Dr. Catherine Whiting Medical Officer of Health North Bay & District Health Unit

1. PERFORMANCE MEASUREMENT AT THE LOCAL HEALTH UNIT LEVEL Panel Presentation on Performance Measurement in Public Health Association of Local Public Health Agencies Annual Conference June 14, 2004 Dr. Catherine Whiting Medical Officer of Health North Bay & District Health Unit

2. Performance Measurement at the Local Health Unit Level • This is the process of assessing whether we have met the responsibilities we have been given: • Are we doing what we have been mandated to do? • Meet minimum Mandatory Health Programs and Services Guidelines (MHPSG’s) – defined as “standards” both general and program

3. Performance Measurement at the Local Health Unit Level • If we are meeting our responsibilities, then we are making our contribution to the achievement of stated, province-wide public health goals • Do we have the measures to determine this? • Are we making a local difference: is there a change in local health status indicators and behaviours?

4. Performance Measurement at the Local Health Unit Level • Are we meeting our responsibilities efficiently and effectively using best practice as assessed through our processes, our structures and research and evaluation?

5. Performance Measurement at a Local Health Unit Our Struggles with Performance Measurement: • Mandatory Program Indicator Questionnaire (MPIQ) – implementation report on achieving minimum standards of Mandatory Health Programs and Services Guidelines • One of our “benchmarks” with other health units • Attempting to set local objectives and targets in planning process to assess whether we are making a difference, i.e. what can we reasonably contribute to the provincial goals and directions?

6. Performance Measurement at the Local Health Unit Level • Use of Program Logic Models to describe how we organize activities to work towards outcome objectives • Balanced Scorecard (BSC) development through internal operational review in 2002 • Process and outcome performance measurement indicators • to evaluate implementation of review’s recommendations

7. Performance Measurement at the Local Health Unit Level • Currently implementing the recommendations from the internal operational review and its evaluation • Next step is to formally implement BSC (Internal/Board) • Four (4) performance indicators developed for BSC: • Efficient and effective programs (activities and outcomes) • Client and partner satisfaction • Finances (sound financial control) • Staff learning and development

8. Performance Measurement at the Local Health Unit Level • Developed quality policy statement for North Bay & District Health Unit • Developed and implementing eleven (11) quality system policies and procedures, eg. management responsibility; document, data and record control; program/activity planning and delivery; development and training • Quality System also includes management and staff work instructions, and quality records (training, audit reports, logs)

9. Performance Measurement at the Local Health Unit Level • Limited local program evaluation and research (resource driven) • Successful partnerships with Northern Public Health Research, Education and Development (PHRED), Health Units and Northern Health Intelligence Program (NHIP)  pooled resources, eg. Northern Ontario Perinatal Child Health Survey – Consortium • Regional collaboration is starting to work well for us (NHIP, HU, PHRED, University and maybe District Health Councils)

10. Performance Measurement at the Local Health Unit Level • Need to create opportunities for “partnerships” where everyone contributes to common research and in the process, meets their individual mandates • Need more provincially funded system-wide research/evaluation

11. Performance Measurement at the Local Health Unit Level Some of the Challenges: • Resources and recruitment ($ and people) • Adequate data sources (provincial and local) linked to provincial objectives • Implementation of our programs requires assistance from many others at local level (agencies, ministries, municipalities)  they are not being held “responsible” for this requirement • Lack of standard templates (eg. Community Health Status Reports) • Lack of provincial health goals to link to public health goals and to hold other government ministries/agencies accountable

12. Performance Measurement at the Local Health Unit Level What Has Worked: • Use of consultants (outsourcing and building capacity within) • Board support (operational review, quality assurance) • Preparation for accreditation (OCCHA) • Use of PHRED best practice and benchmarking reports