San Joaquin Valley Performance Management Tool: Our Process and Journey

1. San Joaquin ValleyPerformance Management Tool:Our Process and Journey Central California Center for Health and Human Services California State University, Fresno Donna DeRoo, MPA, ABD, Fresno State Allison Hensleit, MBA, Fresno State Sara Bosse, Fresno County Department of Public Health Ashley Hart, Fresno State

2. Recognition • San Joaquin Valley Public Health Consortium • San Joaquin Valley Public Health Departments Participating Counties: • Fresno, Madera, Merced, San Joaquin, Tulare • California Department of Public Health • Center for Disease Control and Prevention • National Network of Public Health Institutes (NNPHI) • Open Forum December 2012

3. Learning Objectives • Participants will increase their understanding and knowledge of the process and lessons learned in implementing a performance management system. • Participants will increase their understanding and knowledge of a performance management system’s utilization as it relates to: • Departments Strategic Plan • Community Health Improvement Plan • Quality Improvement Plan • Public Health Accreditation

4. Our Journey Attended First Open Forum Charlotte, NC Fresno County Madera County Merced County [All Divisions] & Tulare County San Joaquin County [2 Divisions] Fresno County San Joaquin County [2 Divisions] 2013 PM QI 2012 2014 Fresno County [2 Divisions] & Madera County Merced County [Training] San Joaquin County Tulare County [All Division]

5. San Joaquin Valley Performance Management Tool

6. How We Did It

7. Approach We chose this one … • Robust discussion • Team building • Highly collaborative • Pulse read of activities • Accommodates flexible schedules • Easily accessible • Accommodates flexible schedules • Remote accessibility

8. Process • Draft User Guide • M1:Brainstorm Aims, & Goals • M2: Prioritize Aims, Brainstorm Goals & Performance Measures • M3: Prioritize Goals & Performance Measures, Draft Targets, Timing, Responsibility, Data sources • M4: Presentation of Performance Management System Tool • Background & general PMQI overview • Background & general PMQI overview M1: 1st Meeting M2: 2nd Meeting M3: 3rd Meeting M4: 4th Meeting

9. Performance Management… The Beginning

10. Step 1: Develop Division Aims • Review overall department aims and how they relate to the division or unit. • Articulate how the division or unit contributes to accomplishing department aims. • Develop specific aims for the division. • Review and adjust aims to reflect accurate assessment of division resources and scope of authority.

11. Step 2: Develop Division Goal Statements S.M.A.R.T • Specific • Action oriented; providing clear direction; easily understood • Measureable • Quantifiable and/or verifiable • Aggressive, but Attainable • Challenging and realistic • Results-Oriented • Focused on outcomes; not methods • Time Bound • Having a reasonable, yet aggressive, time frame

12. Step 3: Develop Performance Measures • Performance measures are the quantitative data elements that let us know: • How well we are doing • If our processes are functioning efficiently • If we are meeting our goals • If and where improvements are necessary • If our customers are satisfied Capacity Measure Process Measure Outcome Measure

13. Step 4: Setting Annual Targets • A target is the desired end of the year performance outcome which is typically determined by past performance. • What needs to be in place before setting targets? • Aim Statements • Goal statements • Performance Measures/Indicators

14. Annual Target Logic Model How do I determine what should be the target?

15. Annual Targets & Red Line Targets In addition to annual targets, Red Line targets are just as important because they help determine the minimum level of acceptability. • Red line targets are unacceptable outcomes at any point and time that require immediate program or organizational attention and intervention. • Setting redline targets is essential, and often left out, to help your organization gauge and prioritize your program improvement efforts. Fell on or Short of Red Line Target Performed Above Red Line & Short of Annual Target Achieved or Exceeded Target Red Line Target Annual Target

16. We have the tool….now what do we do? “Kick the tires and light the fires” • Implement it – immediately. • Allow your teams to become comfortable navigating through the system. • Embed the process such that it involves all employees within an organization. • Set a date from which all designated performance measure data will be inserted into the performance management system.

17. How does it all link together? Performance Management System Quality Improvement

18. Let’s Guide You Through The Tool….

19. Performance Management System Implementation

20. Results in Fresno County • Cohesive system • Increased communication • Increased cross-division projects • Integration aims, goals, and measures into Department strategic planning • Increased accountability • More information available for reports and presentations to the Board of Supervisors

21. Leadership & Staff Engagement

22. Implementation requires commitment… • Complex scheduling coordination • Requires more time than LDHs anticipated • Right leaders in the room • Fear of change • Fear of accountability given reduced resources • Marathon not a sprint • Don’t bite off more than you can chew • Strategic plans may need to be refreshed • Not for the faint of heart – requires commitment

23. Where the magic happened…. • Built community of practice • New collaborations • Improved internal awareness • Potential for maximization of resources • Asking the right questions to propel their community impact forward • Ownership in the performance management system

24. Lessons Learned • We would have expanded the implementation timeline to allow the LHDs a month of piloting the performance management tool • Basic level of Microsoft Excel experience was much lower than anticipated • Underestimated the amount of time required to facilitate the journey from strategic Aims to Performance Measures and Targets • Essential to have the groups working together in a room to discuss and collaborate with one another • Requires a cultural change from the top down

25. Questions?

26. Contact Information • Donna DeRoo, MPA, ABD • dderoo@csufresno.edu; (559) 228-2160 • Allison Hensleit, MBA • allison@csufresno.edu; (415) 702-7373 • Sara Bosse • sbosse@co.fresno.ca.us; (559) 600-3214 • Ashley Hart • ahart@csufresno.edu; (559) 228-2163

27. Appendix

28. Performance Management Data Collection Tool

29. Terms to Know

30. Performance Management Example

31. Performance Management Example It’s the New Year and for 2014 you want to live a healthier lifestyle. • During your annual physical, your doctor recommends that you lose weight. • To determine a reliable indicator of healthy weight, you look at Body Mass Index (BMI) tables and identify the normal weight range for your height. • With that standard in mind, you decide to measure weekly weight loss, with a target of losing 2 pounds per week. You also decide to measure caloric intake and physical activity, with a daily target of limiting your calories to 1800 and walking a mile. • You monitor your weight weekly using your bathroom scale and report (to yourself!) your weight on a spreadsheet. • After tracking weight loss for four weeks, you find that you have only lost an average of one pound per week, so you decide to test an improvement, which involves adding an additional mile of walking per day. • Four weeks later, you find that you are meeting your goal of losing an average of two pounds per week. Source: MPHI Office of Accreditation and Quality Improvement

32. Model Translation When target weight loss was not being met AIM: Live a more healthy lifestyle in 2014.