Building the Framework of a Performance Management System

Summary

Impact Statement:

In becoming ready for PHAB accreditation, the City of St. Louis Department of Health’s performance management team used quality planning to create, test, and install a performance management system. The process included a fishbone diagram of the barriers to a culture of quality, an affinity diagram, the Turning Point Performance Management self-assessment tool, and the NACCHO Roadmap to a Culture of Quality Improvement self-assessment tool. The performance management system was developed using Google Sheets as a platform, and entry of measures is being monitored with continuous QI to improve the rate of entry. Between April 2013 and May 2015, staff self-assessment of the culture of quality in the health department rose by 98%.

Summary:

The health department's performance management system was like a complex puzzle with no clear understanding of how the puzzle pieces fit together and no knowledge of what pieces were missing. A performance management team was established to develop a conceptual model of the system and implement improvement activities as identified from the self-assessments. The team evaluated its system using PHAB standards and the Turning Point Performance Management plan self-assessment tool. As a result of the project, a standard template was developed for monthly reporting of performance measures using Google Sheets, and a performance management plan was written to describe the system and how the activities are measured and monitored for success. This QI initiative has led to many sub-initiatives but will focus primarily on establishing the framework of the performance management system.

Organization that conducted the QI initiative:

City of St. Louis Department of Health

Citation:

Bartow, R. Public Health Quality Improvement Exchange. Building the Framework of a Performance Management System. Fri, 01/29/2016 - 12:29. Available at https://phqix.org/content/building-framework-performance-management-system. Accessed May 28, 2023.

Background and Aim

Planning and Execution Details

QI Implementation:

A fishbone diagram identified a common theme in many areas. which pointed to the need to improve the performance management system. The performance management team brainstormed ideas for becoming performance management leaders, and the affinity diagram was used to group and focus improvement initiatives in the areas of reporting, workforce training, time management, communications, and QI. The performance management self-assessment tool helped staff understand more specifically what was missing in the performance management system, and converting the self-assessment to a Likert scale helped to establish baselines that could be graphed and used for measuring improvements. A quality culture survey was used to help measure and evaluate staff's perception of the quality culture.

Focus activities

Administration:

Performance Management

Quality Improvement and Accreditation Readiness

QI Methods:

Model for Improvement

PDCA/PDSA Cycle (Plan, Do, Check/Study, Act)

QI Tools:

Affinity Diagram

Brainstorming

Fishbone Diagram

Other QI tools:

Self-assessment tool

Bar charts

Pie charts

QI Tool Documentation:

Quality culture fishbone diagram

Performance management leaders affinity diagram

Quality culture survey bar chart

Performance Management Self-Assessment bar and pie charts

Initiative Dates:

10/29/13

Initiative Duration:

Greater than 24 months

Methods of evaluation:

Five tools are used to monitor the performance management system: a performance management self-assessment tool, a monthly report on performance measures, a spreadsheet to monitor the status of the QI activities, a staff survey on quality culture, and an annual report on the performance management system: 1. The Turning Point Performance Management plan self-assessment tool is done annually with senior staff to monitor progress on this performance management initiative and to identify any additional improvement needs. The survey questions are graded on a Likert scale so staff can better analyze and graph improvement efforts. 2. Performance measures have been established for each program area, and a monthly reporting tool was created on Google Sheets, so staff can monitor performance measures and how well they are meeting the targets. This tool is flexible enough to allow staff to track all the measures by program area, whether the data are collected monthly, quarterly, or annually. 3. A performance management plan was developed and will be reviewed and updated annually as part of the Plan, Do, Study, Act (PDSA) process. The plan establishes subcommittees to assist with any QI goals and objectives identified in the plan. 4. An activities spreadsheet was developed to monitor the status of the QI activities listed in the plan. The spreadsheet also includes target dates and lead personnel. 5. Information from the aforementioned tools is compiled into an annual performance management report.

Supplemental Materials:

Report

Monthly report template and conceptual model

Supplemental Files:

Attachment	Size
Performance Management Annual Report 2015.pdf	1.16 MB
Monthly Report Template.xlsx	44.72 KB
PM framework 8-5-15.pdf	165 KB
Performance Management Plan 2015.pdf	695.9 KB
Quality Culture Survey Template- rev 5-30-14.pdf	55.46 KB

Results

Measurable QI Outcomes:

All staff received training on performance management and QI and have a better understanding of performance measures and the performance management system. The performance management self-assessment results show improvement in most areas when comparing January 2014 to January 2016 results. The target is to reach 50% improvement by 2016. After 24 months, scores improved by 43.7% in the visible leadership category, 46.3% in the performance standards category, 53.6% in the performance measures category, 52.7% in the reporting of progress category, and 51.9% in the QI category, for an overall improvement of 49.7%. The number of self-assessment scores of "always" increased from 28% to 72%. The staff survey on quality culture had 16 questions scored on a Likert scale of 0 to 4. The target is to reach a 100% total average percentage change by 2016. The initial survey was given several times between April 2013 and May 2015. After approximately 2 years, scores ranged from a starting low of 1.2 to an ending low of 2.7. In May 2015, there was a 98.1% total average change in scores when compared with the initial survey, and the individual questions scored a percentage change in the range of 60.5% to 146.4%.

