Chapter 17. focuses on performance management in public health. Discuss your thoughts and experiences on performance management.
Chapter 17 Chap 17 Performance Management in Public Health Learning Objectives Understand challenges to performance at many different levels Appreciate historical trends in the development of standards and measures Explain the meaning and use of performance measures and standards Overview Many public health organizations use performance management efforts to track the work they produce and the results they achieve Public health leaders and managers face issues related to performance at many different levels of the public health system including the performance of individuals, programs, agencies, inter-organizational collaborations, and the public health enterprise itself Overview This chapter examines these lessons, as well as various applications using performance standards to improve the performance of public health organizations and systems, including the accreditation of public health agencies The initial development of a performance management framework for use in public health organizations and systems will be described Elements of Performance Management Elements of Performance Management Four Quadrant Performance Standards Performance Measures Reporting of Progress Quality Improvement Process Four Quadrants of Performance Management Standards: direction-setting practices, performance targets, levels of excellence, accepted expectations Measures: quantitative assessment of performance Indicators of progress Reporting of progress: studies of trends, comparing actual to desired levels; sharing with others Standards outline the expectation of what should be achieved 7 Four Quadrants of Performance Management The quality improvement process uses: Use collected data for decisions Report change management processes Revise program strategy Better attain desired performance results Performance management integrates an organization’s use of standards, measurement, and performance improvement to change institutional capacities, processes and priorities 8 Figure 17.1 The Performance Management Model Reprinted from Turning Point National Office. From Silos to Systems: Using Performance Management to Improve the Public’s Health. Seattle, WA: Turning Point; 2003. Copyright Robert Wood Johnson Foundation. From Turning Point, a national program of the Robert Wood Johnson Foundation from 1996–2006. Used with permission from the Robert Wood Johnson Foundation. The performance management model integrates elements of public health practice into a coherent model for understanding and directing complex public health programs, organizations, and systems. Ties together more conceptual and elusive issues in public health policy, such as accountability, effectiveness, and benchmarking, incorporating them into a practical and feasible model. 9 How do you know if something is working ? 1. Performance measurement but not all performance measurement is created equal! 10 Performance Measurement Regular collection and reporting of data to track work that is performed and results that are achieved Effective Performance Measurement Incorporates stakeholder input Promotes top leadership support Creates a clear mission statement Develops long-term goals and objectives Formulates short-term goals and interim measures Devises simple, manageable approaches Provides support and technical assistance Effective performance measurement will consider the above: 12 Benefits of Measuring Performance Clear goals and objectives Identifies strengths and weaknesses Opportunities for collaborative approaches Clearer lines of accountability Improved quality Better tracking of progress over time More effective communication Better resource allocation and deployment Strengthened organizational effectiveness Performance Management Focuses on what is occurring Is a management and oversight tool to facilitate positive change and improvement in performance Deemed relevant to performance Evaluative Research program evaluation More in-depth, helps understand the why Design, implementation, and more Performance indicators determine whether or to what extent a performance standard is achieved Acknowledges critical dimensions of performance, capacities, processes, and outcomes Performance management does not extensively address why or how 14 Performance Measure Performance Measure specific quantitative representation of a capacity, process, or outcome that is deemed relevant to the assessment of performance. One component of a comprehensive evaluation Specific quantitative representation of a capacity, process, or outcome that is deemed relevant to performance Similar to the concept of prevention, performance measurement requires an object. It is critical to specify what (or whose) performance will be measured. Program, agency, health system 15 Performance Measure (Cont) Performance measurement most frequently occurs within the context of a particular program (e.g., childhood immunizations or retail food safety). But can also occur with: performance of an agency (e.g., a state or local health department), partnership, community public health system, an individual is also an appropriate target for performance measurement. Performance Measure (Cont) Performance measures can take several different forms. Performance Standard an expectation of what will be done or accomplished. Ie: community health assessment every three years Performance Indicators Performance measures that are used to determine whether or to what extent a performance standard is achieved Performance Standard: A performance measure that takes the form of a generally accepted, objective standard of measurement—such as a rule or guideline against which the level of performance can be compared—is For example, a performance standard might call for a comprehensive community health assessment to be completed every three years. 