From Standards to Improvement:

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

2. 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

3. A Basic Definition “Performance Management” • Control towards accomplishment • In public health, the active and strategic use of performance data to improve the public’s health

4. 2 1 4 3 Turning Point Performance Management Model Source: Silos to Systems: Using Performance Management to Improve the Public’s Health. Turning Point Performance Management National Excellence Collaborative: Seattle, WA; Turning Point National Program, 2003.

5. Everyday Example: Marathon Runner • Seeks to better last year’s time • Trains 5 x per week at various distances • Records times + variables • Makes adjustments • Pace, workout, shoes, etc.

6. 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

7. 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

8. 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

9. 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.

10. 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

11. 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, 1999:48. Based on Hatry, H.P. et al., Monitoring the Outcomes of Economic Development Programs. Washington D.C.: The Urban Institute Press, 1990.

12. 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)

13. 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

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

15. Performance Management Performance Management is what you dowith information you’ve developed from measuring performance. Caution! It’s 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, 1999:48. Based on Hatry, H.P. et al., Monitoring the Outcomes of Economic Development Programs. Washington D.C.: The Urban Institute Press, 1990.

16. 3. Reporting of Progress • Analyze data • Convert data into useable information • Feedback to managers, staff, policy makers, and constituents • Develop a regular reporting cycle

17. 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

18. 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 organization’s priorities D. Helping staff understand the organization’s mission, priorities, and strategies

19. 4. Quality Improvement Process Q 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 • Use data for decisions to improve policies, programs, and outcomes • Manage change • Create a learning organization

20. Using Performance Data for Improvement • Quality improvement techniques • Policy change • Resource allocation change • Program change Managerial Action

21. The Public Health “Production Model”: Capacity, Process, and Outcomes Workforce Information Organization & Relation-ships Facilities Funding Assess Assure Capacity Outcomes Process (Essential Public Health Services) System Inputs Key Processes Outputs Programs and Services consistent with mandates and community priorities Improved organizational performanceImproved program performance 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.

22. 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 Act Plan Check Do

23. 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.

24. 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

25. 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

26. 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.

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

28. Performance Improvement Resources • Public Health Infrastructure Resource Center: www.phf.org/infrastructure/performance • Case studies • Searchable tools • Publications • PHF’s Alliance for Achieving Results and Outcomes (“AARO”)

29. Share Your Thoughts • What are your “take away” messages? • What will you apply or do differently? ? Thank You!