Public Health Performance Management

Turning Point PM

Collaborative 1

Public HealthPerformance Management

Turning PointPerformance Management

National Excellence Collaborative

April 2004

Public Health Performance Management CurriculumPrepared by Center for Public Health Practice, UIC School of Public Health

Turning Point PM

Collaborative 2

Genesis• Turning Point Performance Management

National Excellence Collaborative States (AK, IL, MO, MT, NH, NY, WV)– “..to move the field of public health from

simply measuring performance of individual programs to actively measuring and managing the performance of an entire agency or system.”

– “..from managing silos to managing a system”

Source: 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.

Turning Point PM

Collaborative 3

Learning Objectives• Define and describe the key concepts and

components of performance management• Identify performance management concepts

and components in a variety of public health organization and system applications

• Describe potential benefits of performance management across a range of public health organization and system applications

• Assess and enhance performance management practices and opportunities in public health work settings

Turning Point PM

Collaborative 4

Today’s ProgramI. Introduction (~10 min)

II. Pre-Test (~10 min)

III. Performance Management 101 (50-60 min)

IV. Applications of Performance Management in Public Health Practice (50-60 min)

V. Case Studies (60-240 min)

VI. Review and Summary (~45 min)

VII. Post-Test/Course Evaluation (~15 min)

Turning Point PM

Collaborative 5

Part II

Pre-Test

Turning Point PM

Collaborative 6

Part III

Performance Management 101

Turning Point PM

Collaborative 7

The Words

“Performance”– Execution, Accomplishment,

Completion, Effectuation

“Management”– Supervision, Direction, Control,

Manipulation

Turning Point PM

Collaborative 8

Basic Concepts

“Performance Management”– Control/Manipulation towards

Accomplishment– Key considerations

• Who or what performs? (subject = “who/what”)

• What is performed? (object = “do what”)

Turning Point PM

Collaborative 9

Focus on Performance

1. Marathon Runner2. Unit Supervisor3. Program Manager4. State Health Agency5. State-Local Public Agency Network6. National Health Priority Initiative7. National Public Health System8. Community Health Improvement Process9. Public Health Workforce Development

Turning Point PM

Collaborative 10

Managing Performance (Ex 1)

Marathon Runner• trains 5x per week at various

distances• records times• seeks to better last year’s time

Turning Point PM

Collaborative 11


Unit Supervisor• meets with employees annually to

review job performance and set expectations for next year

• next year’s salary increment is tied to this year’s job performance?

Turning Point PM

Collaborative 12


Program Manager• establishes objectives• reports quarterly• seeks continuation funding year

after year

Turning Point PM

Collaborative 13

Common Elementsfrom These Simple

Examples?• Subjects (who or what is to perform)

and Objects (what is to be accomplished)

• Goals or targets (level of accomplishment)

• Information about performance• Collection of information• Modifications/Changes possible

Turning Point PM

Collaborative 14

Key Components of Performance Management

• Applying Appropriate Standards

• Measuring Key Aspects of Performance

• Reporting and Interpreting Measurements

• Making Changes Based on Measures of Performance

Turning Point PM

Collaborative 15

Criticalcomponents ofperformance management


Turning Point PM

Collaborative 16

In the performance management cycle...

• All components should be driven by the public health mission and organizational strategy

• Activities should be integrated into routine public health practices

• The goal is continuous performance and quality improvement


Turning Point PM

Collaborative 17

Aren’t Performance Management

and Performance Measurement the Same Thing?

Turning Point PM

Collaborative 18

Performance Measurement

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

• Caution! Some view Performance Measurement as only the first 3 components of Performance Management

Source: Liachello P. Guidebook for Performance Measurement. Seattle WA: Turning Point National Program Office, 1999:48. Based on Hatry HP et al, Monitoring the Outcomes of Economic Development Programs. Washington DC: The Urban Institute Press, 1990.

Turning Point PM

Collaborative 19

Terminology• Performance Measure

• A specific quantitative representation of a capacity, process, or outcome deemed relevant to the assessment of performance (a generic term that includes standards, targets, indicators)

• Performance Standard• Standards are one form of performance measure; they

are generally objective standards or guidelines that are used to assess performance.

