from standards to improvement: laura b. landrum, illinois public health institute nwcphp hot topics...
TRANSCRIPT
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From Standards to Improvement:
Laura B. Landrum,Illinois Public Health Institute
NWCPHP Hot Topics Forum, August 11, 2005
Steps to Managing Effective Public Health Organizations
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Learning Objectives
Define key concepts and components of performance management
Identify a variety of public health organizational and programmatic applications of performance management
Describe potential benefits of performance management
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A Basic Definition
“Performance Management”
Control towards accomplishment
In public health, the active and strategic use of performance data to improve the public’s health
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Source: Silos to Systems: Using Performance Management to Improve the Public’s Health. Turning Point Performance Management National Excellence Collaborative: Seattle, WA; Turning Point National Program, 2003.
Turning Point Performance Management Model
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Seeks to better last year’s time
Trains 5 x per week at various distances
Records times + variables
Makes adjustments Pace, workout, shoes, etc.
Everyday Example: Marathon Runner
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Individual Process (e.g., disease reporting)
Unit or Team
Program or Division
Public Health Workforce Development
National Health Priority Initiative
State Health Agency
State-Local Public Agency Network
Community Health Improvement Process
National Public Health System
Performance Management Scenarios at Many Levels
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Question
A. Identify relevant standards
B. Select indicators for those standards
C. Set goals and objectives
D. Communicate expectations
In planning for bioterrorism preparedness, which of the following has your jurisdiction done best?
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Identify and apply relevant standards of performance (what will be measured)
Objective standards or guidelines that describe optimal or required performance
Typically from external sources: National or state organizations, funders, scientific data, benchmarking, etc.
Use existing standards wherever possible
1. Applying Appropriate Standards
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1. Applying Appropriate Standards
Set goals and targets.
The planned or expected level of performance
May be the same as, higher, or lower than the standard
What must be achieved, by whom, and when
Communicate expectations.
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Question
A. Refine selected indicators of performance
B. Define specific measures for those indicators
C. Develop data systems that capture the measures
D. Collect the data
In responding to a potential bioterrorism event, which of the followingmeasurement functions has your jurisdiction done best?
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Specific data or information used to assess progress toward a performance standard
Regular collection and reporting of data to track work produced and results achieved
Source: Lichiello, P. Guidebook for Performance Measurement. Seattle, WA: Turning Point National Program Office, 1999:48. Based on Hatry, H.P. et al., Monitoring the Outcomes of Economic Development Programs. Washington D.C.: The Urban Institute Press, 1990.
2. Performance Measurement
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Quantitative measures of capacities, processes, or outcomes relevant to the assessment of public health performance
For example: The number of trained epidemiologists available to
investigate outbreaks (capacity measure)
The percentage of notifiable diseases reports submitted within the required time lines (process measure)
Percentage of food-borne outbreaks controlled in time to prevent serious health complications in the jurisdiction (outcome measure)
2. Performance Measurement
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Requires detailed data definitions and sources Trained epidemiologists = Persons whose job
role is identified as “Epidemiologist” and have received formal epidemiology training through one of the following, as reported in the state learning management system:
(a) a masters or doctorate program
(b) a graduate public health certificate program
(c) completion of the CDC “Fundamentals of Epidemiology” course in the past three years with an 80% score or higher
2. Performance Measurement
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Is performance measurement the same thing as performance management?
A. Yes
B. No
Question
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Performance Management is what you dowith information you’ve developed from measuring performance.
Caution! It’s not performance management if…
It addresses only the first three components (missing QI)
Use of data stops after measurement or achievement at one point in time (Ex: an audit, some accreditation programs)
Source: Lichiello P. Guidebook for Performance Measurement. Seattle, WA: Turning Point National Program Office, 1999:48. Based on Hatry, H.P. et al., Monitoring the Outcomes of Economic Development Programs. Washington D.C.: The Urban Institute Press, 1990.
Performance Management
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Analyze data
Convert data into useable information
Feedback to managers, staff, policy makers, and constituents
Develop a regular reporting cycle
3. Reporting of Progress
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Provide context for the report
How do the performance measures relate to mission and goals?
Create clear, easy to read report designs Use simple charts and tables
Determine frequency When and how often
3. Reporting of Progress
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Question
A. Involving external partners in public health work
B. Setting priorities for action (paralysis by analysis)
C. Deploying people and dollars to implement the organization’s priorities
D. Helping staff understand the organization’s mission, priorities, and strategies
In your jurisdiction, what are the most difficult challenges to establishing a good quality improvement process?
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Establish a program or process to manage change and achieve quality improvement in public health policies, practice, and infrastructure based on what is learned through performance measures
4. Quality Improvement Process
Use data for decisions to improve policies, programs, and outcomes
Manage change
Create a learning organization
Q
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Managerial Action
Quality improvement techniques
Policy change
Resource allocation change
Program change
Using Performance Data for Improvement
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Process(Essential Public Health Services)
Outputs
Outcomes
System Inputs
WorkforceInformation
Organization & Relation-
shipsFacilitiesFunding
Assess Assure
Key Processes
Improved Outcomes&
Customer Satisfaction
Develop Policy
Source: Turnock B.J. Public Health: What It Is and How It Works, 3rd Edition. Boston, MA; Jones & Bartlett, 2004.
Programs and Services consistent with mandates and community priorities
Capacity
The Public Health “Production Model”: Capacity, Process, and Outcomes
Improved organizational performance
Improved program performance
Increased Value&
Public Support
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1. Identify gaps between actual and desired performance
2. Establish priorities
3. Analyze root causes of performance problems in the system
4. Develop improvement plans
5. Manage implementation
Steps in Performance Improvement
Plan
DoCheck
Act
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Lessons Learned from Turning Point Survey…
State health agency performance management practices are widespread, although often not system-wide or with processes leading to quality improvement.
Three-quarters (76%) of states that manage performance report that their efforts result in improved performance, with positive outcomes broadly defined.
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States most frequently manage performance related to health status, overlooking many factors in performance.
Less frequently managed in public health:
Human resource development
Public health capacity
Customer focus and satisfaction
Lessons Learned from Turning Point Survey…
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Question
A. Increased effectiveness and accountability in public health practice
B. Motivation of staff to investigate problems and find solutions
C. Better alignment of resources and efforts with the public health mission
D. More informed decision making with clearer targets
In your opinion, what are the most important reasons to use Performance Management?
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Where to Begin…
How well does your public health organization or partnership manage performance within its jurisdiction?
Use the assessment to find out if you have the necessary systems in place to achieve results and continually improve performance.
Performance Management Self-Assessment Tool
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Guidebooks for public health
Real-life examples, tools, and case stories from practice
Self-assessment tool
Evidence from literature
Training curriculum
Performance Improvement Resources
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Public Health Infrastructure Resource Center: www.phf.org/infrastructure/performance
Case studies
Searchable tools
Publications
Performance Improvement Resources
PHF’s Alliance for Achieving Results and Outcomes (“AARO”)
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Share Your Thoughts
What are your “take away” messages?
What will you apply or do differently?
?
Thank You!