Performance Management Essentials

July 24, 2020

There are various approaches and frameworks for developing a performance management system, but common across all is emphasis on ongoing, systematic approaches to improve results through data- driven decision making, organizational learning, and a culture of accountability. Effective public health agencies deliver the 10 essential public health services while collecting data on population health outcomes and service delivery—data that can go largely underutilized. By using performance management systems and principals to apply data, public health agencies can identify practices that are working well, change those that are not, and ultimately, improve population outcomes.

Approaches and Results

To explore public health agency performance management processes, ASTHO focused on providing technical assistance to develop and implement performance management systems consistent with Public Health Accreditation Board’s (PHAB) requirements. Of the six public health agencies who participated in the technical assistance program, three were PHAB accredited (Kansas Department of Health and Environment, Maine Center for Disease Control and Prevention, Montana Department of Public Health and Human Services), and three were working towards accreditation (Alaska Division of Public Health, Puerto Rico Department of Health, Guam Department of Public Health and Social Services).

Even with existing performance management processes, public health agencies can face challenges when sustaining and aligning efforts across diverse programs, with changes in leadership, staff turnover, and initiative fatigue. At any stage, an investment in helping staff and leadership understand the value of a performance management system proves worthwhile. Below are four top takeaways from this process that can be applied moving forward.

Ensure Common Understanding and Awareness

Consistency and common understanding of key terms among staff and leaders can build a strong foundation for promoting a performance management culture. The term used in the PHAB Standards and Measures guidelines is integration of performance management and quality improvement practices and processes for the continuous improvement. The term “performance management” is often related to individual employee performance and the term “systems” is often confused with an IT application. In the context of accreditation, the term “performance management system” should reference the people and processes of the agency’s performance management practice of collecting and analyzing data to track results and make decisions. The Montana Department of Public Health and Human Services, Division of Public Health and Safety has a performance management system called HealthStat. Recently, Montana used focus groups and an evaluation rubric to assess awareness and functionality of not just the IT platform, but also the people and processes that operate HealthStat. This qualitative and quantitative data will guide improvements in data quality and system utilization and help ensure common understanding of terms, features, and purpose.

Institute a Leadership-Driven Culture of Performance Management

Leadership must intentionally engage all levels of the agency in reaching decisions about the functionality and integration of various components of the system. Successful leaders using performance management have demonstrated humility, respect, and curiosity as they engage with the data and promote systems improvement. With the support of a new health official, the Kansas Department of Health and Environment is addressing gaps in its existing agency-wide performance management system by assembling a formal performance management team that includes leadership representation, developing a training strategy for staff at all levels, and improving the tracking and reporting mechanisms that support the system.

Align Key Agency Plans

The performance management culture and system do not stand alone but rather build on the expected performance identified from data collected in the State Health Assessment to create the State Health Improvement Plan (SHIP), Strategic Plan, and Quality Improvement Plan. These plans serve as guides for the public health agency’s priorities and bring structure and organization to the agency. Plans help to orient and train staff, inform the public and partners, prioritize operations, and note areas for improvement. A high functioning performance management system can be the nexus for monitoring and demonstrating the alignment of these plans. As it begins to pilot a new performance management system, the Puerto Rico Department of Health created a conceptual framework (coming soon) that includes the SHIP, Strategic, Quality Improvement, and Workforce Development Plans, outlining efforts and responsibilities for monitoring and reporting plan progress.

Promote Quality Improvement Without Playing the Blame Game

A performance management system should identify opportunities for improvement without placing blame for not achieving previous goals. Rather than focus on individual programs or staff, the Maine Center for Disease Control and Prevention established standardized criteria for program performance measures to ensure a systematic approach to monitor measures, expanding the performance management systems to all divisions and units, and ultimately identifying and prioritizing new quality improvement projects. For more on this work, see Maine’s performance measure request form.


Core to the success of creating and sustaining a performance management system is a common vision, strong leadership support, established agency plans that are integrated into managing an agency, and a culture of accountability. When successful, this can help transform an agency’s practice so it’s aligned, data-driven, and focused on achieving improved outcomes for the population.

*For more detailed recommendations about the Performance Management Framework and how strategic planning, monitoring, and budgeting overlap with performance management, refer to: A Performance Management Framework for State and Local Government: From Measurement and Reporting to Management and Improving (National Performance Management Advisory Commission, 2010)


This ASTHOBrief represents a collaboration between ASTHO, participating state and territorial health agencies, and the Center for State, Tribal, Local and Territorial Support (CSTLTS) within the Centers for Disease Control and Prevention (CDC). Funding for this effort is supported by cooperative agreement award numbers: 6 NU38OT000290 and 6 NU38OT000317.