MPH 540 Module 7 Performance Management and QI Example

Measuring What Matters: Performance Management and Quality Improvement in a Health Department

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Master of Public Health Program, Aspen University

MPH 540: Public Health Administration

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Month Day, Year

Measuring What Matters: Performance Management and Quality Improvement in a Health Department

A health department that does not measure its performance cannot know whether it is improving. Performance management provides a system for setting standards, measuring results, reporting progress and improving processes. Quality improvement offers methods for making those improvements. This paper describes a performance management system for a composite local health department and walks through one quality improvement project.

Why Performance Management

Public health leaders are expected to show results to elected officials, funders and residents. Health departments that have gone through national accreditation report that the process stimulated quality and performance improvement and strengthened accountability and management (Kronstadt et al., 2016). Performance management turns that expectation into a routine practice.

Components of the System

A performance management system has four components. Standards define what the department aims to achieve, drawn from national standards, strategic plans and community priorities. Measures track progress with specific indicators. Reporting shares results regularly with staff, leaders and the public. Quality improvement uses results to identify and fix problems. The components form a continuous cycle.

A Composite Dashboard

The composite department selected measures across its main services. The table shows a sample.

Choosing Good Measures

Good measures are relevant to goals, within the department's influence, based on reliable data and reported often enough to guide action. The department avoided measures it could not affect, such as county life expectancy, as operational measures, while still tracking long-term outcomes in its community health improvement plan. Each measure has a named owner responsible for collecting data and explaining changes, and definitions are written down so results stay comparable over time.

A Quality Improvement Project

The dashboard showed that only 41% of food inspection reports reached restaurant owners within five days, and the average turnaround was 12 days. Owners complained that delays left violations uncorrected. A team of four inspectors, a supervisor and a data clerk took on the problem using the Plan-Do-Study-Act cycle.

Plan

The team mapped the process from inspection to report delivery and found that inspectors wrote notes on paper, returned to the office to type reports, waited for supervisor review and then mailed reports. They identified three causes of delay: retyping, batch supervisor review once a week and mailing. They set an aim of delivering 90% of reports within five days within six months. Front-line inspectors, who knew the process best, led the mapping rather than managers.

Do and Study

The team tested tablet-based inspection forms that generated reports on site, with supervisor review only for reports with critical violations, and emailed reports to owners. In a two-month test with two inspectors, average turnaround fell to three days and 94% of reports were delivered within five days. Owners reported faster correction of violations.

Act

The department adopted the new process for all inspectors, trained staff and updated its written procedure. Six months later, 92% of reports were delivered within five days. The team shared results at an all-staff meeting, which built interest in further projects. The department later applied the same tablet approach to septic and pool inspections.

Sustaining a Quality Culture

Many departments start quality improvement projects but struggle to sustain them. Interviews with local departments on the road to accreditation pointed to committed leaders, protected staff hours and the accreditation structure as what kept improvement going, and to turnover, cuts and crises as what stalled it; building skills across all staff reduced the effect of turnover (Verma & Moran, 2014). The composite department now requires each division to complete one project a year.

Beyond Internal Processes

Performance management also supports the broader role public health leaders are asked to play. As chief health strategists, health departments need data systems and a culture of measurement that extend to community partners and cross-sector goals (DeSalvo et al., 2017). The department's next step is a shared dashboard with its hospital and school partners.

Engaging Staff in Measurement

Staff are more likely to use measures they helped choose. The department held workshops in each division where staff proposed measures and targets, which built understanding of why measurement matters and reduced fears that data would be used to punish individuals.

Displaying Data

Dashboards should be simple, with a small number of measures, clear targets and color coding to show progress. Trend lines are more useful than single numbers. The department reviews the dashboard monthly with managers and quarterly with the board of health.

Linking to Strategy

Performance measures should connect to the strategic plan so that daily work reflects long-term goals. Each strategic priority in the department's plan has at least one dashboard measure, making progress visible.

Common Pitfalls

Departments often track too many measures, measure only activities rather than results or collect data without using it. Another pitfall is treating quality improvement as a one-time project. The department reviews its measure set each year, retiring measures that no longer guide action.

Customer Perspective

The inspection project began with complaints from restaurant owners. Seeking feedback from the people served, whether residents, businesses or partners, helps identify problems worth solving and measures that matter to the public.

From Measures to Culture

Over time, the department hopes measurement becomes part of how staff think rather than an extra task. Signs of a quality culture include staff proposing projects themselves, managers asking what the data show before making decisions and teams celebrating improvements. Leaders reinforce this culture by recognizing improvement work in evaluations and staff meetings.

Conclusion

Performance management gives a health department a continuous cycle of standards, measures, reporting and improvement. The composite department's dashboard revealed a slow inspection process, and a Plan-Do-Study-Act project cut report turnaround from 12 days to 3. Leadership support, staff skills and regular reporting sustain such gains and strengthen accountability to the public.

References

DeSalvo, K. B., Wang, Y. C., Harris, A., Auerbach, J., Koo, D., & O'Carroll, P. (2017). Public Health 3.0: A call to action for public health to meet the challenges of the 21st century. Preventing Chronic Disease, 14, Article E78. https://doi.org/10.5888/pcd14.170017

Kronstadt, J., Meit, M., Siegfried, A., Nicolaus, T., Bender, K., & Corso, L. (2016). Evaluating the impact of national public health department accreditation: United States, 2016. MMWR. Morbidity and Mortality Weekly Report, 65(31), 803-806. https://doi.org/10.15585/mmwr.mm6531a3

Verma, P., & Moran, J. W. (2014). Sustaining a quality improvement culture in local health departments applying for accreditation. Journal of Public Health Management and Practice, 20(1), 43-48. https://doi.org/10.1097/PHH.0b013e3182a5a4a0