Micaela Kirshy, MPH, LICSW Project Manager, Performance Management and Quality Improvement Demystifying Domain 9: Performance Management Strategies and.

Micaela Kirshy, MPH, LICSW

Project Manager, Performance Management and Quality Improvement

Demystifying Domain 9: Performance Management Strategies and Resources

Roundtable Session Overview

Explanation of Performance Management and Public Health Accreditation Board (PHAB) Domain 9

Public Health Performance Management Framework

The Public Health Performance Management Self-Assessment Tool

Performance Management Tools and Resources

Closing the loop: Meeting Domain 9 Standards

“Performance management is the practice of actively using performance data to improve the public's health.

This practice involves the strategic use of performance measures and standards to establish performance targets

and goals.”

Source: From Silos to Systems: Using Performance Management to Improve Public Health Systems – prepared by the Public Health Foundation for the Performance Management National Excellence Collaborative, 2003

What is Performance Management?

PHAB Accreditation: Domain 9 Standards

Standard 9.1 Use a Performance Management System to Monitor Achievement of Organizational Objectives

Standard 9.2 Develop and Implement Quality Improvement Processes Integrated Into Organizational Practice, Programs, Processes, and Interventions

PHAB Accreditation: Domain 9

For the health department to most effectively and efficiently improve the health of the population, it is important to monitor the quality of performance of public health processes, programs, interventions and other activities. A fully functioning performance management system that is completely integrated into health department daily practice at all levels includes:

1) setting organizational objectives across all levels of the department,

2) identifying indicators to measure progress toward achieving objectives on a regular basis

3) identifying responsibility for monitoring progress and reporting,

4) identifying areas where achieving objectives requires focused quality improvement processes.

Developed in 2013, adapted from the 2003 Turning PointPerformance Management System Framework

Performance Standards

Identify relevant standards

Select indicators

Set goals and targets

Communicate expectations

Think about:• Do you set or use standards, targets or goals

for your organization or program? • How do you communicate the expectations

and strategic direction for your organization or program?

Performance Management Successes/Barriers:Performance Standards

Success Factors

Choose standards by themes to be cross-cutting

Training

Scrutinize regularly

Use QI tools/methods to align and prioritize

Align standards with policies

Strategic plan alignment

Risk FactorsDifficult to develop standards

Lack of meaningful vision

Lack of program goals

Tension between goals vs. program focus

Funder driven standards vs. department driven standards

Poor decision making

Measurement becomes the standard

Refine indicators and define measures

Develop data systems

Collect data

Performance Measurement

Think about:• How do you measure capacity, process or

outcomes?• What tools exist to support the efforts?

Performance Management Successes/Barriers:Performance Measurement

Success Factors

Results focus

Mission Data

Routine part of work

Leadership interest

Experience teaches

Training internally

SMART measures developed through collaborating and listening

Risk Factors

Lack of clarity about what and how to measure

Measures not connected to objectives

Difficult to capture in one place

Data overload – too much data gathering without prioritization

Analyze and interpret data

Report results broadly

Develop a regular reporting cycle

Reporting of Progress

Think about:• Do you document or report your unit /

program’s progress?• Is this information regularly available? To

whom?• What is the frequency of analysis and

reporting?

Performance Management Successes/Barriers:Reporting Progress

Success FactorsIT Infrastructure

Standardized reporting

Training on data interpretation

Leadership investment in IT

University partnerships

Transparency and access to data

Visible and useable data

Tied to business plan

Risk FactorsSystems are siloed

Community-level not integrated

Data outdated

Bias in favor of financial needs

Internal reports too long

External reports too brief

Limited investment in time/people

No follow-up action

No sense of “why”

No analysis

Lack of infrastructure

Use data for decisions to improve policies, programs and outcomes

Manage changes

Create a learning organization

Quality Improvement

Think about:• Do you have a quality improvement

process?• What do you do with information gathered

through reports?• Do you have the capacity to take action for

improvement when needed?

