Performance management models for public health: Public Health Accreditation Board/Baldrige connections, alignment, and distinctions.

CONTEXT: The nationally known Malcolm Baldrige Award for Excellence ("Baldrige program") recognizes outstanding performance management and is specifically cited by the Public Health Accreditation Board (PHAB) as a potential framework for PHAB's requisite performance management system. The authors developed a crosswalk that identifies alignments between the 2 programs and is a highlight of the Quest for Exceptional Performance tool that is intended to help health departments capitalize on the connections between the 2 programs. OBJECTIVE: To provide deeper insight into the most robust connections between the 2 programs. DESIGN: The authors developed a crosswalk by listing the PHAB measures, identifying corresponding Baldrige areas to address, and assigning a rating regarding the strength of the alignment. Subsequently, they generated a matrix with numerical scores reflecting the strength of the PHAB-Baldrige alignments that were then analyzed for frequency and strength of alignment by PHAB domain and by Baldrige category. PARTICIPANTS: The tool developers and 3 public health leaders with experience in the Baldrige program contributed to both the design and the analyses. MAIN OUTCOME MEASURES: The measures used reflected both the frequency and strength of alignments. RESULTS: Of the 123 alignments identified in the crosswalk, 39 were rated as high, 40 as medium, and 44 as low. The strongest connections were in the areas of performance management, quality improvement, strategic planning, workforce development, assessment and analysis, and customer service. CONCLUSIONS: While the areas with the most frequent and strongest connections provide the most useful basis for health departments pursuing Baldrige recognition or using Baldrige criteria as a framework for performance management, all alignments could be considered for both purposes.

Understanding and controlling variation in public health.

Variation in work processes is a critically important concept and method for creating true and sustainable improvement in public health services and activities. This article describes the concept of variation based on W. Edwards Deming's profound knowledge and defines basic terms such as common cause and special cause variation. Control charts are explained as the primary tool for calculating variation within work processes. The article also provides an example of how variation theory can be applied to create sustainable improvement in public health.

Taking improvement action based on performance results: Washington State's experience.

Washington state used the Multistate Learning Collaborative grants to address improvement opportunities identified through the results of the Standards Performance Review cycles and county-specific local public health indicators. State and local health departments initiated statewide collaboratives to address the high priorities for system and individual health department improvements. Two individual agency quality improvement efforts are highlighted, one in a large local health department and the other in the State Department of Health, with emphasis on the results in establishing an agency quality improvement infrastructure and Rapid Cycle Improvement teams.

Accreditation/Performance assessment on-site reviews in Michigan, Missouri, North Carolina, and Washington: implications for States and an evolving national model.

In 1988, the Committee for the Study of the Future of Public Health identified the core functions of assessment, policy development, and assurance as key roles of the public health governmental sector. Some states have developed accreditation or performance assessment programs to measure how state and/or local government carry out these functions. Several of these programs share a common "on-site review" component defined as a site-specific visit to assess, observe, interview, review, evaluate, and/or survey a local/state agency or program regarding its ability to meet a set of public health standards. This article describes the experience of four states-Michigan, Missouri, North Carolina, and Washington-in developing and conducting on-site reviews for accreditation or performance assessment.

Lessons learned from the multistate learning collaborative.

Given the recent interest in public health accreditation programs and related efforts, there is a need to learn from the shared experiences of states that have developed, implemented, and evaluated their own efforts. The Multistate Learning Collaborative provided such an opportunity. Five states were selected to participate in this national peer group. The states represented in the Collaborative reflect different accreditation and assessment models, varying levels of maturity, and various designs based on the context and needs of a given state. However, despite these differences, common themes, critical elements, and shared challenges have emerged.

Application of quality measurement and performance standards to public health systems: Washington State's approach.

To date, there have been few points of intersection between the quality work done in the general health system and performance review in the public health system. This article describes Washington State's set of performance standards for public health, the accreditation-type evaluation process, and some of the results of the recent performance evaluation against the Washington State Standards. Taking action on the evaluation results could enhance the capacity of public health to join general health systems in Washington State to address several of the priority areas described in Transforming Health Care Quality, the 2003 Institute of Medicine Report.