Performance Policy Statement
State and territorial health agencies manage and develop public health programs and policies that protect and improve the health of residents in their jurisdictions. They are the statutory agents for public health program oversight and accountability. Central to this work is their responsibility as custodians of the public’s trust. Each state and territorial public health agency must continuously monitor and improve their performance in order to track successes, identify deficiencies, and implement improvement processes. As focus increases on the efficiency, effectiveness and accountability of state and territorial government, state and territorial public health agencies are developing and demonstrating sound financial, infrastructure and program deployment decisions, and effectiveness and cost-savings advancements linked to improved population health outcomes.
1. GENERAL PRINCIPLES OF PERFORMANCE IMPROVEMENT
Performance improvement is a means to achieve improved health outcomes in states. It is the effort to assess and improve the level of operational effectiveness of processes within a system. In this case, it is a multifaceted, interdependent process using strategies that together help document, measure, develop and modify public health systems to achieve better health outcomes. These strategies use quantifiable measures to reduce variability and promote continuous improvement.
Performance improvement is best demonstrated through positive change in capacity, process and outcomes of the public’s health as practiced in government, private and voluntary sector organizations. Performance improvement can occur system-wide and within individual organizations and programs that are part of the public health system. It involves strategic changes to address public health system (or organizational) strengths and weaknesses and the use of evidence to inform decision-making.
The following components of performance improvement are integral to the performance improvement plans of state and territorial public health agencies.
- Capacity–organizational structure and reporting, health information technology, personnel/workforce, leadership, funding, regulations, legislation, state and territorial executive branch policy.
- Process–workflow, practice, data collection, assessment, evaluation, policy and procedures.
- Outcomes–evidence of positive changes in population health status resulting from improvements in processes, policies and infrastructure.
2. PUBLIC HEALTH SYSTEMS IMPROVEMENT A. Workforce Development
The U.S. governmental public health workforce is vital to improving the health of the American public. In state and territorial government alone, over 100,000 workers are charged with achieving public health’s mission of fulfilling society’s interest in ensuring conditions in which people can be healthy. Recent national efforts surrounding performance standards and accreditation have focused on strengthening the governmental public health workforce. As more tools are developed to measure performance and accountability in serving the public, a robust, capable public health workforce will be required to meet increasingly rigorous standards.
ASTHO encourages development of innovative solutions to the workforce crisis and renewed federal investments through:
- Communication about the workforce crisis to a wide audience.
- Advocacy for increased federal resources for states to further develop their workforce activities.
- Continued evaluation of public health workforce needs through quantitative research and enumeration.
- Activities that replenish the workforce by marketing public health careers and highlighting the benefits of working in public health.
- Improved competitiveness of careers in public health.
- Formation of partnerships within and outside the public health system.
- Fostering of innovation in meeting the public health workforce crisis.
B. Performance Standards and Quality Improvement
Through its partnership with the National Public Health Performance Standards (NPHPSP), ASTHO supports the mission to improve the quality of public health practice and the performance of public health systems. ASTHO endorses the use of the state system assessment because it develops and advances quality improvement efforts by:
- Providing performance standards for public health systems and encouraging their widespread use.
- Encouraging and leveraging national, state and local partnerships to build a stronger foundation for public health preparedness.
- Promoting continuous quality improvement of public health systems.
- Strengthening the science base for public health practice improvement.
C. Linking System Assessment to Accreditation
ASTHO encourages states to use system assessment results in performance improvement activity planning, to achieve measureable changes within the public health system. Performance improvement is shown through positive change in capacity, process, and public health outcomes as delivered by government, private, and voluntary sectors. Performance improvement can occur system-wide and within individual entities such as the state and territorial public health agency.
ASTHO endorses the use of the NPHPSP state assessment as a preparation tool for national accreditation and encourages the Public Health Accreditation Board to consider using the NPHPSP in part of its accreditation program.
D. Voluntary National Accreditation
A voluntary national accreditation program is a tool to advance the pursuit of excellence, continuous quality improvement, and accountability for the public’s health. It is a journey, not an end point, in the performance improvement process for state and territorial health agencies. The 2003 Institute of Medicine (IOM) report, “The Future of the Public’s Health,” called for the establishment of a national Steering Committee to examine the benefits of accrediting governmental public health departments. In September 2006, the ASTHO membership endorsed the recommendations of the Exploring Accreditation Steering Committee for a voluntary national accreditation program.
ASTHO supports the development and implementation of a national voluntary health agency accreditation program that will:
- Improve health outcomes.
- Drive continuous quality improvement.
- Clarify public expectations of state, territorial and local health departments.
- Recognize high performers that meet nationally accepted standards of quality and improvement.
- Establish quality and consistency of performance, measures and services that is recognized at federal, state and local levels.
- Increase the visibility and public awareness of governmental public health, leading to greater public trust, increased health department credibility and accountability, and ultimately a stronger constituency for public health funding and infrastructure.
E. Standards Development
ASTHO supports a standards development process that:
- Reflects the attributes laid out in the Final Recommendations for a Voluntary National Accreditation
- Program for State and Local Public Health Departments.
- Addresses process, capacity and indicators of outcomes.
- Adds outcome standards that address improved health indicators as the program evolves.
- Focuses on outcomes that can reasonably be influenced by health departments, understanding that public health is inextricably linked to many systems and occurrences that affect health status.
F. Data Collection and Management
To facilitate positive change in governmental public health services, systems, and infrastructure, state and territorial public health agencies must assess their performance. Data must be collected and analyzed to address capacity, processes and outcomes. This data should include services, personnel, organizational structure, scope of work, financing, planning and quality improvement, agency mission, relationship with local public health agencies, partnership and collaboration, emergency preparedness structure, and performance activities. ASTHO supports the collection and reporting of such data to:
Improve health outcomes.
- Assist state and territorial public health agencies in providing evidence to support resource allocation, program, and infrastructure decisions to policy-makers, funding agencies and consumers.
- Build a comprehensive ASTHO database of state and territorial public health agency information related to the central functions of state and territorial public health agencies.
- Inform a voluntary accreditation program (Public Health Accreditation Board) and aid in the development of performance standards.
- Participate in public health systems research in order to develop public health system improvements and link capacity and process to improved health outcomes.
Approval History:
Performance Policy Committee Review and Approval on May 30, 2008.
Board of Directors’ Review and Approval on July 20, 2011.
Ratified by the ASTHO Assembly of Members on October 20, 2011.
Policy Expires on October 19, 2014.
ASTHO policies are broad statements of enduring principles related to particular policy areas that are used to guide ASTHO’s actions and external communications.
Related ASTHO Documents:
Policy Statements:
ASTHO General Policy Statement
Position Statements:
Workforce Development Services and Systems Research Quality Improvement (QI) Accreditation