17 Dimensions of Performance Processes refer to what is done to, for, with, or by defined individuals or groups to identify and address community or population-wide health problems. The performance of key processes (e.g., monitoring health status, investigating health hazards, and building constituencies) leads to the development of other processes that can also be viewed as outputs. In public health practice, these outputs take the form of interventions (e.g., policies, programs, and services) intended to achieve outcomes that are important to the system. Dimensions of Performance Capacities Refers to the resources and relationships necessary to carry out processes of public health Outcomes Immediate and long-term changes experienced by individuals and populations as a result Performance measures can relate capacities to outcomes Cost-effectiveness of an activity or intervention Performance Measure (Cont) It is clear that the United States fell well short of its Healthy People 2000 target of having 90 percent of the population residing in jurisdictions in which public health’s core functions are being effectively addressed. Healthy People 2010 Source: Turnock BJ, Handler A, Hall W, Potsic S, Nalluri R, Vaughn EH. Local health department effectiveness in addressing the core functions of public health. Public Health Rep. Sep-Oct 1994;109(5):653-658. Turnock BJ, al e. Core Function-Related Local Public Health Performance Journal of Public Health Management and Practice. 1998;4(5):26-32. These efforts to measure core function performance have served several important purposes. By providing information on both key processes and outputs of public health practice, many state–local systems have initiated public health practice improvement strategies. 20 Evolution of Performance Measurement In the 1990s many public health organizations were conducting organizational self-assessments, identifying strengths and weaknesses, and channeling information into capacity-building plans Performance Measures Information pertaining to the capacity to perform Process performance Outputs Ultimate Results Impacts/outcomes Prior to the 1990s it focused on capacities and outputs than the key processes and the focus of public health core functions. 22 Evolution of Performance Measurement In 1997 increased interest in performance measurement in public health expanded to community-driven and state-level collaboration Trends toward strategic effectiveness and evolution of APEX-PH into MAPP Assessment Protocol for Excellence in Public Health Early model for strengthening public health agencies roles in communities APEXPH: Assessment Protocol for Excellence in Public Health: early model/blue print for public health agencies wanting to focus and strengthen their roles in their communities. There was a correlation between where APEXPH was implemented and used and public health performance; APEXPH 23 MAPP Mobilizing for Action through Planning and Partnerships (MAPP) Uses strategic planning Community wide strategic planning tool Link public and private community partners to specific performance expectations for addressing priority health needs in the community Performance standards for use in state and local public health systems and local governing boards MAPP is a structured but flexible process that at its best produces collection action at the community level to improve health 24 Healthy Nashville MAPP MAPP model supports the identification of strategic community health issues by the findings of four assessments: Community health status assessment A forces of change assessment (environmental scan) A community themes and strengths assessment Local public health systems assessment Critical Issues for Success Performance improvement positive change in the capacity, process and outcomes of public health organizations and public health systems (public, private and voluntary organizations that collectively contribute to the health of the public). Performance improvement is the positive change in the capacity, process, and outcomes See Exhibit 17-6 Critical Issues For Success Quality improvement (QI) is the use of a deliberate and defined improvement process to identify needs and improve population health Plan-Do-Check-Act Continuous and measurable improvements result in: Efficiency Effectiveness Performance Accountability Outcomes Quality improvement is focused on activities that are responsive to community needs and improving population health. 28 Accreditation of Public Health Agencies The Future of the Public’s Health in the 21st Century (2003, IOM) Calls for the creation of a national voluntary public health agency accreditation system http://www.phaboard.org/news-room/accreditation-activity/ Public Health Accreditation Board Voluntary Not inexpensive Pg 380 The most recent IOM Report calls for careful study of the feasibility of creating a national voluntary public health agency accreditation system. This recommendation stems from the fact that public health organizations remain one of the few health-related entities that are not subject to national standards and review from an external accrediting body Credentialing of both individuals and organizations has become such an accepted means of fostering quality improvement and accountability throughout the health sector that its absence from the public health system is noteworthy. 29 Accreditation Public Health Accreditation Board Inspiration for PHAB accreditation was derived from pioneering state programs Accreditation must strike a fine balance between minimal and optimal standards The PHAB accreditation program development has been an intensive iterative process building upon the strong foundations of the previous work Accreditation Assessment process: Pre-application and application phase Evidence selection and submission Site visit and accreditation determination Annual reporting Reaccreditation Voluntary accreditation could lead to interest in credentialing segments of the public health workforce Accreditation of Public Health Organizations (Cont) Early attention to and consensus around these issues will determine the quality and relevance of public health practice in the twenty-first century. CEPH Council on Education in Public Health Collaboration between the APHA and the Association of Schools of Public Health Public health schools https://www.nbphe.org/eligibility/ Future Outlook Performance management leading to performance improvement initiatives were undertaken in many different settings during the 1900s, including the public sector The opportunity for more use of performance standards and measurement, emphasizing performance management and quality improvement strategies is great Conclusion Performance management activities - - that include performance standards, measurements, public accountability and quality improvement - - will boost quality if they focus on all aspects of the public health system—its capacity, its processes, and the links between them and important community health outcomes—and if the public health community accepts,