Central California Center for Health
and Human Services
California State University, Fresno
Donna DeRoo, MPA, ABD, Fresno State
Allison Hensleit, MBA, Fresno State
Sara Bosse, Fresno County Department of Public Health
Ashley Hart, Fresno State


San Joaquin Valley Public Health Consortium
San Joaquin Valley Public Health Departments
Participating Counties:
◦ Fresno, Madera, Merced, San Joaquin, Tulare

California Department of Public Health

Center for Disease Control and Prevention


National Network of Public Health Institutes
(NNPHI)
Open Forum December 2012
2


Participants will increase their understanding and
knowledge of the process and lessons learned in
implementing a performance management system.
Participants will increase their understanding and
knowledge of a performance management system’s
utilization as it relates to:
◦
◦
◦
◦
Departments Strategic Plan
Community Health Improvement Plan
Quality Improvement Plan
Public Health Accreditation
3
Attended
First Open
Forum
Charlotte,
NC
2013
Fresno County
Madera County
Merced County
[All Divisions]
&
Tulare County
San Joaquin
County
[2 Divisions]
P
M
2012
Fresno County
San Joaquin
County
[2 Divisions]
QI
Fresno County
[2 Divisions]
&
Madera County
Merced County
[Training]
2014
San Joaquin
County
Tulare County
[All Division]
4
5
Approach
Process
Performance Management Tool
6
We chose this one …
•
•
•
•
Robust discussion
Team building
Highly collaborative
Pulse read of activities
1-on-1
Training
•
Webinars
•
•
Accommodates flexible
schedules
Remote accessibility
•
Accommodates flexible
schedules
Easily accessible
Conference
Calls
7
Met with
Divisions/Sectors/
Programs
Met with Senior
Leadership
• Background &
general PMQI
overview
M1:
M2:
M3:
M4:
1st Meeting
2nd Meeting
3rd Meeting
4th Meeting
Met with ALL
managers &
supervisors
• Background &
general PMQI
overview
Performance
Management
System Tool
Delivered!
• Draft User Guide
• M1: Brainstorm
Aims, & Goals
• M2: Prioritize Aims,
Brainstorm Goals &
Performance
Measures
• M3: Prioritize Goals
& Performance
Measures, Draft
Targets, Timing,
Responsibility, Data
sources
• M4: Presentation of
Performance
Management System
Tool
8
Dept. Mission,
Vision, Values
Dept. Strategic
Aims
Division
Strategic Aims
Division
Standards/Goals
Division
Performance
Measures
9




Review overall department aims and how they relate to the
division or unit.
Articulate how the division or unit contributes to
accomplishing department aims.
Develop specific aims for the division.
Review and adjust aims to reflect accurate assessment of
division resources and scope of authority.
Dept. Mission,
Vision, Values
Dept. Strategic
Aims
Division
Strategic Aims
Division
Standards/Goals
Division
Performance
Measures
10
S.M.A.R.T
 Specific
◦ Action oriented; providing clear direction; easily understood

Measureable

Aggressive, but Attainable

Results-Oriented

Time Bound
◦ Quantifiable and/or verifiable
◦ Challenging and realistic
◦ Focused on outcomes; not methods
◦ Having a reasonable, yet aggressive, time frame
11

Performance measures are the quantitative data
elements that let us know:
 How well we are doing
 If our processes are functioning efficiently
 If we are meeting our goals
 If and where improvements are necessary
 If our customers are satisfied
Capacity
Measure
Process
Measure
Outcome
Measure
12


A target is the desired end of the year performance
outcome which is typically determined by past
performance.
What needs to be in place before setting targets?
◦ Aim Statements
◦ Goal statements
◦ Performance Measures/Indicators
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How do I determine what should be the target?
Funding
Source Sets
Target
Is this
doable?
Performance
Indicator
Organization
Sets Target
Yes
Apply target or set one
higher
No
Set interim targets that
bridge the gap
Yes
Evaluate your history
and set benchmark year
Do we have
the data?
Extrapolate to build
initial target
No
Leverage other program
targets as starting point
Leverage expert input
14
In addition to annual targets, Red Line targets are just as important
because they help determine the minimum level of acceptability.


