Moderator:

Bobbie Berkowitz, PhD, RN
Deputy Director, Turning Point Program

The session began with the moderator introducing the subject of performance measures and noting that the Healthy People 2010 document contains an objective calling for the development of such measures. She noted that the three panelists were selected because they offer different and complementary perspectives on the subject as follow:

Jack Thompson
Associate Director, Health Policy Analysis Program, University of Washington

Summarized the key findings and recommendations of a study he had recently completed for the U.S. Department of Health and Human Services on the potential barriers to the development of performance measures and offer recommendations for addressing those barriers.

• A thorough review of the literature and extensive interviews in three states who have developed performance measures (Illinois, Washington and Oregon) revealed tremendous consistency in the barriers identified. Hence, the researchers concluded that using the available literature (including their own study) would be helpful for anyone to review PRIOR to developing such measures.

• The four general types of barriers to developing performance measures include resistance, design, implementation and using information. To address these barriers Thompson recommended:

• Making goals of performance measures clear and important; 2) Creating standard, easy to understand terminology that balance being "germaine" (to local areas) and "generic" (externally imported); 3) Identifying models for performance measurement systems and disseminating their lessons learned; 4) Encouraging collaboration among different interest groups; 5) Providing appropriate training related to performance measures and 6) Providing incentives to States (either new funds or the flexibility to reallocate existing ones) for developing such measures.

• It is critical to carefully review the pros and cons of linking performance measures to the allocation of funds (i.e., The budget process) given that such linkage could intensify resistance to the development and application of such measures.

Patrick Libbey
Director, Thurston County Public Health and Social Services Department (Washington)

Offered a description of Washington State’s experience with developing performance measures.

• Over the last several years, the State of Washington has evolved a set of performance measures that were first capacity-based and later based on minimum performance standards.

• Washington’s experience underscores the importance of knowing why you’re developing performance standards and ensuring that they are framed in language that is comprehensible to the audience(s) for which they are intended. It also highlights the need for including a broad spectrum of partners both within and outside government in framing and operationalizing such measures.

Elinor Hall
Administrator, Health Division, Oregon Department of Human Services

Offered a description of performance measures in Oregon.

• Oregon has a progress board that includes a broad spectrum of public and private sector leaders charged with developing broad goals for Oregon that include but are not limited to health. As part of their charge, the Board develops "report cards" on how the state is addressing particular issues.

• The Oregon Department of Human Services has also created health-specific materials which they use for marketing. This documentation includes a set of key goals of the Department (e.g. decrease injuries).

• Key issues that Oregon is experiencing include: determining what appropriate outcomes should be; how to encourage collaboration versus competition between state and local entities; and how to incorporate a manageable number (e.g., ten) of essential standards into quality assurance reviews and contracts.

• The importance of knowing why you are undertaking the development of performance standards before you do so;
• The advisability of defining what "success" is for attaining them;
• The value of knowing your audience and using simple language (and whenever possible concrete examples) in communicating your goals and performance measures; and
• The potential opportunity that the public health community has to respond to the public’s general concern about safety by showing how public health’s goals, activities and performance measures help support that safety.

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