Perfrmance Management: A Pillar f Public Health Infrastructure
Tday s Agenda Perfrmance Management and alignment with PHAB prerequisites and PHAB Standards Agency Strategic Plan Health Assessment Health Imprvement Plan Quality Imprvement Plan Tls fr priritizing issues and imprving cmmunity engagement 2
Learning Objectives Participants will be able t: State hw perfrmance management relates t cmmunity health assessment, health imprvement plans, strategic plans and quality imprvement plans Review tls fr priritizing strategic issues and fr wrking with cmmunity grups t develp plicies and plans 3
It s a puzzle! Self-Assessment r Accreditatin 4
Turning Pint Perfrmance Management Cllabrative, 2003 PERFORMANCE STANDARDS Identify relevant standards Select indicatrs Set gals & targets Cmmunicate expectatins REPORTING OF PROGRESS Analyze data Feed data back t managers, staff, plicy makers, cnstituents Develp a regular reprting cycle PERFORMANCE MANAGEMENT SYSTEM PERFORMANCE MEASUREMENT Refine indicatrs & define measures Develp data systems Cllect data QUALITY IMPROVEMENT PROCESS Use data fr decisins t imprve plicies, prgrams & utcmes Manage changes Create learning rganizatin 5
Perfrmance Standards Establish perfrmance standards State r Public Health Accreditatin Bard (PHAB) standards Agency-level Strategic and Imprvement Plans Establish and define utcmes and indicatrs Prgram perfrmance measures Prcess utcmes Health utcmes PERFORMANCE STANDARDS 6
Perfrmance Measurement PERFORMANCE MEASUREMENT Mnitring f Perfrmance Review f perfrmance (Accreditatin/Self- Assessment) results Prgram evaluatin results Mnitring f Indicatrs and Outcmes Prgram utcmes results Prcess/shrt-term utcmes Health indicatrs and utcmes 7
Quality Imprvement Prcess Establish QI structure and capacity in agency Establishing QI cuncils and plans Cnducting QI teams Quality imprvement methds and tls Plan-D-Check/Study-Act cycle Rapid Cycle Imprvement (RCI) Imprvement cllabratives Lean Six Sigma Adapting r adpting mdel practices QUALITY IMPROVEMENT PROCESS 8
Definitin f Quality Imprvement A management prcess and set f disciplines that are crdinated t ensure that the rganizatin cnsistently meets and exceeds custmer requirements. QI Tp management philsphy resulting in cmplete rganizatinal invlvement qi Cnduct f imprving a prcess at the micr-system level Bill Riley and Russell Brewer, Review and Analysis f QI Techniques in Plice Departments, JPHMP Mar/April 2009 9
Example f Building QI int the Standards and Measures Dmain 9: Evaluate and cntinuusly imprve prcesses, prgrams, and interventins. Standard 9.1 B: Evaluate and cntinuusly imprve prcesses, prgrams, and interventins prvided by public health r ther practitiners r agencies. Standard 9.2 B: Implement QI f PH prcesses, prgrams and interventins 10
Plan-D-Study-Act: Standard 9.1 9.1.3 B: Establish gals, bjectives and perfrmance measures fr prcesses, prgrams and interventins. Plan D Cnduct specific prgram activities that cntribute t achieving gals and perfrmance measures. 9.1.5 B: Identify needs fr imprvements are based n evaluatin data and results Act Study 9.1.4 B & 9.1.5 B: Mnitr perfrmance measures and evaluate effectiveness 11
Plan-D-Study-Act: Standard 9.2 9.2.1 B Establish a quality imprvement plan based n rganizatinal plicies and directin. Plan D 9.2.2 B Implement QI effrts 9.2.4 L/S Revisin f the plan with new bjectives based upn the review. Act Study 9.2.4 L/S Annual review f the quality plan includes: perfrmance measures are tracked, reprted and used t assess the impact f imprvement actins and meaningful imprvement is demnstrated in at least ne bjective. 12
