Alameda county public health department's (ACPHD) implementation of a performance accountability system

Since 2007, Alameda County Public Health Department (ACPHD) has been developing and implementing a strategic plan for achieving health equity that aims to ensure organizational accountability through measurable outcomes and community involvement. ACPHD chose Results Based Accountability (RBA) as the appropriate method to track and assess our work on improving health and achieving health equity in the populations that we provide numerous programs and health services. The RBA framework is a disciplined way of thinking and taking action to help programs improve their performance, allowing for maximum impact on their service populations. RBA starts with ends and works backward, step by step, towards means. For public health programs, the ends are how clients are better off when the program works effectively.

ACPHD will describe our RBA implementation process and lessons learned from this major department-wide initiative. Thirty in-house RBA Champions participated in an intensive RBA train-the-trainer course and share, on a regular basis, their experiences, insights and challenges within an ACPHD learning community. They are in the process of providing RBA trainings in their respective programs and community partnerships. Other accomplishments include identifying an existing department wide information system to track progress toward achieving health equity, and provide a universal system for programmatic updates on outcome-based successes. The team has created a new template for an ACPHD-wide quarterly reporting system that will allow programs to report progress electronically.

Some lessons from implementation include: the importance of clearly communicating the RBA purpose and methodology for institutionalization and sustainability; the need to delineate Directors and Trainers' mutual roles and responsibilities in RBA implementation with programs; and what considerations are required to create a systems-wide reporting format that emphasize health outomes.