Transcript No Slide Title

From Silos to Systems:
Performance Management
in Public Health
Turning Point
Performance Management Collaborative
October 2002
Turning Point
Learning Objectives
• Gain understanding of the
components of a performance
management system
• Identify at least three benefits of
performance management
Turning Point
Turning Point’s National
Excellence Collaboratives,
2000-2004
• Funded by Robt. Wood Johnson Foundation
- States, communities, national partners
– Combine collective experience, skills
– Take next steps in transforming public health
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Review of literature & current practice; analysis
Development of innovative models
Testing and disseminating innovation
Evaluation
Turning Point
Turning Point: National
Excellence Collaboratives
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Public Health Statute Modernization
Performance Management
Information Technology
Social Marketing
Leadership Development
Turning Point
Performance Management
Collaborative (PMC)
7 Turning Point States
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Illinois*
New York
Montana
Alaska
•New Hampshire
•Missouri
•West Virginia
* Lead State
Turning Point
More PMC Members
• TP National Program Office at Univ. of
WA/School of Public Health
• National Partners
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ASTHO
NACCHO
CDC
HRSA
ASTHLHLO
Turning Point
PMC Vision
Widespread use of dynamic and
accountable public health
performance management
Turning Point
PMC Goals
• To develop useful and feasible performance
management models for states
• To stimulate national dialogue and consensus
on performance management in public health
• To support the application of performance
management as a core discipline of public
health practice
Turning Point
What Is Performance
Management?
• The practice of actively using
performance data to improve the
public’s health.
• Performance management can be
carried out at the program,
organization, community and state
levels.
Turning Point
Four Components of
Performance Management
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Performance Standards
Performance Measures
Reporting of Progress
Quality Improvement
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Why Develop a PM System?
• To maximize public health’s
effectiveness. This requires
– More than measurement alone
– More than standards alone
– All four PM components to be
continuously integrated into a system of
performance management
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Using Data to Achieve Results
• Quality
improvement
efforts
• Policy change
Managerial Action
• Resource
allocation
change
• Program change
Turning Point
Survey of Performance
Mgmt. Practices in States
• Baseline Assessment
– Conducted by PHF
– 47 of 50 States Responded
• Survey Asks About:
– Use of Performance Targets, Reports
– Impact on Program and Policy
– Need for New Tools
Turning Point
Nearly All SHAs Have Some Performance
Management Efforts
However, only about half apply performance management efforts statewide
beyond categorical programs
Figure 1. Agencies or programs to which SHAs apply performance management efforts (N=47)
None
4% (2)
SHA wide
32% (15)
Categorical
programs
only
43% (20)
Local public
health
agencies only
4% (2)
SHA wide
and local
public health
agencies
17% (8)
Turning Point
Performance Management Efforts Result in Improved
Performance for Three-Quarters of SHAs
Figure 19. Percentage of SHAs that report
their performance management efforts
resulted in improved performance (N=41)
No
24% (10)
Reported Positive Outcomes:
 Improved delivery of services—program
services, clinical preventive services, essential
services
 Improved administration/management—
contracting, tracking/reporting, coordination
 Legislation or policy changes
Yes
76% (31)
Turning Point
SHAs Most Likely to Have Components of Performance
Management for Health Status;
Least Likely for Human Resource Development
Figure 8. Areas most and least likely to have performance targets, measures or standards, reports, and
processes for quality improvement (QI)/change, of SHAs that apply performance management efforts SHA
wide, SHA wide and to local public health agencies, or to local public health agencies only (N=25)
Most Likely
Performance Targets
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Performance Measures or
Standards
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Performance Reports
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Process for QI/Change
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Least Likely
Health Status
Data & Information Systems
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Health Status
Data & Information Systems
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Health Status
Data & Information Systems
Management Practices
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Health Status
Customer Focus and Satisfaction
Management Practices
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Human Resource Development
Public Health Capacity
Human Resource Development
Customer Focus and Satisfaction
Human Resource Development
Public Health Capacity
Human Resource Development
Public Health Capacity
Turning Point
Top Three Models/Frameworks Explicitly Incorporated
by SHAs Into Their Performance Management Efforts
• Healthy People Objectives
• Core Public Health
Functions
• Ten Essential Public
Health Services
States use a variety of
performance management
models/frameworks, in a
variety of combinations
Turning Point
Most SHAs Have Performance Measures, Targets, and
Reports, While Fewer States Have
Process for Quality Improvement or Change*
Figure 15. Percentage of SHAs that have specified components of performance management for
public health capacity (N=25)
Percentage of States (N=25)
100
90
80
70
60 (15)
60
50
44 (11)
40 (10)
36 (9)
40
30
20
10
0
Performance Targets
Performance Measures
or Standards
Performance Reports
Process for QI/Change
*Correlation analysis revealed that there is a comparatively weak relationship between having performance targets,
performance measures or performance reports and process for quality improvement (QI)/change. That is, in general,
fewer states indicated that they did have a process for change, even though they indicated having performance targets,
performance measures, or performance reports. This was the case for all areas of performance management studied
(Human Resource Development, Data & Information Systems, Customer Focus and Satisfaction, Financial Systems,
Management Practices, Public Health Capacity, and Health Status). Figure 15 illustrates this finding.