Reprting Prgress Perfrmance in standards Perfrmance/prgress in Strategic and Imprvement Plan implementatin Indicatrs and utcmes Prcess utcmes Health indicatrs Prgram evaluatin data Regular data tracking, analysis and review Basis fr QI effrts REPORT PROGRESS 13
Applicatin f P-D-S-A Cycle PLAN Standards PLAN Target Imprvements PLAN Standards ACT Areas fr Imprvement DO ACT Evaluate Mdify r Implement DO Imprvement ACT wrk Areas fr Imprvement DO Evaluate STUDY Reprt/Recmmend STUDY Study Results STUDY Reprt/Recmmend Self-Assessment r Accreditatin Perfrmance Imprvement Cycle Self-Assessment r Accreditatin 14
Let s Discuss! What is yur experience with the fur cmpnents f perfrmance management in yur Health Department? 15
PHAB Pre-Requisites Currently, PHAB has required that all applicants submit three dcuments with their request fr an accreditatin survey: Cmmunity/State Health Assessment Cmmunity/State Health Imprvement Plan Agency Strategic Plan Few specific requirements established t date fr the cntents f these prerequisites 16
CHAs/CHIPs, SPs, and QI Plans and Standards Requirements CHA/SHA: Link t requirements in Dmain 1 and Dmain 4 CHIP/SHIP: link t requirements in Dmain 4 and are explicitly required in Dmain 5, Standard 3 SP: Explicitly required in Dmain 5, Standard 2 QI Plan: Explicitly required in Dmain 9, Standard 2 These dcuments prvide evidence fr sme f the requirements in these standards. 17
Dmain 1: Cnduct & disseminate assessments [f] ppulatin health status Standard 1.1 B: Cllect and maintain reliable, cmparable, and valid data that prvide infrmatin n cnditins f public health imprtance and n the health status f the ppulatin. 1.1.1 B: Demnstrate that a surveillance system is in place fr receiving reprts 24/7 and fr identifying health prblems, threats, and envirnmental hazards 1.1.2 B: Cmmunicate with surveillance sites n at least an annual basis 1.1.3 B: Cllect additinal primary and secndary data n ppulatin health status 1.1.4 L/S Prvide reprts f primary and secndary data t SHA/LHDs Standard 1.2 B: Analyze public health data t identify trends in health prblems, envirnmental public health hazards, and scial and ecnmic risks that affect the public s health. 1.2.1 B: Analyze and draw cnclusins frm data t identify trends ver time, clusters, health prblems, behaviral risk factrs, envirnmental health hazards, and scial and ecnmic cnditins that affect the public s health 1.2.2 S: At least annually, prvide statewide public health data t varius audiences in the frm f reprts n a variety f public health issues Standard 1.3 B: Prvide and use the results f health data analysis t develp recmmendatins regarding public health plicy, prcesses, prgrams r interventins. 1.3.1 B Use data t recmmend and infrm public health plicy, prcesses, prgrams and/r interventins 1.3.2 S Develp and distribute statewide health data prfiles t supprt health imprvement planning prcesses at the state level 1.3.3 S Prvide supprt t LHDs in the develpment f cmmunity health data prfiles 1.3.2 L Develp and distribute cmmunity health data prfiles t supprt public health imprvement planning prcesses at the lcal level 18
Dmain 4: Engage with the cmmunity t identify and address health prblems Standard 4.1 B: Engage the public health system and the cmmunity in identifying and addressing public health prblems thrugh an nging, cllabrative prcess. 4.1.1 B: Establish and actively participate in cllabrative partnerships and calitins t address public health issues 4.1.2 B: Recruit and engage gverning entity members, stakehlders, cmmunity partners and the public t participate in cllabrative partnerships and calitins t address imprtant public health issues 4.1.3 S: Prvide technical assistance t LHDs and/r public health system partners regarding mdels fr recruiting and engaging the cmmunity Standard 4.2 B: Prmte understanding f and supprt fr plicies and strategies that will imprve the public s health. 