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Turning Point PM
Collaborative 1
Public HealthPerformance Management
Turning PointPerformance Management
National Excellence Collaborative
[meeting name]
[location][date]
Public Health Performance Management CurriculumPrepared by Center for Public Health Practice, UIC School of Public Health
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Genesis• Turning Point Performance Management
National Excellence Collaborative States (AK, IL, MO, MT, NH, NY, WV)– “..to move the field of public health from
simply measuring performance of individual programs to actively measuring and managing the performance of an entire agency or system.”
– “..from managing silos to managing a system”
Source: Silos to Systems: Using Performance Management to Improve the Public’s Health. Turning Point Performance Management National Excellence Collaborative: Seattle WA; Turning Point National Program, 2003.
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Learning ObjectivesLearners will be able to:1. Define and describe the key concepts and
components of performance management2. Identify performance management concepts and
components in a variety of public health organization and system applications
3. Describe potential benefits of performance management across a range of public health organization and system applications
4. Assess and enhance performance management practices and opportunities in public health work settings
5. Advocate for the use of performance management in public health practice settings
6. Identify and access resources to support performance management applications
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Today’s ProgramI. IntroductionII. Pre-TestIII. Performance Management 101IV. Applications of Performance
Management in Public Health PracticeV. Case StudiesVI. Review and SummaryVII. Post-Test/Course Evaluation
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Part II
Pre-Test
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Part III
Performance Management 101
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The Words
“Performance”– Execution, Accomplishment,
Completion, Effectuation
“Management”– Supervision, Direction, Control,
Manipulation
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Basic Concepts
“Performance Management”– Control/Manipulation towards
Accomplishment– Key considerations = the context
• Who or what performs? • What is performed?
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Focus on Performance1. Marathon Runner2. Not Your Father’s Oldsmobile3. Unit Supervisor4. Program (and Mega-Program) Manager5. National Health Priority Initiative6. National Public Health System7. State Health Agency8. State-Local Public Agency Network9. Community Health Improvement Process10. Public Health Workforce Development
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Managing Performance (Ex 1)
Marathon Runner• trains 5x per week at various
distances• records times• seeks to better last year’s time
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Managing Performance (Ex 2)
Your Father’s Oldsmobile?• Performance dimensions include fuel
economy, comfort, safety, etc.• Raw materials include steel, plastic, rubber• Tire air pressure measurements• Dashboard instruments assist operators in
making some adjustments; onboard computer chips also monitor performance
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Managing Performance (Ex 3)
Unit Supervisor• meets with employees annually to
review job performance and set expectations for next year
• next year’s salary increment is tied to this year’s job performance?
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Managing Performance (Ex 4)
Program Manager• establishes objectives• reports quarterly• seeks continuation funding year
after year
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Common Elementsfrom These Simple
Examples?• Context (who or what is to perform and
what is to be accomplished) • Goals or targets (form & level of
accomplishment)• Information about performance• Collection of information• Modifications/Change possible
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Key Components of Performance Management
• Applying Appropriate Standards
• Measuring Key Aspects of Performance
• Reporting and Interpreting Measurements
• Making Changes Based on Measures of Performance
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Criticalcomponents ofperformance management
Source: Silos to Systems: Using Performance Management to Improve the Public’s Health. Turning Point Performance Management National Excellence Collaborative: Seattle WA; Turning Point National Program, 2003.
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In the performance management cycle...
• 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: Silos to Systems: Using Performance Management to Improve the Public’s Health. Turning Point Performance Management National Excellence Collaborative: Seattle WA; Turning Point National Program, 2003.
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Is Performance Managementthe Same Thing as
Performance Measurement?
[Maybe Yes / Maybe No]
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• Performance Measurement is the regular collection and reporting of data to track work produced and results achieved.
• Performance Management is what you do with information you’ve developed from measuring performance. – Set agreed-upon performance goals– Allocate or prioritize resources– Inform management decisions– Report on progress
• Caution! Some view Performance Measurement as only the first 3 components of Performance Management
Source: lichiello P. Guidebook for Performance Measurement. Seattle WA: Turning Point National Program Office, 1999:48. Based on Hatry HP et al, Monitoring the Outcomes of Economic Development Programs. Washington DC: The Urban Institute Press, 1990.