Other QI Outcomes:

Data collection methods were established for some of the new measures, and baselines are being created. Staff increased their involvement and capacity for the performance management system by assigning measures to more employees and by creating subcommittees for the performance management team. Staff refined the monthly reporting template so that they could identify the employee accountable for reporting the data on each measure. Staff added a column so that they could insert a goal/objective number for the measures that are tied to the strategic plan objectives. Each program has its own tab (page), so staff created links within the file to calculate totals or to reduce duplication of some measures that are used by multiple programs. Initially, staff started out using Microsoft Excel for the monthly reports, but it limited the number of people who could access the report at the same time. Staff switched to Google Sheets to resolve this problem and created editing protection locks on tabs and cells. Several performance measures were refined to focus more on quality, not just quantity. Staff reduced the number of measures initially used and plan to increase them once data systems are in place and staff are more accustomed to the new processes. The subcommittees established were also given goals to help maintain specific PHAB standards that staff believed needed more attention.

Future Plans:

The performance management team will annually review and update the performance management plan and monitor and standardize the processes. The team will also continue to do the performance management self-assessment annually and initiate QI in areas identified as needing improvement. Plans are to refine the annual report on the performance management efforts to better highlight the improvement in program measures and QI initiatives. The performance management team noticed that staff turnover affects the performance management system, so the team is starting to cross-train employees to ensure that data collection is ongoing. Plans are also under way to better engage the health department's governing entity in the performance assessment and improvement efforts as described in PHAB Measure 12.3.3. Because of this, the team added the Board of Health to the conceptual model of the performance management framework and is developing plans to ensure accountability of the performance management system by the governing entity. Staff will continue using NACCHO's Roadmap to a Culture of Quality Improvement to help guide them through the phases of developing a culture of quality.

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

Submission Status:

Completed

Comments

What a wonderful QI project!

What a wonderful QI project! Many of us in the field are currently undergoing this same situation. Would you be willing to share your reporting sheets and PM plan? Also, can you please tell me who you had on your project team? We are in the process of creating our PM team to revamp our PM system, and just wanted some advice on how to choose the right positions to be involved. Thanks!

Gurleen Roberts, MPH
Director of Quality Management
Cobb & Douglas Public Health
Marietta, GA
gurleen.roberts@dph.ga.gov

By implementing this PM

By implementing this PM system in your organization, did you see the work culture change in any particular way?

Is is possible to get a copy

Is is possible to get a copy of your Quality Culture Survey tool?

Dan Ward, MPA

Performance Improvement Manager

Idaho Division of Public Health

wardd@dhw.idaho.gov

(208) 334-6563

Never mind

I like your use of results

I like your use of results from the Turning Point Self Assessment to track progress on improving your performance management system. The pie chart displays are impactful!

I will definitely be using you Culture of Quality Survey. As we are retooling our performance managment system one of our goals is to build in more accountability for regular review of performance measures as well as creating opportuity for more visable staff engagement in quality improvment activites, i.e. use of QI tools, quality is part of staff meeting agenda, etc. Thanks for sharing!

It is reassuring to see that

It is reassuring to see that many of us see opportunity for improvement with our performance management systems. I appreciate the streamline linkage recommendations. What a great tool that is easy to explain and share! Accountability and ensuring a purpose!

Sara Warren

The Building the Framework

The Building the Framework for a Performance Management System presentation at the Open Forum was very informative. You mentioned you are willing to share your excel templates. How can I get a copy of them?
Denise Matthews
Healthy Community Manager
Eagle County Public Health and Environment

denise.matthews@eaglecounty.us
970-328-8816

Thanks everyone for all the

Thanks everyone for all the positive feedback!

Denise- I sent you a link to the document, let me know if you have any questions.

Rhonda Bartow

Building the Framework of a Performance Management System

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

Comments

What a wonderful QI project!

By implementing this PM

Is is possible to get a copy

Never mind

I like your use of results

It is reassuring to see that

The Building the Framework

Thanks everyone for all the

QI Spotlight

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Building the Framework of a Performance Management System

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

Comments

QI Spotlight