Performance Management & Quality Improvement

Results That Matter Team members have been assisting public and nonprofit organizations in performance management and quality improvement for over 30 years, and have helped standard setters and professional organizations develop best-practice criteria and national policies. Our consulting expertise includes, for example, quality and productivity improvement, performance measurement and improvement, performance budgeting, performance reporting, and performance management systems with feedback for organizational learning. Our various training programs in performance management and quality improvement topics have been taken by thousands of managers and auditors from nonprofits and all levels of government in the U.S. and other countries, and the United Nations. The RTM Team leader won the Harry Hatry Lifetime Achievement Award for Performance Measurement Practice from the American Society for Public Administration. The RTM Team is also on the Public Health Foundation’s (PHF’s) Quality Improvement and Performance Management consulting team. PHF posted our “Triple Loop Learning Model” integrating QI into performance management as a leading “performance management application in public health.”

Project Highlights

The RTM Team provided performance-based budgeting (PBB) training to the Guam Waterworks Authority (GWA) to help GWA managers develop performance measures that, if improved, can drive desired outcomes, and to set performance targets as part of GWA’s budget process. As always, we presented PBB in the context of a performance management system.

- The RTM Team provided performance management (PM) systems training and follow-up technical assistance to help four county health departments in southern Illinois start PM systems both to establish systems of continuous performance improvement of their programs and services and to help prepare for public health accreditation.

We have been working with the Public Health Foundation (PHF) to develop and customize a Performance Management Systems Workshop for state and local health departments, focusing on an approach to performance management centered on quality improvement (QI).
- Managers of the Maine Center for Disease Control and Prevention attended an early version of the workshop to help the Maine CDC begin to transition from doing individual QI projects to QI-based performance management. Maine CDC subsequently re-engaged PHF for the RTM Team to do follow-up online technical assistance to help programs develop relevant goals, objectives, and performance measures for their emerging PM system.
- The full workshop was next delivered for the Kentucky Department of Public Health and Kentucky local health departments (LHDs) aimed at helping the LHDs learn ways to develop or improve PM systems in ways that will help them improve performance and prepare for public health accreditation.
- We especially customized the workshop for the Federated States of Micronesia (FSM), and delivered it in Pohnpei, FSM, for the FSM Department of Health and Social Affairs and all 4 state health departments of FSM. (See other RTM Team international experience.)
- The RTM Team delivered the PHF workshop to the Utah Department of Health and several Utah local health departments with the cooperation of the Utah Association of Local Health Departments.
- We also delivered the PHF workshop to the West Virginia Bureau for Public Health and provided follow-up online technical assistance to West Virginia which enabled the bureau to launch a new performance management system.
- We will soon customize and deliver the workshop and follow-up assistance for the New York City Department of Health and Mental Hygiene. The customization builds on NYC DOHMH’s history of performance measurement and periodic reviews. A new administration is considering changes to the department’s performance management system and hopes to use our customized PHF workshop and assistance to begin the process of developing a more strategic approach to performance management.

We have also worked with PHF to help the Knox County (TN) Health Department (KNHD) begin developing a PM system to improve performance and help prepare for accreditation. We provided online overview training drawn from the PM Systems Workshop above to most KNHD program managers and more intensive on-site training to several pilot program teams and a cross-functional pilot team that works with the Together! Healthy Knox community health improvement partnership. The pilot teams will develop strategic goals and objectives, draft performance measures and sources for data and targets, and identify existing or potential new QI projects to help achieve key objectives or improve specific measures, with follow-up review and assistance from the RTM Team.

We also worked with PHF to review the emerging PM system of the Norwalk (CT) Health Department and provide recommendations for improvement.

For the National Association of County & City Health Officials (NACCHO), we provided Quality Improvement and Evaluation Coaching to 16 local health departments across the country. Most training and coaching was for eight “user” health departments that tested preparedness products and practices developed by NACCHO’s Advanced Practice Centers (APCs) based in eight other local health departments. The APCs received more limited training in how to replicate a variation on the users’ QI process. The eight user departments all benefited by developing new preparedness capabilities or improving existing processes, which varied from infectious disease emergency response in a large urban county to continuity of operations in a small rural county. The eight APCs all benefited from quality improvements developed for their products. Future user health departments will benefit from the improved products. See the article on this project in the Journal of Public Health Management Practice.

As part of our strategic planning assistance for the Delaware Division of Public Health, we provided performance management training and advice, including how to make their strategic plan the driver of a “triple loop learning” performance management system that would help the division simultaneously achieve several levels of quality and management improvement. This project was done in partnership with the Association of State & Territorial Health Officials.

