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

2. 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

3. What is Performance Management?
“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
Performance management uses a set of management and analytic processes supported by technology that enables an organization to define strategic goals and then measure and manage performance against those goals.

4. 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

5. 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.

6. Developed in 2013, adapted from the 2003 Turning Point
Most have seen this Turning Point Model – the 30,000 foot view of what we’re talking about today.
Turning Point Performance Management National Excellence Collaborative convened about a decade ago. Four year collaborative funded by RWJF established in 2000.
Turning Point Performance Management Collaborative (PMC) – seven states (AK, IL, MO, MT, NH, NY, WV) and five national partners (ASTHO, NACCHO, CDC, HRSA, PHF) working to study and promote systems to manage public health performance
20+ years ago where we started seeing literature and observation about performance management working in other industries. We began asking questions, what does performance management look like in public health?
Managing performance is what you do at the program, organization (local/state), or system level to ensure you get results. It’s the opposite of leaving things to chance.
Developed in 2013, adapted from the 2003 Turning Point
Performance Management System Framework

7. 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?

8. Performance Management Successes/Barriers: Performance Standards
Success Factors
Risk 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
Difficult 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

9. Performance Measurement
Refine indicators and define measures
Develop data systems
Collect data
Think about:
How do you measure capacity, process or outcomes?
What tools exist to support the efforts?

10. Performance Management Successes/Barriers: Performance Measurement
Success Factors
Risk Factors
Results focus
Mission  Data
Routine part of work
Leadership interest
Experience teaches
Training internally
SMART measures developed through collaborating and listening
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

11. Reporting of Progress Analyze and interpret data
Report results broadly
Develop a regular reporting cycle
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?

12. Performance Management Successes/Barriers: Reporting Progress
Success Factors
Risk Factors
IT 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
Systems 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

13. Quality Improvement
Use data for decisions to improve policies, programs and outcomes
Manage changes
Create a learning organization
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?

14. Performance Management Successes/Barriers Quality Improvement
Success Factors
Risk Factors
Mandated 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
No 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”

15. Visible Leadership Engage leadership in performance management
Align performance management with organizational priorities
Track and incentivize progress
Think about:
Does senior management take a visible role in performance management?
Is performance management emphasized as a priority and goal for your work?

16. Performance Management Successes/Barriers: Visible Leadership
Success Factors
Risk Factors
Learn from successes
Outspoken proponents
Reward success
Looking for small wins
Educate leaders
“Silo busting”
Building a culture
Lack 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

17. 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.”

18. 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

19. 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.

20. Snapshot of the Performance Management Self-Assessment

21. 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?

22. 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

23. 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

24. Performance Standards Resources
Healthy People 2020 Resources
Provides 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

25. Performance Standards Resources
Healthy People 2020 Resources
Provides 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

26. 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

27. Public Health Foundation
Micaela Kirshy