Performance Management & PHAB Accreditation: Leveraging Accreditation to Improve Performance

Transcription

1 Performance Management & PHAB Accreditation: Leveraging Accreditation to Improve Performance Leslie M. Beitsch Assoc. of OH Health Commissioners September 29, 2015

2 Performance Management and Quality Improvement: Models that work The session will provide guidance on how a health department can assess and improve its performance management system. Objectives: Describe and discuss how Public Health Performance Management can be a tool for achieving healthy communities Assess relative strengths and weaknesses of a performance management system through interactive exercises Share use of QI tools that can help with assessing and building a performance management (PM)/QI system

3 Health District Progress towards Accreditation Lucas County Fulton County Williams County Ottawa County Defiance County Wood County Henry County Sandusky County Paulding County Seneca County Putnam County Hancock Findlay County Sandusky Erie County Huron County Conneaut Ashtabula Lake County Ashtabula County Geauga County ClevelandShaker Heights Lorain Cuyahoga County Elyria Lorain County Trumbull County Warren Niles Kent Portage County Girard Summit County Medina County Youngstown Mahoning County Legend Not Started Started Prep Completed Prereqs Submitted SOI Documents Submitted Site Visit Action Plan Accredited Van Wert County Shelby Wyandot CountyCrawford County Alliance Salem Ashland Ashland CountyWayne County Stark Canton County Allen County Richland County Galion Massillon Columbiana County Hardin County East Liverpool Marion County Carroll County Mercer County Auglaize County Holmes County Morrow County New Philadelphia Tuscarawas County Logan County Knox County Jefferson Steubenville County Shelby County Union County Delaware County Coshocton County Coshocton Harrison County Darke County Piqua Champaign County Miami County Licking County Guernsey County Columbus Belmont County Franklin County Muskingum County Clark County Madison County Noble County Preble CountyMontgomery County Oakwood Fairfield County Greene County Perry County Monroe County Pickaway County Fayette County Morgan County Middletown Hocking County Butler County Hamilton Warren CountyClinton County Washington County Marietta Springdale Ross County Athens County Belpre Vinton County Hamilton Norwood County Cincinnati Highland County Clermont County Pike County Meigs County Jackson County Brown County Adams County Scioto County Portsmouth Gallia County Lawrence County Ironton

4 Strategic Planning Higher Quality and Performance Assess Community Health Improve Community Health Improved Outcomes Aligned Organization Performance Management System Your Public Health Department

5 What is Performance Management? A systematic process by which an organization involves its employees in improving the effectiveness of the organization and achieving the organization s mission and strategic goals. By improving performance and quality, public health systems can save lives, cut costs, and get better results. Enables health departments to be more: Effective (Do The Right Things) Efficient (Do It Right) Transparent Accountable

6 Effective - (Do The Right Things) Efficient - (Do It Right) What and How How You Do It Efficiency RTW Wrong Appropriate Things Done Ineffectively WTW % Inappropriate Things Done Ineffectively RTR WTR Right Appropriate Things Done Effectively Mgt % Inappropriate Things Done Effectively Leadership Effectiveness Right Things Wrong Things What You Do % % Management is doing things right; leadership is doing the right things. Peter F. Drucker

7 Continuous Quality Improvement System in Public Health Turning Point Baldrige MAPP QI Teams LSS Big QI MACRO MESO Advance Tools of QI A C A C P D P D QFD Individual qi Basic Tools of QI INDIVIDUAL A C Daily Management S D MICRO Little qi A C P D Rapid Cycle

8 QA, QC, QI Plan Strategic Preventive Assure Reactive Works on problems after they occur Regulatory usually by State or Federal Law Led by management Periodic lookback Schedule Meets a standard (Pass/Fail) Control Operational Real time Inspect Operational After the fact Quality Improvement Proactive Works on processes Seeks to improve (culture shift) Led by staff Continuous Proactively selects a process to improve Exceeds expectations

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10 Components of a PM System Plan SHIP/CHIP (e.g., MAPP) Strategic Plan Operating Plans Financial Plan (Budget) At least 4 types of plans should be ALIGNED: they should mutually support each other SHIP/CHIP Focuses on strategic change & efforts to support SHIP/CHIP STRATEGIC PLAN Covers all programs or organizational units OPERATING PLANS ( Business Plan, Service Plan, or Performance Plan ) BUDGET (Financial Plan)

11 De-siloifying MCH Preparedness HIV STD Family Planning

12 Our Research Found Four Barriers to Strategic Implementation The Vision Barrier Only 5% of the work force understand the strategy Tyranny of the urgent The People Barrier Only 25% of managers have incentives linked to strategy 9 of 10 companies fail to execute strategy The Management Barrier 85% of executive teams spend less than one hour/ month discussing strategy 60% of organizations don t link budgets to strategy The Resource Barrier Today s Management Systems Were Designed to Meet The Needs of Stable Industrial Organizations That Were Changing Incrementally You Can t Manage Strategy With a System Designed for Tactics

13 Baldrige Criteria For Organizational Performance Excellence 2 Strategic Planning 5 Human Resource Focus 1 Leadership 7 Business Results 3 Customer & Market Focus 6 Process Management 4 Information and Analysis

14 Mission / Vision Performance Based Program Budgeting Measures Quarterly Performance Report Agency Strategic Plan & Performance Report Performance Management System Healthy People 2000/2010 Benchmarks CHD Quality Improvement Indicators County Health Dept Plan Program Plans State/Local Performance Standards Local and State Needs Assessments Federal Grant Requirements

15 What is Performance Management? Core practices and processes generally include: goal setting financial planning operational planning data collection consolidation of data data analysis reporting of data quality improvement evaluation of results monitoring of key performance indicators (dashboards) others??? The focus of PM activities is to ensure that goals are consistently met in an effective and efficient manner by an organization, a department, or an employee.

