PERFORMANCE MANAGEMENT IN ACTION: THE MONTANA MODEL.

PERFORMANCE MANAGEMENT IN ACTION: THE MONTANA MODEL

Topic Big ‘QI’ – organization-wide Little ‘qi’ – program/unit

Improvement

Quality Improvement Planning

Evaluation of Quality

Processes

Quality Improvement Goals

Individual ‘qi’

Contrasting Big “QI”, Little “qi”, and Individual “qi”

System focus

Tied to the Strategic Plan

Responsiveness to a community need

Cut across all programsand activities

Strategic Plan

Specific project focus

Program/unit level

Performance of a processover time

Delivery of a service

Individual program/unit level plans

Daily work level focus

Tied to yearly individualperformance

Performance of daily work

Daily work

Individual performance plans

MACRO

MESO

MICRO

INDIVIDUAL

Turning Point

Baldrige

QFD

LSS

Daily Management

P

DC

A

P

DC

AP

DC

A

S

DC

A

Big ‘QI’Little ‘qi’

Individual ‘qi’

QI Teams

Rapid Cycle Advance

Tools of QI

Basic Tools of QI

Continuous Quality Improvement System in Public Health

MAPP

MCH Preparedness HIV STD Family Planning

De-siloifying

Our Research Found Four Barriers to Strategic Implementation

Only 5% of the work force understand the

strategy

60% of organizations don’t link budgets to

strategy

Only 25% of managers have incentives linked

to strategy

85% of executive teams spend less than one

hour/ month discussing strategy

9 of 10 companies

fail to execute strategy

The People Barrier

The Vision Barrier

The Management Barrier

The Resource Barrier

You Can’t Manage Strategy With a System Designed for Tactics

Today’s Management Systems Were Designed to Meet The Needs of Stable Industrial Organizations That Were Changing Incrementally

Four components of a performance management system

Source: Turning Point Performance Management Collaborative, From Silos to Systems: Performance Management in Public Health (in press).

In a performance managementsystem...• 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.

11LeadershipLeadership

77BusinessBusinessResultsResults

66Process Process

ManagemenManagementt

33Customer & Customer &

Market Market FocusFocus

2 2 Strategic Strategic PlanningPlanning

Baldrige Criteria For Organizational Performance

Excellence

44Information and AnalysisInformation and Analysis

5 5 Human Human

Resource Resource FocusFocus

Healthy People2000/2010 Benchmarks

Agency Strategic Plan& Performance Report

PerformanceBased Program

BudgetingMeasures

QuarterlyPerformance

Report

Local and StateNeeds

Assessments

PerformanceManagement

System

State/LocalPerformance

Standards

County HealthDept Plan

ProgramPlans

Federal GrantRequirements

CHD QualityImprovement

Indicators

Mission / Vision

Using Systems to

Comply

MONTANA’S ACCREDITATION

STRATEGY

Montana Department of Public Health and Human ServicesPublic Health and Safety Division

Lindsey Krywaruchka and Denny Haywood

Integrated Management System Concept

PHAB Criteria and Systems

How To: Building a Performance Management System

Case Study: Chronic Disease and Health Promotion Bureau

Objectives

Take Home Message:Take Home Message: Pursue accreditation by building systemsPursue accreditation by building systems

12

A Fully Interconnected

Unit

INTEGRATED MANAGEMENT

SYSTEM


System

Support

Outputs of one process are input to another. Interaction and feedback between the parts.

System

A set of interacting or interdependent processes.

Pile of Sand Engine

Not A System Is A System 14

Must be defined, usually documented.Consistently applied.Build in opportunity for evaluation, improvement, and sharing.

Systematic

Approaches that are repeatable and use data and information so learning is possible.

15

All work, including management, consists of linked processes forming a system, even if the system was not designed and is not understood.

Every system is perfectly aligned to achieve the results it creates. Process determines performance.Process determines performance.

The results of an aligned system far exceed a system that fights against itself.