• Performance Target• The planned or expected level of performance

• Performance Indicator• Indicators are another form of performance measure;

they are the data or information that is used to assess progress toward a performance standard

Turning Point PM

Collaborative 20

Different Indicators Used to Measure Performance (Staff Competency)Self

Assessment --------->

--------->

--------->

--------->

Self ImprovementApplication

Course Instructor

Assessment

Competency Acquisition Application

Workplace Assessment

Personnel Mgt/ Competency Demo

Application

External Certifying

Body Assessment

Credentialing Application

Turning Point PM

Collaborative 21

Managers Can UsePerformance Measures to …• Identify aspects of the work that have and

have not resulted in satisfactory results• Identify trends• Further investigate the nature of particular

problems• Set targets for future periods• Motivate managers and staff to improve

performance• Hold managers and staff accountable• Develop and improve programs and policies• Help design policies and budgets and explain

these to stakeholdersSource: Liachello P. Guidebook for Performance Measurement. Seattle WA: Turning Point National Program Office, 1999:48. Based on Hatry HP et al, Monitoring the Outcomes of Economic Development Programs. Washington DC: The Urban Institute Press, 1990.

Turning Point PM

Collaborative 22

Performance Management

“Performance Management is what you do with the information you’ve developed from measuring performance.”

Source: Liachello P. Guidebook for Performance Measurement. Seattle WA: Turning Point National Program Office, 1999.

Turning Point PM

Collaborative 23



Turning Point PM

Collaborative 24

Applying Appropriate Standards

• Identify and apply relevant standards• Standards are one form of performance measure;

they are generally objective standards or guidelines that are used to assess performance.

• Identify appropriate indicators• Indicators are another form of performance

measure; they are the data or information that is used to assess progress toward a performance standard.

• Set goals and targets• The planned or expected level of performance

• Communicate expectations

Turning Point PM

Collaborative 25

Is there a Performance Standards component?

• Have performance goals and targets been established, and appropriate indicators identified?

• Do these benchmark against similar organizations or use national, state, or scientific guidelines?

• Are expectations communicated?

Turning Point PM

Collaborative 26

Measuring Performance

• Relies on indicators that document where performance is in relation to the target or standard

• Develop data systems• Collect data

Turning Point PM

Collaborative 27

Is there a Performance Measurement component?

• Have the indicators been refined?

• Have data systems been developed?

• Has data been collected?

Turning Point PM

Collaborative 28

Reporting Progress

• Analyze data• Convert data into useable

information• Feedback to managers, staff,

policy makers, and constituents• Develop a regular reporting cycle

Turning Point PM

Collaborative 29

Reporting Progress

• Provide context for the report– How do the performance measures

relate to mission and goals• Create clear, easy to read, report

designs– Use simple charts and tables

• Determine Reporting Frequency– When and how often

Turning Point PM

Collaborative 30

Is there a Reporting of Progress component?

• Are data analyzed?• Are data fed back to managers,

staff, constituents, etc. in useable and understandable format?

• Is there a regular reporting cycle in place?

Turning Point PM

Collaborative 31

Improving Quality

Establish a program or process to manage change and achieve quality improvement in public health policies, practice and infrastructure based on what is learned through performance measures

• Use data for decisions to improve policies, programs, and outcomes

• Manage change• Create a learning organization

Turning Point PM

Collaborative 32

Is there a Quality Improvement component?

• Where is the change process?

• Is there a process to manage changes being made?

• Is there a learning organization?

Turning Point PM

Collaborative 33

For SuccessfulPerformance Management

All four Performance Management components must be present!

And they must be integrated into the organization’s or system’s core operations!

Turning Point PM

Collaborative 34

Concepts and Componentsto Assess in Examples

• Something needing “improvement” (is/is not) clearly identified

• Goals or targets for improvement (are/are not) established

• Appropriate measures of performance (are/are not) collected

• Reports of measurements (do/do not) reach the proper parties

• Information from measurements (are/are not) used to make improvements

Turning Point PM

Collaborative 35

Summary - Example 1Marathon

(1)

Who/What Runner

Do What Run fast

Standards Previous time

Indicators “Splits”

Reporting Log

Improvement

Strategy

Turning Point PM

Collaborative 36

Summary - Example 2Supervisor (2)

Who/What Worker

Do What Job duties

Standards Set annually

Indicators Work prods

Reporting Perf Appraisal

Improvement

New Objs, More $ ?

