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Performance Management & Quality Improvement Resources
Learn about the products developed by the Turning Point's Performance Management National Excellence Collaborative (PMC), as well as tools specifically for public health, other evidence-based resources and general quality improvement tools to help you manage your organization's performance.
In addition, visit PHF's Performance Management and Quality Improvement website to view recent quality improvement (QI) articles that highlight tools and methods that can be used to make improvements in public health.
 Turning Point Performance Management publications:
Performance Management Tools for Public Health
Self-Assessment Tool
This self-assessment tool will help you and your team identify the extent to which you have components of a performance management system. Developed by and for public health agencies to aid their performance improvement efforts, this tool is organized around each of the four components of performance management identified in the Turning Point model.
Performance Management in Action: Tools and Resources
This searchable database provides users with sample documents, assessment tools, job descriptions, standards and measures, strategic plans, and reports to assist state health agencies. The toolkit is organized around the four components of performance management identified in the PMC model. The four components are 1) Performance Standards, 2) Performance Measurement, 3) Reporting of Progress, and 4) Quality Improvement Process. These resources were originally compiled by PHF for Turning Point as a PDF file in 2004.
Tip: To view all resources related to a specific component (for example, Performance Standards), click on that component in the model to the right, or use the search function. |
   
Source: From Silos To Systems: Using Performance Management to Improve the
Public's Health, prepared by the Public Health Foundation for the Turning Point Performance Management National Excellence Collaborative, 2003.
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NPHPSP Online Resource Center
This online database allows users to access performance improvement resources matched to the 10 Essential Public Health Services (EPHS), as well as to specific Model Standards in the National Public Health Performance Standards Program (NPHPSP). Although designed to help NPHPSP instrument users improve after completing their performance assessments, the site's EPHS framework and keyword search functions make it useful for anyone working to improve their public health organization or systems.
The Public Health Memory JoggerTM II
The new Public Health version of Goal QPC’s popular quick reference guide, Memory JoggerTM II,contains 22 tools for quality improvement with easy-to-follow how-to instructions, tips, and illustrations specific to public health. With these tools you can help your public health organization or team with tasks such as the following: discover the root causes of performance problems with a Cause and Effect (Fishbone) Diagram; organize ideas with the Affinity Diagram; analyze performance data with Pareto Charts, Control Charts, or Radar Charts; set priorities with Multi-voting or a Priority Matrix; monitor the impact of changes with Check Sheets; and many more.
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Accreditation & Other National Initiatives
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Canadian Best Practices Portal - The National Association of County and City Health Officials (NACCHO) presented its Model Practice Program at a Public Health Agency of Canada (PHAC) sponsored workshop (Promising Practices Workshop, Canadian Best Practices System, Toronto, Ontario on May 10-11, 2007). PHAC has been working with leaders in research and practice to guide practitioners to the most promising policy- and program-related options in cases of uncertainty and in absence of scientific evidence. PHAC identified NACCHO as a leader in developing approaches to support decisions in the absence of scientific evidence. In 2007, PHAC launched the Canadian Best Practice Portal to increase access to systematic review of evidence and best practice interventions. Visit the PHAC The Canadian Best Practices Portal for additional information.
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Evidence-Based Resources
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Evidence-based Public Health Birth Outcomes Course - "From Evidence to Practice" is a self-paced, web-based course, that teaches the evidence-based public health decision-making process by plunging learners into a realistic situation. In the course, learners are asked to understand and employ the evidence-based framework to research and develop an intervention strategy that addresses disparities in birth outcomes in a local community.
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Guide to Community Preventive Services (Community Guide) - The Community Guide provides public health decision makers with recommendations regarding population-based interventions to promote health and to prevent disease, injury, disability, and premature death, appropriate for use by communities and health care systems. The Community Guide is a federally sponsored initiative and is part of a family of federal public health initiatives including Healthy People 2010 and the Guide to Clinical Preventive Services. A Task Force on Community Preventive Services, appointed by the CDC, provides recommendations for the Community Guide.
