264021 Balancing flexibility and accountability: Integrating performance measurement into an established federal public health program

Wednesday, October 31, 2012 : 11:30 AM - 11:50 AM

Nikie Sarris, MPH , Community Health Promotion Research, RTI International, Research Triangle Park, NC
Mahima Ashok, Ph.D., M.S. , Social and Health Organizational Research and Evaluation, RTI International, Waltham, MA
LaShawn M. Curtis, DrPH , Public Health and Environment Division, Community Health Promotion & Research Program, RTI International, Atlanta, GA
Brenda Stone-Wiggins, MPH, PhD , Public Health and Environment/Community Health Promotion Research Program, RTI International, Research Triangle Park, NC
Deborah S. Porterfield, MD, MPH , Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
James Emshoff, PhD , EMSTAR Research, Inc., Atlanta, GA
Rebekah Hudgins, MA, MPH , AnthroEval Consulting, LLC, Decatur, GA
Background: This presentation outlines the process and lessons learned in developing and implementing performance measures for the Preventive Health and Health Services Block Grant Program. Established in 1981, the program provides flexible funding to states, D.C., US territories, and Native American tribes to respond to critical local public health issues that cause illness, disability, and death. Balancing the states' need for flexibility to respond to local priorities and the funder's need to assess program impact was the major challenge. Description: We field-tested recommendations for overcoming the challenges of performance measurement in public health programs by: engaging key stakeholders in measure development, assessing the availability of data sources for measures, developing proxies for outcomes that are difficult to measure or for which data sources are limited, and piloting measures with Block Grant grantees of varied characteristics. Quantitative and qualitative data from the pilot sites informed system improvements and roll-out of the performance measures. Lessons Learned: Stakeholder engagement was critical for developing and implementing a balanced performance measurement system. In order to accommodate the history of the Block Grant's flexibility, and to make performance measure reporting acceptable to grantees, staffing and provision of technical assistance were emphasized. A structured menu of indicators can facilitate aggregation of performance measures data for funders. Recommendations: Stakeholder engagement in a participatory process is a necessary strategy for achieving a balance of accountability and flexibility in established programs that may resist the shift. Determining the appropriate mix of quantitative and qualitative reporting elements is also critical.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Public health administration or related administration

Learning Objectives:
Explain the key challenges of shifting an established federal program with a flexible reporting system to a performance measures system for increased accountability. Identify effective strategies (e.g., identifying and involving key stakeholders, piloting quantitative and qualitative performance measures) for facilitating the transition to a performance measures system in a federal public health program.

Keywords: Performance Measures, Public Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was the Project Manager and have been intimately involved in the integration of performance measures into the federal Block Grant Program. I led or contributed to: Block Grant performance measure development, piloting of performance measures, engaging stakeholders, and planning for implementation of the Block Grant performance measurement system. My involvement with this project and topic area has spanned two years.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.