16 What is Performance Management within Public Health? Performance management is the practice of actively using performance data to improve the public's health. This practice involves the strategic use of performance measures and standards to establish performance targets and goals. Source: From Silos to Systems: Using Performance Management to Improve Public Health Systems prepared by the Public Health Foundation for the Performance Management National Excellence Collaborative, 2003.

17 Refreshed Framework, 2013 Source: From Silos to Systems: Using Performance Management to Improve Public Health Systems prepared by the Public Health Foundation for the Performance Management National Excellence Collaborative, Updated framework by the Public Health Foundation, 2013.

18 Developed in 2013, adapted from the 2003 Turning Point Performance Management System Framework

19 Mini-Exercise Using the Turning Point Model as a reference: What are examples of activities within your Health Department does that fall within a performance management system? Cross table discussion Record and prepare to report out

20 Performance Standards Standards may be set based on national, state or scientific organizations, by benchmarking against similar organizations, or by other methods. Example in practice: Healthy People 2020 objective of a 10% improvement in the cases of pertussis among children under 1 year of age (National Notifiable Diseases Surveillance System) Consensus nat l PH standards: PHAB standards Source:

21 Performance Standards Identify relevant standards Select indicators Set goals and targets Communicate expectations Think about: Do you set or use standards, targets or goals for your organization or program? How do you communicate the expectations and strategic direction for your organization or program?

22 Performance Measurement How will you measure achievement of the standard you set? It is important to set criteria and establish scope (programmatic vs. state) Example in practice: New Hampshire used the following criteria to select final measures: Data should be available for several years to show trends. Data should be reliable, in that we are confident in the accuracy of the data and that it measures what is intended to measure. The measures should reflect new and growing initiatives. The measures should be a good indicator of whether or not a program or intervention is working. Source: Improving the Public s Health in New Hampshire,

23 Performance Measurement Refine indicators and define measures Develop data systems Collect data Think about: How do you measure capacity, process or outcomes? (think about all 3!) What tools exist to support the efforts?

24 Reporting Progress Reporting Progress - How a public health agency tracks and reports progress depending upon the purpose of its performance management system and the intended users of performance data. A robust reporting system makes comparisons to national, state, or local standards or benchmarks to show where gaps may exist within the system. Periodicity is important Consistently a weak area in nat l surveys

25 Analyze and interpret data Reporting of Progress Report results broadly Develop a regular reporting cycle Think about: Do you document or report your unit / program s progress? Is this information regularly available? To whom? What is the frequency of analysis and reporting?

26 Use data for decisions to improve policies, programs and outcomes Manage changes Quality Improvement Create a learning organization Implement priority QI activities Think about: Do you have a quality improvement process? What do you do with information gathered through reports? Do you have the capacity to take action for improvement when needed?

27 Visible Leadership Visible Leadership - Senior management commitment to a culture of quality that aligns performance management practices with the organizational mission, regularly takes into account customer feedback enables transparency about performance compared with targets for conversations between leadership and staff.

28 Visible Leadership Engage leadership in performance management Align performance management with organizational priorities Track and incentivize progress Think about: Does senior management take a visible role in performance management? Is performance management emphasized as a priority and goal for your work?

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30 PM Frameworks from the Field

31 Minnesota Public Health System

32 Nebraska Division of Public Health

33 Washington State Department of Health

34 ODH STATE HEALTH IMPROVEMENT PLAN Five-Year Strategic Plan 30,000 FT ODH QUALITY IMPROVEMENT PLAN STRATEGIC IMPLEMENTATION PLAN 20,000 FT PROGRAM WORK PLANS 10,000 FT INDIVIDUAL PERFORMANCE PLANS SEA LEVEL

35 Definition of Quality Improvement In Public Health Quality improvement in public health is the use of a deliberate and defined improvement process, such as Plan-Do-Check-Act, which is 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. Defining Quality Improvement in Public Health; Journal of Public Health Management & Practice: January/February Volume 16 - Issue 1 - p 5 7, Riley, William J. PhD; Moran, John W. PhD, MBA, CQIA, CQM, CMC; Corso, Liza C. MPA; Beitsch, Leslie M. MD, JD; Bialek, Ronald MPP; Cofsky, Abbey -

36 Continuous Improvement Act Plan PDCA was made popular by Dr. Edwards Deming who is considered by many to be the father of modern quality control Check/ Study Do The continuous improvement phase of a process is how you make a change in direction. The change usually is because the process output is deteriorating or customer needs have changed.

