Turning Point 1

Performance Management

Using Information to Improve Public Health

PracticeFebruary 13, 2003

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Learning Objectives

• Gain understanding of the components of a performance management system

• Identify potential benefits of performance management

• Advance where we are in performance management

• Learn from one another

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Turning Point’s National Excellence Collaboratives,

2000-2004• Funded by Robt. Wood Johnson Foundation

- States, communities, national partners– Combine collective experience, skills– Take next steps in transforming public health

• Review of literature & current practice; analysis• Development of innovative models• Testing and disseminating innovation• Evaluation

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Turning Point: National Excellence Collaboratives

• Public Health Statute Modernization• Performance Management• Information Technology• Social Marketing• Leadership Development

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Performance Management Collaborative (PMC)

• Illinois*• New York• Montana• Alaska

•New Hampshire•Missouri•West Virginia

* Lead State

7 Turning Point States

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More PMC Members

• TP National Program Office at Univ. of WA/School of Public Health

• National Partners– ASTHO– NACCHO– CDC– HRSA– ASTHLHLO

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PMC Vision

Widespread use of dynamic and accountable public health

performance management

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PMC Goals• To develop useful and feasible performance

management models for states • To stimulate national dialogue and

consensus on performance management in public health

• To support the application of performance management as a core discipline of public health practice

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What Is Performance Management?

• The practice of actively using performance data to improve the public’s health.

• Performance management can be carried out at the program, organization, community and state levels.

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Performance Management

• What you do with the information you’ve developed from measuring performance

• Using performance measurement to manage public health capacity and processes– Review services and programs– Assess progress against targets– Conduct employee evaluations– Formulate and justify budgets

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Four Components of Performance Management

• Performance Standards• Performance Measures• Reporting of Progress• Quality Improvement

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Performance Standard

• A generally accepted, objective standard of measurement such as a rule or guideline against which an organization’s level of performance can be compared

• Establishes the level of performance expected

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Performance Standard

Descriptive – capacities or processes– A system for communicable disease

surveillance and control shall be maintained

– The information systems in use enable the collection, use and communication of data

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Performance Standard

• Numerical – establishes a quantifiable level of achievement – At least 80% of community health

center clients will be satisfied with the services received

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Performance Measurement

• The selection and use of quantitative measures, capacities, processes and outcomes to develop information about critical aspects of activities, including their effect on the public

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Performance Measurement

• The regular collection and reporting of data to track work produced and results achieved.

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Performance Measure

• The specific quantitative representation of a capacity, process or outcome deemed relevant to the assessment of performance

• It measures something …usually progress toward an objective or goal

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Performance Measures

• Examples– Percentage of children with age-

appropriate immunization levels at age two

– Percentage of target audiences that recall content of public service announcements, brochures or presentations

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Jargon Alert

• Don’t let the terms goals, objectives, standards, indicators, measures catch you.

• What’s important is that we use intelligently selected and written measures to assist us in assessing if we are doing the right things in the right way.

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Reporting of Progress

• Don’t hoard the data– Share with those who provided the

data

• Convert it into useable information– So what?

• Know your audience– Is it agencies, lawmakers?

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Reporting of Progress

• Provide context for the report– How do the measures relate to your

mission and goals• Create clear,easy to read, report

designs– Use Simple charts and tables

• Determine Reporting Frequency– When and how often

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Using Charts

0

2

4

6

8

10

1999 2000

Percent Low Birth Weight

Medicaid

Non- Medicaid

State

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Quality Improvement

• 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

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Quality Improvement

• A dynamic and continuous process • Doesn’t just look at outcomes – but

the process to get there• Not a new concept – 1950’s W.

Edward Deming• Plan–Do-Check-Act

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Examples of Quality Improvement

• Florida Dept. of Health performs regular performance management reviews and provides feedback to local county administrators. Jointly develop a plan.

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In a performance

managementsystem...• All components should

be driven by the public health mission and organizational strategy

• Activities should be integrated into routine public health practices

• The goal is continuous performance and quality improvement

Source: Turning Point Performance Management Collaborative.

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Why Develop a PM System?