Turning Point PM

Collaborative 37

Summary – Example 3Program Mgr (3)

Who/What Program

Do What Program Goals

Standards Approved Objectives

Indicators Info on Activities

Reporting Quarterly Reports

Improvement

Revised Workplan

Turning Point PM

Collaborative 38

Summary - Examples 1-3Marathon

(1)Supervisor (2) Program Mgr (3)

Who/What Runner Worker Program

Do What Run fast Job duties Program Goals

Standards Previous time

Set annually Approved Objectives

Indicators “Splits” Work prods Info on Activities

Reporting Log Perf Appraisal Quarterly Reports

Improvement

Strategy New Objs Revised Workplan

Turning Point PM

Collaborative 39

OK, Sounds Simple Enough!

But How Does This Workfor More Complex Examples?

Turning Point PM

Collaborative 40

Part IV

Applicationsof Performance Management

in Public Health Practice

Turning Point PM

Collaborative 41

Public HealthPerformance Measures

• Quantitative measures of capacities, processes, or outcomes relevant to the assessment of public health performance– Ex: The number of trained epidemiologists

available to investigate outbreaks (capacity measure)

– Ex: The percentage of notifiable diseases reports submitted within the required time lines (process measure)

– Ex: Percentage of clients who rate health department services as “good” or “excellent” (outcome measure)

Turning Point PM

Collaborative 42

PHS Missionand Purpose

----------------Philosophy

Goals"Core Functions"

Structural Capacity-----------------

Information ResourcesOrganizational Resources

Physical ResourcesHuman ResourcesFiscal Resources

Processes-------------------The 10 Essential

Public HealthServices

Outcomes---------------Effectiveness

EfficiencyEquity

Conceptual Framework of the Public Health System as a Basis for Measuring Public Health System Performance

MACRO

CONTEXT

PUBLIC

HEALTH

SYSTEM

Source: Handler A, Issel M, and Turnock B. 2001. A conceptual framework to measure performance of the public health system. Am J Public Health, 91:1235-1239.

Turning Point PM

Collaborative 43

PHS Missionand Purpose

PhilosophyGoals

"Core Functions"

Structural Capacity-----------------

Information ResourcesOrganizational Resources

Physical ResourcesHuman ResourcesFiscal Resources

Outcomes---------------Effectiveness

EfficiencyEquity

Conceptual Framework of the Public Health System as a Basis for Measuring Public Health System Performance

Processes-------------------The 10 Essential

Public HealthServices

Source: Handler A, Issel M, and Turnock B. 2001. A conceptual framework to measure performance of the public health system. Am J Public Health, 91:1235-1239.

MACRO

CONTEXT

PUBLIC

HEALTH

SYSTEM

Public Health Performance Measures: Public Health Performance Measures: Capacity, Process, and OutcomesCapacity, Process, and OutcomesPublic Health Performance Measures: Public Health Performance Measures: Capacity, Process, and OutcomesCapacity, Process, and Outcomes

CapacityCapacity Process(Essential Public Health Services)

Process(Essential Public Health Services)

OutputsOutputs

OutcomesOutcomes

System InputsSystem Inputs

WorkforceWorkforce

InformationInformation

Organization & Organization & RelationshipsRelationships

FacilitiesFacilities

FundingFunding

WorkforceWorkforce

InformationInformation

Organization & Organization & RelationshipsRelationships

FacilitiesFacilities

FundingFunding

Improved Improved organizational organizational performanceperformance

Improved Improved program program performanceperformance

Improved Improved organizational organizational performanceperformance

Improved Improved program program performanceperformance

AssessAssess AssureAssure

Programs and Programs and Services Services consistent consistent with with mandates and mandates and community community prioritiespriorities

Programs and Programs and Services Services consistent consistent with with mandates and mandates and community community prioritiespriorities

Key Processes Key Processes

Improved Outcomes& Customer Satisfaction

Improved Outcomes& Customer Satisfaction

Increased Value& Public Support

Develop Policy

Source: Turnock BJ. Public Health: What It Is and How It Works, 3rd Edition. Boston MA; Jones & Bartlett, 2004.

