Title: From Silos to Systems: Performance Management in Public Health Turning Point Performance Management Collaborative October 2002
1From Silos to Systems Performance
Management in Public Health Turning Point
Performance Management CollaborativeOctober
2002
2Learning Objectives
- Gain understanding of the components of a
performance management system - Identify at least three benefits of performance
management
3Turning 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
4Turning Point National Excellence Collaboratives
- Public Health Statute Modernization
- Performance Management
- Information Technology
- Social Marketing
- Leadership Development
5Performance Management Collaborative (PMC)
7 Turning Point States
- Illinois
- New York
- Montana
- Alaska
- New Hampshire
- Missouri
- West Virginia
- Lead State
6More PMC Members
- TP National Program Office at Univ. of WA/School
of Public Health - National Partners
- ASTHO
- NACCHO
- CDC
- HRSA
- ASTHLHLO
7PMC Vision
- Widespread use of dynamic and accountable
public health performance management
8PMC 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
9What 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.
10Four Components of Performance Management
- Performance Standards
- Performance Measures
- Reporting of Progress
- Quality Improvement
11Why 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
12Using Data to Achieve Results
- Quality improvement efforts
- Policy change
- Resource allocation change
- Program change
Managerial Action
13Survey 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
14Nearly 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
16SHAs 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)
17Top 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
18Most 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.
19Most 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
20Funding 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)
21What 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.
22Learning Projects
- Natl PH Performance Standards
- Florida Quality Improvement Program
- Balanced Scorecard
- State-Based Standards in WA
- Workforce Preparedness Centers
23More 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.
26Four 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.
28The 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
29Future 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?
30Whats 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
31Performance Management Series of Reports
- Literature Review
- Baseline Assessment Survey of States
- From Silos to Systems Performance Management in
Public Health - Toolkit