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Accreditation & Other National Initiatives
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Making the Connection – Multi-State Learning Collaborative (MLC) - The National Network of Public Health Institutes (NNPHI) MLC Issue 4 newsletter (December 2007) highlights New Hampshire’s efforts to assess the local public health system readiness for national voluntary accreditation. The regional public health networks stem from the state's Turning Point initiative, which aims to achieve state and local public health system standards in the National Public Health Performance Standards Program (NPHPSP) as well as develop local entities that can meet standards in the Operational Definition of a Functional Local Health Department. Additional "Making the Connection" newsletters describing the activities of MLC states are available on NNPHI’s website
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Michigan's Quality Improvement Guidebook for Local Public Health Practitioners - Released in February 2008, the Michigan Local Public Health Accreditation Program and its partners designed a guidebook for individuals and/or teams to begin or advance their use of a quality improvement (QI) model to improve public health practice and move toward improving outcomes. The QI model, strategies, methods, and tools contained in the guidebook are the basis of a myriad of approaches available in the marketplace today. This guidebook was designed with and for local public health practitioners in Michigan, but its contact and structure are flexible enough for use by other states. For more information, visit the Michigan Local Public Health Accreditation Program website.
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New Performance Data Now Available on WhyNotTheBest.org - This website enables health care providers, researchers, and professionals to conduct side-by-side comparisons of 4,500 hospitals nationwide, track performance over time against numerous benchmarks, and download reports, case studies, and improvement tools. WhyNotTheBest.org is a health care quality improvement resource provided by The Commonwealth Fund.
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Evidence-Based Resources
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NLM Healthy People 2010 Information Access Project - This link provides pre-formulated search strategies that make it easy to find information about evidence-based strategies to achieve Healthy People 2010 objectives, using the National Library of Medicine's PubMed database. It includes a “Public Health Infrastructure” focus area for searching, including a search for articles related to performance standards.
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Partners in Information Access for the Public Health Workforce - Guidelines - Geared to public health professionals, this site centralizes access to evidence-based guidelines and other information resources needed to improve and protect the public's health. Find links to Agency for Healthcare Research and Quality clinical guidelines, CDC recommendations, Association of State and Territorial Health Officials (ASTHO) and National Association of County and City Health Officials (NACCHO) databases of state and local model practices, international guidelines, and more.
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'Grey Literature' Gateway - Much information about "best practices" or promising methods never makes it to the peer-reviewed journals. Hundreds of health-related organizations (from the Institute of Medicine to advocacy groups) publish their own findings, technical reports, literature reviews, conference proceedings, and official documents - almost all of which escape PubMed. Known as "grey literature," such reports have varying scientific rigor, but may be the best available source of evidence to solve today's public health problems. This New York Academy of Medicine site catalogs grey literature from nonprofit professional associations, policy or research institutes, foundations, consulting groups, government entities, and others. Search their online collection or sign up to receive "Grey Literature reports" by e-mail.
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General Quality Improvement Resources and Tools
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Failure Modes and Effects Analysis (FMEA) - This tool is a step-by-step approach for identifying all possible failures in a design, a process, or a product or service. Failures are prioritized according to how serious their consequences are, how frequently they occur and how easily they can be detected. The purpose of the FMEA is to take actions to eliminate or reduce failures, starting with the highest-priority ones. FMEA is used during design to prevent failures. Later it’s used for control, before and during ongoing operation of the process.
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Model for Improvement - The Model for Improvement, developed by Associates in Process Improvement, is a simple yet powerful tool for accelerating improvement that has been used successfully by hundreds of health care and public health organizations to improve processes and outcomes. The model has two parts: A) Three fundamental questions, which can be addressed in any order [What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement?]; and B) the Plan-Do-Study-Act (PDSA or Plan-Do-Check-Act, PDCA) cycle to test and implement changes. The PDSA cycle guides the test of a change to determine if the change is an improvement.