4.2.1 S: Disseminate the results f cmmunity health assessments t statewide stakehlders 4.2.1 L: Disseminate the results f cmmunity health assessments t the cmmunity 4.2.2 B: Engage the cmmunity abut plicies and strategies that will prmte the public s health 4.1.3 L: Link stakehlders t technical assistance regarding mdels f recruiting and engaging with the cmmunity, as requested 19
Dmain 5: Develp public health plicies and plans Standard 5.2 B: Develp and implement a health department rganizatinal strategic plan. 5.2.1 B: Cnduct a strategic planning prcess 5.2.2 B: Develp a strategic plan 5.2.3 B: Implement the strategic plan 5.2.4 B: Review and revise the strategic plan Standard 5.3 L/S: Cnduct a cmprehensive planning prcess resulting in a cmmunity health imprvement plan [CHIP]/state health imprvement plan [SHIP]. 5.3.1 L/S: Cnduct a cmmunity/state health imprvement prcess that includes brad participatin frm the cmmunity/stakehlders 5.3.2 L/S: Prduce a cmmunity/state health imprvement plan as a result f the cmmunity/[] health imprvement prcess 5.3.3 L/S: Implement elements and strategies f the cmmunity/state health imprvement plan, in partnership with thers 5.3.4 L/S: Mnitr prgress n strategies and health imprvement in rder t revise the CHIP/SHIP, as needed 20
Dmain 9: Evaluate & cntinuusly imprve prcesses, prgrams, &interventins Standard 9.1 B: Evaluate public health prcesses, prgrams, and interventins prvided by the agency and its cntractrs. 9.1.1 B: Engage gverning entity in establishing agency plicy directin regarding a perfrmance management system 9.1.2 B: Establish agency plicy and capacity t implement a perfrmance management system 9.1.3 B: Establish gals, bjectives and perfrmance measures fr prcesses, prgrams and interventins 9.1.4 B: Mnitr perfrmance measures fr prcesses, prgrams and interventins 9.1.5 B: Evaluate the effectiveness f prcesses, prgrams, and interventins and identify needs fr imprvement 9.1.6 B: Implement a systematic prcess fr assessing and imprving custmers satisfactin with agency services 9.1.7 S: Prvide training and technical assistance regarding evaluatin methds and tls t SHA and LHD staff 9.1.7 L: Require staff participatin in evaluatin methds and tls training Standard 9.2 B: Implement quality imprvement f public health prcesses, prgrams, and interventins. 9.2.1 B: Establish a quality imprvement plan based n rganizatinal plicies and directin 9.2.2 B: Implement quality imprvement effrts 9.2.3 S: Prvide training and technical assistance regarding quality imprvement methds and tls t SHA and LHD staff 9.2.3 L: Demnstrate staff participatin in quality imprvement methds and tls training 21
CHA/CHIP/SP/QI Plan Strategic Plan Emerging and New Initiatives may nt be in ther 2 plans CHIP Health Status and Health Risk Interventins t address Health Assessment may nt be in ther 2 plans Sme initiatives r activities verlap 2 r 3 f the Plans QI Plan Operatinal Issues and Current Data n Prcess Outcmes may nt be in ther 2 plans Cmmunity Health Assessment infrms all three agency plans 22
Planning and Develping Agency Level Plans 23
Develpment f Agency Plans MAPP is an excellent framewrk fr develpment f CHIPs and Strategic Plans fr lcal agencies Cnducting the fur MAPP assessments in nt required, if data and results are available thrugh ther reprts and assessments There are many ther gd prcesses fr develpment f Strategic Plans and QI Plans 24
