Performance management encompasses the ongoing process of measuring, monitoring, and reporting of progress toward strategic organization, division, and program goals and objectives.1 Performance management is closely linked with quality improvement (QI), as it provides a structured, data-driven approach to identifying and prioritizing opportunities for improvement. However, performance management is distinct from quality improvement.
This page is organized by the four components laid out in The Turning Point Model. This model was developed for public health and is used by many local health departments. It conceptualizes performance management as the continuous use of four components: performance standards, performance measures, reporting of progress, and quality improvement.
- Turning Point Performance Management National Excellence Collaborative. From Systems to Silos: Using Performance Management to Improve the Public’s Health. Retrieved from http://www.turningpointprogram.org/pages/pdfs/perform_manage/pmc_silos_to_systems.pdf
If you are just getting started with performance management or trying to make the one you have more “systematic”, it makes sense to consider a performance management framework. Below are some common performance management frameworks and a brief description. “Regardless of the PM framework utilized, all reinforce several central tenets such as customer focus; streamlined, value added processes; and strategic alignment. All steer QI efforts toward organizational priorities, ensuring that QI complements PM rather than competes with it.”2
2. Beitsch LM, Yeager VA, Moran JW. Utilizing performance management to harness the power of quality improvement in public health. Front Public Health Serv Sys Res 2015; 4(5):33–8. http://uknowledge.uky.edu/frontiersinphssr/vol4/iss5/6/.
- Baldrige Performance Excellence – measures organizational health across 7 domains (leadership, strategy, customers, operations, workforce, results)
- PHAB/Baldrige Crosswalk – A crosswalk between the PHAB standards and the Baldrige criteria which includes descriptions of how the standards align across each respective framework.
- Balanced Scorecard – measures organizational health across 4 domains (financial, customer/stakeholder, internal business process, and organizational capacity/workforce
- Results-Based Accountability – An approach to measuring impact at the community or population level. This helps organizations think through their role in the broader community context so you can identify the metrics that focus on whether improvements are the result of your services.
Identifying performance measures means considering what is important to your agency and deciding what data you can use to measure it. Choosing performance measures involves choosing agency-wide strategic measures that align with your strategic plan, as well as choosing program-specific measures in order for each program to report on its work to the department as a whole.
For high-level agency-wide measures:
- This guide from Public Health Foundation (pages 41-67) walks through the development of performance measures from your agency’s strategic priorities and includes guidance on prioritizing what to measure.
In order to identify program-specific performance measures, it is important to clarify the outcomes your program intends to achieve and to establish measures.
- Logic models are one helpful tool for charting a course to measure program impact. You can refer to The Kellogg Foundation’s comprehensive guide to logic models
- Metrics for Healthy Communities: Building a culture of health through better measurement – this includes a logic model guide and searchable examples for common public health programs and activities.
Examples of performance measures
- Big City Health Department Population Indicator and Performance Measures Library: This resource is intended to provide a library of indicators and performance measures, categorized by common public health topic areas. LHDs can use this library as one resource to find and identify common performance measures that may be adapted to an LHD's own performance management system.
- Example Performance Measures from Clear Impact: This webpage provides examples of measures for different program areas, based on the results-based accountability model for selecting performance measures
Once you know what you’re measuring, you will need to set targets and standards. In order to put the data you collect to use, you will need to put it into context.
Agencies can select standards and targets based on internal or performance or by national standards. Below are some sources of national benchmarks for public health.
- County Health Rankings: allows you to compare your county data against peer counties
- Healthy People 2020
- National Public Health Performance Standards Program (NPHPS)
- Community Indicators Consortium
Presenting data in a visual form is an important component of an effective PM system. Displaying your measures in an easy-to-read format can help LHD staff gain familiarity with the PM system.
Agencies new to performance management should start by developing norms around tracking and reporting performance measures. A few key performance measures in a simple spreadsheet can help your agency get used to tracking performance data in a manageable way. Below are some examples of agency dashboards and datasets, as well as resources for choosing balanced sets of measures.
Minnesota Department of Health's Introduction to Performance Management breaks down the different components included in a dashboard (page 5).
One purpose of measuring performance is to identify areas that may be ripe for quality improvement. The linkage between your performance management and quality improvement plans is critical. Below are some examples of combined PM and QI plans.
Combined QI/PM plans
Jackson County, OR -Adopted 2017
Lane County, OR - Adopted 2017
Wedco County, KY-Adapted 2017
*These documents were evaluated against the PHAB Standards and Measures Version 1.5 by NACCHO Staff. These individuals, based on their understanding of the standards and measures, have classified them as meeting the PHAB requirements and being high-quality documents. These have not been approved by PHAB or any PHAB site visitors for the purposes of meeting relevant standards and measures.
- Designing, Deploying, and Using an Organizational Performance Management System in Public Health: Cultural Transformation Using the PDCA Approach – an article written by the Public Health Foundation that provides a how-to guide of sorts for approaching PM.
- A Performance Management Framework for State and Local Government: From Measurement and Reporting to Management and Improving – Authored by the National Performance Management Advisory Commission, this offers good step-by-step guidance.
- PHF Performance Management toolkit - PHF's landing page for performance management contains links to a variety of tools, resources, and examples of public health performance management
- MN Department of Health Introduction to PM – This guide provides some general advice and examples of how to make a dashboard.
- QI Roadmap Resources- For more resources around performance management, visit the "Resources" page and sort by the foundational element, “QI Infrastructure.”