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Jargon Alert![Terms may be used
differently]• Performance Measure• A specific quantitative representation of something
deemed relevant to the assessment of progress toward a goal or objective
• Performance Standard• Standards are one form of performance measure; they
are objective measures or guidelines that are commonly used to assess performance (“standard” here means a standard way of measuring rather than something specific to achieve)
• Performance Target• The planned or expected level of performance (generally
expressed in standard terms)
• Performance Indicator• Indicators are another form of performance measure;
they are the data or information that is used to assess progress toward a performance standard or target
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Different Indicators Used to Measure Performance (Workforce
Competency)Self
Assessment --------->
--------->
--------->
--------->
Self ImprovementApplication
Course Instructor
Assessment
Competency Acquisition Application
Workplace Assessment
Personnel Mgt/ Competency Demo
Application
External Certifying
Body Assessment
Credentialing Application
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Performance MeasuresAre Useful to …
• Identify aspects of the work that have and have not resulted in satisfactory results
• Identify trends• Further investigate the nature of particular
problems• Set targets for future periods• Motivate managers and staff to improve
performance• Hold managers and staff accountable• Develop and improve programs and policies• Help design policies and budgets and explain
these to stakeholdersSource: lichiello P. Guidebook for Performance Measurement. Seattle WA: Turning Point National Program Office, 1999:48. Based on Hatry HP et al, Monitoring the Outcomes of Economic Development Programs. Washington DC: The Urban Institute Press, 1990.
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Criticalcomponents ofperformance management
Source: Silos to Systems: Using Performance Management to Improve the Public’s Health. Turning Point Performance Management National Excellence Collaborative: Seattle WA; Turning Point National Program, 2003.
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Applying Appropriate Standards
• Identify and apply relevant standards (what will be measured)
• Standards are one form of performance measure; they are generally objective standards or guidelines that are used to assess performance (“standard” here means a standard way of measuring rather than something specific to achieve).
• Identify appropriate indicators (how it will be measured)
• Indicators are another form of performance measure; they are the data or information that is used to assess progress toward a performance standard.
• Set goals and targets• The planned or expected level of performance
• Communicate expectations
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Is there a Performance Standards component?
• Have performance goals and targets been established, and appropriate indicators identified?
• Do these benchmark against similar organizations or use national, state, or scientific guidelines?
• Are expectations communicated?
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Measuring Performance
• Relies on indicators that document where performance is in relation to the target established for a standard
• Develop data systems• Collect data
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Is there a Performance Measurement component?
• Have the indicators been refined?
• Have data systems been developed?
• Are data being collected?
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Reporting Progress
• Analyze data• Convert data into useable
information• Feedback to managers, staff,
policy makers, and constituents• Develop a regular reporting cycle
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Reporting Progress
• Provide context for the report– How do the performance measures
relate to mission and goals• Create clear, easy to read, report
designs– Use simple charts and tables
• Determine Reporting Frequency– When and how often
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Is there a Reporting of Progress component?
• Are data analyzed?• Are data fed back to managers,
staff, constituents, etc. in useable and understandable format?
• Is there a regular reporting cycle in place?
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Improving Quality
Establish a program or process to manage change and achieve quality improvement in public health policies, practice and infrastructure based on what is learned through performance measures
• Use data for decisions to improve policies, programs, and outcomes
• Manage change• Create a learning organization
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A Few Words about Change
• Results are properties of systems: every system is perfectly designed to achieve exactly the results it gets– Results do not occur by new goals or targets, but
through systemic change– Improvement comes only with change; but change
doesn’t always improve results– Smart improvement relies on understanding how
systems work– Systems rely on interdependencies which are as
important as the system’s elements– Change is more difficult than setting goals,
measuring or holding people accountable. “I would rather (measure, complain, blame, accept good enough, fight) than change!”
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Is there a Quality Improvement component?
• Where is the change process?
• Is there a process to manage changes being made?
• Is there a learning organization?
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For SuccessfulPerformance Management
All four Performance Management components should be present!
And they should be integrated into the organization’s or system’s core operations!
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Concepts and Componentsto Assess in Examples
• Context for “improvement” (is/is not) clear?• Goals or targets for improvement (are/are
not) established?• Appropriate measures of performance
(are/are not) collected?• Reports of measurements (do/do not) reach
the proper parties?• Information from measurements (are/are
not) used to make improvements?
