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From Silos to Systems: Performance Management in Public Health Turning Point Performance Management Collaborative October 2002

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Title: From Silos to Systems: Performance Management in Public Health Turning Point Performance Management Collaborative October 2002


1
From Silos to Systems Performance
Management in Public Health Turning Point
Performance Management CollaborativeOctober
2002
2
Learning Objectives
  • Gain understanding of the components of a
    performance management system
  • Identify at least three benefits of performance
    management

3
Turning Points 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

4
Turning Point National Excellence Collaboratives
  • Public Health Statute Modernization
  • Performance Management
  • Information Technology
  • Social Marketing
  • Leadership Development

5
Performance Management Collaborative (PMC)
7 Turning Point States
  • Illinois
  • New York
  • Montana
  • Alaska
  • New Hampshire
  • Missouri
  • West Virginia
  • Lead State

6
More PMC Members
  • TP National Program Office at Univ. of WA/School
    of Public Health
  • National Partners
  • ASTHO
  • NACCHO
  • CDC
  • HRSA
  • ASTHLHLO

7
PMC Vision
  • Widespread use of dynamic and accountable
    public health performance management

8
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

9
What Is Performance Management?
  • The practice of actively using performance data
    to improve the publics health.
  • Performance management can be carried out at the
    program, organization, community and state levels.

10
Four Components of Performance Management
  • Performance Standards
  • Performance Measures
  • Reporting of Progress
  • Quality Improvement

11
Why Develop a PM System?
  • To maximize public healths 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

12
Using Data to Achieve Results
  • Quality improvement efforts
  • Policy change
  • Resource allocation change
  • Program change

Managerial Action
13
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

14
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 (N47)

15
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 (N41)
  • Reported Positive Outcomes
  • Improved delivery of servicesprogram services,
    clinical preventive services, essential services
  • Improved administration/management contracting,
    tracking/reporting, coordination
  • Legislation or policy changes

16
SHAs Most Likely to Have Components of
Performance Management for Health StatusLeast
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 (N25)
17
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
18
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 (N25)
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.
19
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 (N40)
Note Respondents could choose more than one
response, so total does not equal 100
20
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 (N47)

21
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.

22
Learning Projects
  • Natl PH Performance Standards
  • Florida Quality Improvement Program
  • Balanced Scorecard
  • State-Based Standards in WA
  • Workforce Preparedness Centers

23
More Learning Projects
  • WI Performance-Based Contracting
  • MI Accreditation Program
  • Foundation on Accountability Health Care Quality
    Measures
  • Professional Credentialing

24
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
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
Source Handler A, Issel M, and Turnock B. 2001.
A conceptual framework to measure performance of
the public health system. Am J Public Health,
911235-1239.
25
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,
911235-1239.
26
Four components of a performance management
system
Source Turning Point Performance Management
Collaborative, From Silos to Systems Performance
Management in Public Health (in press).
27
  • 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.
28
The Management Challenge 9 of 10 companies fail
to execute strategy
  • 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
    lt1 hour per month discussing strategy
  • Resource Barrier 60 of organizations dont link
    budgets to strategy

Source Balance Scorecard Collaborative,
www.bscol.com
29
Future Performance Management Issues
  • How do we move from silos to systems?
  • How do we create a model quality improvement
    process that converts performance data into
    information then action?
  • How can we inform and influence federal
    initiatives to improve performance of public
    health?

30
Whats 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

31
Performance Management Series of Reports
  • Literature Review
  • Baseline Assessment Survey of States
  • From Silos to Systems Performance Management in
    Public Health
  • Toolkit
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