Cover Sheet for Example Documentation for PHAB Domain 9 Standard 1 Measure 6

The following documentation has been submitted to ASTHO for the Accreditation Library as a potential example of Health Department documentation that might meet the PHAB Standard and Measure 9.1.6. This document is not intended to be a template, but is a reference as state health agencies develop and select accreditation documentation specific to the health department's activities.

Please note that the inclusion of documentation in this library does not indicate official approval or acceptance by PHAB.

Document Title:

Preconference Session slides on Performance Management and QI

Document Date:

October 2016

Version of Standards and Measures Used: 1.5

Related PHAB Standard and Measure Number

Domain: 9 Standard: 1 Measure: 6 Required Documentation:

1

Short description of how this document meets the Standard and Measure’s requirements: The Michigan Department of Health and Human Services provided a no-cost pre-session in advance of the Michigan Premier Public Health Conference to train Michigan’s LHDs and Tribal public health agencies in the basics of performance management. A brief overview of the Plan-Do-Study-Act cycle was also provided. The intent of this training was to build capacity for performance management and quality improvement among Michigan’s LHDs and Tribal public health agencies

Submitting Agency:

Michigan Department of Health and Human Services

Staff Contact Name:

Rachel Melody

Staff Contact Position:

Performance Management and Quality Improvement Specialist

Staff Contact Email: Melodyr1@michigan.gov

Staff Contact Phone:

(517) 284-4026

Embracing Quality in Public Health

Performance Management and

Quality Improvement Training

for Public Health Practitioners

1

October 11, 2016

2

Introductions

• MDHHS

• MPHI

• and You!• Name, Organization, Position

• How familiar are you with Performance Management?

• How familiar are you with Quality Improvement?1. Novice/Beginner

2. Advanced Beginner

3. Competent

4. Proficient

5. Expert

3

Pre-test

4

5

By the end of this session, you should be able to:

• Describe the importance and benefits of performance management and quality improvement, and how they relate to your work;

• Identify key components of a performance management system;

• Describe the fundamentals of quality improvement; and

• Describe the approach two peer health departments took to performance management and quality improvement.

Pre-Session Objectives

Today’s Roadmap

• Why this, why now?

• Performance Management in Public Health• Performance Management Primer

• Kent County Health Department’s Performance Management Experience

• Quality Improvement in Public Health• Quality Improvement Overview

• Team Activity

6

Our Mission as Public Health Professionals

To improve and protect the health of the public.

7

8

Social Determinants of Health

9

10

• How do we find the right

path?

• How do we follow that

path without getting off

track?

• How do we know we

made the right choice?

• How do we keep getting

better?

11

A Strategy

12

Silos….To Systems

Why Performance Management?

13

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

QI added Council on

Linkages Public Health

Core Competencies

PHF publishes QI

Handbook

HHS PH Quality Forum

develops definition of QI

for Public Health

To Stay on the Cutting Edge of Public Health Practice

14

Public Health

Memory Jogger

Published

HHS PH Forum develops

definition of Quality for

Public Health

HHS publishes Vision for

PH Quality

Journal of Public Health

Management and Practice

special issue on QI in PH

Journal of Public

Health

Management and

Practice special

issue on QI in PH

PHAB

Accreditation

Program

Launches

PHAB awards

first accredited

status to 11 state

and local public

health

departments

20th Anniversary Edition of

the Journal of Public

Health Management and

Practice on Transforming

Public Health through

Accreditation

PHAB awards

accredited status to

first Tribal health

department; 151

public health agencies

accredited to date

To achieve PHAB Accreditation

15

• Public Health Accreditation Board’s

(PHAB) National Public Health

Accreditation Program

• Sets standards for quality public health

performance

• Aligned with 10 Essential Public Health

Services + Administration and

Governance

PHAB Standards for PM and QI

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 Organization Practice, Programs, Processes, and Interventions

16

PHAB Accreditation Across the Nation

17

It’s Good Public Health Practice

• A systematic process to help an organization achieve its mission and strategic priorities

• Maintains focus on areas of interest to the organization

• Facilitates a culture of quality within the organization

18

Performance Management PrimerSystems that Support Quality

19

Performance Management Purpose

“…to move the field of public health from simply measuring performance of individual programs to actively measuring and managing performance of

an entire agency system.”

Silos to Systems: Using Performance Management to Improve the Public’s Health.

Turning Point Performance Management National Excellence Collaborative:

Seattle, WA; Turning Point National Program, 2003

20

What does Performance Management do?

• Helps answer calls for increased accountability by:• Showing that your activities are having the right result

• Providing evidence of the value and effectiveness of your work

• Improving efficiency

• Provides useful, credible information for assessing:• Your capacity to undertake your work

• The quality of your efforts

• The outcomes of your efforts

21

Performance Measurement vs. Performance Management

Performance Measurement:

The regular collection and reporting of data to track work produced and results achieved.

Virginia Department of Planning and Budget, Planning and Evaluation Section.

Virginia’s Handbook on Planning & Performance

(Richmond: VA Department of Planning and Budget, 1998).

