Managing Organizational Performance by Aligning SMART Expectations through a System of Shared Accountability

State: FL Type: Model Practice Year: 2015

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DOH-Broward identified a gap between the individual level performance and that of the programs. There were inconsistencies between these performance expectations and those of the supervisory staff overseeing the employees in these programs.  The goal was to bridge the gap between the evaluation of individual level performance and that at the level of the program as a whole, and in doing so, tying the performance expectations and appraisals of program managers directly to those of their subordinates, making both jointly responsible for outcomes. Tying in performance expectations in this manner created a system of “Shared Accountability” for improving organizational outcomes. The objectives included creating alignment of the individual performance measures are aligned to the supervisor’s measures which are aligned to the unit measures which are aligned to the program measures which are aligned to the LHD measures which is in direct alignment with the LHD mission, vision, and values. An additional objective was to develop an agency performance management system to track organizational outcomes and tie those outcomes into individual employee performance.

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Broward County Health Department
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Managing Organizational Performance by Aligning SMART Expectations through a System of Shared Accountability
The Florida Department of Health in Broward County (DOH-Broward) a unit under the Florida Department of Health (DOH) is the county health department located in Fort Lauderdale, Florida.  It provides population/community-based services to the county’s 1.8 million residents and over 10 million annual visitors, and is responsible for assessing, maintaining, and improving health and safety within the county. Broward County’s 2013 population estimate of 1,838,844, represents 9% of the State’s population, and is the second most populous county of the 67 counties in the State of Florida and the eighteenth most populous county in the United States (US Census).  Its diverse population includes residents representing more than 200 different countries and speaking more than 130 different languages.  31.4% of the residents are foreign-born.   Broward County is a minority/majority county demonstrated by its 2013 population by race (Black 28.5%, Asian 3.6%, Hispanic 26.9%, other races 4.1%, more than one race .2%, for a total of 59.5% and White 40.8%). Public health is a fundamental element of the quality of life available to residents and visitors in Broward County and focuses on protecting, promoting, and improving the health of all people in Florida through integrated state, county, and community efforts and a cooperative agreement with the county. DOH-Broward currently employs a staff of approximately 600 and has an annual budget in excess of $44 million. Public Health Issue that that historically, the Florida Department of Health performance evaluation system was based on behavioral competencies that were largely subjective in nature.  Attempts were made to quantify the evaluation of these competencies.  For example, employees were rated on a scale of 1 to 5 on their level of communications, dependability, and level of teamwork and cooperation.  Predictably, the correlation between a certain level of job performance and a satisfactory score in a performance expectation under this system varied by supervisor, as there was no standardized, objective mechanism for determining a score in a particular competency, and the system relied instead on the supervisor’s subjective determinations regarding employee performance with supporting documentation. Goals and objectives of proposed practice: DOH-Broward identified a gap between the individual level performance and that of the programs. There were inconsistencies between these performance expectations and those of the supervisory staff overseeing the employees in these programs.  The goal was to bridge the gap between the evaluation of individual level performance and that at the level of the program as a whole, and in doing so, tying the performance expectations and appraisals of program managers directly to those of their subordinates, making both jointly responsible for outcomes. Tying in performance expectations in this manner created a system of “Shared Accountability” for improving organizational outcomes. The objectives included creating alignment of the individual performance measures are aligned to the supervisor’s measures which are aligned to the unit measures which are aligned to the program measures which are aligned to the LHD measures which is in direct alignment with the LHD mission, vision, and values. An additional objective was to develop an agency performance management system to track organizational outcomes and tie those outcomes into individual employee performance. The practice was implemented during the time period of April 2012-July 1, 2014. Activities included staff training and development meetings with each supervisor within the organization. Entry of expectations into both the performance evaluation system and ActiveStrategy and deployment of those expectations to each employee in the organization. All 4 objectives were met by establishing 57 programmatic, 8 divisional and 4 director level scorecards encompassing over 9,900 metrics. The application includes indicators that are linked to employee’s SMART metrics on their performance expectations, and which float up to supervisors and program managers. Multi-level business reviews are conducted monthly. Factors That Lead to Success of the Practice: - Transition to new system was mandated throughout the agency- Senior Leadership was committed to the practice change.- The creation of a committee that facilitated the deployment of the application.- A clear understanding of each metric and its relationship to organizational objectives by the program owners was imperative. The impact of deploying the SMART expectations with shared accountability across the organization is that it has increased the accountability and the performance of each program.  Each metric owner is aware and accountable for their role and impact on the organization.  82% of all metrics are meeting target, increasing the achievement of community health, improving public health outcomes and driving the Florida Department of Health vision “To be the Healthiest State in the Nation”.  
