Performance improvement is a critical piece of the NPHPSP activities and is highlighted in the stated mission and goals of the program. If the results of the assessments are not used for action planning and performance improvement, then the hard work of the assessments will not have its intended impact.
Performance improvement is shown through positive change in capacity, process and outcomes of public health as practiced in government, private, and voluntary sector organizations. Performance improvement can occur system-wide as well as within individual organizations that are part of the public health system. It involves strategic changes to address public health system (or organizational) weaknesses and the use of evidence to inform decision-making.
Performance improvement can be achieved through the practice of "performance management." As defined by the Turning Point Performance Management Collaborative, performance management is the practice of actively using performance data to improve the public's health. This practice involves the strategic use of performance measures and standards to establish performance targets and goals, to prioritize and allocate resources, to inform managers about needed adjustments or changes in policy or program directions to meet goals, to frame reports on the success in meeting performance goals, and to improve the quality of public health practice.
Therefore, performance improvement is what systems and organizations should strive to achieve; performance management is how it can be done.
This information and the following links provide sites that are using the NPHPSP assessments with guidance and resources for this important activity.
The NPHPSP performance assessments should provide system participants with an understanding of the gaps between their current performance and the optimal level of performance described by the standards. System partners can then determine where the largest or most crucial gaps in performance are; these are the areas on which the action plan should focus.
The results should be incorporated into a broader planning process, such as a community health improvement process such as MAPP, a state health improvement process, or a local board of health strategic planning process.
If this type of planning process is not underway, go to the "What Next?" section of the NPHPSP User Guide for strategies and ideas for moving forward with performance improvement efforts. The Resources link also provides useful information.
Depending on which assessments are used, different levels of improvement planning may be needed:
- State / local system performance improvement planning - every responding state or local public health system should conduct improvement planning. These plans should be based both on the CDC quantitative reports, as well as on qualitative ideas and comments that emerged during the assessment discussions. Improvement strategies and areas for accountability should be identified for the public health agency and system partners.
- Governance body improvement planning - governing entities that undertake the governance assessment often use their results to develop a strategic plan for the board of health. To the extent possible, boards should work with their local health official and other agency staff to identify key areas and strategies for improvement. If the local public health system assessment was done, the two sets of information can be quite insightful. In these cases, the governance action plan should be coordinated with the system performance improvement plan.
- Statewide performance improvement planning - in states where a coordinated statewide approach is used to implement multiple NPHPSP assessments, the statewide action plans should be developed. CDC provides statewide aggregate reports to states that use the local instrument in all or most local jurisdictions. Another report is also available that summarizes both the state and local data, if both instruments have been used.
Once improvement planning is underway, the action plans should be institutionalized to assure that the performance continues at the higher levels.
Reassessments every three to four years can aid in monitoring progress and identifying new gaps that need to be addressed.
The NPHPSP partnership has recently established a monthly teleconference series for individuals who are coordinating statewide efforts to implement the National Public Health Performance Standards (NPHPS).
The purpose of the calls is for participants to share lessons learned in using the NPHPSP assessment instruments as well as to discuss ideas for moving forward in implementing performance improvement activities.
For More Information
about this teleconference series, please contact :
National Network of Public Health Institutes (NNPHI)
This section includes sample tools and links to resources for groups that have completed the NPHPSP assessment and have entered the post assessment / performance improvement phase. Many of these resources are available for download and customization.
- Follow-up Letter [PDF - 77KB]
- 27 KB]
- a sample follow-up letter that can be customized and used to reconvene system partners for quality improvement planning purposes.
- Performance Improvement / Post-Assessment Reports view post-assessment reports describing assessment results and next steps for performance improvement. Sample reports are provided from the states of Illinois, Maine, New Hampshire, Montana, and New Mexico.
- State of Illinois (State Assessment Report) [PDF - 3.32MB]
- Portland, Maine (Local Assessment Report) [PDF - 1.33MB]
- Southern Stratford County, New Hampshire (Local Assessment Report) [PDF - 308KB]
- State of Montana (State Assessment Report) [PDF - 1.24MB]
- State of New Mexico (State Assessment Report) [PDF - 1.72MB]
- Improvement Plan by Essential Service [PDF
- 53 KB]
- an example of a team's improvement plan for one priority area (essential service. The outline includes a focus topic, goal, related objectives, and performance measures, as well as documentation of leadership support, resources, expertise, and plans for reporting progress.
- Improvement Briefing Sheet [PDF
- 50 KB]
- an example briefing sheet one site used to provide a contextual analysis, including notes from the assessment process, for an Essential Service and related indicators.
- Prioritization Process [PDF
- 250 KB]
- an example four step process for identifying priorities from among all NPHPSP Essential Service and indicator scores.
- Quality Improvement Template [PDF - 10KB]
- 35 KB]
- a document used to gather information from teams or small groups regarding the next steps and performance improvement strategies that will be implemented.
- Links to Quality Improvement Resources - on-line documents are available of a variety of resources that NPHPSP users can access in their efforts to improve performance in each Essential Service. For example, if your public health system wants to improve its efforts to develop a community health profile, visit this resource to view numerous links that can assist in building a community health profile. See:
- State Public Health System Performance Improvement Resources
- Local Public Health System Performance Improvement Resources
- State Public Health System Performance Improvement Resources
- Mobilizing for Action through Planning and Partnerships (MAPP) - the MAPP process is a comprehensive community health improvement process, which includes the Local Public Health System Performance Assessment as one of the components. Even if the full MAPP process is not used, the guidance for developing an improvement plan can be valuable for those who have conducted a performance assessment.
- Turning Point Performance Management Collaborative Resources - The following link includes information about performance management, links to reports, and information about state activities. Resources on this page include a literature review of performance management, a baseline assessment of state practices, the From Silos to Systems: Performance Management in Public Health document, and the Turning Point Guidebook for Performance Measurement.
- Public Health Institutes - The mission of the National Network of Public Health Institutes (NNPHI) is to promote multi-sector activities resulting in measurable improvements of public health structures, systems, and outcomes. NNPHI members have expressed interest in facilitating quality improvement processes with the National Public Health Performance Standards assessment results.
- PHF Public Health Infrastructure Resource Center - The Public Health Foundation's Public Health Infrastructure Resource Center (PHIRC) website was created to meet the needs and interests of states, communities, and the public in assessing and building public health infrastructure. This website serves as a gateway to information and resources on building capacity of public health systems.
- Prioritization section from APEXPH in Practice.pdf [PDF - 3 MB] - this section from NACCHO's APEXPH in Practice workbook includes a discussion of the use of priority-setting within planning processes. Several common methods, including their advantages and disadvantages, as well as process steps and examples, are described.
- Potential Lull-Breaking Strategies [PDF - 61KB]