turning point from silos to systems: performance management in public health turning point...
TRANSCRIPT
Turning Point
From Silos to Systems: Performance Management
in Public Health
Turning Point Performance Management Collaborative
October 2002
Turning Point
Learning Objectives
• Gain understanding of the components of a performance management system
• Identify at least three benefits of performance management
Turning Point
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
Turning Point: National Excellence Collaboratives
• Public Health Statute Modernization• Performance Management• Information Technology• Social Marketing• Leadership Development
Turning Point
Performance Management Collaborative (PMC)
• Illinois*• New York• Montana• Alaska
•New Hampshire•Missouri•West Virginia
* Lead State
7 Turning Point States
Turning Point
More PMC Members
• TP National Program Office at Univ. of WA/School of Public Health
• National Partners– ASTHO– NACCHO– CDC– HRSA– ASTHLHLO
Turning Point
PMC Vision
Widespread use of dynamic and accountable public health
performance management
Turning Point
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
Turning Point
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.
Turning Point
Four Components of Performance Management
• Performance Standards• Performance Measures• Reporting of Progress• Quality Improvement
Turning Point
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
Turning Point
Managerial Action
• Quality improvement efforts
• Policy change
• Resource allocation change
• Program change
Using Data to Achieve Results
Turning Point
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
Turning Point
Nearly All SHAs Have Some PerformanceManagement Efforts
However, 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)
Categorical programs
only43% (20)
None4% (2)
SHA wide32% (15)
Local public health
agencies only4% (2)
SHA wide and local
public health agencies17% (8)
Turning Point
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
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)
No24% (10)
Yes76% (31)
Turning Point
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)
Most Likely Least Likely
Performance Targets Health Status Data & Information Systems
Human Resource Development Public Health Capacity
Performance Measures orStandards
Health Status Data & Information Systems
Human Resource Development Customer Focus and Satisfaction
Performance Reports Health Status Data & Information Systems Management Practices
Human Resource Development Public Health Capacity
Process for QI/Change Health Status Customer Focus and Satisfaction Management Practices
Human Resource Development Public Health Capacity
Turning Point
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 managementmodels/frameworks, in avariety of combinations
Turning Point
Most SHAs Have Performance Measures, Targets, and Reports, While Fewer States Have
Process for Quality Improvement or Change*
Figure 15. Percentage of SHAs that have specified components of performance management for public health capacity (N=25)
36 (9)
44 (11)
60 (15)
40 (10)
0
10
20
30
40
50
60
70
80
90
100
Performance Targets Performance Measuresor Standards
Performance Reports Process for QI/Change
Pe
rce
nta
ge
of
Sta
tes (
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.
Turning Point
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
63 (25)
8 (3)
20 (8)
13 (5)
30 (12)
0
10
20
30
40
50
60
70
80
90
100
Incentives forAgencies, Programs,
Divisions
Incentives for Staff Disincentives forAgencies, Programs,
Divisions
Disincentives for Staff None
Pe
rce
nta
ge
of
Sta
tes
(N
=4
0)
Turning Point
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)
Number of SHAs that ranked each answer 1-3
1st 2nd 3rd
1. Funding sources/support 18 7 3
2. Detailed examples/a set of models from other states’ performance management systems
9 10 4
3. Consultation/technical assistance 3 5 7
4. “How to” guide/toolkit (tie) 4 5 3
4. A set of voluntary national performance standards for public health systems (tie)
6 1 5
Turning Point
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.
Turning Point
Learning Projects
• Nat’l PH Performance Standards• Florida Quality Improvement
Program• Balanced Scorecard• State-Based Standards in WA• Workforce Preparedness Centers
Turning Point
More Learning Projects
• WI Performance-Based Contracting• MI Accreditation Program• Foundation on Accountability
Health Care Quality Measures• Professional Credentialing
Turning Point
PHS Missionand Purpose
----------------Philosophy
Goals"Core Functions"
Structural Capacity-----------------
Information ResourcesOrganizational Resources
Physical ResourcesHuman ResourcesFiscal Resources
Processes-------------------The 10 Essential
Public HealthServices
Outcomes---------------Effectiveness
EfficiencyEquity
Conceptual Framework of the Public Health System as a Basis for Measuring Public Health System Performance
MACRO
CONTEXT
PUBLIC
HEALTH
SYSTEM
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.
Turning Point
PHS Missionand Purpose
PhilosophyGoals
"Core Functions"
Structural Capacity-----------------
Information ResourcesOrganizational Resources
Physical ResourcesHuman ResourcesFiscal Resources
Outcomes---------------Effectiveness
EfficiencyEquity
Conceptual Framework of the Public Health System as a Basis for Measuring Public Health System Performance
Processes-------------------The 10 Essential
Public HealthServices
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.
MACRO
CONTEXT
PUBLIC
HEALTH
SYSTEM
Turning Point
Four components
of a performance
management system
Source: Turning Point Performance Management Collaborative, From Silos to Systems: Performance Management in Public Health (in press).
Turning Point
In a performance
managementsystem...• 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.
Turning Point
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 <1 hour per month discussing strategy
• Resource Barrier: 60% of organizations don’t link budgets to strategy
Source: Balance Scorecard Collaborative, www.bscol.com
Turning Point
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?
Turning Point
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
Turning Point
Performance Management Series of Reports
Literature ReviewBaseline Assessment Survey of
StatesFrom Silos to Systems:
Performance Management in Public Health
Toolkit