Red line targets are unacceptable outcomes at any point and time
that require immediate program or organizational attention and
intervention.
Setting redline targets is essential, and often left out, to help your
organization gauge and prioritize your program improvement
efforts.
Fell on or Short
of Red Line
Target
Performed Above
Red Line & Short of
Annual Target
Red Line Target
Achieved or
Exceeded
Target
Annual Target
15
“Kick the tires and light the fires”


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Implement it – IMMEDIATELY.
Allow your teams to become comfortable navigating through
the system.
Embed the process such that it involves all employees within
an organization.
Set a date from which all designated performance measure
data will be inserted into the performance management
system.
16
Performance Management
System
Division
Standards/Goals
Division Strategic
Aims
Dept.
Strategic Aim
CHIP, CHA
Mission
Vision
Values
Quality Improvement
Division
Performance
Measures
17
18
Performance Management System
Implementation
19

Cohesive system

Increased communication

Increased cross-division projects


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Integration aims, goals, and measures into
Department strategic planning
Increased accountability
More information available for reports and
presentations to the Board of Supervisors
20
Leadership & Staff Engagement
21

Complex scheduling coordination

Requires more time than LDHs anticipated

Right leaders in the room

Fear of change

Fear of accountability given reduced resources

Marathon not a sprint

Don’t bite off more than you can chew

Strategic plans may need to be refreshed

Not for the faint of heart – requires commitment
22

Built community of practice

New collaborations

Improved internal awareness

Potential for maximization of resources


Asking the right questions to propel their community
impact forward
Ownership in the performance management system
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


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We would have expanded the implementation timeline to
allow the LHDs a month of piloting the performance
management tool
Basic level of Microsoft Excel experience was much lower than
anticipated
Underestimated the amount of time required to facilitate the
journey from strategic Aims to Performance Measures and
Targets
Essential to have the groups working together in a room to
discuss and collaborate with one another
Requires a cultural change from the top down
24

Donna DeRoo, MPA, ABD
◦ dderoo@csufresno.edu; (559) 228-2160

Allison Hensleit, MBA
◦ allison@csufresno.edu; (415) 702-7373

Sara Bosse
◦ sbosse@co.fresno.ca.us; (559) 600-3214

Ashley Hart
◦ ahart@csufresno.edu; (559) 228-2163
26
Appendix
27
28
Term
AIM Statement
Definition
• A clearly articulated aim statement
provides both the foundation and the focus
of the problem-solving effort. AIM
statements answer the question:
Example
• Increase the means of communication
between management and staff
• Increase opportunities for staff to work
cohesively together as a team.
• “What are we trying to achieve?”
Performance
Standard/Goal
• Objective standards or guidelines that are
used to assess an organization’s
performance.
• “What approaches will we utilize to achieve
our Aim?”
Performance
Measure
• Quantitative measures of capacities,
processes, or outcomes relevant to the
assessment of a performance
standard/goal.
• “What quantitative data do we have
available to measure our progress against
our goals?”
Performance
Targets
• Specific and measureable goals related to
agency or system performance.
• “What is he end of year performance we are
trying to achieve?
• One epidemiologist on staff per
100,000 population served.
• 80 percent of all clients who rate health
department services as “good” or
“excellent.”
• Number of trained epidemiologists
available to investigate
• Percentage of clients who rate health
department services as “good” or
“excellent.”
• Targets may be the same as, exceed, or
be an intermediate step toward the
measure.
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30
It’s the New Year and for 2014 you want to live a healthier lifestyle.






During your annual physical, your doctor recommends that you lose
weight.
To determine a reliable indicator of healthy weight, you look at Body
Mass Index (BMI) tables and identify the normal weight range for your
height.
With that standard in mind, you decide to measure weekly weight
loss, with a target of losing 2 pounds per week. You also decide to
measure caloric intake and physical activity, with a daily target of
limiting your calories to 1800 and walking a mile.
You monitor your weight weekly using your bathroom scale and
report (to yourself!) your weight on a spreadsheet.
After tracking weight loss for four weeks, you find that you have only
lost an average of one pound per week, so you decide to test an
improvement, which involves adding an additional mile of walking
per day.
Four weeks later, you find that you are meeting your goal of losing
an average of two pounds per week.
Source: MPHI Office of Accreditation and Quality Improvement
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When target
weight loss
was not being
met
AIM: Live a more healthy lifestyle in 2014.
Performance
Standard/Goal
Reduce BMI to
27
Performance
Measure
Performance
Target
Reporting
Weight
Two lbs per
week
Recording
weight
Caloric Intake
<1800
calories per
day
Recording
calories
1 mile walk
Recording
Physical
Activity
Physical
Activity
Quality
Improvement
Test add’l
physical
activity
32