Transcript Overview of Performance Management Systems Pooja Verma, MPH Program Analyst Accreditation & QI

Overview of Performance Management Systems
Pooja Verma, MPH
Program Analyst
Accreditation & QI
NACCHO
Objectives
• Define performance management and related terms
• Identify the key steps in building a performance
management system
• Provide tips and examples for developing performance
measures
• Identify performance management resources
Defining
Terminology
What is a performance management system?
Source: Turning Point Performance Management Collaborative, 2003.
Performance
Standards
Public Health Standards:
• Public Health Accreditation
Board (PHAB)
• National Public Health
Performance Standards
(CDC)
Performance Standards
“Generally accepted, objective
standards of measurement such
as a rule or guideline against
which an organization’s level of
performance can be compared.”
- Turning Point Management Collaborative, 2003
80% of clients rate health
department services as “good” or
“excellent.”
Performance
Measures
Performance Measures
“A specific quantitative
representation of a capacity,
process, or outcome deemed
relevant to assessment against a
performance standard.”
- Turning Point Management Collaborative, 2003
% of clients that rate health
department services as
“good” or “excellent.”
Reporting of Progress
• Includes performance against meeting
standards and progress toward strategic goals
and objectives
• Internal and external stakeholders
• Foundation for identifying QI efforts
Reporting of
Progress
Quality Improvement
The use of a deliberate and defined improvement
process focused on activities that are responsive to
community needs and improving population health.
It refers to a continuous and ongoing effort to
achieve measurable improvements in the
efficiency, effectiveness, performance,
accountability, outcomes, and other indicators of
quality in services or processes which achieve
equity and improve the health of the community. *
* Definition developed by the Accreditation Coalition Workgroup
and approved by the Accreditation Coalition on June 2009
Quality
Improvement
What are the first steps in building a PM system?
• Establish a Performance Management
Committee/Team
• Conduct a Performance Management selfassessment
 Turning Point Self-Assessment Tool
 Baldrige Performance Excellence
Program
• Train staff!
Performance
Measurement
Why is performance measurement important?
• Foundation for decision making
• Alignment of efforts with agency strategic direction
• Shift in focus from individuals/activities to results
• Meaningful feedback to employees
• Promotes learning and improvement culture
*Adapted from MarMason Consulting
What do we measure in public health?
Outcomes
Efficiency
Effectiveness
Healthy People
Structures
Information Technology
Human Resources
Fiscal Resources
Processes
10 Essential Public
Health Services
Types of Performance Measures
Capacity/Input:
• Human/capital resources
Process/Output:
• Intermediate steps in developing product or providing
service
Short-Term Outcome:
• Immediate results of the product or service provided
Long-Term Outcome:
• Intended, desired, or actual long-term results
Linking Performance Measures
Strategic
Direction
Short/
Intermediate
term
(Division level)
Input and
Process
(Program
level)
Monthly/Quarterly
Long-term
(Organization
level)
2-3 years
1-2 years
Logic Model: Infant Mortality Performance Measures
Input
- # of health
educators
- # of
nurses
- $$ for
education
materials,
clinics, etc.
Process/
Output
- # of
education
classes
- # of
women in
Pre-Natal
Program
- # Pre-natal
clinics
Short-term
Outcome
- % of
women that
understand
risk factors
- % of low
income
pregnant
women
w/access to
Pre-natal
care
Intermediate
Outcome
- % high risk
pregnant
women that
smoke
- % of high
risk
pregnant
women with
adequate
nutrition
Longterm
Outcome
-%
premature
births
-%
newborns
w/low birth
weight
-Infant
mortality
rate
Considerations for Developing Performance Measures
• Do not select too many
• Feasibility of data collection
• Measurable over time
• Collectively represent major
strategic goals and objectives
• Customer and stakeholder support
Frameworks for Performance Measurement
Balanced Scorecard
1. Financial
Malcolm Baldrige National
Quality Award Criteria:
2. Internal Business
Processes
1. Leadership
3. Learning and Growth
3. Customer Focus
4. Customer
4. Measurement and
Analysis
2. Strategic Planning
5. Workforce/HR Focus
6. Operations Focus
7. Results
Developing Performance Measures
• What are you measuring?
Rate of positive CT test at clinics
• Who is the target population? Clients tested for Chlamydia
• What is your numerator?
# clients tested positive CT
• What is your denominator?
# of total CT tests at clinics
• What is your data source?
DOH records
• Who is responsible?
Jane Doe
Establish Performance Targets/Benchmarks
Use a method to establish thresholds for performance:
• Industry benchmarks (e.g. HP2020, County Health Rankings)
• Regulatory requirements
• Other health department’s data
• Past performance
*Adapted from MarMason Consulting
SMART Objectives
Specific
Measurable
Attainable
Relevant
Time specific
Decrease the rate of CT
positivity at clinic sites from
8.1% to 6.5% by the end of
2013.
Performance measure:
The rate of Chlamydia (CT) positivity at provider clinic sites.
Target population:
Numerator:
Denominator:
Which are you using—a target
or benchmark?