22

Performance Measurement vs. Performance Management

Performance Management:

“…what you do with the information you’ve developed from measuring performance.”

Patricia Lichiello

Turning Point Guidebook for Performance Measurement

23

How is Performance Management different than what you do currently?

• Systems approach that is fully integrated across the organization

• Strategic & ongoing approach that’s built by you

• Uses data to demonstrate performance & drive improvement

24

PHAB Standard 9.1

Use a Performance Management System to Monitor Achievement of Organizational Objectives

• Involve staff at all levels in training, development, and implementation

• Measure achievement of organizational goals on an ongoing basis

• Incorporate the voice of the customer

25

What does PHAB mean by Performance Management?

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, and

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

26

27

“No, Thursday’s out. How about never—is never good for you?

“If only I’d thought to take my phone with me, I could be getting some work done.”

“It’s a working vacation.”

28

Performance Management One Step at a Time

• A fully functional performance management system should be created over time

• Start with:• Communication

• Planning

• Existing resources

29

Performance Management starts with a vision… and some data

• Vision & Mission

• State/Community Health Assessment• Where are we now?

• State/Community Health Improvement Plan• Where do we need to go as a public health system?

• Agency Strategic Plan• Where do we need to go as a public health agency?

• Quality Improvement Plan• What are we working to improve?

• Program Logic Models• What do we do & how do we do it?

30

Performance Standards

• Identify relevant standards

• Select indicators

• Set goals and targets

• Communicate expectations

31

Performance Standards, Indicators, Goals, Targets, HUH???

• Here’s the idea:– Start with a generally accepted standard for performance by

looking outside of your agency

– Figure out what indicators of performance make sense for your agency that are related to those standards

– Establish goals for the performance of your agency in each of those areas

• In the end you will end up with:– Goals & objectives that link to generally accepted performance

standards

32

Performance Standards: A Balanced Approach

• Healthy People 2020

• National Prevention Strategy

Health Determinants & Status

• PHAB Standards, including those under Domains 2, 3, 7, and 10

• National Public Health Performance Standards Program (CDC)

• Michigan Local Public Health Accreditation Minimum Program Requirements

Resources & Services

• PHAB Standards, including those under Domains 1, 4, 5, and 6

• CDC Principles of Community Engagement

• Scotland National Standards for Community Engagement

• CDC Public Health Preparedness Capabilities, National Standards for State and Local Planning

Community Engagement

• Core Competencies for Public Health Professionals (PHF)

• PHAB Standards, including those under Domain 8

Workforce

33

Performance Standards

• Start with what exists

• Set goals that are important to your

agency

• Set objectives that are challenging but

achievable

• Don’t go overboard!

34

Performance Measurement

• Refine Indicators and

define measures

• Develop data systems

• Collect data

35

Performance Measures

Quantitative measures that provide information about the degree to which an organization is achieving its mission

“The program on the left measures how well I’m doing; the program on the right measures how well the program on the

left is doing.”

36

Criteria for Constructing Performance Measures

• Relevant to an organization’s mission, vision, goals, objectives, activities

• Understandable

• Offer a point of comparison

• Sensitive to change

• Based on usable, routinely collected data

• Show change over time

• Drive improvement

37

• Can focus on agency inputs (resources used to implement the program):• Staff hours, dollars expended, partners engaged

• Can focus on agency outputs (service units or products delivered):• Screenings completed, people served, services delivered

Performance Measures

38

• Can focus on agency processes (steps completed to implement the program or its components):• Steps to process an application, time to service

• Can focus on agency outcomes (benefit of the agency or service for the customer or community):• Immunization rates, STI rates, access to fruits and vegetables

Performance Measures

39

• Quality (services delivered that meet standards):• % of clients highly satisfied with services

• Error rate (services that do not meet standards):• % of applications returned for revisions

• Efficiency (cost to deliver a service in dollars or time):• Dollars per client served

• Revenue (amount collected):• Dollar value of Medicaid reimbursements

Performance Measures

40

Creating Performance Measures

• Begin with your agency vision & mission

• Review community health improvement plan &

strategic plan objectives

• Review QI plan areas of focus

• Review program logic models

– Brainstorm measures that align with what the agency

does and what the agency is trying to accomplish

– Connect performance measures with performance

standards 41

• DO specify what is measured

• DO specify when it is measured

• DO NOT specify why the measure is important

• DO NOT specify degree of change or a performance target

Unit of Measurement

(number, percentage,

rate)

Attribute of performance

(input, output, process,

outcome)

Timeframe

(per month, per quarter,

per year)

For Example:

# of restaurant inspections completed per month

% of programs completing a quality improvement project per

fiscal year

Creating Performance Measures

42

• Measure what matters:• Are we accomplishing our mission?

• Are we achieving our strategic goals and objectives?

• Are we meeting the needs of our customers?

• Are our processes working as we expect?

• Are our processes efficient?

• Are we improving?

Selecting Performance Measures

43

• Collecting, managing, & reporting performance measures has a cost

• Every performance measure provides a very narrow look at a big picture

Be strategic in which measures and how many measures you include

Selecting Performance Measures

44

Selecting Performance Measures

• Your final list of possible measures should be:

– Clearly and logically related to standards, objectives, &

activities

– Feasible to collect over time, and

– Within the scope of your influence.