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Summary - Example 1
Marathon Runner (Ex 1)Context Runner; complete race in shortest possible time
Standards Previous time
Measuring “Splits”
Reporting Log
Improvement
Strategy
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Summary - Example 2
Not Your Father’s Oldsmobile (Ex 2)Context An automobile: safe, reliable, efficient personal
transportation
Standards Miles per gallon, cost
Measuring Tire air pressure; oil, water, battery, speed
Reporting Dashboard and other instruments
Improvement
Adjustments as indicated
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Summary - Example 3
Supervisor (Ex 3)Context Worker; job duties
Standards Set annually
Measuring Work prods
Reporting Performance appraisal
Improvement
New objectives, more $ ?
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Summary – Example 4
Program Manager (Ex 4)Context Program; program goals
Standards Approved objectives
Measuring Info on activities
Reporting Quarterly reports
Improvement
Revised workplan
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OK, Sounds Simple Enough!
But How Does This Workfor More Complex Examples?
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Part IV
Applicationsof Performance Management
in Public Health Practice
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Examples 4A, 4B, 4CHD Program
Ex 4ACommunity
Ex 4BStatewide
Ex 4CContext Program;
program goalsProgram; program goals
Program; program goals
Standards Approved objectives
Approved objectives
Approved objectives
Measuring Info on activities
Info on activities
Info on activities
Reporting Quarterly reports
Quarterly reports
Quarterly reports
Improvement
Revised workplan
Revised workplan
Revised workplan
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Managing Performance (Ex 5)
• Congress appropriates $1 billion annually x5 years for state-based efforts to respond to childhood obesity epidemic
• States must: – Appoint State Coordinators– Establish broadly based advisory committee– Prepare timelines for state and local plans,
information and surveillance systems, lab services, professional training, media strategies, etc.
– Renewal funding available to continue and extend these activities
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Components PresentIn These Examples?
• Context for “improvement” (is/is not) clear?• Goals or targets for improvement (are/are
not) established?• Appropriate measures of performance
(are/are not) collected?• Reports of measurements (do/do not) reach
the proper parties?• Information from measurements (are/are
not) used to make improvements?
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Summary – Example 5
National Childhood Obesity (Ex 5)Context ?
Standards ?
Measuring ?
Reporting ?
Improvement ?
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Summary – Example 5
National Childhood Obesity (Ex 5)Context Who or what unclear; performance task clear
Standards Standard approaches certainly exist
Measuring Data and data collection systems in place
Reporting Since who or what is unclear, reporting target?
Improvement Mechanisms for change poorly defined
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Managing Performance (Ex 6)
National Public Health System• Healthy People 2000 Objective 8.14 calls
for 90% of population to be served by LHD effectively carrying out IOM core functions
• Core functions further described in Essential Public Health Services framework
• Replaced by Infrastructure Chapter in Healthy People 2010
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Comparison of Performance Measures Aggregated by Core Function
0
10
20
30
40
50
60
70
80
90
100
1992Mystate
1994Mystate
1999Mystate
1993National
1995National
Assessment
Policy Development
Assurance
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Components PresentIn This Example?
• Context for “improvement” (is/is not) clear?• Goals or targets for improvement (are/are
not) established?• Appropriate measures of performance
(are/are not) collected?• Reports of measurements (do/do not) reach
the proper parties?• Information from measurements (are/are
not) used to make improvements?
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Summary – Example 6
National Public Health System (Ex 6)
Context ?
Standards ?
Measuring ?
Reporting ?
Improvement ?
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Summary – Example 6
National Public Health System (Ex 6)
Context System components/participants unclear;“effectively carry out core functions” = ?
Standards Core function related measures not widely used
Measuring No consensus as to how to collect information
Reporting Not clear since system components not specified
Improvement Not driven by performance measurement
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Performance Management in Public Health Practice
• Active and strategic use of performance measures to improve the public’s health– Ex: Achieving Healthy People 2010
national health goals and objectives– Ex: Improving public health organization
and system performance (core functions, essential public health services, capacity, preparedness, etc.)
