From%20Standards%20to%20Improvement:

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From Standards to Improvement
NWCPHP Hot Topics Forum, August 11, 2005
Steps to Managing Effective Public Health
Organizations
Laura B. Landrum,Illinois Public Health
Institute
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Learning Objectives

• Define key concepts and components of performance
  management
• Identify a variety of public health
  organizational and programmatic applications of
  performance management
• Describe potential benefits of performance
  management

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A Basic Definition

• Performance Management
• Control towards accomplishment
• In public health, the active and strategic use
  of performance data to improve the publics
  health

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Turning Point Performance Management Model
Source Silos to Systems Using Performance
Management to Improve the Publics Health.
Turning Point Performance Management National
Excellence Collaborative Seattle, WA Turning
Point National Program, 2003.
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Everyday Example Marathon Runner

• Seeks to better last years time
• Trains 5 x per week at various distances
• Records times variables
• Makes adjustments
• Pace, workout, shoes, etc.

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Performance Management Scenarios at Many Levels

• Individual Process (e.g., disease reporting)
• Unit or Team
• Program or Division
• Public Health Workforce Development
• National Health Priority Initiative
• State Health Agency
• State-Local Public Agency Network
• Community Health Improvement Process
• National Public Health System

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Question
In planning for bioterrorism preparedness, which
of the following has your jurisdiction done best?

• Identify relevant standards
• Select indicators for those standards
• Set goals and objectives
• D. Communicate expectations

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1. Applying Appropriate Standards

• Identify and apply relevant standards of
  performance (what will be measured)
• Objective standards or guidelines that describe
  optimal or required performance
• Typically from external sources National or
  state organizations, funders, scientific data,
  benchmarking, etc.
• Use existing standards wherever possible

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1. Applying Appropriate Standards

• Set goals and targets.
• The planned or expected level of performance
• May be the same as, higher, or lower than the
  standard
• What must be achieved, by whom, and when
• Communicate expectations.

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Question
In responding to a potential bioterrorism event,
which of the followingmeasurement functions has
your jurisdiction done best?

• Refine selected indicators of performance
• Define specific measures for those indicators
• Develop data systems that capture the measures
• D. Collect the data

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2. Performance Measurement

• Specific data or information used to assess
  progress toward a performance standard
• Regular collection and reporting of data to
  track work produced and results achieved

Source Lichiello, P. Guidebook for Performance
Measurement. Seattle, WA Turning Point National
Program Office, 199948. Based on Hatry, H.P. et
al., Monitoring the Outcomes of Economic
Development Programs. Washington D.C. The Urban
Institute Press, 1990.
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2. Performance Measurement

• Quantitative measures of capacities, processes,
  or outcomes relevant to the assessment of public
  health performance
• For example
• The number of trained epidemiologists available
  to investigate outbreaks (capacity measure)
• The percentage of notifiable diseases reports
  submitted within the required time lines
  (process measure)
• Percentage of food-borne outbreaks controlled in
  time to prevent serious health complications in
  the jurisdiction (outcome measure)

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2. Performance Measurement

• Requires detailed data definitions and sources
• Trained epidemiologists Persons whose job role
  is identified as Epidemiologist and have
  received formal epidemiology training through one
  of the following, as reported in the state
  learning management system
• (a) a masters or doctorate program
• (b) a graduate public health certificate program
• (c) completion of the CDC Fundamentals of
  Epidemiology course in the past three years with
  an 80 score or higher

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Question

• Is performance measurement the same thing as
  performance management?
• A. Yes
• B. No

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Performance Management

• Performance Management is what you dowith
  information youve developed from measuring
  performance.
• Caution! Its not performance management if
• It addresses only the first three components
  (missing QI)
• Use of data stops after measurement or
  achievement at one point in time (Ex an audit,
  some accreditation programs)

Source Lichiello P. Guidebook for Performance
Measurement. Seattle, WA Turning Point National
Program Office, 199948. Based on Hatry, H.P. et
al., Monitoring the Outcomes of Economic
Development Programs. Washington D.C. The Urban
Institute Press, 1990.
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3. Reporting of Progress

• Analyze data
• Convert data into useable information
• Feedback to managers, staff, policy makers, and
  constituents
• Develop a regular reporting cycle

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3. Reporting of Progress

• Provide context for the report
• How do the performance measures relate to mission
  and goals?
• Create clear, easy to read report designs
• Use simple charts and tables
• Determine frequency
• When and how often

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Question
In your jurisdiction, what are the most difficult
challenges to establishing a good quality
improvement process?

• Involving external partners in public health work
• B. Setting priorities for action (paralysis by
  analysis)
• C. Deploying people and dollars to implement the
  organizations priorities
• D. Helping staff understand the organizations
  mission, priorities, and strategies

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4. Quality Improvement Process

• 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

Q

• Use data for decisions to improve policies,
  programs, and outcomes
• Manage change
• Create a learning organization

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Using Performance Data for Improvement

• Quality improvement techniques
• Policy change
• Resource allocation change
• Program change

Managerial Action
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The Public Health Production Model Capacity,
Process, and Outcomes
Capacity
Process (Essential Public Health Services)
Outcomes
System Inputs
Outputs
Key Processes
Programs and Services consistent with mandates
and community priorities
Improved organizational performanceImproved
program performance

• Workforce
• Information
• Organization Relation-ships
• Facilities
• Funding

Develop Policy
Improved Outcomes Customer Satisfaction
Increased Value Public Support
Source Turnock B.J. Public Health What It Is
and How It Works, 3rd Edition. Boston, MA Jones
Bartlett, 2004.
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Steps in Performance Improvement

• Identify gaps between actual and desired
  performance
• Establish priorities
• Analyze root causes of performance problems in
  the system
• Develop improvement plans
• Manage implementation

Plan
Act
Do
Check
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Lessons Learned from Turning Point Survey

• State health agency performance management
  practices are widespread, although often not
  system-wide or with processes leading to quality
  improvement.
• Three-quarters (76) of states that manage
  performance report that their efforts result in
  improved performance, with positive outcomes
  broadly defined.

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Lessons Learned from Turning Point Survey

• States most frequently manage performance related
  to health status, overlooking many factors in
  performance.
• Less frequently managed in public health
• Human resource development
• Public health capacity
• Customer focus and satisfaction

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Question
In your opinion, what are the most important
reasons to use Performance Management?

• Increased effectiveness and accountability in
  public health practice
• B. Motivation of staff to investigate problems
  and find solutions
• C. Better alignment of resources and efforts
  with the public health mission
• D. More informed decision making with clearer
  targets

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Where to Begin
Performance Management Self-Assessment Tool

• How well does your public health organization or
  partnership manage performance within its
  jurisdiction?
• Use the assessment to find out if you have the
  necessary systems in place to achieve results and
  continually improve performance.

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Performance Improvement Resources

• Guidebooks for public health
• Real-life examples, tools, and case stories from
  practice
• Self-assessment tool
• Evidence from literature
• Training curriculum

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Performance Improvement Resources

• Public Health Infrastructure Resource Center
  www.phf.org/infrastructure/performance
• Case studies
• Searchable tools
• Publications

• PHFs Alliance for Achieving Results and Outcomes
  (AARO)

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Share Your Thoughts

• What are your take away messages?
• What will you apply or do differently?

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Thank You!