• To maximize public health’s effectiveness. This requires– More than measurement alone– More than standards alone– All four PM components to be

continuously integrated into a system of performance management

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Managerial Action

• Quality improvement efforts

• Policy change

• Resource allocation change

• Program change

Using Data to Achieve Results

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How Does NH Measure Up

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Survey of Performance Mgmt. Practices in States

• Baseline Assessment– Conducted by PHF– 47 of 50 States Responded

• Survey Asks About:– Use of Performance Targets, Reports– Impact on Program and Policy– Need for New Tools

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Nearly All SHAs Have Some PerformanceManagement Efforts

However, only about half apply performance management efforts statewide beyond categorical programs

Figure 1. Agencies or programs to which SHAs apply performance management efforts (N=47)

Categorical programs

only43% (20)

None4% (2)

SHA wide32% (15)

Local public health

agencies only4% (2)

SHA wide and local

public health agencies17% (8)

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Reported Positive Outcomes:

Improved delivery of services—program services, clinical preventive services, essential services

Improved administration/management— contracting, tracking/reporting, coordination

Legislation or policy changes

Performance Management Efforts Result in Improved Performance for Three-Quarters of SHAs

Figure 19. Percentage of SHAs that report their performance management efforts resulted in improved performance (N=41)

No24% (10)

Yes76% (31)

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SHAs Most Likely to Have Components of Performance Management for Health Status;

Least Likely for Human Resource Development

Figure 8. Areas most and least likely to have performance targets, measures or standards, reports, and processes for quality improvement (QI)/change, of SHAs that apply performance management efforts SHA wide, SHA wide and to local public health agencies, or to local public health agencies only (N=25)

Most Likely Least Likely

Performance Targets Health Status Data & Information Systems

Human Resource Development Public Health Capacity

Performance Measures orStandards

Health Status Data & Information Systems

Human Resource Development Customer Focus and Satisfaction

Performance Reports Health Status Data & Information Systems Management Practices

Human Resource Development Public Health Capacity

Process for QI/Change Health Status Customer Focus and Satisfaction Management Practices

Human Resource Development Public Health Capacity

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Top Three Models/Frameworks Explicitly Incorporated by SHAs Into Their Performance Management Efforts

• Healthy People Objectives

• Core Public Health Functions

• Ten Essential Public Health Services

States use a variety of performance managementmodels/frameworks, in avariety of combinations

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Most SHAs Have Performance Measures, Targets, and Reports, While Fewer States Have

Process for Quality Improvement or Change*

Figure 15. Percentage of SHAs that have specified components of performance management for public health capacity (N=25)

36 (9)

44 (11)

60 (15)

40 (10)

0

10

20

30

40

50

60

70

80

90

100

Performance Targets Performance Measuresor Standards

Performance Reports Process for QI/Change

Pe

rce

nta

ge

of

Sta

tes (

N=

25

)

*Correlation analysis revealed that there is a comparatively weak relationship between having performance targets, performance measures or performance reports and process for quality improvement (QI)/change. That is, in general, fewer states indicated that they did have a process for change, even though they indicated having performance targets, performance measures, or performance reports. This was the case for all areas of performance management studied (Human Resource Development, Data & Information Systems, Customer Focus and Satisfaction, Financial Systems, Management Practices, Public Health Capacity, and Health Status). Figure 15 illustrates this finding.

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Most States Use Neither Incentives nor Disincentives to Improve Performance

Figure 18. Percentage of SHA performance efforts that include incentives or disincentives to improve performance (N=40)

Note: Respondents could choose more than one response, so total does not equal 100

63 (25)

8 (3)

20 (8)

13 (5)

30 (12)

0

10

20

30

40

50

60

70

80

90

100

Incentives forAgencies, Programs,

Divisions

Incentives for Staff Disincentives forAgencies, Programs,

Divisions

Disincentives for Staff None

Pe

rce

nta

ge

of

Sta

tes

(N

=4

0)

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Funding for Performance Management Chosen as Number One Way to Improve States’ Efforts

Figure 5. Types of aid identified as most useful to SHAs to improve SHA performance management efforts, in rank order (N=47)

Number of SHAs that ranked each answer 1-3

1st 2nd 3rd

1. Funding sources/support 18 7 3

2. Detailed examples/a set of models from other states’ performance management systems

9 10 4

3. Consultation/technical assistance 3 5 7

4. “How to” guide/toolkit (tie) 4 5 3

4. A set of voluntary national performance standards for public health systems (tie)

6 1 5

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Where do we go from here?

• One step at a time• Develop performance measures• Develop reports• Develop quality improvement

processes• Look beyond categorical programs

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Where do we go from here?

• Look beyond health indicators• Look at systems• Refine, revise, • Learn from one another

• Keep on Truckin