Performance Management Successes/BarriersQuality Improvement

Success FactorsMandated use of QI

Formal QI office or staff providing TA

Visibility of successes

HC partners

Leadership devoting time for sharing

Open team for PM

Standing discussion/agenda item

Risk FactorsNo experience in QI

QI vs. QA

Lack of time and resources

Lack of collaboration between and among departments

Fear of consequences

Disconnect with reporting

No expectation of need for QI

“Little QI” vs. “Big QI”

Visible Leadership

Think about:• Does senior management take a visible role

in performance management?• Is performance management emphasized

as a priority and goal for your work?

Engage leadership in performance management

Align performance management with organizational priorities

Track and incentivize progress

Performance Management Successes/Barriers:Visible Leadership

Success FactorsLearn from successes

Outspoken proponents

Reward success

Looking for small wins

Educate leaders

“Silo busting”

Building a culture

Risk FactorsLack of clarity about what QI culture is and requires

Lack of common priorities

Use of data to penalize

Risk averse and resistant to change

Failing to ask tough questions

Status quo/culture takes time to change

Political Considerations

Turnover

Public Health Performance Management Self-Assessment Tool

“How well does your public health team, organization, or system manage performance? Use this assessment to find

out if you have the necessary components in place to achieve results and continually improve performance. This

self-assessment tool is a guide that was designed to be completed as a group, and can be adapted to fit an

organization or system’s specific needs.”

Using the Performance Management Self-Assessment Tool

Teams or programs can use this tool to assess relative performance management strengths and weaknesses in their areas of work

Organizations can use this tool to assess relative performance management strengths and weaknesses across divisions and programs

Systems composed more than one organization can use this tool to assess how well they are managing across the different parts of the system

Tips for Using the Performance Management Self-Assessment

Preview the entire tool and definitions before you begin. The detailed questions in Sections II - V may help you better understand performance management and more accurately complete Section I, Visible Leadership.

Be honest about what you are currently doing or not doing to manage performance. If you are doing very little in an area, it is better to say "Never" or “Sometimes” than to overstate the attention and resources allocated to it. For questions marked "Never," decision makers can determine the activity’s relevance, and if appropriate, choose to shift priorities or invest resources. Using information for such decision making is a basic tenet of performance management.

If you are unsure how to answer a question, the leave it blank until you can find the answer.

Use the Notes section at the bottom of each page. Write down improvement ideas, insights, or any qualifications to self-assessment answers. Your individual or group responses will help you interpret the results and choose follow-up actions to the assessment.

Snapshot of the Performance Management Self-Assessment

Public Health Performance Management Self-Assessment

As you complete this assessment, or as a next step, your team should also discuss other important questions:

What are examples of work that fall within a performance management system? Do we call them performance management?

For those components of performance management we are doing, how well are we doing them?

In which areas do we need to invest more time and resources to manage performance more successfully?

What can leadership and staff do to make the performance management system work?

What steps could we try out this month (or this week) to improve our performance management system?

Closing the Loop: Tackling Domain 9

Standard 9.1 Use a Performance Management System to Monitor Achievement of Organizational Objectives

Public Health Performance Management Self-Assessment Tool

Standard 9.2 Develop and Implement Quality Improvement Processes Integrated Into Organizational Practice, Programs, Processes, and Interventions

QI activities based on identified needs of the program or organization

Resources and Tools

Stories: Performance Management Examples From the Field

Tool: Performance Management PDCA (Plan-Do-Check-Act) Self-Assessment Tool

Whitepaper: Performance Management and Cultural Transformation Using PDCA Approach

Technical Assistance: PHF’s Performance Management Workshop

Performance Standards Resources

Healthy People 2020 ResourcesProvides performance standards for health departments and other organizations

National Public Health Performance Standards Program (NPHPS)

Which has developed a set of standardized goals for state and local public health systems and boards of health. The Program defines performance in each of the 10 Essential Public Health Services

Performance Standards Resources

Healthy People 2020 ResourcesProvides performance standards for health departments and other organizations

National Public Health Performance Standards Program (NPHPS)

Which has developed a set of standardized goals for state and local public health systems and boards of health. The Program defines performance in each of the 10 Essential Public Health Services

COMING SOON: PHF Performance Management Toolkit

One stop shop for all of your Performance Management needs

Search for resources by Framework component

Performance Management stories from others in the field

Link to the Performance Management Self-Assessment

Additional tools and resources

Public Health Foundation

www.phf.org

Micaela Kirshy

[email protected]