Turning Point PM

Collaborative 45

Performance Management in Public Health Practice

• Active and strategic use of performance measures to improve the public’s health through managing public health capacity and processes– Achieving Healthy People 2010 national health

goals and objectives– Improving public health organization and

system performance (core functions, essential public health services, capacity, preparedness, etc.)

Turning Point PM

Collaborative 46

Public Health Applications• Human resource development• Data and information systems• Customer focus and satisfaction• Financial systems• Management practices• Public Health capacity• Health status

Turning Point PM

Collaborative 47

Nearly All SHAs Have Some PerformanceManagement Efforts

However, only about half apply performance management efforts statewide beyond categorical programs

Figure 1. Agencies or programs to which SHAs apply performance management efforts (N=47)

Categorical programs

only43% (20)

None4% (2)

SHA wide32% (15)

Local public health

agencies only4% (2)

SHA wide and local

public health agencies17% (8)Source: Turning Point Survey on Performance Management Practices in

States: Results of a Baseline Survey of State Health Agencies. Seattle WA; Turning Point National Program Office, 2002.

Turning Point PM

Collaborative 48

Most SHAs Have Performance Measures, Targets, and Reports, While Fewer States Have

Process for Quality Improvement or Change*

Figure 15. Percentage of SHAs that have specified components of performance management for public health capacity (N=25)

36 (9)

44 (11)

60 (15)

40 (10)

0

10

20

30

40

50

60

70

80

90

100

Performance Targets Performance Measuresor Standards

Performance Reports Process for QI/Change

Pe

rce

nta

ge

of

Sta

tes

(N

=2

5)

*Correlation analysis revealed that there is a comparatively weak relationship between having performance targets, performance measures or performance reports and having a process for quality improvement (QI)/change.

Source: Turning Point Survey on Performance Management Practices in States: Results of a Baseline Survey of State Health Agencies. Seattle WA; Turning Point National Program Office, 2002.

Turning Point PM

Collaborative 49

Most States Use Neither Incentives nor Disincentives to Improve Performance

Figure 18. Percentage of SHA performance efforts that include incentives or disincentives to improve performance (N=40)

Note: Respondents could choose more than one response, so total does not equal 100.

63 (25)

8 (3)

20 (8)

13 (5)

30 (12)

0

10

20

30

40

50

60

70

80

90

100

Incentives forAgencies, Programs,

Divisions

Incentives for Staff Disincentives forAgencies, Programs,

Divisions

Disincentives for Staff None

Pe

rce

nta

ge

of

Sta

tes

(N

=4

0)


Turning Point PM

Collaborative 50

SHAs Most Likely to Have Components of Performance Management for Health Status;

Least Likely for Human Resource Development

Figure 8. Areas most and least likely to have performance targets, measures or standards, reports, and processes for quality improvement (QI)/change, of SHAs that apply performance management efforts SHA wide, SHA wide and to local public health agencies, or to local public health agencies only (N=25)

Most Likely Least Likely

Performance Targets Health Status Data & Information Systems

Human Resource Development Public Health Capacity

Performance Measures orStandards

Health Status Data & Information Systems

Human Resource Development Customer Focus and Satisfaction

Performance Reports Health Status Data & Information Systems Management Practices


Process for QI/Change Health Status Customer Focus and Satisfaction Management Practices



Turning Point PM

Collaborative 51

Performance Measure SourcesCapacity Process Outcom

eHealthy People 2010 ✔ ✔ Core Functions ✔ EPHS ✔ NPHPS (based on EPHS and CF)

✔ ✔

APEX-PH ✔ ✔ ✔ MAPP ✔ ✔ ✔


Turning Point PM

Collaborative 52

Lessons Learned

• State performance management practices are widespread, although often not system-wide or with processes leading to quality improvement or changes.

• States generally report their efforts result in improved performance, with positive outcomes broadly defined.

• No single or composite framework is used in most states, and there are insufficient data to inform choices in performance management approach.

Turning Point PM

Collaborative 53


State Health Agency• Mission: to protect and promote the

health of the state’s population• Local public health agencies are units of

state health agency• Health status & other info collected• Resources deployed to local units based

on progress toward pre-established targets

Turning Point PM

Collaborative 54

Components PresentIn This Example?






Turning Point PM

Collaborative 55

Summary – Example 4State Health Agency (4)

Who/What ?

Do What ?

Standards ?

Indicators ?