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Public HealthPerformance Measures
• Quantitative measures of capacities, processes, or outcomes relevant to the assessment of public health performance– Ex: The number of trained epidemiologists available
to investigate outbreaks (capacity measure)– Ex: The percentage of notifiable diseases reports
submitted within the required time lines (process measure)
– Ex: The annual incidence of selected infectious diseases in the community (outcome measure)
– Ex: Percentage of clients who rate health department communicable disease services as “good” or “excellent” (outcome measure)
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PHS Missionand Purpose
PhilosophyGoals
"Core Functions"
Structural Capacity-----------------
Information ResourcesOrganizational Resources
Physical ResourcesHuman ResourcesFiscal Resources
Outcomes---------------Effectiveness
EfficiencyEquity
Conceptual Framework of the Public Health System as a Basis for Measuring Public Health System Performance
Processes-------------------The 10 Essential
Public HealthServices
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.
MACRO
CONTEXT
PUBLIC
HEALTH
SYSTEM
Public Health Performance Measures: Public Health Performance Measures: Capacity, Process, and OutcomesCapacity, Process, and OutcomesPublic Health Performance Measures: Public Health Performance Measures: Capacity, Process, and OutcomesCapacity, Process, and Outcomes
CapacityCapacity Process(Essential Public Health Services)
Process(Essential Public Health Services)
OutputsOutputs
OutcomesOutcomes
System InputsSystem Inputs
WorkforceWorkforce
InformationInformation
Organization & Organization & RelationshipsRelationships
FacilitiesFacilities
FundingFunding
WorkforceWorkforce
InformationInformation
Organization & Organization & RelationshipsRelationships
FacilitiesFacilities
FundingFunding
Improved Improved organizational organizational performanceperformance
Improved Improved program program performanceperformance
Improved Improved organizational organizational performanceperformance
Improved Improved program program performanceperformance
AssessAssess AssureAssure
Programs and Programs and Services Services consistent consistent with with mandates and mandates and community community prioritiespriorities
Programs and Programs and Services Services consistent consistent with with mandates and mandates and community community prioritiespriorities
Key Processes Key Processes
Improved Outcomes& Customer Satisfaction
Improved Outcomes& Customer Satisfaction
Increased Value& Public Support
Develop Policy
Source: Turnock BJ. Public Health: What It Is and How It Works, 3rd Edition. Boston MA; Jones & Bartlett, 2004.
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Public Health PM Applications
• Public Health Infrastructure Capacity– Human resource development– Data and information systems
• Public Health Processes– Essential Public Health Services– Management practices
• Public Health Outcomes– Health status– Customer focus and satisfaction
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Lessons Learned• State performance management practices are
widespread, although often not system-wide or with processes leading to quality improvement or changes.
• States generally report their efforts result in improved performance, with positive outcomes broadly defined.
• No single or composite framework is used in most states, and there are insufficient data to inform choices in performance management approach.
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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 Least Likely
Performance Targets Health Status Data & Information Systems
Human Resource Development Public Health Capacity
Performance Measures orStandards
Health Status Data & Information Systems
Human Resource Development Customer Focus and Satisfaction
Performance Reports Health Status Data & Information Systems Management Practices
Human Resource Development Public Health Capacity
Process for QI/Change Health Status Customer Focus and Satisfaction Management Practices
Human Resource Development Public Health Capacity
Source: Turning Point Survey on Performance Management Practices in States: Results of a Baseline Survey of State Health Agencies. Seattle WA; Turning Point National Program Office, 2002.
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Nearly All SHAs Have Some PerformanceManagement 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)
Categorical programs
only43% (20)
None4% (2)
SHA wide32% (15)
Local public health
agencies only4% (2)
SHA wide and local
public health agencies17% (8)Source: Turning Point Survey on Performance Management Practices in
States: Results of a Baseline Survey of State Health Agencies. Seattle WA; Turning Point National Program Office, 2002.
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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)
36 (9)
44 (11)
60 (15)
40 (10)
0
10
20
30
40
50
60
70
80
90
100
Performance Targets Performance Measuresor Standards
Performance Reports Process for QI/Change
Pe
rce
nta
ge
of
Sta
tes
(N
=2
5)
*Correlation analysis revealed that there is a comparatively weak relationship between having performance targets, performance measures or performance reports and having a process for quality improvement (QI)/change.
Source: Turning Point Survey on Performance Management Practices in States: Results of a Baseline Survey of State Health Agencies. Seattle WA; Turning Point National Program Office, 2002.
