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From Silos to Systems: Performance Management in Public Health Turning Point Performance Management Collaborative October 2002. Learning Objectives. Gain understanding of the components of a performance management system Identify at least three benefits of performance management .
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From Silos to Systems: Performance Management in Public HealthTurning Point Performance Management CollaborativeOctober 2002
Learning Objectives • Gain understanding of the components of a performance management system • Identify at least three benefits of performance management
Turning Point’s National Excellence Collaboratives, 2000-2004 • Funded by Robt. Wood Johnson Foundation - States, communities, national partners • Combine collective experience, skills • Take next steps in transforming public health • Review of literature & current practice; analysis • Development of innovative models • Testing and disseminating innovation • Evaluation
Turning Point: National Excellence Collaboratives • Public Health Statute Modernization • Performance Management • Information Technology • Social Marketing • Leadership Development
Performance Management Collaborative (PMC) • Illinois* • New York • Montana • Alaska 7 Turning Point States • New Hampshire • Missouri • West Virginia • * Lead State
More PMC Members • TP National Program Office at Univ. of WA/School of Public Health • National Partners • ASTHO • NACCHO • CDC • HRSA • ASTHLHLO
PMC Vision Widespread use of dynamic and accountable public health performance management
PMC Goals • To develop useful and feasible performance management models for states • To stimulate national dialogue and consensus on performance management in public health • To support the application of performance management as a core discipline of public health practice
What Is Performance Management? • The practice of actively using performance data to improve the public’s health. • Performance management can be carried out at the program, organization, community and state levels.
Four Components of Performance Management • Performance Standards • Performance Measures • Reporting of Progress • Quality Improvement
Why Develop a PM System? • To maximize public health’s effectiveness. This requires • More than measurement alone • More than standards alone • All four PM components to be continuously integrated into a system of performance management
Using Data to Achieve Results • Quality improvement efforts • Policy change • Resource allocation change • Program change Managerial Action
Survey of Performance Mgmt. Practices in States • Baseline Assessment • Conducted by PHF • 47 of 50 States Responded • Survey Asks About: • Use of Performance Targets, Reports • Impact on Program and Policy • Need for New Tools
Nearly All SHAs Have Some PerformanceManagement EffortsHowever, only about half apply performance management efforts statewide beyond categorical programs Figure 1. Agencies or programs to which SHAs apply performance management efforts (N=47)
Performance Management Efforts Result in Improved Performance for Three-Quarters of SHAs Figure 19. Percentage of SHAs that report their performance management efforts resulted in improved performance (N=41) Reported Positive Outcomes: • Improved delivery of services—program services, clinical preventive services, essential services • Improved administration/management— contracting, tracking/reporting, coordination • Legislation or policy changes
SHAs Most Likely to Have Components of Performance Management for Health Status;Least Likely for Human Resource Development Figure 8. Areas most and least likely to have performance targets, measures or standards, reports, and processes for quality improvement (QI)/change, of SHAs that apply performance management efforts SHA wide, SHA wide and to local public health agencies, or to local public health agencies only (N=25)
Top Three Models/Frameworks Explicitly Incorporated by SHAs Into Their Performance Management Efforts • Healthy People Objectives • Core Public Health Functions • Ten Essential Public Health Services States use a variety of performance management models/frameworks, in a variety of combinations
Most SHAs Have Performance Measures, Targets, and Reports, While Fewer States HaveProcess for Quality Improvement or Change* Figure 15. Percentage of SHAs that have specified components of performance management for public health capacity (N=25) *Correlation analysis revealed that there is a comparatively weak relationship between having performance targets, performance measures or performance reports and process for quality improvement (QI)/change. That is, in general, fewer states indicated that they did have a process for change, even though they indicated having performance targets, performance measures, or performance reports. This was the case for all areas of performance management studied (Human Resource Development, Data & Information Systems, Customer Focus and Satisfaction, Financial Systems, Management Practices, Public Health Capacity, and Health Status). Figure 15 illustrates this finding.
Most States Use Neither Incentives nor Disincentives to Improve Performance Figure 18. Percentage of SHA performance efforts that include incentives or disincentives to improve performance (N=40) Note: Respondents could choose more than one response, so total does not equal 100
Funding for Performance Management Chosen as Number One Way to Improve States’ Efforts Figure 5. Types of aid identified as most useful to SHAs to improve SHA performance management efforts, in rank order (N=47)
What Did We Learn? • SHA performance management practices are widespread, although often not system-wide or with processes leading to quality improvement or changes. • SHAs report their efforts result in improved performance, with positive outcomes broadly defined. • No single framework is used by most SHAs, and there are insufficient data to inform leaders’ choices in performance management approach.
Learning Projects • Nat’l PH Performance Standards • Florida Quality Improvement Program • Balanced Scorecard • State-Based Standards in WA • Workforce Preparedness Centers
More Learning Projects • WI Performance-Based Contracting • MI Accreditation Program • Foundation on Accountability Health Care Quality Measures • Professional Credentialing
Conceptual Framework of the Public Health System as a Basis for Measuring Public Health System Performance P U B Structural Capacity L ----------------- M I Information Resources A C Organizational Resources C Physical Resources Human Resources R H Fiscal Resources O E A PHS Mission C L and Purpose O T ---------------- Philosophy N H Goals T "Core Functions" Outcomes Processes E S --------------- ------------------- X Y The 10 Essential Effectiveness T S Public Health Efficiency T Services Equity E M Source: Handler A, Issel M, and Turnock B. 2001. A conceptual framework to measure performance of the public health system. Am J Public Health, 91:1235-1239.
P U B Structural Capacity L ----------------- M I Information Resources A C Organizational Resources Physical Resources C Human Resources R H Fiscal Resources O E A PHS Mission C L and Purpose O T Philosophy N H Goals T "Core Functions" Outcomes Processes E S --------------- ------------------- X Y The 10 Essential Effectiveness T S Public Health Efficiency T Services Equity E M Conceptual Framework of the Public Health System as a Basis for Measuring Public Health System Performance Source: Handler A, Issel M, and Turnock B. 2001. A conceptual framework to measure performance of the public health system. Am J Public Health, 91:1235-1239.
Four components of a performance management system Source: Turning Point Performance Management Collaborative, From Silos to Systems: Performance Management in Public Health (in press).
In a performance • management • system... • All components should be driven by the public health mission and organizational strategy • Activities should be integrated into routine public health practices • The goal is continuous performance and quality improvement Source: Turning Point Performance Management Collaborative.
Vision Barrier: Only 5% of the workforce understands the strategy People Barrier: Only 25% of managers have incentives linked to strategy Management Barrier: 85% of executive teams spend <1 hour per month discussing strategy Resource Barrier: 60% of organizations don’t link budgets to strategy The Management Challenge9 of 10 companies fail to execute strategy Source: Balance Scorecard Collaborative, www.bscol.com
Future Performance Management Issues • How do we move from “silos to systems”? • How do we create a model quality improvement processthat converts performancedata into informationthenaction? • How can we inform and influence federal initiatives to improve performance of public health?
What’s the Transformation? • Widespread Use shifts from a measurement to a more balanced and cohesive management model • Shifts from categorical to a systems- wide scope targeting capacity, process and outcomes
Performance Management Series of Reports • Literature Review • Baseline Assessment Survey of States • From Silos to Systems: Performance Management in Public Health • Toolkit