The Santa Clara County Mental Health Department s Director, Dr. Nancy Pena, is convening a Performance Measures Committee to develop a dashboard of performance measures to respond to a wide variety of needs associated with the agency s Strategic Framework. These needs and the aims of this committee are described in the charter presented below. CHARTER FRAMING THE ISSUES: Issues driving the efforts of this Committee range from macro or community-level needs to those of individual client served by the system (see levels in diagram below). These issues that frame the committee s charge and to which the committee must respond include: - Agencies, programs and individual providers system-wide are committed to improving client outcomes and require performance measures in order to reliably achieve that improvement - To effectively manage outcomes, leadership and management must be able to see: 1) system-level performance, including the overall value and service provided to the community; 2) program performance, including effectiveness with specific client cohorts, and 3) clientspecific-outcomes - Leadership, middle managers and supervisors require information to determine level of performance and to identify opportunities for improvement - Currently available data can inform performance measures related to processes but is limited in terms of informing outcomes - County rules and regulations require the contractors be evaluated in order to either extend existing contractors or establish new contracts (with existing or new contractors) - Current data technology system development should influence and be influenced by performance measures - Client and family members need more input into services, at all levels Draft #3 Page 1 of 6 July 29, 2010
Stakeholder Input Performance Measures - A variety of internal and external stakeholders are expecting/demanding greater transparency around reporting of the system s performance to ensure their constituents are being effectively served - Establishment of measures will be most effective if done in collaboration with contract agencies that will be responsible for gathering required data inputs and responding to the reported performance measures MISSION: The Performance Measures Development Committee mission is to develop a dashboard of measures of client outcomes, financial performance, operational efficiency, and organizational capacity. These measures must support leaders and managers in the complex of challenge: aligning vision and mission with customer requirements and day-to-day work managing and evaluating business strategy monitoring operation efficiency improvements building organizational capacity communicating progress to all employees and stakeholders This mission is further delineated by responding the three key questions that the Model For Improvement calls for, in terms of setting the stage for effective achievement of desired improvement in measuring, reporting and using measurement. Levels of Measurement Dimensions of the System to be Measured Local & Statewide Communities Mental Health Conditions: Expectations & Results Local & Statewide Mental Health Systems Programs & Services Individuals & Families System Performance: Expectations & Results Provider Performance: Expectations & Results Client Level Outcomes: Expectations & Results NOTE: System in the above chart represents the entire span of services controlled by Santa Clara County Mental Health Services. Provider in the Programs and Services represents both an agency level of reporting and the reporting unit within an agency. Aim: What are we trying to accomplish? - Support improved outcomes at the individual client level, program level, system level and community level (see domains below) - Support performance reporting to Mental Health Board and other internal and external stakeholders (transparency) Draft #3 Page 2 of 6 July 29, 2010
- Support performance management by executive team, middle managers and supervisors (process improvement) through qualitative and quantitative measurement of experience of care that enables greatest possible effectiveness of services - Support provider performance evaluation for contracting/extensions and oversight Measures: How will we know a change is an improvement? - Improved measurement of client and family outcomes - Managers are able to identify and act on opportunities for improvement as well as celebrate and reward success at the system-level, program level (including with specific client cohorts) and individual client level - Contractors are appropriately evaluated, selected and contracted/recontracted per county requirements - There is sufficient transparency in reporting performance so that the MHB and other stakeholders are confident about knowledge of system and program-level performance - Improved cost effectiveness of services Positive