The public health issue is that historically, the Florida Department of Health performance evaluation system was based on behavioral competencies that were largely subjective in nature.  Attempts were made to quantify the evaluation of these competencies.  For example, employees were rated on a scale of 1 to 5 on their level of communications, dependability, and level of teamwork and cooperation.  Predictably, the correlation between a certain level of job performance and a satisfactory score in a performance expectation under this system varied by supervisor, as there was no standardized, objective mechanism for determining a score in a particular competency, and the system relied instead on the supervisor’s subjective determinations regarding employee performance with supporting documentation. The identified target population included 98 leadership positions and 551 employees of the Florida Department of Health in Broward County. The identified target population included 98 leadership positions and 551 employees of the Florida Department of Health in Broward County. The percent of employees reached that have individual SMART performance expectations is 100% of salaried staff.  OPS / hourly employees do not receive performance appraisals, but their supervisors are still jointly responsible and accountable for their performance results in the supervisors’ and program manager’s performance appraisal.  In the past, DOH-Broward Performance Evaluation Competency Dictionary was utilized as a hands-on guide that outlined the critical behavioral competencies required for front line staff, supervisors/unit managers, and managers/senior leaders.  In the year 2000, the Hay Group developed a Competency Index for the Florida Department of Health which included 23 core competencies. In 2006, the Florida Department of Health in Miami-Dade County developed a competency dictionary that encompassed all of the behavioral standards included on employee performance expectations at that time. In 2008, DOH-Broward adopted and subsequently revised that competency dictionary for use in evaluating employee performance. A total of fifteen competencies were finally included in the Performance Evaluation Competency Dictionary.  Each competency has a competency level from 1 to 5 (arranged on an ascending scale with the highest level: five, representing outstanding performers); a definition (the meaning of the competency within the organization), a core question, and performing rating anchors (behavioral examples on how the competency is demonstrated on the job at different levels of proficiency). On January 1, 2014, the State of Florida Personnel System and all of the agencies therein, including the Department of Health (DOH), transitioned away from this performance evaluation system to an objective “SMART” (Specific, Measurable, Achievable, Relevant, Timely) expectations system based on quantifiable programmatic performance metrics. Going forward, performance expectations were required to be SMART format.  Guidance was provided from DOH as to the general guidelines for setting employee performance expectations, beginning with a review of the individual position descriptions and the setting of performance expectations correlating to the enumerated duties in each employee’s corresponding position description.  The result of this exercise was that many front-line employees had performance expectations set that mirrored their job duties, and these expectations measured with clarity and specificity the individual aspects of their job performance. When building the performance expectations for the employees throughout a program, DOH-Broward started at the ground level, piecing together the frontline employee expectations, broken down into very specific dimensions of their job duties.  Careful consideration was given to the variable components of performance. Specifically, where a job duty was expected to be performed within a certain time frame and to a certain level of quality, separate performance expectations were established to evaluate each dimension of the performance of this job duty. This would allow for us to see whether an employee who was performing work at a rapid pace was also performing that work to a requisite level of accuracy and quality.  For example, an expectation would be set as to the performance of a job duty within a certain timeframe.  A second performance expectation would be established to measure the quality to which this work was performed.  By separating these dimensions of the performance and appraising them independently, we are able to hone in on the aspect(s) of the performance that may be deficient, as well as those that are meeting or exceeding expectations. Otherwise, it would be difficult to measure an employee’s performance in a particular area if the performance expectation contemplated both timeliness and accuracy, with actual performance that had varying accuracy and varying timeliness. Once the standards had been set for measuring the employees’ performance, the assurance of meeting these expectations were allocated to the supervisor(s) in their own performance expectations.  This gave supervisors a vested interest in monitoring employee performance more closely and with greater regularity, as opposed to the annual or bi-annual review and evaluation process that took place under the previous performance management system.  If DOH-Broward wanted to see how a supervisor was performing, we would be able to see – with specificity – how the individual parts of the unit(s) or division(s) of that program were faring, and could track any notable performance aberrations or over/under performance down to the individual employees.  Even when the overall performance of that unit or division may be meeting expectations, DOH-Broward would be able to see if there were certain employees that were failing to carry their own weight, and whether those performing above expectations were bolstering the overall numbers and compensating for the underperformance by others. The innovation was that similar connections between the performance expectations of the program manager and subordinate supervisors were made, so that the program manager’s performance expectations would be comprised of the performance expectations of each of his or her direct report supervisors, which in turn were comprised of their direct reports, all the way down to the frontline employees.  Ultimately, the cascading of performance expectations up and down the chain of supervision ensures that the program manager is held accountable for each and every performance expectation in the program. While the correlation between front-line employee job performance and performance appraisal of the corresponding performance expectation was mostly straightforward and pretty clear, there was a gap between the individual level performance and that of the programs, overall, and there were inconsistencies between these performance expectations and those of the supervisory staff overseeing the employees in these programs.  