Integrated management systems ensure that performance excellence happens by design, not by chance.

Why Is Managing Systematically Important?

16

PHSD Integrated Management System


System

Support

Define the ProblemsDefine the Problemsand Prioritiesand Priorities

Decide How To AttainDecide How To Attain Desired OutcomesDesired Outcomes

Plan RequiredPlan Required Work Tasks Work Tasks & Resources& Resources

Allocate DollarsAllocate DollarsTo Do Planned WorkTo Do Planned Work

Do The WorkDo The Work

Are We On Track?Are We On Track?Tasks – Dollars – Outcomes Tasks – Dollars – Outcomes

Have We Have We AttainedAttainedHigh Level Outcomes?High Level Outcomes? Why or Why Not? Why or Why Not?

Build Capacity To Do WorkBuild Capacity To Do Work 17

Integrated Management System Documents


System

Support

State PublicHealthAssessment

State PublicHealthImprovementPlan

PHSDivisionStrategicPlan

PHSDProgram/ActivityOperationalPlan





PHSDProgram/ActivityOperationalPlans

PHSDivisionBudget

Program/ActivityMetrics

StrategicObjectives &Metrics







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Potential Contradiction

PHAB CRITERIA AND SYSTEMS


System

Support

Some criteria call for:

Policy and procedures

Process

Protocol

Others call for:

Two examples

Protocol – or – Two Examples

Two isolated cases cannot ensure excellent Two isolated cases cannot ensure excellent performance happens every time! performance happens every time!

Systems and systematic approaches ensure quality Systems and systematic approaches ensure quality the first time and every time.the first time and every time.

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SystemsSystematicStandardizedProcessProtocolStandard Operating ProceduresComprehensive PlanningStrategic PlanningOperational Planning Integrated

“Systems” Terms Used In PHAB Criteria

The criteria are good, but are moreThe criteria are good, but are moreunderstandable when organizedunderstandable when organizedas a system……as a system……


System

SupportUse PHAB Criteria To Build Use PHAB Criteria To Build SystemsSystemsResulting InResulting InPerformance ExcellencePerformance Excellence 21

1.1: Conduct collaborative process resulting inCommunity Health Assessment.

4.1: Engage with the public health system and community to identify and address public health problems.

PHAB Standards – Needs Assessment


System

Support


22

5.2: Conduct comprehensive planning processresulting in State Health Improvement plan.

5.3: Develop organizational strategic plan. 4.2: Engage the community and

governing entity in deliberating optionsand alternatives.

7.2: Identify strategies to improveaccess to health care services. 12.1.1 A: Provide mandated public

health operations, programs,and services.

12.2: Keep the governing entity informed of its public healthresponsibilities and its role in updatinglaws, rules, and regulations.

PHAB Standards – Strategic Planning


System

Support



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5.3: Implement organizational strategic plan. 5.4: Maintain all hazards emergency operations plan. 2.4: Maintain a plan, policies, and procedures for urgent and

non-urgent communications. 7.2: Implement strategies

to improve access to healthcare services.

11.1: Develop and maintainoperational infrastructure. 11.1.1.A: Maintain operational

policies and procedures. 12.1.1 A: Provide mandated

public health operations, programs, and services.

PHAB Standards – Operational Planning


System

Support







24

11.2: Establish effective financial management systems. 11.2.3 A: Maintain financial management systems. 11.2.4 A: Seek resources for infrastructure, processes, programs, and

interventions.

PHAB Standards – Budget


System

Support

PHSDivisionBudget

25

2.1: Conduct timely investigations.2.2: Contain / mitigate health problems and hazards.2.3: Ensure expertise and capacity to

investigate, contain, and mitigateproblems and hazards.

PHAB Standards – Management

Domain 2: Investigate Health Problems and Environmental Hazards


System

Support








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3.1: Provide health education and promotion policies, programs, processes, and interventions

3.2: Provide information through multiplemethods to a variety of audiences.