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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)
Note: Respondents could choose more than one response, so total does not equal 100.
63 (25)
8 (3)
20 (8)
13 (5)
30 (12)
0
10
20
30
40
50
60
70
80
90
100
Incentives forAgencies, Programs,
Divisions
Incentives for Staff Disincentives forAgencies, Programs,
Divisions
Disincentives for Staff None
Pe
rce
nta
ge
of
Sta
tes
(N
=4
0)
Source: Turning Point Survey on Performance Management Practices in States: Results of a Baseline Survey of State Health Agencies. Seattle WA; Turning Point National Program Office, 2002.
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Performance Measure SourcesCapacity Process Outcom
eHealthy People 2010 (#1)
✔ ✔
Core Functions (#2) ✔ EPHS (#3) ✔ NPHPS (based on EPHS and CF)
✔ ✔
APEX-PH ✔ ✔ ✔ MAPP ✔ ✔ ✔
Source: Turning Point Survey on Performance Management Practices in States: Results of a Baseline Survey of State Health Agencies. Seattle WA; Turning Point National Program Office, 2002.
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Managing Performance (Ex 7)
State Health Agency• Mission: to protect and promote the health of
the state’s population• Local public health agencies are units of
state health agency and work under its direction
• Health status & other info (including activity counts, costs, staffing, etc.) collected
• Resources deployed to local units based on progress toward pre-established targets
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Components PresentIn This Example?
• Context for “improvement” (is/is not) clear?• Goals or targets for improvement (are/are
not) established?• Appropriate measures of performance
(are/are not) collected?• Reports of measurements (do/do not) reach
the proper parties?• Information from measurements (are/are
not) used to make improvements?
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Summary – Example 7
State Health Agency (Ex 7)Context ?
Standards ?
Measuring ?
Reporting ?
Improvement ?
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Summary – Example 7
State Health Agency (Ex 7)Context State agency/local unites;
promote/protect public health
Standards HP 2010, Baldridge Quality Stds
Measuring Outcomes, costs, satisfaction, etc.
Reporting Agency management
Improvement Incentives for progress; info for resource allocation
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Managing Performance (Ex 8)
State-Local Public Health Agency Network• Mission to protect and promote• State certifies local public health
agencies• Core function based standards applied• Annual grants made to local agencies
meeting standards via formula based on population and need
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Components PresentIn This Example?
• Context for “improvement” (is/is not) clear?• Goals or targets for improvement (are/are
not) established?• Appropriate measures of performance
(are/are not) collected?• Reports of measurements (do/do not) reach
the proper parties?• Information from measurements (are/are
not) used to make improvements?
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Summary – Example 8
State-Local PH Network (Ex 8)Context ?
Standards ?
Measuring ?
Reporting ?
Improvement ?
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Summary – Example 8
State-Local PH Network (Ex 8)Context State and LHDs (+ partners?);
promote/protect public health
Standards HP 2010, core function based LHD stds
Measuring Outcomes, LHD stds, activities?
Reporting State agency?
Improvement Decisions/resource allocations based on info?
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Examples and Case Studies*1. Marathon Runner2. Not Your Father’s Oldsmobile3. Unit Supervisor4. Program (and Mega-Program) Manager5. National Health Priority Initiative6. National Public Health System7. State Health Agency*8. State-Local Public Agency Network**9. Community Health Improvement Process*10. Public Health Workforce Development**
* Indicates number of case studies available for various PM applications
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Part V
Case Studies
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Part V
Example 9 Case Study
Moose CountyCommunity Health
Improvement Process Using MAPP
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The CHIP
Process
CommunityHealth NeedsAssessment
CommunityHealth Plan
Program Development
Implementation
Evaluation
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The MAPP Model
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Another View of MAPP Model
Community Health Status
Assessment
Local Public Health System Assessment
Organize For
Success
Review Mandates, Mission,
Stakeholder Expectations,
and Goals
Vision For Success
Identify Strategic Issues
Formulate Strategies
Implement Strategies
Evaluate
Community Generated
Themes
Contextual Environment Assessment
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Tobacco Use By 2002, reduce cigarette smoking to a prevalence of no more than 24 percent among people aged 18 and older. (Baseline: 1996 BRFS percentage 27.3).