For example, a program supervisor might be held responsible for the aggregate performance of certain program goals, but the performance of their employees did not always translate into the performance of the program, overall, or the program manager, who should be held accountable for the program’s performance. When training the supervisory and management staff at DOH-Broward, it became evident that certain performance expectations were expected to be performed by front-line employees, but many of these expectations had no bearing upon the performance of the programs in which they resided.  In researching establishing a system of “Shared Accountability”, DOH-Broward was unable to locate any other LHD’s directly aligning performance expectations for staff directly to organizational performance. There was no central Public Health performance management system that incorporated administrative and process metrics in a uniform reporting structure at the programmatic level. During the 2008 DOH-Broward strategic planning cycle, the lack of a centralized performance management system to measure, analyze and improve organizational performance was identified.  Moreover, there was no system that cascaded the performance expectations and shared the accountability for the work across all levels of supervision, ensuring that the program managers would be accountable for the work performed by employees many levels subordinate.  One of the ten Essential Public Health Services is to evaluate the effectiveness, accessibility, and quality of personal and population-based health services. This includes objectives, need to implement quality programs, performance management systems, ongoing evaluation to examine personal health services, population based services, and the public health system. The Organizational Development Team led the task of identifying, developing, and implementing a performance management system with the objectives of:1) Deploying a central performance management system across all programs and areas;2) Creating cascading scorecards from the organizational level down to the employee level that would be incorporated into the performance management system;3) Creating metrics for employees that are linked to their performance evaluations; and,4) Establishing a comprehensive multi-level scorecard business review process. DOH-Broward has implemented through this system performance/productivity standards, trends identification, benchmarks establishment, and performance variance tracking which are necessary for systematic performance improvement. There are 57 programmatic, 8 divisional and 4 director level sets of SMART performance expectations, with the director level appraisals encompassing a myriad of performance expectations – some of which are seemingly unrelated – spanning all of the programs and employees in their chains of supervision. These SMART metrics are tracked in the ActiveStrategy system for convenience, real-time access and review, and the links to subordinate or supervisory performance expectations are readily viewable. DOH-Broward has developed and implemented a comprehensive performance management system that continuously monitors organizational performance through the use of metrics that are necessary to manage processes activities at all levels down to the individual employee using cascading scorecards.  Employee metrics are measured and linked to their employee performance evaluations using SMART goals. This assures that DOH-Broward is aligned to the objectives in the Broward County Community Health Improvement Plan, the Florida Department of Health Strategic Plan, the State Health Improvement Plan, and meets the indicator goals on the CHD Administrative Snapshot, County Performance Snapshot, and the County CHD Dashboard that is in alignment with public health objectives. The current practice is innovative in that it includes comprehensive and varied public health data sets in a performance management system that cascades with other scorecards and performance appraisals. In doing so, DOH-Broward is able to track metrics necessary to manage the processes in the organization and improve organizational performance. In researching performance management systems DOH-Broward were unable to identify any local public health departments that had a centralized performance management system in place. In response to this concern, DOH-Broward decided to develop our own public health performance management system, the centerpiece of which is ActiveStrategy, a cascading scorecard based data system that allows DOH-Broward to record, monitor, trend, benchmark, and communicate performance data to employees, other agencies and the community.  ActiveStrategy is utilized by some the largest and most distinguished national and international organizations such as LifeLock, the Coca-Cola Company, Kaiser Permanente, NATO, and Westinghouse.  DOH-Broward is the only health department in the United States utilizing the ActiveStrategy software application to monitor the performance of over 9,900 metrics that was developed internally based on public health issues ranging from the highest organizational level to the individual employee.  The performance of organizational, division, program, and site/unit level metrics are reviewed at four separate business reviews that correspond to each organizational level and facilitates cross-organizational collaboration and performance improvement, and the links between these levels and the impact of individual performance on programmatic results is regularly ascertained. Performance reviews are used to report on findings and to analyze performance. Senior Leaders use the reviews to assess the ability to respond rapidly to changing organizational needs and challenges of their programs and of the organization.   The practice of measuring health performance through the use of metrics and cascading scorecards as an approach is unique to the public health sector. The Baldrige Criteria for Performance Excellence category 2, 4 and 7 are all linked to the creation and measurement of organizational data and results that are found only in organizations that are engaged actively in monitoring their metrics at all levels of the organization. Baldrige categories 1, 3, 5 and 6 also are results oriented and depict a national tool to emphasize organizational excellence, reviewing practices, and seeking opportunities for improvement. URL: http://www.baldrigepe.org/ Other references on how cascading scorecards  are evidence based include the Harvard Business Review articles written by Robert Kaplan and David Norton, “The Balanced Scorecard-Measures That Drive Performance” (1992), “Putting The Balanced Scorecard To Work” (1993), “The Balanced Scorecard: Translating Strategy Into Action” (1996). This data collection through cascading scorecards also meets requirements in alignment with Public Health Accreditation.            