As part of our participation in the Auditor Roles in Performance Measurement project, we helped develop the training course “Auditing Performance Management Systems” for government auditors, which we have provided in person and online in partnership with the Institute for Internal Auditors. A management version of the course is also available to help government managers develop and improve PM systems.

In an earlier project, the RTM Team leader helped the New York City Health Department increase the productivity of dentists serving thousands of children from low income families in department and school clinics, resulting in better quality care and improved responsiveness to the communities served.

We helped elected and appointed officials of the City of Albuquerque develop the direction of new performance measurement initiatives. Albuquerque invited us back to provide interdepartmental workshops and consulting to help the City develop performance measures based on City Council–approved goals. Our assistance provided the foundation for an integrated performance management system, which the City has developed and maintained for over a decade.

- We advised the Port Authority of New York & New Jersey on best practices in performance budgeting, efficiency measurement, and strategy management, and on how to adapt their budget system to achieve responsible cost savings and revenue gains. They have used our recommendations to develop a performance management system that encourages both near-term efficiency savings and longer-term infrastructure investments.

- For the New York City Department of Homeless Services (DHS), we evaluated the Family Services Performance Incentive Program (PIP) for allocating performance-based funding bonuses or reductions to over 100 nonprofit shelters. Our evaluation led to the award of over $4 million in performance bonuses based on shelters moving clients into permanent housing, and to improvements to make the PIP fairer to nonprofit shelter providers.

We also developed “model budget parameters” for DHS to use to make shelter budgets consistent over time. These parameters also guide budget negotiations to ensure cost-effective DHS investments while giving nonprofit shelter providers the resources they needed to provide quality services.

- We helped the Governmental Accounting Standards Board (GASB) develop “suggested criteria” for effective performance reporting and communication, which have been used by state and local governments across the U.S. to improve public accountability. We also helped the GASB evaluate the use of the criteria, which influenced development of national reporting guidelines.

We evaluated the State of Minnesota’s performance reporting, especially its government-wide web-based performance reports, to help the new governor’s office improve public use of performance information and increase accountability.

Additional Resources

Driver-Outcome Performance Measurement for Actionable, Strategic Performance Improvement (PDF) is a paper describing an approach to performance measurement that keeps performance management focused on achieving high priority outcomes.
Performance Management and Cultural Transformation Using the PDCA Approach is a Public Health Foundation paper on developing, using, and improving a performance management system based on Quality Improvement (QI) cycles.
Public Health Performance Management Systems Organized as QI Cycles (PDF) is a presentation to APHA’s 2013 annual meeting by Paul Epstein of the RTM Team.
Performance Management Resouces: A presentation, article, and papers for free download on performance management systems and related performance measurement and governance and info with links to books with chapters on these topics.
Quality Improvement Coaching (PDF) is a short piece describing our “Step-wise QI Cycles” to help organizations use QI strategically for better results and our systemic performance management approach to deepen continuous learning and improvement.
Strategic Performance Management (PDF) briefly lists our range of services and shows locations of many of our recent public health projects.

Selected Clients

Association of State and Territorial Health Officials
Cerro Gordo County [Iowa] Department of Public Health
Champaign-Urbana [Illinois] Public Health District
Clay County [Illinois] Health Department
City of Albuquerque, New Mexico
City of New York
- Department of Health and Mental Hygiene
- Department of Homeless Services
- Mayor’s Office of Operations
- Department of Personnel
- Department of Citywide Adminstrative Services
- Special Services for Children
- Department of Environmental Protection
City of Norwalk [Connecticut] Health Department
City of Wichita, Kansas
Gunnison County [Colorado] Department of Health and Human Services
New Jersey cities and towns (twelve municipalities)
Sarasota County, Florida
Southern Nevada Health District (Clark County/Las Vegas)
Dallas County, Texas
Oklahoma City County Health Department
Palm Beach County Health Department
Hartford Public Library
Jackson County [Illinois] Health Department
Kentucky Department for Public Health
Knox County [Tennesee] Health Department
Madison County [Illinois] Health Department
Maine Center for Disease Control & Prevention
Saint Clair County [Illinois] Health Department
State of New Jersey
- Administrative Office of the Courts
- Department of Community Affairs
State of Connecticut
State of Delaware Division of Public Health
State of Maine Center for Disease Control & Prevention
State of Minnesota, Office of the Governor
National Association of County & City Health Officials
New York State Office for the Aging
Port Authority of New York and New Jersey
Public Health Foundation
The Institute of Internal Auditors
The United Nations
The Governmental Accounting Standards Board
Vice President Gore’s National Performance Review