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NACCHO Quality Improvement Resources - Quality improvement (QI) continues to gain momentum as health departments work to meet performance standards and prepare to participate in accreditation efforts. On this site you can find reports, tools and resources to support local health department quality and performance improvement efforts.
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NACCHO's Quality Improvement Toolkit - NACCHO’s Accreditation Preparation & Quality Improvement (QI) toolkit offers resources from local, state, and federal agencies, academic institutions, and other stakeholders. This site offers the public the opportunity to share any QI tools that help your health department improve.
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Online Assessment Tool for Quality Improvement in Primary Care - The Robert Wood Johnson Foundation's Diabetes Initiative developed a quality improvement tool for patient care teams in primary care with the goal to improve self management support. The "Assessment of Primary Care Resources and Supports for Chronic Disease Self Management" (PCRS) online tool allows teams to track and monitor their assessment results to evaluate capacity for self-management support and monitor progress toward improvement.
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Plan-Do-Check-Act Workplan & Guidance (New Hampshire) - The New Hampshire Department of Health and Human Services has applied the Plan-Do-Study-Act (PDSA, often called Plan-Do-Check-Act or PDCA) model to develop one-page work plan templates geared toward quality improvement. The file includes two tools used by the state health department: 1) a worksheet with a description of the Plan-Do-Study-Act approach to performance improvement; and 2) a PDSA workplan with a column for each stage of the cycle and questions to address at each stage. Included are blank worksheets and samples of completed forms to show how users may plan and report progress on activities using the PDSA format. This template has been used for agency programs, contractors, and NPHPSP system improvement action plans.
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Quality from Scratch: A Model For Small Business - In a small business, quality planning and business planning are synonymous. This article describes quality improvement models that small business leaders can utilize to segment their processes into measurable and stable components.
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Quality Improvement Keeps Accreditation Flying - As part of the NC Multi-State Learning Collaborative projects, the NC Division of Public Health and the NC Institute for Public Health presented a PHTIN training on quality improvement On October 16, 2007. This training, designed for NC local health department staff, explored the role of quality and performance improvement to increase the efficiency and effectiveness of your organization.
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Quality Improvement Tools to Identify Root Causes of Public Health Problems - These presentation slides are from a 90-minute workshop by Stacy Baker, Public Health Foundation, at the American Public Health Association (APHA) 2007 annual conference. The presentation explains how quality improvement concepts (such as "Plan-Do-Check-Act" or PDCA) and tools can be applied to accelerate problem solving, focus on root causes, and fully engage public health teams. Tools practiced and demonstrated in the workshop include 5 Whys, Brainwriting, Affinity Diagram, and Cause & Effect (Fishbone) diagram. Additional information on these and other tools is available in the Public Health Memory Jogger II. Handout materials included a 5 Whys Worksheet, Root Cause Analysis Checklist, and QI Storyboard from an Orange County, FL syphilis project for which PHF provided training and team coaching. Contact PHF for additional information on using these slides or to request a similar workshop for your group.
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Quality Management and Risk Management Training (HRSA) - These downloadable trainings cover expectations regarding risk management and quality improvement, components of a risk management program and implementation strategies, and components of a quality improvement program and implementation strategies. Each training module is led by George Rust, MD, MPH, deputy director of the National Center for Primary Care at Morehouse School of Medicine.
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Tacoma-Pierce County Health Department Quality Improvement Plan 2006-2007 - The purpose of the QI program at the Tacoma-Pierce County Health Department is to improve the performance level of key processes and outcomes thoughough the department. This quality improvement plan includes a description of their QI program, including activities, dedicated resources, roles and responsabilities, and a timeline.
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The Public Health Memory JoggerTM II - The new Public Health version of Goal QPC’s popular quick reference guide, Memory JoggerTM II, contains 22 tools for quality improvement with easy-to-follow how-to instructions, tips, and illustrations specific to public health. With these tools you can help your public health organization or team with tasks such as the following: discover the root causes of performance problems with a Cause and Effect (Fishbone) Diagram; organize ideas with the Affinity Diagram; analyze performance data with Pareto Charts, Control Charts, or Radar Charts; set priorities with Multi-voting or a Priority Matrix; monitor the impact of changes with Check Sheets; and many more.
