Leadership in Performance Management and Quality Improvement

December 20, 2018|10:16 a.m.| ASTHO Staff

Susan-RamseyDynamic leaders create dynamic state and territorial health agencies. Performance management is a systematic process that helps them achieve their mission and strategic goals. Tools and resources are available to assist public health agencies in incorporating performance management (PM) and quality improvement (QI) into their work. Successful implementation, however, hinges on leadership setting the vision and offering strategic support, while health agency staff focus on the workflow and related processes.

ASTHO spoke with Susan Ramsey, business owner and managing consultant of Pearls of Wisdom Consulting, based in Olympia, WA. Her background includes more than 25 years in public service for the state of Washington, where she served as the director for the office of performance and accountability at the Washington State Department of Health. Below Ramsey describes what she has learned over the course of her career, what it takes to implement effective PM/QI initiatives, and how public health leaders can enhance their impact in this field.

Why is PM/QI important in the context of public health?
An organizational culture of PM/QI is important for the public health field as it allows agencies to demonstrate they are good stewards of the funds provided to them. Performance management enables leaders to build a system that utilizes fact-based decision-making. Essentially, if data shows that agencies are unable to meet the target, it creates an opportunity to develop an intervention with QI tools and techniques. Each of these practices and tools require interconnectivity with each other and should not be practiced in silos.

You worked for the Washington State Department of Health for over 20 years. During your tenure, what kinds of changes emerged in the PM/QI field?
Washington state has an extensive history of supporting PM/QI activities within different state government agencies. During my tenure, governors passed executive orders to implement programs that focused on various PM/QI activities. In 1997, Gov. Locke set up the Plain Talk program focusing on customer service and engagement. This was followed by the Government Management and Accountability Program by Gov. Gregoire. More recently, Gov. Inslee established the Results Washington Program, which focuses on performance management and continuous improvement. All Washington state governors have endorsed the PM/QI system, which requires agencies and staff to report their PM/QI activities on a monthly basis. In addition, every governor has encouraged the use of QI processes, such as the Turning Point Model, Plan-Do-Check-Act, and Lean Six-Sigma, in public health settings.

How did these changes shape your work?
This kind of support from the governors helped me enhance my abilities, skills, and knowledge. I believe it is important for agencies to train their employees to have such expertise and technical skills. I received the Lean Six-Sigma Black Belt Certification during my tenure at the health department and encouraged my staff and colleagues in partner agencies to obtain this certification. In turn, they have developed a train-the-trainer program that helps other staff members to become QI-certified. This skillset has helped me better assist tribal agencies, local public health leaders, and state health departments in my consultancy practice.

Following the recent midterm elections, some health departments may face significant turnover. What values and management skills do incoming public health leaders need to ensure their agencies are “fluent” in PM/QI?
Public health leaders should create a high-functioning and efficient organizations based on the PM/QI management culture, which comprises four important elements: (1) PM/QI thinkers, (2) PM/QI processes, (3) PM/QI management practices, and (4) PM/QI leadership. Leaders should empower their staff to be analytical thinkers, inspire innovation, and lead change. Effective leadership stems from fact-based conversation, prioritization, and analysis. In order to best utilize PM/QI tools, it is critical for leaders to demonstrate problem-solving skills, practice visual management, seek and analyze the root cause of problems, and respect staff at all levels of the agency’s hierarchy.

Embracing or recognizing the following values can help leaders ensure their agencies are “fluent” in PM/QI: humility, curiosity, respect, transparency, and customer service. Critical reflection helps keep the agency on track and leaders should also cultivate curiosity and inspire their staff to learn about PM/QI and how it supports their work. It is imperative to build trust among staff by practicing transparency to alleviate resistance to PM/QI within the agency. Lastly, leaders need to be aware of customer satisfaction as one key element of QI and continuous assessment is essential to meet and exceed the expectations of both internal and external stakeholders.

What can staff do at all levels of a health agency do to incorporate PM/QI into their work?
A PM/QI culture is an organization-wide effort that requires collaboration among all staff members. Staff at all levels need to establish work systems and processes that allow for professional growth. It is the responsibility of the leader to create a vision and develop strategies while enabling staff to contribute their expertise to the process. Essentially, teams and programs must break down silos to standardize work processes, as well as share lessons learned and best practices with each other to increase the efficiency of their agency.

Developing an infrastructure based on QI is crucial for the success of programmatic areas. Program teams must analyze data to determine whether they are on track to achieve their goals and objectives. It is also important for state and territorial health officials to look at this infrastructure to know if their agency is functioning well. This is one of the reasons public health accreditation has gained traction, as it positively influences agency programs and infrastructure.

For more information on this topic, see ASTHO’s performance management and quality improvement toolkits, infographics, and case studies here.

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