Understanding Performance Management and Quality Improvement

May 18, 2017|5:02 a.m.| Denise Pavletic

In a previous interview with Kaye Bender, president and CEO of the Public Health Accreditation Board, Bender shares how performance management and quality improvement (QI) might not always be consistent across programs or divisions: state and territorial health departments might be doing QI work before performance management work, when it should really be the latter. Ideally, state and territorial health departments should measure and monitor their performance toward established goals and targets and if they are not meeting those goals and targets, they should then engage in QI efforts to determine the root cause and improve policies, programs, and outcomes. Thus a performance management system should be established before doing QI. Below is information that may be helpful in your performance management and QI efforts.

What is performance management?

Performance management is a systematic process by which a state or territorial health agency involves its employees in improving the effectiveness of the agency and achieving the agency’s mission and strategic goals.

Why is performance management important and how can it help a state health agency?

By improving performance and quality, state and territorial health agencies, along with their public health systems partners can save lives, cut costs, and get better results. Performance management enables state health agencies to be more efficient, effective, transparent, and accountable. Performance management can positively influence a state health agency in many ways, such as:

  • Better return on dollars invested in health.
  • Greater accountability for federal funding and increase in the public’s trust.
  • Increased emphasis on quality of work, rather than quantity.

What does a performance management system look like in a state health agency?

A performance management system can best be demonstrated using the nationally recognized public health model called the Turning Point Model for Public Health Performance Management.


Source: PHF. “About the Performance System Framework.” Available at: http://www.phf.org/focusareas/performancemanagement/toolkit/Pages/PM_Toolkit_About_the_Performance_Management_Framework.aspx. Accessed 5-16-2017.

To successfully implement the Public Health Performance Management System, visible leadership is a must. Senior management should align performance management practices with the organization’s mission, regularly take into account customer feedback, and enable transparency about performance against targets between leadership and staff.

Important questions leadership should think about:

  • Does senior management take a visible role in performance management?
  • Is performance management emphasized as a priority and goal for your work?

As noted above, the Public Health Performance Management System has four core components:

  1. Performance Standards: Standards may be set based on national, state, or scientific organizations, by benchmarking against similar organizations or by other methods.For example, using Healthy People 2020 Leading Health Indicators can reduce the proportion of adolescents who are obese by 10 percent.

      Important questions leadership think about:  

    • Do you set or use standards, targets or goals for your organization or programmatic areas?
    • How do you communicate the expectations and strategic direction for your organization or programmatic areas? 
  1. Performance Measurement: It is important to set criteria and establish scope (programmatic vs. state level). Public health organizations may want to keep several questions in mind when establishing and collecting performance measurement data. For example:

    • Are there defined methods and criteria for selecting performance measures?
    • Do quantitative measures have clearly established benchmarks for success? 
    • How are data on the selected measures collected, and how often?

    Important questions leadership should think about:

    • How do you measure capacity, process, and outcomes?
    • What tools exist to support these efforts?
  1. Reporting Progress: A public health agency tracks and reports progress depending upon the purpose of its performance management system and the intended users of performance data. A robust reporting system makes comparisons to national, state, or local standards or benchmarks to show where gaps may exist within the system.

    Important questions leadership should think about:  

    • Do you document or report your agency or program’s progress?
    • Is this information regularly available? To whom?
    • What is the frequency of analysis and reporting?
  1. Quality Improvement: It is vital to use this data in the establishment of a program or process to manage change and achieve quality improvement in public health policies, programs, or infrastructure based on performance standards, measures, and reports.

    Important questions leadership should think about:

    • Do you have a quality improvement process?
    • What do you do with information gathered through reports?
    • Do you have the capacity to take action for improvement when needed?

How is performance management different from quality improvement?
Quality Improvement is one of four quadrants of a complete performance management system. It is important that a state or territorial health agency begin with establishing a performance management system as described above that include setting standards, measures and targets, report progress to stakeholders and then use a systematic QI process to address areas not meeting targets.

The performance management system framework shown above depicts the practices by which performance management can be achieved. Continuous integration of these practices into the core operations of an organization enables performance management to produce long lasting benefits. The core practices within the circle must be supported by visible leadership in order to sustain a culture of performance excellence.

For more information on performance management systems, performance measures, or quality improvement, contact Denise Pavletic, ASTHO’s Director of Quality Improvement and Performance Management, at dpavletic@astho.org. If you are interested in joining ASTHO's Performance Management/Quality Improvement peer network, click here.