Public Health Performance Management Systems Organized as Quality Improvement Cycles
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1 Public Health Performance Management Systems Organized as Quality Improvement Cycles Paul Epstein Results That Matter Team ( For APHA Annual Meeting Boston November 5, 2013
2 Presenter Disclosures Paul David Epstein (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose, other than the obvious relationship with my own consulting firm that does paid work of the type I am presenting.
3 Results That Matter Team Measuring & improving performance since 1985, including more than 30-years experience with performance management (PM) systems With the Public Health Foundation (PHF), developed a new QI-based approach to PM systems & provided training & assistance to start using it to over 40 public health agencies across the U.S. & internationally Use of RTM Team s Community Balanced Scorecard (CBSC) tools for collaborative health improvement planning & implementation, strategic planning, & accreditation preparation Work with PHF, ASTHO, NACCHO, & directly for PH organizations, hospitals, partnerships, others QI &Evaluation Coaching for LHDs across the U.S. (NACCHO) 3 chapters in The Public Health Quality Improvement Handbook, including one on Community Balanced Scorecards Results That Matter Team ( 3
4 Context: The Turning Point Framework Performance management is the practice of actively using performance data to improve the public s health. It involves strategic use of performance measures and standards to establish performance targets and goals. In alignment with the organizational mission, performance management practices can also be used to prioritize and allocate resources; to inform managers about needed adjustments or changes in policy or program directions to meet goals; to frame reports on the success in meeting performance goals; and to improve the quality of public health practice. Performance management includes the following components: Visible Leadership, Performance Standards, Performance Measurement, Reporting Progress, Quality Improvement 2013 Refresh of 2003 Framework A performance management system is the continuous use of all the components above so that they are integrated into an agency s core operations: Health Status Public Health Capacity Workforce Development Data & Information Systems Customer Focus & Satisfaction Financial Systems Management Practices Service Delivery Performance management can be carried out on multiple levels, including the program, organization, community, and state levels. Self-Assessment Tool with 96 Questions on 8 pages (2013) & Many Other Resources at PHF.org 4
5 Performance Management (PM) & Performance Management Systems (PMS) Performance Management: Using performance information to help make better decisions. Performance Management System: Using performance information on a regular basis as part of a continually repeated cycle of performance monitoring, analysis, and improvement, in which measured results are fed back into decision making to improve future performance. Results That Matter Team ( 5
6 QI PDCA Cycle Meets the PM System Definition Traditionally applied to specific processes & practices as a QI Cycle Decide on further improvements Develop improvement plans & targets Act Plan Monitor, analyze, & interpret data Check Do Implement improvements & collect data Sometimes called PDSA for Plan-Do-Study-Act Results That Matter Team ( 6
7 QI Framework for a Public Health Organization-wide PM System Direction Plan SHIP/CHIP Strategic Plans Operating Plans Financial Plan (Budget) Focus to date for Public Health Agencies Quick Start Expectations Act Performance-based Decision Making Decisions on Changes to Improve Results Engagement of: Leaders & managers Employees Partners Other stakeholders Consistent way to manage information Do Program & Policy Implementation Operational QI A P C D Information Check Performance Monitoring & Reporting for the Population & Organization (incl. SHA/CHA) Analysis of Results Data Self-assessment tool with 17 questions on 1 page at PHF.org 7
8 Entire Governments Have Used QI Cycles for PM Systems City of Austin, TX King County, WA Plan Strategic Planning & Annual Performance Planning Act Performance- based Decision Making Do Performance Budgeting & Service Delivery Check Performance Monitoring & Reporting Results That Matter Team ( 8
9 QI Framework for a PH PM System Includes All Four Turning Point Quadrants + Visible Leadership Direction Plan SHIP/CHIP Strategic Plan Operating Plans Financial Plan (Budget) TP: Performance Standards & Performance Measures Expectations Act Performance-based Decision Making Decisions on Changes to Improve Results TP: Visible Leadership & Quality Improvement Do Program & Policy Implementation Operational QI A P C D Information Check Performance Monitoring & Reporting for the Population & Organization (incl. SHA/CHA) Analysis of Results Data TP: Reporting of Progress 9
10 Plan SHIP/CHIP 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 major changes & efforts to support CHIP STRATEGIC PLAN Covers all programs or organizational units OPERATING PLANS ( Business Plan, Service Plan, or Performance Plan ) Operating plans should align with each other BUDGET Results That Matter Team ( 10