Turning Point
Most States Use Neither Incentives nor Disincentives
to Improve Performance
Figure 18. Percentage of SHA performance efforts that include incentives or disincentives to improve
performance (N=40)
100
Percentage of States (N=40)
90
80
70
63 (25)
60
50
40
30 (12)
30
20 (8)
20
13 (5)
8 (3)
10
0
Incentives for
Agencies, Programs,
Divisions
Incentives for Staff
Disincentives for
Agencies, Programs,
Divisions
Disincentives for Staff
Note: Respondents could choose more than one response, so total does not equal 100
None
Turning Point
Funding for Performance Management Chosen as
Number One Way to Improve States’ Efforts
Figure 5. Types of aid identified as most useful to SHAs to improve SHA performance
management efforts, in rank order (N=47)
Number of SHAs that ranked each
answer 1-3
1st
2nd
3rd
1. Funding sources/support
18
7
3
2. Detailed examples/a set of models from other states’
performance management systems
9
10
4
3. Consultation/technical assistance
3
5
7
4. “How to” guide/toolkit (tie)
4
5
3
4. A set of voluntary national performance standards for
public health systems (tie)
6
1
5
Turning Point
What Did We Learn?
• SHA performance management practices are
widespread, although often not system-wide or
with processes leading to quality improvement or
changes.
• SHAs report their efforts result in improved
performance, with positive outcomes broadly
defined.
• No single framework is used by most SHAs, and
there are insufficient data to inform leaders’
choices in performance management approach.
Turning Point
Learning Projects
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Nat’l PH Performance Standards
Florida Quality Improvement Program
Balanced Scorecard
State-Based Standards in WA
Workforce Preparedness Centers
Turning Point
More Learning Projects
• WI Performance-Based Contracting
• MI Accreditation Program
• Foundation on Accountability Health
Care Quality Measures
• Professional Credentialing
Turning Point
Conceptual Framework of the Public Health System as a Basis for
Measuring Public Health System Performance
M
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Structural Capacity
----------------Information Resources
Organizational Resources
Physical Resources
Human Resources
Fiscal Resources
PHS Mission
and Purpose
---------------Philosophy
Goals
"Core Functions"
Processes
-------------------
Outcomes
---------------
The 10 Essential
Public Health
Services
Effectiveness
Efficiency
Equity
Source: Handler A, Issel M, and Turnock B. 2001. A conceptual framework to measure performance of the
public health system. Am J Public Health, 91:1235-1239.
Turning Point
Conceptual Framework of the Public Health System as a Basis for
Measuring Public Health System Performance
M
A
C
R
O
C
O
N
T
E
X
T
P
U
B
L
I
C
H
E
A
L
T
H
S
Y
S
T
E
M
Structural Capacity
----------------Information Resources
Organizational Resources
Physical Resources
Human Resources
Fiscal Resources
PHS Mission
and Purpose
Philosophy
Goals
"Core Functions"
Processes
-------------------
Outcomes
---------------
The 10 Essential
Public Health
Services
Effectiveness
Efficiency
Equity
Source: Handler A, Issel M, and Turnock B. 2001. A conceptual framework to measure performance of the
public health system. Am J Public Health, 91:1235-1239.
Turning Point
Four components
of a performance
management
system
Source: Turning Point Performance Management Collaborative,
From Silos to Systems: Performance Management in Public Health
(in press).
Turning Point
In a performance
management
system...
• All components should
be driven by the public
health mission and
organizational strategy
• Activities should be
integrated into routine
public health practices
• The goal is continuous
performance and quality
improvement
Source: Turning Point Performance Management Collaborative.
Turning Point
The Management Challenge
9 of 10 companies fail to execute strategy
• Vision Barrier: Only 5% of • Management Barrier:
the workforce understands
85% of executive teams
the strategy
spend <1 hour per month
discussing strategy
• People Barrier: Only 25%
of managers have
• Resource Barrier: 60%
incentives linked to
of organizations don’t link
strategy
budgets to strategy
Source:
Balance Scorecard Collaborative, www.bscol.com
Turning Point
Future Performance
Management Issues
• How do we move from “silos to systems”?
• How do we create a model quality improvement
process that converts performance data into
information then action?
• How can we inform and influence federal
initiatives to improve performance of public
health?
Turning Point
What’s the Transformation?
• Widespread Use shifts from a
measurement to a more balanced and
cohesive management model
• Shifts from categorical to a systemswide scope targeting capacity,
process and outcomes
Turning Point
Performance Management
Series of Reports
Literature Review
Baseline Assessment Survey of
States
From Silos to Systems: Performance
Management in Public Health
Toolkit
Turning Point