Building & Improving a Performance Management System Public - PowerPoint PPT Presentation

Building & Improving a Performance Management System Public Health Foundation Utah Department of Health Amanda McCarty, MS, MBA

… PHF Mission : We improve the public’s health by strengthening the quality and performance of public health practice www.phf.org Innovative Solutions. Measurable Results. 2

Wor Works ksho hop p Ob Objec jective tives – Learn to use a PM System model based on Quality Improvement (QI) principles, the Essential Services of Public Health, and the domains of PHAB to structure a PM system for your public health agency – Practice using parts of the model so you can help agency program managers develop goals, objectives, and performance measures in ways that support improving health outcomes – Target engagement of key stakeholders to help make PM system development successful 3

Agenda 1. Turning Point-compatible PM System Model based on Quality Improvement (QI) Cycles 2. Parts of a QI-based PM System: – Aligning goals and objectives for a selected program – Drafting performance measures for a selected program 3. PM System Development as QI: Design, Deployment, Assessment, & Improvement – Analyzing stakeholders to engage in system development 4. Action Planning 4

Overview: Context The Turning Point Framework 5

The Four Major Parts of Turning Point • Performance Standards: Organizational or system expectations to improve public health practices based on internal or external goals or benchmarks • Performance Measures: Clearly defined indicators for collecting data to assess achievement of standards • Reporting of Progress: Documenting and analyzing results vs. expectations and communicating such information as feedback to guide future performance improvement decisions • Quality Improvement : A process to manage change and improve performance in public health policies, programs, or infrastructure based on standards, data, and reports 6

The Turning Point Framework – A good description of what you need for performance management but does not provide guidance on developing an organization-wide Performance Management System – Questions this model leaves unanswered are: – How do we select standards & measure against them? – What process do we use to determine what programs or practices to improve? – How do we make this a “system” to manage our organization, not just more things to do? – How do we do it in the PH context, e.g., incorporating SHA/CHA, SHIP/CHIP, MAPP, Strategic Planning, and Accreditation? 7

Performance Management & Performance Management Systems Performance Management: Using performance information to help make better decisions. Performance Management System: Using performance information on a regular basis as part of a continually repeated cycle of performance monitoring, analysis, and improvement, in which measured results are fed back into decision making to improve future performance . 8

QI “PDCA” Cycle Meets the PM System Definition As applied to specific processes & practices Decide on further Develop improvement improvements plans & targets Act Plan Check Do Monitor, analyze, & Implement improvements interpret data & collect data Sometimes called “PDSA” for “Plan -Do-Study- Act” 9

Organization-wide PM Systems – Applies a PM cycle to management and governance systems throughout the organization, usually involving: • Planning: strategic, policy, operational, & financial (e.g., budget) • Operations: program & policy implementation • Monitoring & analysis of performance at all levels: from strategic to operational (sometimes to employee level) • Decision making to sharpen plans & strategies and improve performance at all levels – Can incorporate PH context such as SHA/CHA, SHIP/CHIP, the essential services of PH or domains of PHAB – Can be viewed as a large- scale “systemic” QI PDCA Cycle 10

QI Framework for a Public Health Organization-wide PM System Plan SHIP/CHIP (e.g., MAPP) Strategic Plans Operating Plans Direction Expectations Financial Plan (Budget) Engagement of: Act • Do Leaders & managers • Program & Policy Performance-based Employees Implementation Decision Making • Partners Operational QI • Other stakeholders Decisions on Changes P to Improve Results Info Technology Backbone A D C Check Data Information Performance Monitoring & Reporting for the Population & Organization (incl. SHA/CHA, MAPP) Analysis of Results 11

QI Framework for a PH PM System Includes All Four TP: Performance Standards Plan Turning Point Quadrants & Performance Measures SHIP/CHIP (e.g., MAPP) Strategic Plan Operating Plans Direction Financial Plan (Budget) Expectations Act Do Program & Policy Performance-based TP: Quality Implementation Decision Making Improvement Operational QI Decisions on Changes P to Improve Results A D C Check Data Information Performance Monitoring & Reporting for the Population & Organization (incl. SHA/CHA, MAPP) Analysis of Results TP: Reporting of Progress 12

At least 4 types of plans should be aligned: they should mutually support each other Plan SHIP/CHIP (e.g., MAPP) Strategic Plan SHIP/CHIP Operating Plans Financial Plan (Budget) Focuses on strategic change & STRATEGIC PLAN efforts to support SHIP/CHIP Covers all programs or OPERATING PLANS organizational units (“Business Plan,” “Service Plan,” or “Performance Plan”) BUDGET 13

Views from Different Parts of the System Altitude 30,000 ft. Vision & Mission SHIP/CHIP with Health SHA/CHA & Public Health Policy Outcome Priorities Priorities 20,000 ft. Strategic Plan with Priority Change Goals Operating Plan with Objectives, Performance Measures, Improvement Plans, & Initial Targets 10,000 ft. Performance Budget with Negotiated Targets Programs, Services, Projects & Initiatives, Ground Performance Monitoring & Improvement 14

Alignment of Plans Across the Organization – The PHAB domains (including the Essential Services of PH) provide a way to align all operating plans of a PH agency – In addition to alignment of the SHIP/CHIP and strategic plan – The operating plans of all programs, projects, or organizational units must be: • Aligned with the public health agency’s mission and goals • Consistent (or not inconsistent) with the strategic plan 15

Goal oal Alig Alignme nment nt is is NOT the the Sam Same e as as Goal oal Pr Profu ofusion sion

Casc Cascad ading T ing The he Str Strate tegy Ma y Map by p by Pr Prog ogram am Or Or Unit Unit Top Level Strategy Map Zoom in: Maps for programs or Structures the organizational performance mgt. units system Zoom in again: Measures, targets, timeframes for program objectives 17

Questions to ask your organization Who are the stakeholders in Performance Management? What important things happened over the past 12-18 months and how did the team perform? What important issues does the team face? Are there things that the organization/work group/program is doing that it should not be doing or that it could modify? Are there things that the team is neglecting to do that it should do? What things could the team do that would help you perform better?

Measurement Problem – Top strategic goals & measures may be outcome- focused: • Reduce number of smokers in our service area by 20,000/year – But as deployment goes down to programs and organizational units the measures often become more output or process focused, e.g., • Number of stop smoking clinics held • Number of pamphlets handed out at a Stop Smoking Fair – A disconnect occurs: • Is it credible that doing well on these program measures will achieve the desired outcome? 19

Solving the Measurement Problem – Help program staff understand that they need to: • Use evidence to show that improving results on their output or process measures really does drive outcomes, or … • Develop new measures and targets that have an evidence-base, or … • Use the PDCA cycle to develop their own evidence . – Ultimately, program measures • Can be of any type (e.g., output, process, timeliness, customer satisfaction, intermediate or “participant” outcomes) • So long as improvement in the program measures logically contribute to improving outcomes, i.e.: • Improving program measures drives better outcomes 20

Or is a “Measurement Problem” Really a “Strategy Design Problem”? – Program measures may be inadequate to drive outcomes because the program cannot adequately address an issue on its own – Many public health issues can only be adequately addressed by multiple programs and partners – Efforts of all partners must be strategically-aligned and measurement of outcomes and drivers must reflect efforts and accomplishments of all partners 21

Highest Level Outcomes Population Outcomes Place Outcomes 22

Lagging & Leading Indicators Population & place outcomes tend to “lag” … So you need short term or intermediate actions that lead to enable mid-course corrections to your strategy. Some intermediate actions are “ participant outcomes” or other “intermediate outcomes” 23