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: [email protected]
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