Reporting ?

Improvement ?

Turning Point PM

Collaborative 56


State-Local Public Health Agency Network• Mission to protect and promote• State certifies local public health

agencies• Core function based standards applied• Annual grants made to local agencies

meeting standards via formula based on population and need

Turning Point PM

Collaborative 57







Turning Point PM

Collaborative 58

Summary – Example 5State-Local Public Health Network (5)

Who/What ?

Do What ?

Standards ?

Indicators ?

Reporting ?

Improvement ?

Turning Point PM

Collaborative 59


• Congress appropriates $1 billion annually x5 years for state-based efforts to respond to childhood obesity epidemic

• States must: – Appoint State Coordinators– Establish broadly based advisory committee– Prepare timelines for state and local plans,

information and surveillance systems, lab services, professional training, media strategies, etc.

– Renewal funding available to continue and extend these activities

Turning Point PM

Collaborative 60







Turning Point PM

Collaborative 61

Summary – Example 6National Epidemic of Childhood Obesity (6)

Who/What ?

Do What ?

Standards ?

Indicators ?

Reporting ?

Improvement ?

Turning Point PM

Collaborative 62

Summary - Examples 4-6SHA (4) State-Local (5) Nat’l Priority (6)

Who/What SHA State-Local PHA PH and Medical Care System

Do What Health PH Practice Obesity Prevalence

Standards Perf target CF standards HP 2010 standards

Indicators S-P-O Assessed Unclear

Reporting Quarterly Limited HP 2010 process

Improvement

$ deployed Not included Not included

Turning Point PM

Collaborative 63


National Public Health System• Healthy People 2000 Objective 8.14 calls

for 90% of population to be served by LHD effectively carrying out IOM core functions

• Core functions further described in Essential Public Health Services framework

• Replaced by Infrastructure Chapter in Healthy People 2010

Turning Point PM

Collaborative 64

Comparison of Performance Measures Aggregated by Core Function

0

10

20

30

40

50

60

70

80

90

100

1992Mystate

1994Mystate

1999Mystate

1993National

1995National

Assessment

Policy Development

Assurance

Turning Point PM

Collaborative 65







Turning Point PM

Collaborative 66

Summary – Example 7National Public Health Network (7)

Who/What ?

Do What ?

Standards ?

Indicators ?

Reporting ?

Improvement ?

Turning Point PM

Collaborative 67

Example 7 to the Next Level

• Which PM components could be enhanced? How?

• For a companion effort at the state (or local) level, describe how the various PM components would be used.

• Have you been (are you now) involved in a similar effort? If so which PM components are in place? How could these be improved?

Turning Point PM

Collaborative 68

Examples and Case Studies

1. Marathon Runner2. Agency Supervisor3. Program Manager4. State Health Agency (C)5. State-Local Public Agency Network (D,E)6. National Health Priority Initiative7. National Public Health System8. Community Health Improvement Process

(A)9. Public Health Workforce Development (B)

Turning Point PM

Collaborative 69

Part V

Case Studies

Turning Point PM

Collaborative 70

Part VI

Review and Summary

Turning Point PM

Collaborative 71


Source: From 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.

Turning Point PM

Collaborative 72

Apply Standards, Set Targets

Marathon Runner Previous personal best time

Unit Supervisor Expectations established for specific job duties

Program Manager Objectives approved by granting agency

State Health Agency Outcomes – Healthy People 2010 ObjectivesProcess - National Public Health Performance Standards

State-Local Public Agency Network

Outcomes – Healthy People 2010 ObjectivesProcess - National Public Health Performance Standards

National Health Priority Target established for childhood obesity prevalence

National Public Health System


Community Health Improvement Process


Public Health Workforce

Development

Core public health practice competencies

Turning Point PM

Collaborative 73

Measure PerformanceMarathon Runner

Unit Supervisor

Program Manager

State Health Agency


National Health Priority




Development

Turning Point PM

Collaborative 74

Report InformationMarathon Runner

Unit Supervisor

Program Manager

State Health Agency






Development

Turning Point PM

Collaborative 75

Quality ImprovementMarathon Runner

Unit Supervisor

Program Manager

State Health Agency






Development

Turning Point PM

Collaborative 76

In the performance management cycle...