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Affinity Diagram - This tool is often used to group ideas generated by brainstorming. It allows users to organize and present large amounts of data (ideas, issues, solutions, problems) into logical categories based on users’ perceived relationships of the data. The final diagram will show the relationship between the issue in question and the categories.
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Applying QI Techniques to Analyze Problems and Find Solutions - This quality improvement (QI) presentation was given by Stacy Baker of the Public Health Foundation at the 2006 National Public Health Performance Standards Program (NPHPSP) Annual Training. The presentation describes the Plan-Do-Check-Act approach to QI, and uses NPHPSP-related examples to show how several QI techniques can be applied to public health performance improvement in the "Plan" and "Check" phases. Techniques highlighted include "affinity diagram," "fishbone diagram," nominal group technique, "check sheets," and Pareto charts. In addition, slides explain why performance solutions need to be matched to "root causes" and identify resources to get started with QI. Contact PHF for additional information on using these slides or to request a similar workshop for your group.
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Check Sheet - This is a simple form used to record observations and analyze data on performance. Individuals or teams and use a check sheet to log data on the frequency of events, types of problems, causes of errors, or conformance with standards. As examples, public health teams could use a check sheet to record types of misdirected information requests, clients’ participation in partner referral, the completeness of records, or how safety incidents were handled. A Check Sheet can be used to check the effects of solutions that have been implemented, as well as to describe current performance.
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Control Chart - You can use this tool to monitor a process. It graphically depicts the average value and the upper and lower control limits (the highest and lowest values) of a process. All processes have some form of variation. A Control Chart helps you distinguish between normal and unusual variation in a process. If you want to reduce the amount of variation in a process, you need to compare the results of the process with a standard. In public health, a Control Chart can be used, for example, to examine variations in the number of clients contacted in outreach work.
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Evaluation in the Context of Continuous Quality Improvement (CQI): Targeting Organizational Capacity - This presentation, developed by Angela Martin, PhD, of the Michigan Public Health Institute, addresses relationships among evaluation, quality improvment, and performance measures for public health programs and organizational capacity. Presented at the 2007 Multistate Learning Collaborative (MLC-2) Open Forum.
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Fishbone (or Ishikawa) Diagram - This tool allows participants to organize a large amount of information by showing links between events and their potential or actual causes. It provides a means of generating ideas about why the problem is occurring and possible effects of that cause. It important to remember that a fishbone diagram generates hypotheses and this exercise should be followed by checking assumptions.
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Flow Chart - This tool graphically represents the steps of a process or the steps that users have to take to use a service. The Flow Chart helps teams analyze the number of steps and the time required for each step, and to identify opportunities for improvement. This is a good tool to use in both the planning and monitoring phases of the performance improvement process; when you want to describe activities, identify problems, identify the causes of problems, detect "bottlenecks," and define indicators for a process. Public health professionals can use the Flow Chart to analyze and improve processes such as inspections, contracting, partner notification, immunization clinic flow, or health communications.
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JHPIEGO - The primary goal of JHPIEGO is to improve the performance of reproductive healthcare providers and other healthcare professionals in order to improve the quality of services they provide. This website provides a good introduction to performance improvement fundamentals and method, as well as a few tools with which to get started. The section titled “Tools for the Trainer” provides check lists, case studies, and model course schedules geared towards performance improvement in reproductive health.
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Online Performance Improvement Initiatives - This interactive online map hosted by the National Association of County and City Health Officials (NACCHO), connects users to jurisdictions that are working on performance improvement, certification, and/or accreditation.