In early 2013, the Department of Management Services announced the transition to an online performance management system and the use of a new set of performance expectations that would be SMART (Specific; Measurable; Achievable; Relevant; Time). The stated goal was for “each employee to be assigned clear performance expectations based on objective standards where progress can be tracked.”  Training was provided as to how an expectation would be created to meet the criteria for being “SMART”, but little guidance provided as to what things should actually be measured, aside from reference to an individual employee’s position description.  With the transition to SMART expectations, the accountability for job performance often rested with the lowest level employee tasked with performing the work, and the supervisor did not share any responsibility.  Alignment of programmatic performance indicators to core individual employee performance was not in place. DOH-Broward adopted ActiveStrategy, the centerpiece of the performance management system, as a means to create a cascading scorecard based data system to record, monitor, trend, benchmark, and communicate performance data to all employees.  Scorecards were created at the organization, division, program, and site/unit/employee level. The organization created 57 programmatic, 8 divisional and 4 director level scorecards with over 9,900 metrics in the system. Employee performance expectations were programmed in ActiveStrategy to ensure each of the expectations was being tracked, and to demonstrate how the individual and programmatic metrics roll up to organizational indicators. Employee metrics roll up to the programmatic metrics and are aggregated to the overall performance of the metrics. The segmentation of performance is also cascaded from the main metric down to the site/unit and to the employee. Targets are used to assess gaps, monitor, and evaluate performance monthly and annually. The application includes indicators that are linked to employee’s SMART metrics on their performance expectations. Supervisors and program managers alike are held accountable for the performance of their subordinate employees and programs/divisions/units. 100% of DOH-Broward employees have individual metrics that are aligned to a programmatic indicators or high level scorecards, resulting in shared accountability for all job performance. Leaders at various levels of the organization create employee SMART metrics which are shared with their employees. These metrics are based on the program and employee activities. The SMART measures are included in the employee performance evaluation and in the performance management system. At DOH-Broward, we achieved 100% SMART expectations set for the January to June 2014 rating period.  We have performance expectations for senior leaders that include performance expectations concerning work performing by employees several degrees down the chain of supervision.  In researching establishing a system of “Shared Accountability”, DOH-Broward was unable to locate any other LHD’s directly aligning performance expectations for staff directly to organizational performance. One example is the Deputy Director for DOH-Broward.  She supervises the health center administrators, who in term supervise all of the clinical staff, some of which are supervisors themselves.  Her performance appraisal has forty-three (43) performance expectations, spanning from high level job duties of managing her budget to assurance of frontline clinical employee duties, such as seeing patients within a certain cycle time.  The result is that an employee who does not see patients in a timely manner will receive a substandard evaluation score for failing to meet their performance expectations with respect to cycle.  But the Deputy Director of the entire county health department also would have this performance expectation adversely affected in her performance appraisal.  She has “Shared Accountability” with the frontline employee tasked with completing the work as she is personally responsible for the aggregate for all employees in the division. The performance of organizational, division, program, and site/unit level metrics are reviewed at four separate business reviews that correspond to each organizational level and facilitates cross-organizational collaboration and performance improvement. Performance reviews are used to report on findings and to analyze performance. Senior Leaders use the reviews to respond rapidly to changing organizational needs and challenges of their programs and the organization.  Employee performance is measured at various levels in the metrics and is linked to the SMART expectations in their employee performance evaluation. With the implementation of the performance management system, conducting business reviews and including the SMART objectives in the employee evaluations that roll up to the programmatic indicators, the organization has seen significant improvement in the results of several key organizational metrics. The criteria that was utilized to select participant that received the practice was 1) Any leader in the organization responsible for evaluating employee performance.2) Staff responsible for implementing organizational processes.The criteria that were used to deploy the practice included reviewing all program metrics to identify any existing and potential metrics for measurement starting with the current programmatic metrics that were utilized and reviewing them for relevance. Metrics had to be high level, relevant to the program and activity. Metric had to be measurable and with a method of measurement. New metrics were added and old ones that were deleted.  Metric were reviewed for targets and trending data by program and later by employee. Divisional scorecards were created from the metrics as were programmatic scorecards. Employee SMART performance expectation metrics were created from the programmatic metrics. The SMART expectations were deployed in January 1, 2014.  