AddictionSedentary LifestyleHypertensionAdvertising (Indirect)
Coalition will implement CDC=s community-based tobacco control program, focusing on delaying initiation, cessation programs, and advertising control.
Coalition will provide support to LHD with in-kind donations, staff, and clinical counseling space.
Cerebrovascular Disease (Stroke) By 2004, reduce stroke deaths to no more than 70 per 100,000 (Baseline: 1997 crude rate 76.5 per 100,000).
Limited number smokers seeking counseling.Media messages promote smoking.Peer pressure.
Health Problem Outcome Objective
Risk Factor Impact Objective
Contributing Factors
Community Health Plan
Proven Intervention Strategies
Resources Available Barriers
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Description of the Health Problem, Risk Factors and Contributing Factors
Corrective Actions
Proposed Community Organizations
Evaluation Plan
The problem is the high death rate associated with Cerebrovascular disease (county CR = 76.5, state CR =61.7 p/100,000 or 23% above state rate). The major risk factor is cigarette smoking and county has higher percentage of smokers (27.6%) , especially males (31%) than state (24%, 28%, respectively). Addiction appears to be the chief contributing factor.
In order to effectively address this health problem a multi-sited and multi- targeted campaign is required to delay initiation of smoking behavior, assist persons attempting to quit, and provide counter advertising to tobacco promotions.
A coalition of community groups, including the LHD, Cancer Society, Lung Association, General Hospital, Teens Against Butts will collaborate with in- kind donations, staff, and clinical counseling space to assist in meeting objectives.
Coalition will meet quarterly to assess progress in achieving goals. Coalition will use the evaluation tool developed by the CDC to determine effectiveness of programming efforts. Surveys will be conducted amongst coalition members to ascertain stakeholder satisfaction with program.
Community Health Plan
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Components PresentIn This Example?
• Context for “improvement” (is/is not) clear?• Goals or targets for improvement (are/are
not) established?• Appropriate measures of performance
(are/are not) collected?• Reports of measurements (do/do not) reach
the proper parties?• Information from measurements (are/are
not) used to make improvements?
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Summary – Example 9
Moose County CHIP Using MAPPContext ?
Standards ?
Measuring ?
Reporting ?
Improvement ?
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Summary – Example 9
Moose County CHIP Using MAPPContext Moose County Health Partnership;
Improve community health via health priorities
Standards HP 2010, MAPP assessments (incl. NPHPS)
Measuring Outcomes and community contributing factors
Reporting Partnership, policy makers, public
Improvement Not clear, commitment of partners?
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Moose County CHIPCase Study to the Next Level• Have you been (are you now)
involved in a similar effort? If so which PM components are in place? Which PM components are missing or could be enhanced? How?
• For a companion effort at the state level, describe how the various PM components would be used.
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Part V
Example 10 Case Study
PH Workforce Developmentin Grey State/Coyote County
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1 – Assess Competency Using Consistent Methods and Tools
2 – Enhance Specific Competencies Based on Assessment
3 – Document Competent Performance in Workplace via Human Resource Management
4 – Recognize Competent Performance via System Incentives such as Credentialing
1 – Assess Competency Using Consistent Methods and Tools
2 – Enhance Specific Competencies Based on Assessment
3 – Document Competent Performance in Workplace via Human Resource Management
4 – Recognize Competent Performance via System Incentives such as Credentialing
Public HealthWorkforce Preparedness
Public HealthWorkforce Preparedness
44
11
Core PublicHealth Practice
& BT/ERCompetencies
2
33
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Collaborative 85
Different Indicators Used to Measure Performance (Workforce
Competency)Self
Assessment --------->
--------->
--------->
--------->
Self ImprovementApplication
Course Instructor
Assessment
Competency Acquisition Application
Workplace Assessment
Personnel Mgt/ Competency Demo
Application
External Certifying
Body Assessment
Credentialing Application
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Collaborative 86
• 9 core competencies for all public health workers
• PLUS Function-specific competencies for 8 emergency response functional roles:– leaders– communicable disease– clinical– environmental health– public health laboratory– medical examiner– public information– other professionals– technical and support
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Coyote County Health Dept Training Plan
• ALL STAFF HRS– Anthrax/BT Primer (150 Staff) – 1.5 hrs 225– Smallpox Primer (125 Staff ) - 1-5 hrs 118– SNS Drill (90 staff) – 8 hrs 720– CERT Training (10 staff) - 21 hrs
210– Phase I Training (210 staff) - 2 hrs 420– Phase II Training (211 staff) - 7 hrs 1477
• BT-IC TEAM (Health Department Leaders)– Weapons of Mass Destruction (8 staff) – 12 hrs 96– Forensic Epidemiology (4 staff) – 12 hrs 48– Risk Communications (10 staff) – 11 hrs 110– Community-wide ER Response Drill (6 staff) – 6 hrs 36– Incident Command Drill (10 staff) – 3 hrs 30
• SPECIALIZED STAFF– Smallpox Vaccine Administration (25 RN staff)- 1 hr
25– RN Team Captains (20 RN staff ) – 4 hrs 80– PH Training Network Satellite - (50+ staff/15+ presentations) 1-6 hrs 150
• TRAINING INVESTEMENT (including Phase I and II) • # Staff hours 3800 +• # Trainings – 14• # Estimated cost (including materials, space, prep.) >$98,000
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CCHD Workers Before & After
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Components PresentIn This Example?