11 Alignment of Operating Plans Across the Organization The Essential Services of Public Health provide a way to align all operating plans of a PH agency Use a top level strategy map based mostly on the Essential Services (and additional domains of PHAB) for which program or organizational unit maps can be cascaded Results That Matter Team ( 11
12 Top Level Strategy Map Based on Essential Services: Can Be Used to Align Strategies & Operating Plans STRATEGIC GOALS & OBJECTIVES ( Generic Categories for Program or Issue Objectives) Community Health Outcome Goals Health status & related outcomes, disparities, determinants, risks. Community Implementation Objectives Projects, services, & actions to improve health or the conditions for health. Community Process & Learning Objectives S. Help Other Programs Accomplish Their Objectives All policy, planning, & decision processes that can affect health. Also, gathering & using information. # 2 Investigate, Contain PH Problems & Hazards # 5 Develop PH Policies & Plans H1. Improve Health Status & Eliminate Disparities # 6 Enforce Public Health Laws # 1 Assess, Disseminate Population Health Status & PH Issues H2. Improve the Environment for Health & Reduce Health Risks # 3 Inform, Educate About PH Issues (Promote Health) # 9 Evaluate & Improve Processes, Programs, & Interventions # 7 Promote Strategies to Improve Access to Services # 10 Contribute to & Apply the Evidence Base of PH Community Assets Objectives Financial & non-financial resources (e.g., people, organizations, partnerships, facilities, equipment) and how they function to support health strategies. # 4 Engage the Community to ID & Address Health Problems # 8 Maintain a Competent PH Workforce #11 Maintain Administrative & Management Capacity #12 Maintain Capacity to Engage the PH Governing Entity 12
13 Plan Expectations Expectations start with performance measures High Level Public Health Outcomes Population Outcomes Place Outcomes Results That Matter Team ( 13
14 Lagging & Leading Indicators Population & place outcomes tend to lag So you need performance drivers that lead to enable mid-course corrections to your strategy. Some performance drivers are participant outcomes or other intermediate outcomes Results That Matter Team ( 14
15 Performance Drivers to Outcomes Population or Place Outcomes Performance Drivers, including Participant Outcomes or other Intermediate Outcomes Performance Driver Chains of Success in a Strategic PM System Results That Matter Team ( 15
16 County Infectious Disease Program Strategy: STI Focus STRATEGIC GOALS & OBJECTIVES Community Health Outcome Goals H1. Reduce STI rates H2. Increase access to STI testing Community Implementation Objectives #3 Promote STI testing & healthy behaviors #2 Investigate outbreaks #7 Partner with community associations/agencies S Promote immunizations Community Process & Learning Objectives #1 Identify appropriate target groups #9 Apply CQI to STI process/program #10 Achieve CDC standards and investigate new methodologies/technologies Community Assets Objectives #4 Coordinate with partner agencies and produce/disseminate information #8 Sustain employee competence through continuing education #12 Report to Leadership Team and BOH 16
17 Infectious Disease (STI) Measures that Show Driver Relationships Driver relationships among measures tell the stories of your program & help you manage programs for success. Community Health Outcome Goals Goal H1. Reduce STI Rates Outcome: Number of new chlamydia cases per 100,000 county residents Outcome/Driver: Number of residents who receive chlamydia testing Community Implementation Objectives Objective (PHAB 3): Promote STI testing and healthy behaviors Outcome/Driver: Number of STI clinic clients who report intention to change according to Stages of Change model after counseling at time of service Performance driver: % people with chlamydia who receive education Community Process & Learning Objectives Objective (PH. 10): Achieve CDC Standards and investigate new methodologies/technologies Performance driver: % of chlamydia cases investigated within 14 days of date of diagnosis Performance driver: % of chlamydia cases reported within 3 days Community Assets Objectives Objective (PHAB 4): Coordinate with partner agencies and produce/disseminate information Performance driver: Number of clinics who report chlamydia cases within 3 days Performance driver: % of hits to the County Health Dept STI website 17
18 Scorecard Example in Excel Results That Matter Team ( 18
19 Possible scenario for analysis & management review after three-quarters Driver: Good Results Outcome: Good Results Driver: Good Results Driver: Cautionary Results
20 Dashboard Sample: Web-based Click measure for data definition Click arrow or diamond for trend line 20
21 One-click Trend vs. Target on Web-based System 21
22 Related PM System Resources: See RTMteam.net & PHF.org At RTMteam.net home page, in What s New click on Performance Management Resources for a page of links, downloads, and references, including links to several PHF resources At PHF.org home page, in Our Focus Areas click on Performance Management and also check Key Resources & Tools for PM resources Example: From both sites, find links to the paper Performance Management and Cultural Transformation Using the PDCA Approach by John W. Moran, Paul D. Epstein, & Leslie M. Beitsch (PHF, 2013) Or contact Paul Epstein at paul@rtmteam.net or Results That Matter Team ( 22
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