Performance Improvement Processes

Survey of Tools and Approaches

Heidi Deutsch, MA, MSDMMAPP Program Manager

Overview

Defining Terms APEXPH MAPP Performance Standards PACE EH PATCH Performance

Measurement

Terms

Performance Standards

Performance Measurement

Vs. Community Health

Assessment

Performance Monitoring

Performance Management

Performance Standards: Generally accepted, objective standard of measurement against which an organization’s level of performance can be compared.

Performance Measures: Analyzes the success by comparing data on what actually happened to what was planned or intended.

Community Health Assessment: type of performance measure.

Terms

Performance Monitoring: Quantifying progress over time.

Performance Management or Performance Improvement: The process of using standards, measures, monitoring progress, towards performance improvement.

Terms

APEXPH - Overview

Part 1 – Organizational Capacity Assessment

Part 2 – The Community Process

Part 3 – Completing the Cycle

APEXPH - Benefits

Assess organization and management of LHD

Provide framework for working with community

Link internal assessment with community’s priority areas

Establish the leadership role of the LHD

APEXPH – Limitations

LHD focused

Measures may be out of date

Part 3 not well developed

Did not provide adequate attention to EH

Part 3

MAPP - Origins

APEXPH MAPP

Build LHD leadership Build LHD leadership, AND promote community responsibility for Public Health

Assess LHD capacity for delivering public health services

Assess capacity of entire local public health system

Operational planning Strategic planning

Focus on health statusFocus on health status, community perceptions, forces of change, and system capacities

Develop plans to address needs

Strategically match needs, resources, ideas, and actions

MAPP - Overview

The MAPP Assessments

Local Public Health System

MCOs

Home Health

Parks

Economic Development

Mass Transit

Employers

Nursing Homes

Mental HealthDrug

Treatment

Civic Groups

Laboratory Facilities

Hospitals

EMS

Community Centers

Doctors

LHD

Churches

Philanthropist

Elected Officials

Tribal Health

Schools

Police

Fire

Corrections

Environmental Health Urban

Planners

MAPP - Challenges

Time Investment System

Approach

MAPP - Benefits

Increases visibility of public health.

Creates advocates for public health.

Anticipates and manages change.

Creates a stronger public health infrastructure.

Builds stronger partnerships.

Builds public health leadership.

NPHPS/LPHSA - Overview

3 instruments - local, state and governance

Measures the capacity of the local public health system to conduct essential public health services

Four Concepts Applied in NPHPS

1. Based on the ten Essential Public Health Services

2. Focus on the overall public health system

3. Describe an optimal level of performance

4. Support a process of quality improvement

NPHPS/LPHSAThe Instrument

Indicator

ModelStandard

Measures

Essential Service

NPHPS/LPHSA - Limitations

Time Systems focused Not a complete

performance improvement tool

Improves organizational and

community communication

Brings partners to same table

Promotes cohesion and collaborative

Provides a systems view of public health services delivery

Provides a benchmark for improvements

NPHPS/LPHSA - Benefits

PACE EH - OverviewProtocol for Assessing Community Excellence in

Environmental Health

A tool offering local health officials guidance in conducting a community-based environmental health assessment and creating an accurate profile of a community’s environmental health status

Key Objectives of PACE EH

• Evaluate Environmental Health Conditions

• Target Populations at Risk

• Set Priorities

• Support Health Equity and Social Justice

Constituency-building Assessment function Match resources to

needs Power-sharing with the

community Focus on local

situations and solutions Ground-up policy

development process Database development

PACE EH - Outcomes

PACE EH - Limitations

EH focused Time/investment Does not use the 10

EPHS framework

Know your limitations

PACE EH - Benefits Improved environmental health

New and improved leadership role in community regarding EH issues

Fosters new professional partnerships

Fosters confidence to take on other large initiatives

New relationship between LHD and community, from “clients” to “partners”

Fosters local EH database development

community members increased sense of ownership for the EH of their community

PATCHPlanned Approach to Community

Health

Community planning model to assess and improve the health

and quality of life in their communities.

www.cdc.gov/nccdphp/patch

PATCH – How It Compares

Differences: Focus on health

promotion and traditional health

Not systems based

Uses a typical health assessment approach

Not based on 10 EPHS

Similarities: Community-

based Data driven Looks to increase

community capacity

Performance Measurement

Is progress being made toward desired goals?

Are appropriate activities being undertaken to promote achieving those goals?

Performance Measurement

What are our priority issues?

What are the existing reporting requirements?

What measures do other local agencies have to report on?

What to Measure

Capacities Processes Outcomes

Design Criteria forPerformance Measurement Public contact information? Community/ stakeholder involvement

process? Governance process? Policies/ protocols/ procedures for services? Program Plan/ goals/ objectives/ evaluation? Key indicators of performance, tracking, &

reporting? Workforce development/ credentials/

training? Quality improvement plan?

Tools for Performance Measurement

Sterling Criteria for Organizational Performance Excellence www.floridasterling.com

Public Health Infrastructure Resource Center (PHIRC) www.phf.org

Virginia Excels www.vaexcels.governor.virginia.gov, click on “agency performance information”.

Performance MeasurementPitfalls

Too many measures Measurement time frames too long (the

population-based health outcome measure)

Measure process rather than outcome (“plan to plan”)

Applied in silos rather than systems Marginal approach, not related to core

business

Performance MeasurementLimitations

Need long-term vision, objectives, and indicators of performance in order to

provide appropriate direction for agency plans and measures.

Key Differences

APEXPH / PATCH

MAPP/ PACE-

EH

NPHPS PM

System x xStrategic Planning

x

PI/QI tool x x 1/2 1/2

Traditional x xMeasures for LHD

x x

Key Differences Cont.

APEXPH: Internal LHD and Community Health Assessments

PACE EH: Environmental health improvement process with a broad definition of environmental health

MAPP: A community health improvement process with a broad definition of public health

NPHSP: A performance measurement tool for the local public health system

Performance Measures: Internal LHD performance linked with health outcomes.

Resources

APEXPH, MAPP, NPHPSP www.naccho.org/topics/infrastructure/MAPP.cfm

PACE EH www.naccho.org/topics/environmental/CEHA.cfm

Performance Measurement www.phf.org/infrastructure/ , click on “Performance Management”

Questions:

Importance of PlanningImportance of Planning

MAPP/NPHPSPHeidi Deutsch202-783-5550 x252hdeutsch@naccho.org

PACE EHJonathan Schwartz202-783-5550 x250jschwartz@naccho.org

Performance ManagementStacey Baker202-218 -4416sbaker@phf.org