• Context for “improvement” (is/is not) clear?• Goals or targets for improvement (are/are
not) established?• Appropriate measures of performance
(are/are not) collected?• Reports of measurements (do/do not) reach
the proper parties?• Information from measurements (are/are
not) used to make improvements?
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Summary – Example 10
Coyote County Health Dept.PH Workforce Development
Context ?
Standards ?
Measuring ?
Reporting ?
Improvement ?
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Summary – Example 10
Coyote County Health Dept.PH Workforce Development
Context CCHD; skilled workforce
Standards Competency expectations
Measuring Multiple views beginning with self-assessment
Reporting Individuals, agency mgt, state
Improvement Individual, group, agency training plans
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CCHD Workforce Development Case Study to
the Next Level• Have you been (are you now)
involved in a similar effort? If so which PM components are in place? Which PM components are missing or could be enhanced? How?
• For a companion effort at the state level, describe how the various PM components would be used.
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Part VI
Review and Summary
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Criticalcomponents ofperformance management
Source: From Silos to Systems: Using Performance Management to Improve the Public’s Health. Turning Point Performance Management National Excellence Collaborative: Seattle WA; Turning Point National Program, 2003.
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Apply Standards, Set Targets
Marathon Runner Previous personal best time
Your Father’s Oldsmobile
Safe, reliable, efficient transportation
Unit Supervisor Expectations established for specific job duties
Program Manager Objectives approved by granting agency
National Health Priority Target established for childhood obesity prevalence
National Public Health System
Outcomes – Healthy People 2010 ObjectivesProcess - National Public Health Performance Standards
State Health Agency Outcomes – Healthy People 2010 Objectives, Baldridge Quality CriteriaProcess - National Public Health Performance Standards
State-Local Public Agency Network
Outcomes – Healthy People 2010 ObjectivesProcess - National Public Health Performance Standards
Community Health Improvement Process
Outcomes – Healthy People 2010 ObjectivesProcess - National Public Health Performance Standards
PH Workforce Development
Core public health practice competencies
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Measure PerformanceMarathon Runner Training times for specific distances
Father’s Oldsmobile Air, oil, water, battery, speed, direction, etc.
Unit Supervisor Specific performance expectations for employee
Program Manager Program goals and objectives
National Health Priority
Population studies of health status
National Public Health System
Surveillance of core function or EPHS performance
State Health Agency Outcomes, activities, costs, satisfaction, etc
State-Local Public Agency Network
Outcomes, compliance with standards, activities?
Community Health Improvement
Process
Outcomes and contributing factors in community
PH Workforce Development
Various views of individual competency
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Report InformationMarathon Runner Personal training log
Father’s Oldsmobile Dashboard and other instruments
Unit Supervisor Monthly or quarterly progress reports
Program Manager Quarterly progress reports
National Health Priority
Annual review
National Public Health System
Annual surveillance
State Health Agency Agency management
State-Local Public Agency Network
Unclear
Community Health Improvement
Process
Community Health Partnership, policy makers, public
PH Workforce Development
Individuals, agency management
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Quality ImprovementMarathon Runner Revise race strategy
Father’s Oldsmobile Adjust tire air pressure, oil, water, speed, direction
Unit Supervisor Set new performance expectations
Program Manager Revise program objectives and workplan
National Health Priority
Secure new commitments; redeploy resources; new policies
National Public Health System
Incentives; redeploy resources
State Health Agency Management decisions; incentives; resource allocation
State-Local Public Agency Network
Incentives; resource allocation?
