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Performance Management

Using Information to Improve


Public Health Practice
February 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)
7 Turning Point States
• Illinois* •New Hampshire
• New York •Missouri
• Montana
•West Virginia
• Alaska

* Lead State
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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
Percent Low Birth Weight

10
8
6 Medicaid
4 Non-Medicaid
2 State
0
1999 2000

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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
management
system...
• 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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Using Data to Achieve Results
• Quality
improvement
efforts

• Policy change
Managerial Action
• Resource
allocation
change

• Program change
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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 Performance
Management 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)
None
4% (2)

SHA wide
32% (15)

Categorical
programs
only
43% (20)

Local public SHA wide


health and local
agencies only public health
4% (2) agencies
17% (8)
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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) Reported Positive Outcomes:
No
24% (10) ✔ Improved delivery of services—program
services, clinical preventive services, essential
services
✔ Improved administration/management—
contracting, tracking/reporting, coordination
✔ Legislation or policy changes

Yes
76% (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 • Human Resource Development


• Data & Information Systems • Public Health Capacity

Performance Measures or • Health Status • Human Resource Development


Standards • Data & Information Systems • Customer Focus and Satisfaction

Performance Reports • Health Status • Human Resource Development


• Data & Information Systems • Public Health Capacity
• Management Practices

Process for QI/Change • Health Status • Human Resource Development


• Customer Focus and Satisfaction • Public Health Capacity
• Management Practices

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

• Healthy People Objectives


States use a variety of
• Core Public Health performance management
Functions models/frameworks, in a
• Ten Essential Public variety of combinations
Health Services

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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)
Percentage of States (N=25)

100
90
80
70
60 (15)
60
44 (11)
50
40 (10) 36 (9)
40
30
20
10
0
Performance Targets Performance Measures Performance Reports Process for QI/Change
or Standards

*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
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  and Satisfaction, Financial Systems, 36
Management Practices, Public Health Capacity, and Health Status). Figure 15 illustrates this finding.
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)
100

90

80
Percentage of States (N=40)

70
63 (25)

60

50

40
30 (12)
30
20 (8)

20
13 (5)
8 (3)
10

0
Incentives for Incentives for Staff Disincentives for Disincentives for Staff None
Agencies, Programs, Agencies, Programs,
Divisions Divisions
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Note: Respondents could choose more than one response, so total does not equal 100
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’
9 10 4
performance management systems
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
6 1 5
public health systems (tie)

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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

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