• All components should be driven by the public health mission and organizational strategy

• Activities should be integrated into routine public health practices

• The goal is continuous performance and quality improvement

Source: From 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.

Turning Point PM

Collaborative 77

For SuccessfulPerformance Management

All four Performance Management components must be continuously integrated into the core operations of the agency or system

Turning Point PM

Collaborative 78

Capacity & AccountabilityMarathon Runner

Unit Supervisor

Program Manager

State Health Agency






Development

Turning Point PM

Collaborative 79

Public Health Agency as a Learning Organization:Core Organizational Competencies Support

Strategic Planning / Change Processes

Forces / Trends

StakeholdersHealth System

Planningto Plan

Internal Environment

Capacity Competencies Barriers

External Environment

StrategicIssues

Strategies

Organizational Systems Design & Development

Actions Results

MANDATES

Vision

Mission

Values

< Strategy Formation > < Implementation >

Adapted from John M. Bryson (c) 1985. In Bryson, J.M. & Roering, W.D. (1988). Initiation of strategic planning by governments. Public Administration Review, Nov.- Dec., 995 -1004.

Opportunities / Threats

Strengths / Weaknesses

Core Functions&

Essential Public Health Services

Turning Point PM

Collaborative 80

Success Factors

• Integrate PM into routine public health processes

• Sustainable PM meets state and local needs and political realities

• NPHPS, management models and tools provide a head start

• Early stakeholder involvement increases support and chances of success

Turning Point PM

Collaborative 81

Success Factors (cont’d)

• Align PM measures, activities, and spending with public health priorities

• Trained staff, dedicated resources, and PM culture are essential

• Baseline and trends important• New or adapted information and

management systems are necessary for cross-program management

• Incentives motivate performance and quality improvement

Turning Point PM

Collaborative 82

Why UsePerformance Management?

• To improve public health practice and maximize its effectiveness. This requires– More than setting goals/targets alone;

more than measurement alone. These are necessary, but not sufficient, components

– All four PM components must be continuously integrated into the core operations of the agency/system

Turning Point PM

Collaborative 83

Managerial Action

• Quality improvement efforts

• Policy change

• Resource allocation change

• Program change

Why Use Performance Management?

Turning Point PM

Collaborative 84

Part VII

Post-Test &Course Evaluation

Turning Point PM

Collaborative 85

Performance Mgt Resources

Turning Point PM National Excellence Collaborative1. Guidebook for Performance Measurement. Seattle WA:

Turning Point National Program Office, 1999.2. Performance Management in Public Health: A Literature

Review. Seattle WA; Turning Point National Program Office, 2002.

3. Turning Point Survey on Performance Management Practices in States: Results of a Baseline Survey of State Health Agencies. Seattle WA; Turning Point National Program Office, 2002.

4. From Silos to Systems: Using Performance Management to Improve the Public’s Health. Seattle WA; Turning Point National Program Office, 2003.

Public Health Foundation– Performance Management Toolkit (online via www.phf.org

)

Turning Point PM

Collaborative 86

Part V

Case Study A

Community Health Improvement Process Using

MAPP

Turning Point PM

Collaborative 87

The CHIP

Process

CommunityHealth NeedsAssessment

CommunityHealth Plan

Program Development

Implementation

Evaluation

Turning Point PM

Collaborative 88

The MAPP Model

Turning Point PM

Collaborative 89

Another View of MAPP Model

Community Health Status

Assessment

Local Public Health System Assessment

Organize For

Success

Review Mandates, Mission,

Stakeholder Expectations,

and Goals

Vision For Success

Identify Strategic Issues

Formulate Strategies

Implement Strategies

Evaluate

Community Generated

Themes

Contextual Environment Assessment

Risk Factors

Health Priority

Indirect Contributing FactorsDirect Contributing

Factors

Health Priority

A situation or condition of people which is considered undesirable, is likely to exist in the future, and is measured as death, disease, or

disability.

Risk Factors

Health Priority


Factors

Risk Factor

A scientifically established factor (determinant) that

relates directly to the level of a health problem.

Risk Factors

Health Priority


Factors

Direct Contributing Factor

A scientifically established factor that directly affects the level of a risk factor.

Indirect Contributing Factors

A community specific factor that directlyaffects the level of the direct contributing

factor.