Prior to the deployment, performance expectations and metrics were linked across the organization and entered and tracked in the ActiveStrategy system, which had been in place starting in January 2012 (It was deployed across the organization in June 2013).  The practice is still being updated and comprehensive reviews of the metrics for targets and data are still being conducted, but 100% of employees receiving a performance appraisal have performance expectations for which their supervisor in turn is accountable.  The same is true for that supervisor’s own supervisor, all the way up to the senior leadership team. Key activities include: • April 2012 ActiveStrategy Enterprise software was purchased. • April 2012-June 2013 initial scorecard cascade methodology was established.• April 2013-June 2013 Meetings were conducted with Senior and Program Leaders to identify key metrics for program areas under corresponding divisions which formed the basis for each programmatic scorecard.  • The system was deployed agency-wide after user trainings on 6/14/2013.  • August 2013 – Train the trainer session at the Florida Department of Health in Miami-Dade County, attended by five members of the Organizational Development staff.• August 2013 – December 2013 – Continuous SMART expectations training provided to staff through monthly supervisory and leadership meetings, email communications to all staff, and one-on-one meetings and trainings conducted by the Organizational Development staff.• January 1, 2014 – SMART expectations performance appraisal system in effect.• January 1, 2014 – June 30, 2014 – first interim period for performance appraisal using SMART expectations.• February 2014 - 1st business review meeting utilizing ActiveStrategy metrics and the SMART expectations, utilizing data collected June 2013 to December 2013.• July 1, 2014 – June 30, 2015 – first annual period for performance appraisal using SMART expectations. Besides the stakeholders that were involved in the planning and implementation of the system, additional stakeholders included the programmatic supervisors and the individual employees where appropriate. Supervisors were included in review and development of programmatic metrics with their managers and later utilized to created SMART expectations for their employees. Those SMART expectations included measurement in four areas: 1) Quantity 2) Quality 3) Cost and 4) Time. These metrics are used to measure the performance of each individual utilizing the cascading scorecard system at the programmatic or divisional scorecard levels.  Linkages to the programmatic metrics were established during the creation of the new SMART expectations and are reviewed/revised during each evaluation period. DOH-Broward has a long and successful history in leading and organizing efforts to mobilize Broward County communities, key agencies and individuals into action to address public health issues.  DOH-Broward has innumerable relationships with partners in the community including healthcare partners, the faith community, educational institutions, governmental agencies, non-profit groups and other less traditional partners such as first responders and businesses. DOH-Broward has strong collaborative relationships with public and private health care providers, the Miccosukee and Seminole tribal nations, and serve on many committees, Boards and provider networks that work to address minority health and health disparities in Broward County including: the Coordinating Council of Broward, Broward  Healthy Start Coalition, Health Care Access, Primary Care Group, and Medical Services Planning. DOH-Broward works with its partners, on both a formal and informal basis, and is viewed as the central force that brings together all partners in public health to provide accessible, high quality health services within the community. These relationships assures that DOH-Broward objectives are aligned to the Broward County Community Health Improvement Plan, the Florida Department of Health Strategic Plan, the State Health Improvement Plan, and meets the indicator goals on the CHD Administrative Snapshot, County Performance Snapshot, and the County CHD Dashboard. These plans and dashboards contains metrics that are associated with healthcare partners, the faith community, educational institutions, governmental agencies, non-profit groups and other less traditional partners such as first responders and businesses. DOH-Broward has included in its performance management system and in ActiveStrategy most of the indicators that are measured by these various groups in the community and government plans listed and linked them through cascading scorecards to programs or high level scorecards using targets and monitoring gaps in performance. Information is then used at various levels and presented to various community groups. This performance measurement system can respond to rapid, unexpected organizational and external changes in the community.        The practice of sharing the accountability for performance expectations across chains of supervision does not inherently require any particular start-up or in-kind costs.  However, without a sophisticated system to track and measure these expectations, it can be a daunting task.  The ActiveStrategy system removed significant barriers to the deployment of these shared SMART expectations, as it can readily display the links between individual, programmatic and organizational performance. The initial software cost for ActiveStrategy was $60,000, but that is a system that merely makes it easier to track the metrics being evaluated and is a helpful demonstrative aid. Training and implementation in this system was done internally, with the DOH-Broward Management Information System team installing the software and overseeing its maintenance.  