37 Plan Source: ABCs of the PDCA Cycle, G. Gorenflo and J. Moran, 1. Identify and Prioritize Opportunities 7. Develop Improvement Theory Check/ Study 2. Develop AIM Statement 8. Develop Action Plan 1. Reflect on the Analysis 3. Describe the Current Process Do 2. Document Problems, Observation, and Lessons learned 4. Collect Data on Current Process 1. Implement the Improvement Act 5. Identify All Possible Causes 2. Collect and Document The data Adopt Standardize 6. Identify Potential Improvements 3. Document Problems, Observations, and Lessons Learned Adapt Abandon Do Plan

38 Mini-Exercise: Making A Performance Management System Work At the Table: Identify Your Primary Strength : Describe the Success Factors of this strength What systems and expectations make this work? What training has occurred? What does leadership do to make this work effectively? How can we Sustain this strength?

39 Refreshed Framework, 2013 Source: From Silos to Systems: Using Performance Management to Improve Public Health Systems prepared by the Public Health Foundation for the Performance Management National Excellence Collaborative, Updated framework by the Public Health Foundation, 2013.

40 Mini-Exercise: Where We Can Improve At the Table: Identify Your Weakest Quadrant Review Your Self-Assessment Data. Identify and Summarize Barriers You Encounter Brainstorm Ideas for Improving this weakest link

41 Radar Chart

42 Rating Scale 0 nothing in place 1 just getting started 2 moving in the right direction 3 adequate; have made good progress over the last year 4 very good performance; plans in place to expand the QI program throughout the organization 5 off the chart!!! we have institutionalized QI

43 Phase 1: No Knowledge of QI Phase 2: Not Involved with QI Phase 3: Informal or Ad Hoc QI Phase 4: Formal QI in Specific Areas Phase 5: Formal Agency- Wide QI Phase 6: QI Culture Agency Characteristics Transition Strategies Resources

44 Phase 1: No Knowledge of QI Phase 2: Not Involved with QI Phase 3: Informal or Ad Hoc QI Lack of understanding of QI Competing priorities Satisfaction with status quo Don t value or link QI to PH practice Data not used in decision-making Begin to understand QI Little expectations for using QI Staff view QI as a trend Few QI trainings or resources Limited use of data Not customer-focused Informal QI efforts QI not part of organization s strategy Some performance monitoring and data use Staff anxiety QI training periodically available

45 Phase 4: Formal QI in Specific Areas Phase 5: Formal Agency- Wide QI Phase 6: QI Culture Greater reliance on data Multiple QI champions exist QI training/resources readily available Data driven decision making Discrete QI projects Improvements not Most staff engaged with QI Formal PM system in place All agency plans linked Discrete and interdepartmental QI projects Standardization in processes All staff are committed to QI Emerging issues do not impede QI Ongoing training Data and QI tools used daily Customer is front and center Demonstrating ROI

46 What is your vision of Your QI culture? A good QI culture is the one that looks at the challenges and the problems in public health as opportunities rather than unsolvable frustrations. This culture would make our organization a place where employees feel empowered to solve problems. Leadership, QI tools, attitude, and the PI team are our assets to achieve that empowerment.

47 Mini-Exercise Which exit is your health dept. at right now? What exit do you plan to be in 12 months?

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49 Transtheoretical Model Behavior Change Pros and cons - acknowledgement Not ready resist change Ready Health Behavior Change Model. The model originates from directly observing how people really did or didn t change in response to urgent medical needs.

50 Development of a PM System A well functioning Performance Management System is one that the entire organization can provide input to, find useful, guides day-to-day operations, and helps direct focus to areas needing improvement.

51 Development of a PM System Performance Management Systems all share the same common purpose of providing business intelligence On a timely basis To help make informed decisions at all levels of the organization To ensure that all processes are efficient and effective and Deliver the products and services that our customers desire.

52 Development of a PM System A well-developed Performance Management System is the CNS of the organization since it is providing real time/regular ongoing business intelligence about performance: goals effectiveness and efficiency of programs and services, performance of processes customer satisfaction levels providing knowledge to help leadership prioritize areas needing improvements.

53 Development of a PM System A Performance Management System Should Answer The Following Questions: How are we doing Why? What should we be doing? Does it match the need(s) of our customer? How fast can we improve?

54 Outcome Influence Process Capacity Control Internal AIM Discrete Measureable Time Bound Operational External Strategic

55 Characteristics of QI Small QI Program or activity level Great way to learn a specific model Large QI Organization-wide System focused

56 Realizing Public Health Transformation Through QI Set focus on a vital few priorities Create a sense of urgency for measurable results and a culture of quality Engage every employee Build QI time into daily workload (not extra job) Adopt fact-based decision making Reward and celebrate progress

57 Transformational Change Change requires more than an effort by a charismatic leader with strong personal beliefs and practices. Individual employees are often left out of the equation. They may receive skill instruction and development that does not prepare them to re-envision their work and make the deep personal changes needed to be more effective in a radically altered environment.

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59 A leader is one who knows the way, goes the way, and shows the way. John C. Maxwell