Community Health Improvement
Process
Secure new commitments; redeploy resources
PH Workforce Development
Tailored training plans for individuals and agencies
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In the performance management cycle...
• 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: From Silos to Systems: Using Performance Management to Improve the Public’s Health. Turning Point Performance Management National Excellence Collaborative: Seattle WA; Turning Point National Program, 2003.
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For SuccessfulPerformance Management
All four Performance Management components should be continuously integrated into the core operations of the agency or system
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Capacity & AccountabilityMarathon Runner
Commitment
Leadership
Informed Decision Making
Incentives
Accountability
Father’s Oldsmobile
Unit Supervisor
Program Manager
National Health Priority
National Public Health System
State Health Agency
State-Local Public Agency Network
Community Health Improvement
Process
PH Workforce Development
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Public Health Agency as a Learning Organization:Core Organizational Competencies Support
Strategic Planning / Change Processes
Forces / Trends
StakeholdersHealth System
Planningto Plan
Internal Environment
Capacity Competencies Barriers
External Environment
StrategicIssues
Strategies
Organizational Systems Design & Development
Actions Results
MANDATES
Vision
Mission
Values
< Strategy Formation > < Implementation >
Adapted from John M. Bryson (c) 1985. In Bryson, J.M. & Roering, W.D. (1988). Initiation of strategic planning by governments. Public Administration Review, Nov.- Dec., 995 -1004.
Opportunities / Threats
Strengths / Weaknesses
Core Functions&
Essential Public Health Services
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Success Factors
• Integrate PM into routine public health processes
• Sustainable PM activities meet state and local needs and political realities
• NPHPS, management models and tools provide a head start
• Early stakeholder involvement increases support and chances of success
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Success Factors (cont’d)
• Align PM measures, activities, and spending with public health priorities
• Trained staff, dedicated resources, and PM culture are essential
• Baseline information and trends important
• New or adapted information and management systems are necessary for cross-program management
• Incentives motivate performance and quality improvement
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Performance MeasuresAre Useful to …
• Identify aspects of the work that have and have not resulted in satisfactory results
• Identify trends• Further investigate the nature of particular
problems• Set targets for future periods• Motivate managers and staff to improve
performance• Hold managers and staff accountable• Develop and improve programs and policies• Help design policies and budgets and explain
these to stakeholdersSource: lichiello P. Guidebook for Performance Measurement. Seattle WA: Turning Point National Program Office, 1999:48. Based on Hatry HP et al, Monitoring the Outcomes of Economic Development Programs. Washington DC: The Urban Institute Press, 1990.
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Why UsePerformance Management?
• To improve public health practice and maximize its effectiveness. This requires– More than setting goals/targets alone;
more than measurement alone. These are necessary, but not sufficient, components
– All four PM components should be continuously integrated into the core operations of the agency/system
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Managerial Action
• Quality improvement efforts
• Policy change
• Resource allocation change
• Program change
Why Use Performance Management?
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Performance Mgt Resources1. Turning Point PM National Excellence Collaborative (online via
www.turningpointprogram.org/Pages/perfmgt.html)2. Guidebook for Performance Measurement. Seattle WA:
Turning Point National Program Office, 1999.3. Performance Management in Public Health: A Literature
Review. Seattle WA; Turning Point National Program Office, 2002.
4. Turning Point Survey on Performance Management Practices in States: Results of a Baseline Survey of State Health Agencies. Seattle WA; Turning Point National Program Office, 2002.
5. From Silos to Systems: Using Performance Management to Improve the Public’s Health. Seattle WA; Turning Point National Program Office, 2003.
6. Performance Management Self-Assessment Tool. Washington DC: Public Health Foundation, 2004.
7. Performance Management Toolkit. Public Health Foundation (online via www.phf.org)
8. Performance Measurement and Improvement. Chapter 18 in Public Health Administration: Principles for Population-Based Management. Sudbury MA; Jones & Bartlett, 2000.
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Part VII
Post-Test &Course Evaluation