MAPP is: A cmmunity-wide strategic planning prcess fr imprving public health. A methd t help cmmunities priritize public health issues, identify resurces fr addressing them, and take actin. 25
MAPP as a Framewrk Partnerships and Calitins Organizatinal r Cmmunity Visins Qualitative data n Cmmunity Perceptins Cmmunity Health Assessment Pririty Areas Strategies Public Health Activities MAPP slides curtesy f Laura Landrum 26
The MAPP Paradigm Shift 27
Cmmunity Health Status Assessment Analyzes Data abut Health status Quality f life Risk factrs 28
Cmmunity Health Status Assessment 11 Categries f Data Demgraphic Characteristics Sciecnmic Characteristics Health Resurce Availability Quality f Life Behaviral Risk Factrs Envirnmental Health Indicatrs Scial and Mental Health Maternal and Child Health Death, Illness and Injury Infectius Disease Sentinel Events 29
PDSA Applicatin t Cmmunity/State Health Assessments Plan: Descriptin f planning fr data cllectin and analysis, including cmmunity input and review f results D: Cnduct data cllectin and synthesis Study: Trended data cmpared t targets r gals fr specific types f data, including health risks and status Act: Identify cnclusins and make recmmendatins fr actin t infrm Health Imprvement Plan and agency Strategic Plan 30
CHIPs and SHIPs Standard 5.3 requires: Cnduct a cmmunity/state health imprvement prcess that includes brad participatin frm the cmmunity/stakehlders Prduce a cmmunity/state health imprvement plan as a result f the cmmunity/health imprvement prcess Implement elements and strategies f the cmmunity/state health imprvement plan, in partnership with thers Mnitr prgress n strategies and health imprvement in rder t revise the CHIP/SHIP, as needed 31
Translating MAPP int a Framewrk fr CHIP / SHIP: Team Discussin Elements f MAPP Phase 1: Organizing fr Success & Partnership Develpment Part 1: List any current r previus activities, skills, and prducts that sund similar t cmpnents in MAPP. Hw culd they be incrprated int yur CHIP / SHIP framewrk? Part 2: In incrprating these activities, skills, and prducts int the CHIP / SHIP framewrk, hw wuld yu ensure imprvements in the way yur agency des business? Des yur cmmunity r state partnership represent the key rganizatinal players engaged in imprving the public s health? Phase 2: Visining Is there a visin statement develped by yur partnership grup? Phase 3: Fur Assessments: Cmmunity / Statewide Themes & Strengths Assessment Is there a summary f crsscutting themes? 32
Frmulating Gals and Strategies 33
Identify Strategic Issues Strategic issues are fundamental plicy chices r critical challenges that must be addressed in rder fr a cmmunity t achieve its visin. 34
The Prcess Determine the methd fr cmpleting this phase Present summary f all fur assessments Brainstrm ptential strategic issues Develp an understanding abut why an issue is strategic Cnslidate verlapping r related issues Arrange issues int an rdered list Disseminate results Evaluate the prcess 35
Frmulate Gals and Strategies Frm gal statements related t strategic issues Identify strategies fr achieving gals 36
Example f a Strategic Issue, Gal & Strategy Strategic Issue: Hw can the public health cmmunity ensure access t ppulatin-based and persnal health care services? Gal: All persns living in ur cmmunity will have access t affrdable quality health care. Strategy: Create a netwrk f reduced cst primary care prviders. Prvide free r reduced cst transprtatin services t care site. 37
Hw t 1. Determine hw gals and strategies will be develped 2. Develp gals Reference visin statement and strategic issues 3. Generate a variety f strategies Resist pressures t settle fr an bvius r cmfrtable strategy Reference MAPP assessment data 38