Domain 3: Inform and Educate About Public Health Issues and Functions


System

Support








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Standard 6.1: Review and update laws. Standard 6.2: Educate about meaning, purpose, and benefits of

laws and how to comply. Standard 6.3: Monitor enforcement

activities and notify agencies.


Domain 6: Enforce Public Health Laws


System

Support








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1.3: Analyze public health data to identify problems, hazards, and factors affecting public health.

1.4: Use data analysis to develop recommendations for policy, processes, programs, or interventions.

5.1: Serve as resource forpolicies, practices,and capacity.

7.1: Assess healthcareservice capacity and access.

12.3: Engage the governing entity in the department’sobligations and responsibilities.

PHAB Standards – Evaluation


System

Support


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Standard1.2: Maintain a system to collect, manage, analyze, and use public health condition and importance data.

Standard 9.1: Use a performance management system to monitor achievement of organizational objectives.

Standard 9.2: Develop and implementintegrated quality managementprocesses. 12.3.3 A: Communicate with the

governing entity about assessingand improving performance.

PHAB Standards – Performance Management


System

Support





PHSDivisionBudget



Links all plans and measures.Links all plans and measures.

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8.1: Develop sufficient public health workers. 8.2: Enable organizational and individual training and development. 11.1: Develop and maintain organizational infrastructure.

11.1.4 A: Maintain a human resource system. 11.1.6 A: Provide infrastructure for data

analysis, program management, and communication.

11.1.7 A: Maintain facilities. 10.1: Identify and use

the best availableevidence in making decisions.

10.2: Promote understandingand use of research results,evaluations, and evidence-basedpractices.

PHAB Standards – Support


System

Support








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Translating Strategy Into

Action

HOW TO: BUILDING A

PERFORMANCEMANAGEMENT SYSTEM


System

Support

Set strategy Develop plans Monitor execution Forecast performance Report results

Performance Management System

Processes, information, and systems used by managers to:


System

Support

33

1. Construct Logic Model2. Develop Work Plans3. Establish Systematic Progress Review

Steps to Build

Tying the Integrated Management System together! 34

Desired Outcomes

Metrics

Linked in Chain of Cause-And-Effect

Translates Strategic Plan Strategies Into Actual Work Actions

Structure Integrates All Management Systems

Strategic Planning

Operational Planning

Budgeting and Accounting

Performance Management

Quality Improvement

Human Resources Management

1. Construct Logic Model

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Chronic Disease

Cancer

Subdividing Work Into More Manageable Pieces

Healthcare Provider

Education

School and Childcare Training

MT Asthma Home Visiting

ProgramProgram

Core ActivityCore Activity(Project or Process)(Project or Process)

Makes a very complicated life much easier to manage!

BureauBureau

Asthma Care Monitoring

System

36

Core Activity Definition

A discrete unit of work with a common purpose

One-Time Project or Continual Work Process

Budgetary unit (derived from activity based costing)

Requires a Work Plan (Operational Plan)

Building blocks of Logic Model

Program:Program: AsthmaAsthma versusversus Core Activity:Core Activity:

Asthma Home VisitingAsthma Home Visiting Provider EducationProvider Education School & Childcare TrainingSchool & Childcare Training

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Montanans with chronic conditions manage their disease and experience fewer complications.

Bureau Result meets a Public Need or Solves a Public Problem

Activity C Work Plan:• Provide asthma

training to staff of 25 middle schools.• Provide asthma

assessment training to 30 school nurses.

CollectiveIntermediateResults

Linked Cascading Chain of Cause-And-Effect

Chronic DiseaseBureau

Diabetes Program

Asthma Program

Cancer Program

School-Childcare Training

Provider Education

Surveillance and EpidemiologyExampleExampleDesiredDesiredOutcomesOutcomes

Individuals avoiddiabetes complications and maintain quality of life.

Individuals experience fewer asthma symptoms such that normal activity levels are not hampered.

Fewer Montanans experience late stage cancer.

