Chapter 17
Chap 17
Performance Management in Public Health
Learning Objectives
Understand challenges to performance at many different levels
Appreciate historical trends in the development of standards and measures
Explain the meaning and use of performance measures and standards
Overview
Many public health organizations use performance management efforts to track the work they produce and the results they achieve
Public health leaders and managers face issues related to performance at many different levels of the public health system including the performance of individuals, programs, agencies, inter-organizational collaborations, and the public health enterprise itself
Overview
This chapter examines these lessons, as well as various applications using performance standards to improve the performance of public health organizations and systems, including the accreditation of public health agencies
The initial development of a performance management framework for use in public health organizations and systems will be described
Elements of Performance Management
Elements of Performance Management
Four Quadrant
Performance Standards
Performance Measures
Reporting of Progress
Quality Improvement Process
Four Quadrants of Performance Management
Standards:
direction-setting practices,
performance targets, levels of excellence, accepted expectations
Measures:
quantitative assessment of performance
Indicators of progress
Reporting of progress:
studies of trends, comparing actual to desired levels; sharing with others
Standards outline the expectation of what should be achieved
7
Four Quadrants of Performance Management
The quality improvement process uses:
Use collected data for decisions
Report change management processes
Revise program strategy
Better attain desired performance results
Performance management integrates an organization’s use of standards, measurement, and performance improvement to change institutional capacities, processes and priorities
8
Figure 17.1 The Performance Management Model
Reprinted from Turning Point National Office. From Silos to Systems: Using Performance Management to Improve the Public’s Health. Seattle, WA: Turning Point; 2003. Copyright Robert Wood Johnson Foundation. From Turning Point, a national program of the Robert Wood Johnson Foundation from 1996–2006. Used with permission from the Robert Wood Johnson Foundation.
The performance management model integrates elements of public health practice into a coherent model for understanding and directing complex public health programs, organizations, and systems.
Ties together more conceptual and elusive issues in public health policy, such as accountability, effectiveness, and benchmarking, incorporating them into a practical and feasible model.
9
How do you know if something is working ?
1. Performance measurement but not all performance measurement is created equal!
10
Performance Measurement
Regular collection and reporting of data to track work that is performed and results that are achieved
Effective Performance Measurement
Incorporates stakeholder input
Promotes top leadership support
Creates a clear mission statement
Develops long-term goals and objectives
Formulates short-term goals and interim measures
Devises simple, manageable approaches
Provides support and technical assistance
Effective performance measurement will consider the above:
12
Benefits of Measuring Performance
Clear goals and objectives
Identifies strengths and weaknesses
Opportunities for collaborative approaches
Clearer lines of accountability
Improved quality
Better tracking of progress over time
More effective communication
Better resource allocation and deployment
Strengthened organizational effectiveness
Performance Management
Focuses on what is occu
ing
Is a management and oversight tool to facilitate positive change and improvement in performance
Deemed relevant to performance
Evaluative Research
program evaluation
More in-depth, helps understand the why
Design, implementation, and more
Performance indicators
determine whether or to what extent a performance standard is achieved
Acknowledges critical dimensions of performance, capacities, processes, and outcomes
Performance management does not extensively address why or how
14
Performance Measure
Performance Measure
specific quantitative representation of a capacity, process, or outcome that is deemed relevant to the assessment of performance.
One component of a comprehensive evaluation
Specific quantitative representation of a capacity, process, or outcome that is deemed relevant to performance
Similar to the concept of prevention, performance measurement requires an object.
It is critical to specify what (or whose) performance will be measured.
Program, agency, health system
15
Performance Measure (Cont)
Performance measurement most frequently occurs within the context of a particular program
(e.g., childhood immunizations or retail food safety).
But can also occur with:
performance of an agency (e.g., a state or local health department),
partnership,
community public health system,
an individual is also an appropriate target for performance measurement.
Performance Measure (Cont)
Performance measures can take several different forms.
Performance Standard
an expectation of what will be done or accomplished.
Ie: community health assessment every three years
Performance Indicators
Performance measures that are used to determine whether or to what extent a performance standard is achieved
Performance Standard: A performance measure that takes the form of a generally accepted, objective standard of measurement—such as a rule or guideline against which the level of performance can be compared—is
For example, a performance standard might call for a comprehensive community health assessment to be completed every three years.
17
Dimensions of Performance
Processes
efer to what is done to, for, with, or by defined individuals or groups to identify and address community or population-Âwide health problems.
The performance of key processes
(e.g., monitoring health status, investigating health hazards, and building constituencies) leads to the development of other processes that can also be viewed as outputs.
In public health practice, these outputs take the form of interventions
(e.g., policies, programs, and services) intended to achieve outcomes that are important to the system.