Outcome Domains Thriving With Mental Illness (examples) Physically Healthy Emotionally Content Substance Abuse Remission Safe, Perm. Home Close Supportive Network Sustainable Income/Support Employed/in school Active Productive Time No legal troubles Safe in community No harm to others Health & Well Being Stable Home, Family, Social Relations Meaningful School, Work Activity Safe From Harm or Harming in Community Physically Unhealthy Emotionally Suffering Substance Abusing Homeless/unstable home Isolated/no support No sustainable Income Unemployed/failing school Inactive Meaningless Time Troubles with Law Unsafe in the community Causing harm to others Negative Failing With Untreated and Under-treated Mental Illness (examples) 1 Changes: What changes can we make that will result in improvement? - Develop a dashboard of outcome and process measures to be published monthly - Develop/purchase interactive reporting tool that allows flexible inquiry by agency leadership and program managers Draft #3 Page 3 of 6 July 29, 2010
PRINCIPLES: The following principles will guide the efforts of the committee: - Do not create redundant data systems - Support data consistency across the system - Data must be accessible - Create a family of useful measures, recognizing that no single measure will be perfect (and does not need to be) - Each measure must have a clear end-user and articulated purpose for use - Client and families will be represented throughout the development process AUTHORIZATION, ROLES & RESPONSIBILITIES: As the accountable leader for the quality and effectiveness of mental health services provided through the mental health system, Nancy Pena authorizes the convening this Performance Measures Development Committee, with the above charter. Delegated roles and responsibilities are as follows: - Steering Committee: Define domains of measures, select measures to test, evaluate test results, select final system-wide performance measures including expected end-users - Core Team: Guide staff to carryout Steering Committee direction, decisions and plans - Project Management: Deane Wiley, Division Director, is charged with project management of the committee s work; he is supported by Karin Kalk, who serves as facilitator and expert consultant to the committee. - Staff: Additional county staff are charged with assisting the identification of existing measures for review, supporting testing of selected measures, reporting findings of tests, and implementing routine generation of selected measures - Client and Family Representatives: Client and family representatives will serve in the Steering Committee and participate in testing of draft measures and the overall dashboard. DURATION: The Performance Development Committee is a time-limited group who will meet on a regular basis to develop the required dashboard. Upon completion of this development work, SCC leadership will evaluate whether there is a need to either continue the Committee or develop a new approach to the use, maintenance and evolution of the performance dashboard. Draft #3 Page 4 of 6 July 29, 2010
MILESTONES: The committee s work is structured around the following over-arching activities and associated milestones. OVER-ARCHING ACTIVITIES & MILESTONES: TARGET DATE 1) Convene a System-Wide Steering Committee April 2010 2) Define and Agree to Framework and Requirements - Charter - Conceptual Framework and Domains June 2010 3) Inventory Existing Measures, Reports by County and Contractors - Current Annual Performance Evaluation measures - QIWP Quality Improvement Services - Existing Management Reports - Others? 4) Gather and Review State of the Art and Existing Performance Measurement Tools and Approaches Nationally, Around the State And Locally 5) Select Dashboard Measures - Phase I - Phase II - Phase III - Phase IV 6) Develop Dashboard in Phases: Test Finalize Implement - Phase I - Phase II - Phase III - Phase IV 7) Develop Interactive Tool - Demo ValueOptions - Develop Specifications/Requirements - Identify Vendors - Prepare and Distribute RFP - Evaluate Proposals & Select Vendor - Implement Tool June 2010 Sep 2010 June 2010 Oct 2010 Jan 2011??? Aug 2010 Dec 2010 Mar 2011?????? Draft #3 Page 5 of 6 July 29, 2010
PROPOSED PHASING OF DASHBOARD MEASURE DEVELOPMENT PHASE I Measures to be Developed: 1) Current Measures (in use or in development) 2) New Measures (but well established in the field) with Existing Data PHASE II Measures to be Developed: 3) Innovative Measures with Existing Data 4) Phase I Measures Expanded Scope Scope: Team, Provider Levels PHASE III Measures to be Developed: 5) Innovative Measures with New Data 6) Phase II Innovative Measures Expanded Scope Scope: Team, Provider Levels PHASE IV Measures to be Developed: 7) Innovative Measures with New Data Scope: Team, Provider Levels Draft #3 Page 6 of 6 July 29, 2010