South Carolina Performance Management System MLC-3 work

1. South Carolina Performance Management System MLC-3 work Joe Kyle ….on behalf of the SC team Director, Office of Performance Management Health Services Dept of Health and Environmental Control

2. Overview of Presentation • Description of South Carolina Department of Health and Environmental Control, Health Services Deputy area • Description of what implementation of Performance Management in DHEC’s Health Services has been and what it is striving towards • What Health Services plans on implementing through the MLC-3 grant efforts

3. DHEC andHealth Services • DHEC is the lead environmental and public health agency in the state (combined EPA, CDC, HRSA , DOA (WIC), functions) • Health Services is the largest organizational unit in DHEC, and where most traditional health department services are located • About 3,112 FTE’s and 572 hourly/temporary/per visit employees statewide • Health department is vertically integrated. All employees from counties to regions to state, are state employees, all answer, ultimately, to same boss • 8 Public Health Regions with local health departments in 95 sites in all 46 counties in SC

4. General Role of Central Office and Regions • Central Office (State) Level • State level Health Improvement • Obtaining Resources • Development of Policies, Regulations, etc • Program Guidance & Oversight • Subject Matter Expertise – Consultations (public & private sector) • State, Federal and National relationships, partnerships • Region (Local) Level (local decision level) • Community level Health Improvement • Direct Service Delivery • Implementation of Policies • Region and local relationships, partnerships

5. Beaufort DHEC’s Eight Public Health Regions Region2 Greenville Cherokee Region 3 York Spartanburg Pickens Oconee Union Chester Lancaster Marlboro Region 4 Chesterfield Anderson Laurens Dillon Kershaw Fairfield Darlington Newberry Abbeville Lee Marion Greenwood Florence Richland Saluda McCormick Lexington Sumter Horry Region1 Edgefield Clarendon Calhoun Williamsburg Aiken Orangeburg Region6 Georgetown Barnwell Bamberg Berkeley Dorchester Region5 Allendale Colleton Hampton Charleston Region 7 Jasper Region 8

6. Health Services is..1 Many different types of organizations Regulatory (Environmental Health) Disease Focused (STD, TB, HIV) Population Focused (Child Health, Perinatal Health, Imm) Policy Focused(Community Health & Chronic Disease) Direct Service Delivery-Gap Filler(Family Planning) Core Public Health Provider(Obesity Program) Political

7. Health Services is..2 Many different types of organizations Discipline Driven (Nursing, SW. HE, Nut) Stovepiped (specialized) in central office Organized by funding Organized by disease, issue, population Priority of relationship to the mother ship (feds) More horizontally aware in the Regions Out of necessity—multi-tasking and multi-function staff Organized more by function, unlike central office Centralized to some, decentralized to others Role of accountability Highly consultative with internal stakeholders prior to major decisions

8. Performance Management within Health Services

9. Performance Management antecedents • CHAP • agency accreditation for its HH program-ongoing • Baldrige • region self assessment and annual agency accountability report to legislature • Agency Strategic Plan, 2000-2005 and 2005-2010 • 00-05 first outcome-based plan; 05-10 performance concepts incorporated • Health Services Operational Plan • first attempt at integrated planning based on outcomes • Pilot of Performance Management System • first attempt at “within control” accountability, span of HS

10. Performance Management Framework And Components 1 2 3 4 Public Health Agency Model Turning Point From Silos To Systems

11. Performance Management System

12. Span of Measures and Prioritization

13. Performance Standard • 90% of women testing positive for Chlamydia should be treated within 30 days of test 1 • PerformanceMeasurement • Percent of DHEC family planning and STD clinic clients with positive Chlamydia tests that are treated within 30 days of the specimen collection date 2 ReportProgress/AnalyzeData Quarterly reports for each region provided to STD/HIV Division and reported in PM database. Reports shared at Region level and at quarterly CO/Region meetings 3 • QualityImprovementProcess • Region and STD/HIV Division identify regions that are below standard, initiate QI process to improve performance and communicate results 4

14. CQI Action Steps Performance Measurement Monitoring Problem Identification Problem Prioritization Communicate Define ACT PLAN Action Steps To Improve Performance Measure Implement CHECK DO Analyze Evaluate Innovate

16. Getting the PM work done • Office of Performance Management • CQI Team • Since 1996 • Reps from each region, major program areas • Each region has point of contact or coordinator for PM • Each measure and program area has “owner”, responsible party • Data entry, troubleshooting, consultation

17. Multistate Learning Collaborative Grant What will happen in South Carolina? • Collaborative work will primary focus on two regions (4 and 8) • In these regions, two collaboratives will be formed, sequentially, based on the IHI Collaborative Model: • 1) reducing exposure to 2nd hand smoke; 2) improving first trimester access to prenatal care. • Collaboratives will consist of 7 county teams, with possible participation of region staff and community partners • TA and support from USC (contract), OPM, and other experts • Lessons learned from doing systematic collaborative-based quality improvement, and accreditation work, will be shared out continuously to DHEC, other partners in SC and outside through reports, presentations, site visits (to SC, to other states)—including presentation to SCPHA, and large statewide management conference in year 3

18. Multistate Learning Collaborative Grant What will happen in South Carolina? • Preparing the workforce for accreditation • Linking up our PMS with accreditation, to create one seamless system • Taking advantage of our many face-to-face meetings throughout the state with region and central office staff, to educate, inform, solicit input regarding accreditation • Training. All told, 11 staff in HS will receive training to become a Lean Six Sigma Greenbelt (one from each of the regions, two from OPM, one from OQM)—2 staff trained on IHI model from HS, and 1 staff from our academic partner What do we hope to gain through MLC3and accreditation work includes: improve upon and fully make PM and QI part of our culture, to learn from other states and organizations about how best to do this, and to merge our PM efforts with voluntary accreditation processes