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Pareto Chart - Provides data needed for setting priorities and selecting a focus for performance improvement efforts. A vertical bar chart shows the relative importance of various contributors or causes of a given problem. The chart puts each contributing factor in rank order (from the highest to the lowest) relative to a measurable variable of interest, usually frequency, cost, or time. The chart is based on the Pareto principle, which states that when several factors affect a situation, a few factors will account for most of the impact (i.e., 80% of the problem usually stems from 20% of causes). The Pareto Chart can help public health professionals use data to focus attention where they can have the greatest impact on problems ranging from errors in disease reports to high healthcare costs to incomplete client referrals.
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Prioritization Matrix - This tool is best used when a list of options must be narrowed to a few choices. The matrix evaluates and prioritizes a list of options, and may be used to decide priorities among possible causes of a performance weakness or problem to address, or to choose the best solution(s) for a given problem. Decisions are based on agreed upon criteria, thus reducing the potential for choices based on hidden agendas.
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Quality Assurance Project - The website provides information on activities that contribute to defining, designing, assessing, monitoring, and improving the quality of healthcare. While the Quality Assurance Project’s tools and methods were developed based on quality management principles used in industry and applied in the context of developing country health systems, they can also be used for local public health systems.
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Quality Improvement Story Telling (Storyboard) - This is an organized way of documenting the performance improvement process of a team that is working systematically to resolve a specific problem or improve a process. Improvement "stories" are described in detail in Storybooks and presented publicly through Storyboards. This technique has been adapted and applied to quality improvement efforts in the health sector, and can easily be adapted to describe improvement work focused on public health capacities, processes, or outcomes.
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Quality Toolbox - Developed by Nancy Tague, this contains dozens of practical quality improvement tools that public health professionals can apply to improve performance. It includes tools for: analyzing processes; discovering root causes of performance issues; collecting and analyzing data; planning; and generating, organizing, and evaluating potential improvement ideas. This comprehensive book also includes three case studies of Malcolm Baldrige National Quality Award winners and a chapter on quality management systems to give the tools context. Although not specific to public health, Public Health Foundation recommends this best-selling and affordable guide from the American Society for Quality.
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Quality Tools - “The Quality Tools Policymakers page, sponsored by the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services, offers resources to help national, regional, state, or local decision makers. The tools you will find here include guidelines, measures, benchmarking and comparative data, information on patient safety, and other tools to help you develop policy and improve the quality of care that is delivered to patients.”
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Refining Performance Improvement Tools and Methods: Lessons and Challenges - This article provided by the International Society for Performance Improvement (ISPI) is appropriate for public health professionals with some knowledge of performance improvement (PI) principles and methodology. It provides evidence for the outcomes of differing PI tools as they are used in various health settings.
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Run Chart and Control Chart - Can graphically display trends in processes over time and help detect causes of variation by making non-random variation easier to see and understand. They can be used to identify problems, determine unexpected variations that affect performance, and monitor progress after solutions are implemented. This tool has many applications to public health processes ranging from emergency response times to communicable disease report lags to staff hours per inspection.
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Tackling Health Inequities Through Public Health Practice: A Handbook for Action - This handbook presented by NACCHO includes exercises to help partners consider social justice issues as root causes of health problems. It looks at how far "upstream" should public health groups go tackle the root causes of health problems and provides sample questions (see Fig 5, p. 46) and tools for dialogue.
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The Problem Solving Memory JoggerTM - This quick-reference guide from GoalQPC shows step-by-step how to use quality improvement (QI) techniques to solve problems in any organization or system. Based on the Plan-Do-Check-Act cycle, it illustrates how and when to use QI techniques such as Fishbone Diagrams, Affinity Diagrams, and Pareto Charts in problem solving. A sample story board shows how a team completes seven problem solving steps linked to Plan-Do-Check-Act. The guide is a companion publication to PHF and Goal QPC’s Public Health Memory Jogger IITM, which includes additional instructions, tips, and public health illustrations of quality improvement tools. Note: PHF's web site includes an Orange County, Florida storyboard that shows how a public health team followed these 7 problem solving steps to curb syphilis in the community.
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