What is the target/benchmark?
SMART objective:
People being tested for Chlamydia
Positive CT tests at clinic sites
All CT tests at clinic sites
Target
6.5% (goals based on past performance)
Decrease the rate of CT positivity at clinic sites from 8.1% to
6.5% by the end of 2013.
DOH records
Jim Smith
Source of data:
Who will collect the
information?
How often will the data be
quarterly
analyzed and reported?
2008: 8.6%
Baseline measurement data and 2005: 10.1%
2006: 9.3%
2009: 8.2%
date(s):
2007: 10.5%
2010: 8.1%
Definitions and other
Provider clinics, Planned parenthood sites and others.
comments:
*Adapted from MarMason Consulting
Linking Performance Measures: Example
Decrease morbidity rates
of Diabetes patients by
20% by 2014.
Impact
Intermediate Outcome
-% of patients w/adequate blood
glucose
Short-Term Outcome
-# of patients seen by provider
Improve quality of
life among
Diabetics
Performance Measures
Process/Output
- Length of time b/w request of
service and meeting w/provider
Input/Capacity
- # of service providers on staff
Linking Performance Measures: Example
Decrease % of
obese/overweight youth
to 25% by 2014.
Reduce childhood
obesity
Impact
Intermediate Outcome
- % of low income children w/60
mins of moderately active daily
Short-Term Outcome
- % of low income children that
access parks/playgrounds
Process/Output
- # parks/playgrounds in low
income neighborhoods
Performance Measures
Input/Capacity
- $$/partnerships for new
playgrounds/green space
Collecting & Storing Data
• Database, Spreadsheets
o Excel
o Access
• Performance Management Software
o My Strategic Plan, M3 Planning
o Results Scorecard, Results Leadership Group
Example Performance Dashboard
Objective
Performance
Measure
Baseline
(2010)
Baseline
(2011)
Current
Status
Target
Decrease % of women who
smoke during pregnancy
enrolled in Pre-Natal Partnership
Program (PNPP)
% of women who
smoke during
pregnancy in PNPP
32%
28%
25%
20%
Increase % of low income
women who receive prenatal
care in the 1st four months of
pregnancy
% low income
women receiving
prenatal care w/in 1st
four months of
pregnancy
85%
87%
92%
90%
% of 19-35 month old
children adequately
immunized
59%
60%
66%
75%
Infant Mortality
Immunizations
Increase % of 19-35 mo. olds
adequately immunized
Turning Data Into Knowledge: Data Analysis
Questions to consider:
• How does actual performance compare to a standard or
target?
• Is corrective action necessary?
• Are new goals, objectives, or measures necessary?
• How have existing conditions changed?
Analysis Tools
Analyze Measurement Data
• Run chart
• Statistical analysis
• Control chart
• Matrices
• Flow chart
• Scatter plots
• Decision tree
Identify Root Causes
• Affinity diagram
• Brainstorming
• Fishbone
• Histogram
• Pareto chart
• Story boarding
• 5-whys technique
Reporting Structure
• Frequency
o Program measures – monthly/quarterly
o Division measures – semiannual/annual
o Department measures – every 2-3 years
• Communicate to:
o Management
o PM team and/or QI Council
o Board of health
o Staff
Reporting and Presenting
Questions to consider:
• Who is the audience?
• What is the intended use of the information?
• What is the basic message to be communicated?
• What is the presentation format? (brochure, oral presentation,
report, etc.)
Quality Improvement
Performance Management Process
1. Select performance measures
2. Collect data
3. Store data
4. Analyze data
5. Report and present findings
6. Apply knowledge
“Maybe I’m lucky to be going so
slowly, because I may be going in the
wrong direction.”
~ Anonymous
Performance Management Resources
•
Performance Management Self-Assessment Tool:
http://www.collaborativeleadership.org/pages/pdfs/CL_selfassessments_lores.pdf
•
Turning Point Resources:
http://www.turningpointprogram.org/Pages/perfmgt.html
•
PHF’s Performance Management & QI Website:
http://www.phf.org/focusareas/PMQI/Pages/default.aspx
•
Public Health Performance Management Centers for Excellence:
http://www.doh.wa.gov/PHIP/perfmgtcenters/index.htm
•
Developing, Monitoring, and Using Performance Measures:
http://www.doh.wa.gov/PHIP/perfmgtcenters/modules/Year2/11-0911_PerfMeas_public_main.htm
References
• Turning Point Performance Management Collaborative:
http://www.turningpointprogram.org/Pages/perfmgt.html
• Public Health Performance Management Centers for Excellence:
http://www.doh.wa.gov/PHIP/perfmgtcenters/index.htm
• The Performance Based Management Handbook, U.S. Dept. of Energy:
http://www.doh.wa.gov/PHIP/perfmgtcenters/index.htm
• The Quality Improvement Handbook:
http://bookstore.phf.org/product_info.php?products_id=660
Thank You!
Pooja Verma
Accreditation & QI
NACCHO
(202) 507-4206
[email protected]
www.naccho.org/QI