Getting from Here to Accreditation . . . And Beyond:
Institutionalizing Performance Management and QI
One Local’s Perspective
Torney Smith, Administrator
In the Beginning and Early Years
 1995 – Washington State law requiring
public health standards and accountability
 Expertise was available via contract
• Marnie Mason, Barbara Mauer, State DOH
 Public Health Improvement Partnership
• Standards committee
 Multistate Learning Collaborative (MLC)
• RWJF facilitated learning and sharing
 Exploring accreditation
Washington State Standards
 Results
• Learned our strengths and shortcomings
• Leadership commitment to improvement
• Dialogue on systematizing
 Adoption of PHAB Standards Version 1.0
for Washington
• State systemization
Engagement of all staff
 Initially
• Educate about the opportunities
• Training was critical to success
• Recognition and acclaim
 Currently
• Ongoing training
From idea to Logic models to Variation Theory
to Storyboards and publication
• Recognition and team building
• Use of Logical Decisions for Windows
Quality Council
 Home of agency QI
• Foundation for PHAB Domain 9
 Monitor Achievement of Organizational
Objectives – QI plan updated annually
 Quality Improvement Processes Integrated Into
Organizational Practice – Center for Excellence
• Membership from all levels in agency,
including our board of health
• Divisional reports annually to QC and BOH
• Waiting list for rotational members
Institutionalization of QI then QM
Process
design
Quality
Improvement
Process
improvement
QI
Process
control
Joseph Juran, 1950s
Juran on Leadership for Quality, Free Press, 1989
Organization/Transition of our work
 Becoming electronic
• Microsoft SharePoint and Great Plains
 Developing filing systems
• Docuware
 Useful tools for us include:
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Microsoft Office – Excel and File Explorer
MindManager
PolicyTech
SharePoint
Value of PHAB Accreditation
 A great milestone
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Structure that matures to remain current
Drives national focus for public health QI
Foundation for public health relationships
A basis to increase revenues
Recognition of Vision & Leadership
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RWJF
NNPHI
ASTHO
NACCHO
• APQI
 PHAB
 CDC - OSTLTS
Questions?
 Thank you
Torney Smith
Spokane Regional Health District
1101 W College Ave
Spokane, WA 99201
tsmith@srhd.org
509-324-1518
GETTING FROM HERE TO
ACCREDITATION…AND BEYOND:
INSTITUTIONALIZING PERFORMANCE
MANAGEMENT AND QI
Presented by Joyce Marshall, MPH
Director, Office of Performance Management
Oklahoma State Department of Health
COPPHI Open Forum Meeting
June 12, 2013
Why are Performance Management
and Quality Improvement Important?
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Increases alignment of strategic initiatives
Provides accountability to stakeholders
Systematically defines and measures success
Optimizes human capital potential
Encourages continuous and ongoing cycle of
improvement
Getting Started
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Leadership Support
Staff Involvement and Buy-In
One Page Visual Model/Schematic
Right Tools and Technology for
Organization
• PHAB Standards Alignment
• Continuous Communication
• Plan for Institutionalization
OSDH Performance Management Model
Quality Improvement
National
State
Healthy People
2010/2020
Agency
Strategic Plan
Tool – Strategic
Map
3 Core Functions/10
Essential Services
Turning Point PM
Framework
NPHPSP
Oklahoma Health
Improvement Plan
Tool – State of the
State’s Health
Report
Strategic Targeted
Action
Teams/Plans
Tool – Step Up
Accreditation
United Health
Foundation &
Commonwealth
Fund
Core Services
Document
Tool – Business
Plan
Service
Area
& County
Health
Department
Individual
Employee
Service Area/CHD
Strategic Plans
Tool – Step Up
Community
Community Health
Improvement Plans
Tool – Mobilizing
for Action through
Planning and
Partnerships
(MAPP) Turning
Point & Step UP
Individual
Contribution
Tool – Agency
Individual
Performance
Management
Process (PMP)
Evaluations
Step UP Performance
Management System
2013 State of Oklahoma
Quality Crown Award Winner
Step UP
Performance
Management
System
5 STEPS
3 Templates
Annual
Review
Action
Plan
Strategic
Plan
Overview
Nat’l, OK &
County
Framework
16
Public Health Alignment &
Overview Template
• County Demographic
Information or Service
Target Population
Information
• Alignment to
Oklahoma & Nat’l
Framework
• Quality Improvement
• Customer Satisfaction
• Community
Assessment/HIP
• Emergency
Preparedness
• Funding Sources
• FTE
Strategic Plan Template
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2-5 Goals
2-5 Objectives
1-5 Performance Measures
Alignment to state strategic plan/health
improvement plan
• Baseline/Target and Trend Information
• Data Sources and Formulas
• Uniform and County Specific Performance
Measures/Standards
Sample
Action
Plan
Annual Review Template
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Report Actual Data to Target
Scorecard
Barriers/Lessons Learned
Success Factors
LOOKUP TOOLS
Performance Alignment Example
National: HP 2010/2020, Accreditation, UHF & Commonwealth Fund Reports
State: Oklahoma Health Improvement Plan (Tobacco Flagship Issue)
County Health Department
Agency
Strategic Map
CHD Step UP
Administrator
PMP
Nurse Mgr
PMP
• Achieve improvements in Oklahoma Health Improvement Plan Flagship Issues
• Focus on Core Public Health Priorities
• Leadership PMP: Decrease the percentage of Oklahoma adults who smoke from 25.4% to 22.2%
• Goal: Improve the health status of the citizens of the county
• Objective: CHD will achieve 100% of core performance measures annually
• Tobacco Prevention Core Measure: Reduce the percentage of adults who smoke in county from 22.9% to
22.2%
• Accountability 1: Decrease percentage of adults who smoke in county from 22.9% to 22.2%.
• Accountability 2: Community coalition’s official endorsement and full support of the OHIP SFY 2011 legislative
agenda item of restoring local control by repealing all preemptive clauses in the Prevention of Youth Access to
Tobacco Act and the Smoking in Public Places and Indoor Workplaces Act.
• Accountability: Audit records from one family planning clinic monthly to assure 100% of patients are assessed in
regard to tobacco use and identified users have received cessation counseling.
• Accountability: Assure the importance of tobacco cessation is addressed and referral materials are given to 100%
of all patients determined to be at risk for tobacco-related health issues.
Nurse PMP
Accreditation Domain 9
Documentation
• Leadership/staff engagement in PM
system establishment
• Self-assessment and team responsible for
implementation/oversight
• Written time-framed goals and objectives
• Monitoring process
• Progress analysis, results, and next steps
Accreditation Domain 9
Documentation
• Customer feedback process
• Staff development and participation
opportunities
• Technical assistance provision
• QI Plan
• QI Activities tied to plan
• QI Plan linked to strategic plan
Worth of Performance
Management & QI
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PI/QI Itself
Snowball Effect
Accreditation
Institutionalization and Culture
Better, More Effective Organization
Accountability/Operational & Service Efficiency
Better Services to our Customers/Oklahomans!
QUESTIONS