Intrepid Entrepreneurship: Unnecessary Prerequisite for Launching a Performance Management System

by Leslie Beitsch, MD, JD


Focus on Accreditation and Innovation addresses current issues related to the Public Health Accreditation Board’s national public health department accreditation program, and the Public Health National Center for Innovations. This series highlights the experiences and perspectives of accredited health departments and explores topics related to the Standards and Measures, research and evaluation findings, and the latest innovations in public health practice.

Les Beitsch, MD, JD

Those among you who self-define as bold and daring, take a breather. But if you have a slight proclivity towards procrastination or even outright temerity—listen up! This performance management (PM) concept is not nearly as troublesome as it may appear at first glance. Quick now, while I am still within your brief attention span, glance at PHAB accreditation Standard 9.1. It requires that health departments “Use a performance management system to monitor achievement of organizational objectives.” And then it goes on to state: “A fully functioning performance management system that is completely integrated into health department daily practice at all levels includes: 1) setting organizational objectives across all levels of the department, 2) identifying indicators to measure progress toward achieving objectives on a regular basis, 3) identifying responsibility for monitoring progress and reporting, 4) identifying areas where achieving objectives requires focused quality improvement processes, and 5) visible leadership for ongoing performance management.” Admittedly it appears that PHAB is demanding a great deal. Yet upon closer inspection, it is asking for the basic elements of a system. Now breathe in deeply. Hold it. Slowly exhale through your mouth. Think system. That wasn’t so hard, was it?

Start where you are.

I am frequently asked about the best way to begin PM. Sensing a teachable moment, I interject: “Did you mean a PM system?” Then I tell them the simplest, smartest, easiest way to launch PM is to begin where you are currently–systems are not built overnight, rather they are constructed on the foundations of what you already have in place. In other words, start with what you have, what you already do well. Then think about adding the next component that logically adds to the system while playing to the existing strengths of your health department. And the next…

Don’t make it harder than it is.

You need not make it more difficult than it has to be; stop over-thinking it. Consider the elegant simplicity of the Minnesota Department of Health (MDH) Plan-Do-Check-Act model depicted here.

Answer a few simple questions for yourself and leadership.

You can initiate your PM system by beginning anywhere on the Plan-Do-Check-Act cycle; each component is along the pathway toward developing a system, which then repeats itself in iterative fashion. Guide your organization forward by asking the same questions MDH did. Set your organizational goals: where do you want your health department to be in one year? Five years? What are your few, but vital, major priorities? How will you know you have achieved them? Select the measures you define as reflecting your goals and objectives. Transparency about agency progress is embedded in the question: how well are we doing? Share this information with all staff within the health department, as well as an interested public. Finally, what could we be doing better to achieve our goals? The answers guide the focus of the agency’s QI imperatives.

Leadership must be engaged.

Often overlooked, PM is a leadership prerogative. Leadership can be defined by role, so-called titular leadership, or by how you and others see you. This is where I trot out a tired, shop-worn cliché–accept the Nike challenge. Just do it! My personal approach is inspired by the Turning Point PM model. Find it and other practical guidance by consulting the Public Health Foundation website.

So let’s get started…


Leslie M. Beitsch, MD, JD, joined the faculty of the Florida State University College of Medicine in November 2003 as Professor of Health Policy and Director of the Center for Medicine and Public Health.  He is currently serving as chair of the university’s Department of Behavioral Sciences and Social Medicine. [Full bio]

Leave a Reply