The lack of a performance management system that encompasses all areas of the organization makes it almost impossible to achieve any of the goals and objectives established by the leadership of the organization.  By coordinating all performance metrics and sharing accountability for performance, the organization is able to objectively identify strengths and opportunities for improvement.  As a consequence to the alignment of the organization’s performance management system and each employee’s performance evaluation, reliance on anecdotal information is virtually eliminated.  This has provided the opportunity for employees to meet or exceed predetermined metric targets.  Managers are directly responsible for the performance of their staff, and employee performance determines the manager’s performance evaluation score.  Primary data sources, who collected the data, and how: - My Florida Market Place (MFMP) – Accounts Payable Supervisor – Report- Financial Information Resource System (FIRS) Accounts Payable Supervisor – Report- People First Performance Management module – Human Resources Director – Report Based on analysis, 100% of salaried employees have SMART performance expectations in their performance appraisals, and each employee’s supervisor shares in the responsibility for the performance thereof.  DOH-Broward employee performance objectives are aligned with programmatic objectives, which are aligned with the DOH-Broward strategic objectives.  These, in turn, are aligned with the Broward County Community Health Improvement Plan, the Florida Department of Health Strategic Plan, the State Health Improvement Plan, and meets the indicator goals on the CHD Administrative Snapshot, County Performance Snapshot, and the County CHD Dashboard. Participation included subject matter experts, Senior Leaders, and Program Managers. As a result of this analysis metrics were better aligned with programmatic objectives.  Due to the integration between the performance evaluation system and performance management system, DOH-Broward has observed that a rise in performance in the employee level has resulted in an overall improvement in organizational performance as evidenced by the last performance evaluation cycle which ended 6/30/13, the employee evaluations averaged a score of 4.5 out of a possible 5. Scorecard metrics that “Met Target” increased from 78.8% in July, 2014, to 82.2% in September, 2014.
The lesson learned is: “What gets measured gets done.” This is particularly true when a supervisor tasked with measuring and evaluating employee performance is equally held accountable for that that level of performance.  The implementation of a centralized SMART performance management system allows the organization to integrate multiple metrics into cascading scorecards enabling it to measure, analyze and improve organizational performance, and to hone in on performance at the lowest levels of the organization to identify where performance is falling below or exceeding expectations. Another lesson learned is that leaders have to engage in the performance measurement system through the participation of the business review process. Regular reviews of the performance measurement system and all of the cascading metrics that it contains ensures relevance, accountability, and a culture of continuous improvement. Dedicated human, technological, and fiscal resources need to be applied to ensure sustainability of the system. Partners such as the Senior Leaders, Managers and Supervisors as well as community and government leaders all need data to manage their programs, know the health status of the community, and determine if tax dollars are being used effectively in providing public health services. By holding managers and supervisors accountable for the performance of their subordinates through performance expectations, it creates a culture of shared accountability and creates additional incentives to manage employee performance more closely and to have a better understanding of the individual, programmatic and organizational performance at any given time.  Performance reviews are used to present information to the program as well as to the community partners. The initial investment in ActiveStrategy was $60,000 with a recurring annual license fee of $10,000.  The linking of SMART expectations across the organization involves an initial significant dedication of time and human resources. Once linked, however, it requires minimal revision. The organization is committed in continuing to utilize SMART expectations, and is commitment to the cascading scorecard system and shared accountability in its performance management system. The performance management system has become an integral part of the quality improvement process of the organization. Senior Leaders fully support the ongoing use of the ActiveStrategy performance management system. The initial outlay of $60,000 for ActiveStrategy was a one-time cost. Without any substantial budgetary cuts the agency will be able to sustain the $10,000 annual licensing fee. With significant time already spent in training staff on SMART expectations and setting the individual and programmatic expectations in the online performance management system in People First, these expectations can be duplicated and carried over to future evaluation periods with ease.  
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