional Divisions
Kansas City
Denver
Seattle I
Boston
New York
Dallas
San Francisco
Atlanta
Chicago
Philadelphia
Rockville
Puerto Rico
Ten regional divisions located in Boston, New York, Philadelphia, Atlanta, Chicago, Kansas City, Dallas, Denver, San Francisco, Seattle as well as sub-regional division in Puerto Rico with its overall headquarters in Rockville
Regional divisions are compromised are comprised of a variety of multi-disciplinary staff, including clinicians, public health specialists, financial analysts, management experts, etc.

3. HRSA Funding
HRSA provides over $7 billion in grants or cooperative agreements
To over 3,000 organizations
Through 80 different programs

4. Purpose of Performance Reviews
Improve the performance of HRSA funded programs
Provide direct feedback to the agency about the impact of HRSA policies on program implementation and performance

5. Steps to Performance Review2
Performance
Analysis 3
Performance
Report 1
Performance
Review
Measures 4
Action
Plan

6. Underlying Assumptions
Most grantees are performing well
Performance first  systems support/underlie performance
Many solutions to issues/problems exist within an organization and/or
Can be achieved through partnerships with others
Performance Review Protocol is the framework for our work (Grantee, State, and Community Reviews)
Day-to-day grantee responsibility remains with Headquarters (HRSA project officers and HRSA Division of Grants Management Operations (DGMO) grants officers)
BELL CURVE, we review all grantees
In past we focused on program/grants with problems
90-95% of programs performing well
Our job is to help them to do it better
Previously, focus was on systems with an assumption to produce good outcomes…NOW WE FOCUS ON OUTCOMES!

7. Steps to Performance Review: Performance Measures
Identify target population served by each program
Specify services/resources provided
Identify current program performance measures
Program reporting requirements
Grantee goals/objectives in grant application
HRSA’s GPRA program measures

8. Steps to Performance Review: Performance Measures
Select Performance Review Measures with the grantee
Outcome measures – track impact or effectiveness of a program
Effort measures- assess efforts to implement a program
Need a mix of outcome and effort measures
Total of 3 to 5 measures per program

9. Performance Measures Examples of outcome measures include:
Client results or outcomes (e.g., improved health status, access)
Customer satisfaction (e.g., customer benefit received)
Effectiveness
Examples of effort measures include:
Efficiency (e.g., administrative overhead; unit cost; staffing ratios; staff turnover; waiting time; etc.)
Customer satisfaction (e.g., quality of service provided)

10. Steps to Performance Review: Performance Analysis
Identify factors supporting/hindering performance
Internal systems and processes
External issues, including HRSA policies
Partnerships – critical for most outcome measures
Determine which is the most important to address to improve performance on each measure

11. Steps to Performance Review: Performance Report
Develop Performance Report
Performance Improvement Options
No cost/low cost options
Evidence-based strategies
Partnerships
Requirement issues (if necessary)
Share draft of Performance Report with the grantee, project officer(s), grants officer and OFPO staff for feedback and comments

12. Steps to Performance Review: Action Plan
Finalize Performance Report and request Action Plan from grantee
Grantee Action Plan
Proposed Performance Improvement Actions
Proposed Program Requirements Actions
Review grantee’s Action Plan submission and provide feedback, as appropriate