The purpose of this is to summarize the strengths and weaknesses of using performance measurement in general, and local public health agency accreditation specifically for improving health capacity and services. Will accreditation have any affect on the services provided by local health departments?
Performance in Public Health
Performance measurement, according to Novick, Morrow, and Mays (2008) is one of the four elements of performance management. The other elements of performance management are performance standards; reporting of progress; and quality improvement process (p. 460). To understand performance measurement in its proper context we should address what performance management is. According to Robbins and Coulter (2005) performance management is seen as a system for instituting performance standards and for evaluating the work produced by individuals or organizations to determine whether they have achieved pre-determined objectives (p. 296). Performance management can be used to realize internal quality improvement objectives and to exhibit accountability to stack holders outside of the organization. Performance measurements are used to manage tricky public health processes. These measurements along with standards and performance improvement are used to change an organizations capacity, priorities, and processes to manage the needs of the communities they serve better. From a public health perspective, performance measurement is the gathering of qualitative data about important activities that includes a description of its effect on the public (Novick et al., 2008, p. 459).
Strengths and Weaknesses of Performance Measurement
The performance measurement concept is composed of several components: input from stack holders; leadership support; a clear mission statement; long and short term goals and objectives; and has straightforward and controllable approaches; and has technical assistance and support for those involve in the process. Besides being able to provide information regarding capacity, results, and effectiveness of current activities there are several potential benefits once implemented as a process: improvement of goals and objectives; identification of operational strengths and weaknesses; opportunities to work in partnership to produce mutual approaches; to develop clarity in accountability; advance quality; improve in tracing progress; improve communication among stake holders and others concerned; and improve distribution and utilize of resources. A weakness of performance measurement is that it does not address why a certain observations were seen or how. Other weaknesses of performance measurement are the inconsistencies in terminology, they can take different forms such as a performance standard which identifies what is expected to be done or they can take the form of a performance indicator which identifies the extent and performance standard has been achieved(Novick et al., 2008, pp. 459-462).
Strengths and Weaknesses of Local Public Health Accreditation
As we continue the discussion on improving the capacity and service of healthcare, it seems appropriate to discuss the accreditation of local public health organizations. According to the Public Health Accreditation Board (PHAB) (2010) it is in the process of developing a national voluntary accreditation program for public health departments. Their aim is to protect the health of every community by improving the excellence and the performance of public health departments. PHAB (2010) identifies that public health departments are important for encouraging healthy living as well as safeguarding the communities they serve. The benefit of accreditation is that a set of common standards are used to gauge performance and helps to drive health departments to make improvements to the services that they render and in their performance (PHAB, 2010). Novick et al. (2008) revealed that some future benefits of accreditation may include contacting advantages for Medicaid, having a market advantage over the private sector, have greater accountability, experiencing simpler transfer interstate and intrastate information (Novick et al., 2008). PHAB (2010) explains that there are three key documents that are needed to apply for national accreditation by public health organizations and they include a community health assessment, a community health improvement plan, and a strategic plan for the health department. A national accreditation program for health departments is to get underway some time in 2011 (PHAB, 2010). Michigan, North Carolina, Washington, Illinois, and Missouri have taken part in the study of public health agency accreditation known as Multi-State Learning Collaborative on Performance and Capacity Assessment of Public Health Departments funded by Robert Wood Johnson Foundation and managed by the National Network of Public Health Institute and the Public Health Leadership Society (Novick, et al., 2008, p. 484). There are other models not mentioned here. A weakness to the accreditation of local public health organizations is that the current assessments must find the middle ground between minimal and optimal standards because state programs are more geared toward optimal standards versus federal programs. The success of accreditation is dependent on the value assigned to it by external stakeholders and therefore short-term and long-term benefits must be articulated clearly within the process (Novick et al., 2008, p. 488).
At a time when transparency and accountability are at the forefront of the minds of many Americans, it is important that public health departments improve the capacity and the quality of their services. A good way is to improve in how they manage the performance of their organizations and utilize measures that are clear, concise, and concrete. This will come in time as researchers continue to rein in and tweak assessments. Accreditation of local public health organizations is on the horizon and it will benefit all citizens in all communities as they come up to the level that many community hospitals are at in 2011.
Novick, L., Morrow, C., & Mays, G. (2008). Public Health administration: Principles for population-based management (2nd ed.). Boston: Jones and Bartlett Publishers.
Public Health Accreditation Board. (2010). Retrieved from http://www.phaboard.org/
Robbins, S., & Coulter, M. (2005). Management (8th ed.). Upper Saddle River, NJ: Pearson Education.