45

Putting it on paper

Agency/Program Goal:

Performance

Standard –

What do

you want to

achieve?

Performance

Measures –

How will

you measure

progress?

Data

Sources –

Where will

the

performance

measures

come from?

Current

Status –

Where

are we

now?

Performance

Target –

Where do

we want to

be?

Responsible –

Who will

monitor and

report

performance?

Quality

Improvement

Strategy –

How do we

get better?

46

47

Agency/Program Goal: Sustain Partnerships: Sustain focused, effective partnerships to address identified community health

priorities and get results that improve population health.

Performance Standard –

What do you want to

achieve?

Performance

Measures –

How will you

measure

progress?

Data Sources –

Where will the

performance

measures come

from?

Current

Status –

Where are

we now?

Performance

Target –

Where do

we want to

be?

Responsible –

Who will

monitor and

report

performance?

Quality

Improvement

Strategy – How do

we get better?

Support

ongoing development,

existence and growth

of partner engagement

activities in communities

agencies and networks,

both as a part of and

also independent of

funded initiatives.

Strength of

relationships

Partner tool –

conducted

annually

50% 60% J. Jones Address

through QI

project if

target not

reached

Discussion

48

Reporting of Progress

• Analyze data

• Feed data back to managers, staff, policy

makers, and constituents

• Develop a regular reporting cycle

49

Reporting of Progress

• Compares data to goals and objectives

• Content depends on purpose and intended users

• Should happen on a set, regular schedule

50

Reporting of Progress

A critical step!

• Keeps you accountable

• Provides you support

51

Quality Improvement Process

• Use data for decisions to improve

policies, programs, and outcomes

• Manage changes

• Create a learning organization

52

Quality Improvement Process

• As part of a Performance Management system, an

established quality improvement process:

– Brings consistency to the agency’s approach to managing

performance

– Motivates improvement

– Helps capture lessons learned

53

Quality Improvement

Makes all of this effort worth the trouble!

• Use your data to identify strengths and areas for improvement

• Use your data and experience to identify the ‘why’

• Use your data to test changes

• Use your data to know you’re getting better

54

55

It takes planning to make change!

Reactions to Performance Management

• How does this fit with what you’re already doing?

• How is it different?

• What are your takeaways?

• What are your giveaways?

56

Performance Management Resources

• Michigan Resources – Webinar: Performance Management Basics and Resources

https://www.mphiaccredandqi.org/resources/

– Embracing Quality in Public Health: A Practitioner’s Performance Management Primer https://www.mphiaccredandqi.org/pmqi-primer/

• Resources from other States:– NY DOH Office of Public Health Practice Performance

Management Training Series https://www.phqix.org/content/performance-management-series-virtual-training?utm_source=October+PHQIX+Newsletter&utm_campaign=October+2013+Newsletter&utm_medium=email

57

Break Time!

58

Quality Improvement in Public HealthPlan-Do-Study-Act Introduction

59

60

61

Data will tell us whether we’ve solved the

right problem…

62

63

…and whether our change was an improvement.

Mr. Potato HeadPlan-Do-Study-Act (PDSA) Exercise

64

The Exercise

GOAL: Build Mr. Potato Head as fast and accurately as possible

5 Jobs:

• Builder

• PDSA Scribe

• Timer

• Inspector

• Reporter

65

Builder

• Will make Mr. Potato Head

66

PDSA Scribe

• Will fill out this Table

67

Timer

68

Will time the build and

plot a dot for each PDSA

test.

Inspector

69

Will judge the build and

plot a dot for each test.

Accuracy Score

3 = All pieces are on and positioned correctly.

2 = All pieces are on, but one or more is out of place

1 = One or more pieces are not on

70

Reporter

• Record data on Post-it, give to facilitator

71

Cycle Time Accuracy

1 119 2

The Exercise

GOAL: Build Mr. Potato Head as fast and accurately as possible

5 Jobs:

• Builder

• PDSA Scribe

• Timer

• Inspector

• Reporter

72

Accuracy Score

3 = All pieces are on and positioned correctly.

2 = All pieces are on, but one or more is out of place

1 = One or more pieces are not on

73

DebriefWhat did we learn?

74

Quality Improvement Resources

Embracing Quality in Public

Health: A Practitioner’s

Quality Improvement

Guidebook

https://www.mphiaccredan

dqi.org/qi-guidebook/

75

Quality Improvement Resources

• Public Health Memory Jogger II – Public Health

Foundation

• PHQIX – Public Health Quality Improvement

Exchange: https://www.phqix.org/

• Tool Time for Healthcare (Langford Press)

http://www.langfordlearning.com/shoppingcart/produc

ts/Tool-Time-Handbook-12.1-for-Healthcare.html

76

The time for performance management and QI in public health is now.

77

In Closing

Start now.

Start today.

Just start.

Public health will be better because you did.

78

Post-test & Evaluation

79

Questions? Comments?

80