PCPs utilize the most current and effective evidence-based asthma care practices.

PH professionals are promptly alerted to the incidence of asthma.

Montana schools and child care facilities properly manage asthma.

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Number of Montana chronic disease hospitalizations.

Activity C Work Plan:• Provide asthma

training to staff of 25 middle schools.• Provide asthma

assessment training to 30 school nurses.

Intermediateoutcome metrics

ExampleExampleMetricsMetrics

Detailed, operational and tacticalmetrics

High level outcome metric


Diabetes Program

Asthma Program

Cancer Program


Provider Education

Surveillance and Epidemiology

Percent of Montanans who are up-to-date with colorectal cancer screening.

Number of individuals per 100,000 population who develop diabetes monthly

Number of healthcare professionals receiving spirometry diagnosis and assessment training

Number of school staff or child care providers who received training during the past calendar year.

Number of asthma hospitalizations per 10,000 population monthly

Average number of days from diagnosis to entry into the asthma database.

Linked Cascading Chain of Cause-And-Effect

Montanans with chronic conditions manage their disease and experience fewer complications.

Metrics Derived From Desired Outcomes


Diabetes Program

Asthma Program

Cancer Program


Provider Education

Surveillance and EpidemiologyExampleExampleDesiredDesiredOutcomesOutcomes

Individuals avoiddiabetes complications and maintain quality of life.

Individuals experience fewer asthma symptoms such that normal activity levels are not hampered.

Fewer Montanans experience late stage cancer.

PCPs utilize the most current and effective evidence-based asthma care practices.

PH professionals are promptly alerted to the incidence of asthma.

Montana schools and child care facilities properly manage asthma.

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Number of Montana chronic disease hospitalizations.

ExampleExampleMetricsMetrics


Diabetes Program

Asthma Program

Cancer Program


Provider Education

Surveillance and Epidemiology

Percent of Montanans who are up-to-date with colorectal cancer screening.

Number of individuals per 100,000 population who develop diabetes monthly

Number of healthcare professionals receiving spirometry diagnosis and assessment training

Number of school staff or child care providers who received training during the past calendar year.

Number of asthma hospitalizations per 10,000 population monthly

Average number of days from diagnosis to entry into the asthma database.

Metrics Derived From Desired Outcomes

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All persons who do the work

Brainstorm tasks performed by the program.

Group tasks – part of same work function having same purpose

Label columns by what is being done

Performance Management focuses on what not who!

How to Identify Core Activities

Facilitated Team Work Sessions Facilitated Team Work Sessions

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Defining Core Activities

43

What are the ideal end results of this program?


44

What are the tasks that your program carries out to make those results happen?


45

Silent brainstorming.


46

Group tasks – part of same work function having same purpose.


47

Debate clarifies values, purpose, and function.

Defining Core Activities“affinity diagram”

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Program tasks groupedby function / purpose.

Title of what is being done – Core Activity Name.

Mission – Services and Product Provided to Whom

Desired Outcomes

Strategic Plan Goals, Strategies, Objectives

Intermediate Outcome Metrics

Process Metrics

Action Plan

Budget

2. Develop Work Plans For Each Activity

Montana Giardiasis Surveillance 1987 - 2009 49

BrainstormTasks

Identify Core Activities

Develop Program Logic Model

Refine Program Logic Model

Work Plan Training

Logic ModelTraining

Select Core Activity to Develop First Work Plan

Prepare First Work Plan Independently

Learning Exercise:Review First Work Plan

Complete Other Work Plans Independently

SessionSessionOneOne3 hr3 hr

SessionSessionTwoTwo

2-3 hr2-3 hr

On OwnOn OwnTimeTime

SessionSessionThreeThree1 hr1 hr

Logic Model & Work Plan Development

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Compare Current Progress to Work Plan

Program/Activity Manager Reviews Monthly

Bureau Chief Reviews Quarterly

HealthStat: Division Administrator Reviews Every 6 Months

Similar to CitiStat, CompStat

3. Establish Systematic Progress Review

CRITICAL to Keep CRITICAL to Keep SystemSystem Alive Alive

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Systematically, take a “time out” to communicate and jointly evaluate progress with management.