Hw t Cntinued. 4. Brainstrm barriers t implementatin Think abut Resurces Cmmunity supprt Legal r plicy impediments t authrity Technlgical difficulties Limited rganizatinal r management capacity 5. Draft implementatin details Cnsider What specific actins need t take place? What is a reasnable timeline? Which rganizatins and individuals shuld be invlved? What resurces are required and where will they cme frm? 39
The Actin Cycle Plan What will be dne? Hw will it be dne? Wh will d it and when? Implement Evaluate Evaluating prgress and celebrating success Feeding infrmatin back int the actin cycle Evaluatin shuld ccur thrughut the prcess! 40
Organize Yur SP Prcess What will the prcess entail? Hw lng will it take? What results are we seeking? Hw will we knw we are finished? Wh will d the wrk? 41
Criteria and Methds fr Priritizing Strategic Issues 42
Criteria fr Priritizing Opprtunities Rank tpics/issues that are: Imprtant/ relevant t ppulatin Within agency cntrl High-risk Health Alerts, Drinking Water, CD Investigatins High-vlume WIC, Fd Safety, OSS, Immunizatins Prblem-prne Emergency Preparedness 43
Cntrl and Influence This is a cnceptual tl t help give a team guidance n what t fcus n when trying t pick a tpic t imprve They shuld fcus where they have bth cntrl and knwledge In Public Health we may wrk mre in the influence part f the circle r quadrant 44
N Knwledge Public Health Perfrmance Management Knwledge Cntrl N Cntrl D It Influence Get Help Stay Away 45
Cntrl and Influence It helps t understand where: we have cntrl we may need assistance we can influence nly we shuld stay away frm It als pints ut that we can expand ur cntrl area by becming mre knwledgeable, seeking assistance, and trying t be influential in areas beynd ur cntrl 46
Criteria Matrix Tl Imprtance Cntrl Hi Risk Hi Vl Prb. Prne Ttal pts Imprvement Area HI (3) MED (2) LOW (1) HI (3) MED (2) LOW (1) (1) (1) (1) 1. Immunizatin X X X 6 2. Engage Cmmunity X X X 5 3. CHIP X X X 6 4. Fd Safety X X X X 7 5. Family Planning X X X X 5 47
Priritizatin Matrix Weighing Yur Optins Why use it? T narrw dwn ptins thrugh a systematic apprach f cmparing chices by applying criteria What des it d? Quickly surfaces basic disagreements t reslve up frnt Frces teams t fcus n the best things t d Limits hidden agendas by surfacing criteria as part f prcess Increases chance f fllw-thrugh as get mre buy-in Reduces the chance f selecting smene s pet prject 48
Hw t Use Priritizatin Matrix Use ptential tpics frm assessment results, brainstrming r affinity diagram Develp decisin criteria fr paired cmparisns, e.g.: Imprved quality Lwer cst Imprved utcmes Better service Draw table n flip chart, label the rws with each f the criteria and clumn labels shuld crrespnd t rw labels 49
Hw t Use Priritizatin Matrix Take tpics/issues and ask: Des X cntribute mre than Y in achieving the gal, based n ur criteria? Once yu have agreement n the answer, then decide hw much: 1 = equally imprtant 5= significantly mre imprtant 10= exceedingly mre imprtant 1/5 significantly less imprtant 1/10=exceedingly less imprtant Assign agreed-upn value t the issue cntributing mre and the reciprcal scre t the ther Ttal the scres and priritize the issues, highest t lwest 50
Example f Priritizatin Matrix (Imprtance criterin) 1. Health Data 2. Engage Cmmu. 3. CHIP 4. QI Plan 5. Research Prcesses Rw Ttal 1. Health Data 2. Engage Cmmunity 5 1 5 10 21 1/5 1 5 10 16.2 3. CHIP 1 1 5 10 17 4. QI Plan 1/5 1/5 1/5 5 5.6 5. Research Prcesses 1/10 1/10 1/10 1/5 0.5 51
Ppcrn Exercise Taste criteria Air Ppped Oil r butter Micrwave Rw Ttal Air Ppped Oil r butter Micrwave 52
What questins r cmments d yu have? 53