Dimensions of Performance
Capacities
Refers to the resources and relationships necessary to ca
y out processes of public health
Outcomes
Immediate and long-term changes experienced by individuals and populations as a result
Performance measures can relate capacities to outcomes
Cost-effectiveness of an activity or intervention
Performance Measure (Cont)
It is clear that the United States fell well short of its Healthy People 2000 target of having 90 percent of the population residing in jurisdictions in which public health’s core functions are being effectively addressed.
Healthy People 2010
Source: Turnock BJ, Handler A, Hall W, Potsic S, Nalluri R, Vaughn EH. Local health department effectiveness in addressing the core functions of public health. Public Health Rep. Sep-Oct 1994;109(5): XXXXXXXXXXTurnock BJ, al e. Core Function-Related Local Public Health Performance Journal of Public Health Management and Practice. 1998;4(5):26-32.
These efforts to measure core function performance have served several important purposes.
By providing information on both key processes and outputs of public health practice, many state–local systems have initiated public health practice improvement strategies.
20
Evolution of Performance Measurement
In the 1990s many public health organizations were conducting organizational self-assessments, identifying strengths and weaknesses, and channeling information into capacity-building plans
Performance Measures
Information pertaining to the capacity to perform
Process performance
Outputs
Ultimate Results
Impacts/outcomes
Prior to the 1990s it focused on capacities and outputs than the key processes and the focus of public health core functions.
22
Evolution of Performance Measurement
In 1997 increased interest in performance measurement in public health expanded to community-driven and state-level collaboration
Trends toward strategic effectiveness and evolution of APEX-PH into MAPP
Assessment Protocol for Excellence in Public Health
Early model for strengthening public health agencies roles in communities
APEXPH: Assessment Protocol for Excellence in Public Health: early model
lue print for public health agencies wanting to focus and strengthen their roles in their communities.
There was a co
elation between where APEXPH was implemented and used and public health performance; APEXPH
23
MAPP
Mobilizing for Action through Planning and Partnerships (MAPP)
Uses strategic planning
Community wide strategic planning tool
Link public and private community partners to specific performance expectations for addressing priority health needs in the community
Performance standards for use in state and local public health systems and local governing boards
MAPP is a structured but flexible process that at its best produces collection action at the community level to improve health
24
Healthy Nashville
MAPP
MAPP model supports the identification of strategic community health issues by the findings of four assessments:
Community health status assessment
A forces of change assessment (environmental scan)
A community themes and strengths assessment
Local public health systems assessment
Critical Issues for Success
Performance improvement
positive change in the capacity, process and outcomes of public health organizations and public health systems (public, private and voluntary organizations that collectively contribute to the health of the public).
Performance improvement is the positive change in the capacity, process, and outcomes
See Exhibit 17-6
Critical Issues For Success
Quality improvement (QI)
is the use of a deliberate and defined improvement process to identify needs and improve population health
Plan-Do-Check-Act
Continuous and measurable improvements result in:
Efficiency
Effectiveness
Performance
Accountability
Outcomes
Quality improvement is focused on activities that are responsive to community needs and improving population health.
28
Accreditation of Public Health Agencies
The Future of the Public’s Health in the 21st Century (2003, IOM)
Calls for the creation of a national voluntary public health agency accreditation system
http:
www.phaboard.org/news-room/accreditation-activity
Public Health Accreditation Board
Voluntary
Not inexpensive
Pg 380
The most recent IOM Report calls for careful study of the feasibility of creating a national voluntary public health agency accreditation system.
This recommendation stems from the fact that public health organizations remain one of the few health-related entities that are not subject to national standards and review from an external accrediting body
Credentialing of both individuals and organizations has become such an accepted means of fostering quality improvement and accountability throughout the health sector that its absence from the public health system is noteworthy.
29
Accreditation
Public Health Accreditation Board
Inspiration for PHAB accreditation was derived from pioneering state programs
Accreditation must strike a fine balance between minimal and optimal standards
The PHAB accreditation program development has been an intensive iterative process building upon the strong foundations of the previous work
Accreditation
Assessment process:
Pre-application and application phase
Evidence selection and submission
Site visit and accreditation determination
Annual reporting
Reaccreditation
Voluntary accreditation could lead to interest in credentialing segments of the public health workforce
Accreditation of Public Health Organizations (Cont)
Early attention to and consensus around these issues will determine the quality and relevance of public health practice in the twenty-first century.
CEPH
Council on Education in Public Health
Collaboration between the APHA and the Association of Schools of Public Health
Public health schools
https:
www.nbphe.org/eligibility
Future Outlook
Performance management leading to performance improvement initiatives were undertaken in many different settings during the 1900s, including the public sector
The opportunity for more use of performance standards and measurement, emphasizing performance management and quality improvement strategies is great
Conclusion
Performance management activities - - that include performance standards, measurements, public accountability and quality improvement - - will boost quality if they focus on all aspects of the public health system—its capacity, its processes, and the links between them and important community health outcomes—and if the public health community accepts,