Conduct problem solving about problems or “road blocks” encountered.

Anticipate road blocks on the immediate horizon.

Develop plans and take proactive corrective actions to get the Activity back on schedule or keep it on schedule, including resource allocation. – Initiate QI Corrective Action Procedure

Address “road blocks” or problems early before they become crises

Why regular Progress Review Meetings?

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Are we there yet? Review metrics and work progress

Did we do what we said wewere going to do?

Did it work? Discuss what worked, what didn’t,

and why

What do we need to do differently? Develop action plans to remove “road blocks” or solve problems Revise the work plan as needed Initiate QI “Corrective Action” procedure

Structured Progress Review Meeting

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Governor GregoireState of Washington GMAP

Quarterly Review – Bureau Chief Monthl

y Review – Program Manager

Monthly Review – Program Manager

Quarterly Review – Bureau Chief

Monthly Review – Program ManagerMonthl

y Review – Program Manager







Jan

Feb

Mar

Apr

May

JunJul

Aug

Sep

Oct

Nov

Dec

SystematicSystematic and andContinuous Cycle ofContinuous Cycle of

Program / Core ActivityProgram / Core ActivityProgress ReviewsProgress Reviews


System

Support

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Beginning

From A

Blank Canvas

CASE STUDY:CHRONIC DISEASE

BUREAU


System

Support

Leadership Team Offsite Meeting Dec 2011

Began pilot with one program

Dec 2011 Jan 2012

Carefully selected most supportive people

Already think and manage this way

Developed two internal experts

CDC Coordinated Chronic Disease Prevention and Health Promotion

Initiated one or two programs per week

Feb May 2012

Bureau Chief set deadline

12 Programs and circa 65 Core Activities

Eating the Elephant…

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Logic Model Poster

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Complete Work Plan DatabaseDevelopment and Rollout

Complete Work Plans in All Bureaus

Initiate HealthStatProgress Reviewsin All Bureaus

Next Steps

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SUMMARYAND

CONCLUSIONS


System

Support

PHSD Strategies and ObjectivesWork Plan Metrics and TargetsWork Plan Action PlanWork Plan Budget

and ExpendituresProgram/Bureau/Division

Logic ModelSharePoint Database of

Metrics and Work PlansRegular Progress Reviews

QI Project Initiation

PHSD Performance Management System Components


System

Support

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Organizational performance excellence relies on systems thinking seeing the organization as one fully interconnected unit

Build management systems to comply with PHABBuilding Performance Management System:

1.Construct Logic Model – Identify Activities2.Develop Work Plans3.Establish Regular-Systematic

Progress Reviews

Take Home Message

Montana PHSD Integrated Management System


System

Support

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Baldrige Criteria for Performance Excellence http://www.nist.gov/baldrige/http://www.nist.gov/baldrige/

Government Management Accountability and Performance (GMAP) http://www.accountability.wa.gov/http://www.accountability.wa.gov/

City of Baltimore – CitiStat http://www.baltimorecity.gov/http://www.baltimorecity.gov/

Government/AgenciesDepartments/Government/AgenciesDepartments/CitiStat.aspxCitiStat.aspx

Additional Resources

Lindsey Krywaruchka – [email protected] Haywood – [email protected]

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This presentation was supported by funds made available from the Centers for Disease Control and Prevention, Office for State,

Tribal, Local and Territorial Support, under CD10-1011 Strengthening Public Health Infrastructure for Improved Health

Outcomes

Lindsey Krywaruchka—[email protected] Haywood—[email protected]

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THANK YOU

PERFORMANCE MANAGEMENT IN ACTION: THE MONTANA MODEL.

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Transcript of PERFORMANCE MANAGEMENT IN ACTION: THE MONTANA MODEL.