Risk Factors

Health Priority


Factors

Outcome Objective

The level to which a health problem

(priority) should be reduced.

Risk Factors

Health Priority


Factors

Risk Factors

Health Priority


Factors

Impact Objective

The level to which a risk factor should be

reduced.

Intervention Strategy

Demonstrated to be effective or used as national model and should address an impact

objective.

Risk Factors

Health Priority


Factors

Impact Objective

The level to which a risk factor should be

reduced.

Tobacco Use By 2002, reduce cigarette smoking to a prevalence of no more than 24 percent among people aged 18 and older. (Baseline: 1996 BRFS percentage 27.3).

AddictionSedentary LifestyleHypertensionAdvertising (Indirect)

Coalition will implement CDC=s community-based tobacco control program, focusing on delaying initiation, cessation programs, and advertising control.

Coalition will provide support to LHD with in-kind donations, staff, and clinical counseling space.

Cerebrovascular Disease (Stroke) By 2004, reduce stroke deaths to no more than 70 per 100,000 (Baseline: 1997 crude rate 76.5 per 100,000).

Limited number smokers seeking counseling.Media messages promote smoking.Peer pressure.

Health Problem Outcome Objective

Risk Factor Impact Objective

Contributing Factors

Community Health Plan: Worksheet

Proven Intervention Strategies

Resources Available Barriers

Description of the Health Problem, Risk Factors and Contributing Factors

Corrective Actions

Proposed Community Organizations

Evaluation Plan

The problem is the high death rate associated with cerebrovascular disease (county CR = 76.5, state CR =61.7 p/100,000 or 23% above state rate). The major risk factor is cigarette smoking and county has higher percentage of smokers (27.6%) , especially males (31%) than state (24%, 28%, respectively). Addiction appears to be the chief contributing factor.

In order to effectively address this health problem a multi-sited and multi- targeted campaign is required to delay initiation of smoking behavior, assist persons attempting to quit, and provide counter advertising to tobacco promotions.

A coalition of community groups, including the LHD, Cancer Society, Lung Association, General Hospital, Teens Against Butts will collaborate with in- kind donations, staff, and clinical counseling space to assist in meeting objectives.

Coalition will meet quarterly to assess progress in achieving goals. Coalition will use the evaluation tool developed by the CDC to determine effectiveness of programming efforts. Surveys will be conducted amongst coalition members to ascertain stakeholder satisfaction with program.

Community Health Plan

Turning Point PM

Collaborative 99

Add Slides for Case Study A Here!

Turning Point PM

Collaborative 100







Turning Point PM

Collaborative 101

Summary – Case Study ACommunity Health Improvement Process Using

MAPP

Who/What ?

Do What ?

Standards ?

Indicators ?

Reporting ?

Improvement ?

Turning Point PM

Collaborative 102

Case Study A to the Next Level




Turning Point PM

Collaborative 103

Part V

Case Study B

Workforce Developmentin a State-Local PH Network

Turning Point PM

Collaborative 104

1 – Assess Competency Using Consistent Methods and Tools

2 – Enhance Specific Competencies Based on Assessment

3 – Verify Competent Performance in Workplace via Human Resource Management

4 – Recognize Competent Performance via System Incentives such as Credentialing

1 – Assess Competency Using Consistent Methods and Tools

2 – Enhance Specific Competencies Based on Assessment

3 – Verify Competent Performance in Workplace via Human Resource Management

4 – Recognize Competent Performance via System Incentives such as Credentialing

Public HealthWorkforce Development

Public HealthWorkforce Development

44

11

Core PublicHealth Practice

& BT/ERCompetencies

2

33

Turning Point PM

Collaborative 105

Case Study B

Turning Point PM

Collaborative 106

Case Study B

Turning Point PM

Collaborative 107

Case Study B

Turning Point PM

Collaborative 108

Case Study B

Turning Point PM

Collaborative 109

Case Study B

Turning Point PM

Collaborative 110

Case Study B

Turning Point PM

Collaborative 111







Turning Point PM

Collaborative 112

Summary – Case Study BWorkforce Development in a State-Local PH

Network

Who/What ?

Do What ?

Standards ?

Indicators ?

Reporting ?

Improvement ?

Turning Point PM

Collaborative 113

Case Study B to the Next Level




Health & Medicine

Public Health Performance Management