Performance Improvement
Processes
Survey of Tools and Approaches
Heidi Deutsch, MA, MSDM
MAPP Program Manager
Overview
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Defining Terms
APEXPH
MAPP
Performance Standards
PACE EH
PATCH
Performance Measurement
Terms
Performance Standards
Performance Measurement
Vs. Community Health Assessment
Performance Monitoring
Performance Management
Terms
Performance Standards: Generally accepted,
objective standard of measurement against which an
organization’s level of performance can be compared.
Performance Measures: Analyzes the success by
comparing data on what actually happened to what
was planned or intended.
Community Health Assessment: type of performance
measure.
Terms
Performance Monitoring: Quantifying progress
over time.
Performance Management or Performance
Improvement: The process of using standards,
measures, monitoring progress, towards
performance improvement.
APEXPH - Overview
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Part 1 – Organizational Capacity
Assessment
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Part 2 – The Community Process
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Part 3 – Completing the Cycle
APEXPH - Benefits
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Assess organization and management of LHD
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Provide framework for working with community
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Link internal assessment with community’s
priority areas
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Establish the leadership role of
the LHD
APEXPH – Limitations
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LHD focused
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Measures may be out of
date
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Part 3 not well developed
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Did not provide adequate
attention to EH
MAPP - Origins
APEXPH
MAPP
Build LHD leadership
Build LHD leadership, AND promote
community responsibility for Public
Health
Assess LHD capacity for
delivering public health
services
Assess capacity of entire local public health
system
Operational planning
Strategic planning
Focus on health status
Focus on health status, community
perceptions, forces of change, and system
capacities
Develop plans to address
needs
Strategically match needs, resources,
ideas, and actions
MAPP - Overview
The MAPP Assessments
Local Public Health System
Police
Community
Centers
MCOs
LHD
EMS
Schools
Churches
Home
Health
Laboratory
Facilities
Parks
Elected
Hospitals
Doctors
Officials Nursing Mass Transit
Homes
Philanthropist
Environmental
Civic Groups
Health
Urban
Fire
Planners
Tribal Health
Economic
Employers
Drug
Corrections
Development
Mental Health
Treatment
MAPP - Challenges
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Time
Investment
System Approach
MAPP - Benefits
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Increases visibility of public health.
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Creates advocates for public health.
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Anticipates and manages change.
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Creates a stronger public health
infrastructure.
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Builds stronger partnerships.
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Builds public health leadership.
NPHPS/LPHSA - Overview
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3 instruments - local, state and
governance
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Measures the capacity of the local
public health system to conduct
essential public health services
Four Concepts Applied in
NPHPS
1. Based on the ten Essential
Public Health Services
2. Focus on the overall public
health system
3. Describe an optimal level of
performance
4. Support a process of quality
improvement
NPHPS/LPHSA
The Instrument
Essential
Service
Indicator
Model
Standard
Measures
NPHPS/LPHSA - Limitations
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Time
Systems focused
Not a complete
performance
improvement tool
NPHPS/LPHSA - Benefits
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Improves organizational and
community communication
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Brings partners to same table
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Promotes cohesion and collaborative
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Provides a systems view of public health
services delivery
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Provides a benchmark for improvements
PACE EH - Overview
Protocol for Assessing Community Excellence in
Environmental Health
A tool offering local health
officials guidance in
conducting a communitybased environmental health
assessment and creating an
accurate profile of a
community’s environmental
health status
Key Objectives of PACE EH
•
Evaluate Environmental
Health Conditions
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Target Populations at Risk
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Set Priorities
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Support Health Equity and
Social Justice
PACE EH - Outcomes
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Constituency-building
Assessment function
Match resources to needs
Power-sharing with the
community
Focus on local situations
and solutions
Ground-up policy
development process
Database development
PACE EH - Limitations
Know your limitations
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EH focused
Time/investment
Does not use the 10
EPHS framework
PACE EH - Benefits
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Improved environmental health
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New and improved leadership role in
community regarding EH issues
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Fosters new professional partnerships
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Fosters confidence to take on other
large initiatives
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New relationship between LHD and
community, from “clients” to “partners”
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Fosters local EH database development
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community members increased sense of
ownership for the EH of their community
PATCH
Planned Approach to Community Health
Community planning model to assess
and improve the health and quality of
life in their communities.
www.cdc.gov/nccdphp/patch
PATCH – How It Compares
Similarities:
 Community-based
 Data driven
 Looks to increase
community
capacity
Differences:
 Focus on health
promotion and
traditional health
 Not systems based
 Uses a typical
health assessment
approach
 Not based on 10
EPHS
Performance Measurement
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Is progress being made toward
desired goals?
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Are appropriate activities being
undertaken to promote
achieving those goals?
Performance Measurement
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What are our priority
issues?
What are the existing
reporting requirements?
What measures do other
local agencies have to
report on?
What to Measure
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Capacities
Processes
Outcomes
Design Criteria for
Performance Measurement
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Public contact information?
Community/ stakeholder involvement process?
Governance process?
Policies/ protocols/ procedures for services?
Program Plan/ goals/ objectives/ evaluation?
Key indicators of performance, tracking, &
reporting?
Workforce development/ credentials/ training?
Quality improvement plan?
Tools for
Performance Measurement
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Sterling Criteria for Organizational
Performance Excellence
www.floridasterling.com
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Public Health Infrastructure Resource
Center (PHIRC) www.phf.org
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Virginia Excels
www.vaexcels.governor.virginia.gov, click
on “agency performance information”.
Performance Measurement
Pitfalls
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Too many measures
Measurement time frames too long (the
population-based health outcome measure)
Measure process rather than outcome (“plan to
plan”)
Applied in silos rather than systems
Marginal approach, not related to core business
Performance Measurement
Limitations
Need long-term vision, objectives, and
indicators of performance in order to
provide appropriate direction for agency
plans and measures.
Key Differences
APEXPH /
PATCH
MAPP/
NPHPS
System
x
x
Strategic
Planning
x
PACE-EH
x
PM
PI/QI tool
x
Traditional
x
x
Measures for
LHD
x
x
1/2
1/2
Key Differences Cont.
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APEXPH: Internal LHD and Community Health
Assessments
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PACE EH: Environmental health improvement process
with a broad definition of environmental health
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MAPP: A community health improvement process
with a broad definition of public health
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NPHSP: A performance measurement tool for the
local public health system
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Performance Measures: Internal LHD performance
linked with health outcomes.
Resources
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APEXPH, MAPP, NPHPSP
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PACE EH
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Performance Measurement
www.naccho.org/topics/infrastructure/MAPP.cfm
www.naccho.org/topics/environmental/CEHA.cfm
www.phf.org/infrastructure/ , click on
“Performance Management”
Questions:
MAPP/NPHPSP
Heidi Deutsch
202-783-5550 x252
hdeutsch@naccho.org
PACE EH
Jonathan Schwartz
202-783-5550 x250
jschwartz@naccho.org
Performance Management
Stacey Baker
202-218 -4416
sbaker@phf.org
Importance of Planning