Performance Management Through Use Of Cascading Scorecards In A Centralized Performance Management System

State: FL Type: Promising Practice Year: 2015

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Historically, 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 the Florida Department of Health in Broward County (DOH-Broward) strategic planning cycle, the lack of a centralized performance management system to measure, analyze and improve organizational performance was identified. 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;
3) Creating metrics for employees that are linked to their performance evaluations; and,
4) Establishing a comprehensive multi-level scorecard business review process.

Initially as a stopgap measure, a rudimentary performance management system was established to collect data until a permanent system could be implemented. In January 2012, DOH-Broward Organizational Development made a recommendation to the Senior Leadership Team to purchase ActiveStrategy Enterprise software. This software was the only application that met all the objectives. URL:www.activestrategy.com
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.

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. Multi-level business reviews are conducted monthly.

Senior Leader must be 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 cascading scorecard system has increased the accountability and the performance of each program. Prior to the deployment of the system less than 50% of the identified program metrics were submitted on time. As of September 2014, the submission rate is at 92%. Each metric owner is aware and accountable for their role and impact on the organization. In addition, 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”.
URL:BrowardCHD.org

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Broward County Health Department
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Performance Management Through Use Of Cascading Scorecards In A Centralized Performance Management System
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. Historically, 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. 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;3) Creating metrics for employees that are linked to their performance evaluations; and,4) Establishing a comprehensive multi-level scorecard business review process. Initially as a stopgap measure, a rudimentary performance management system was established to collect data until a permanent system could be implemented. In January 2012, Organizational Development made a recommendation to the Senior Leadership Team to purchase ActiveStrategy Enterprise software. This software was the only application that met all the objectives. URL:www.activestrategy.comDOH-Broward has implemented through this system performance/productivity standards, trends identification, benchmarks establishment, and performance variance tracking which are necessary for systematic performance improvement.Key activities include: • April 2012 ActiveStrategy Enterprise software was purchased. • A core team was identified to develop and administer training, be responsible for system implementation, development, and maintenance.  Trainings were conducted 6/27/2012-1/17/2013 for system administrators.• Each core team member was assigned a division based on the Organizational Chart.• The initial scorecard cascade methodology was established.• 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 after user trainings on 6/14/2013.  • The 1st business review meeting utilizing ActiveStrategy metrics was conducted February 2014 utilizing data collected since June 2013. 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. Multi-level business reviews are conducted monthly. Senior Leader must be 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 cascading scorecard system has increased the accountability and the performance of each program. Prior to the deployment of the system less than 50% of the identified program metrics were submitted on time. As of September 2014, the submission rate is at 92%. Each metric owner is aware and accountable for their role and impact on the organization. In addition, 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”. URL:BrowardCHD.org
Model Practice(s) must be responsive to a particular local public health problem or concern. An innovative practice must be (1) new to the field of public health (and not just new to your health department) OR (2) a creative use of an existing tool or practice, including but not limited to use of an Advanced Practice Centers (APC) development tool, The Guide to Community Preventive Services, Healthy People 2020 (HP 2020), Mobilizing for Action through Planning and Partnerships (MAPP), Protocol for Assessing Community Excellence in Environmental Health (PACE EH). Examples of an inventive use of an existing tool or practice are: tailoring to meet the needs of a specific population, adapting from a different discipline, or improving the content. Historically, 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. 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 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 performance metrics in ActiveStrategy and are aligned to a programmatic or higher level scorecard is 100%. There are 57 programmatic, 8 divisional and 4 director level scorecards with over 9,900 metrics in the system. ActiveStrategy includes indicators that are linked to employee’s SMART metrics on their performance expectations. SMART metrics are Specific, Measureable, Achievable, Relevant, and Timely.DOH-Broward had a fragmented system with minimal accountability and data owners. The DOH-Broward was previously using a manual Microsoft Excel spreadsheet to capture monthly metrics for several programs. The spreadsheet did not include scorecards by programs nor did any metrics rollup or cascade to other scorecards. A comprehensive multi-level business review process was not systematically conducted. Alignment of programmatic performance metrics to core business process was not in place. 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. 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 we 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 the performance management system 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. 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.nist.gov/baldrige 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. Each one of the Winnable Battles are/may be included in the performance management system called Active Strategy Enterprise as a scorecard or in metrics.
Food Safety|Global Immunization|Heathcare-associated Infections|HIV in the U.S.|Lymphatic Filariasis in the Americas|Motor Vehicle Injuries|Nutrition, Physical Activity, and Obesity|Mother-to-Child Transmission of HIV and Syphilis|Teen Pregnancy|Tobacco
The goals of the practice was to purchase a performance management system with the objective:1) deploy the performance management system across all programs and areas2) create cascading scorecards from the top level down to the employee level3) create metrics for employees that are linked to their performance evaluations 4) establish a comprehensive multi-level scorecard business review process Steps taken to implement the program Table 4.1 Date Step Stakeholders Activity Date: 4/12/2012  Step: Initial Conference Call with CEO of ActiveStrategy  Stakeholders: CEO of ActiveStrategy, Account Executive of ActiveStrategy, Director of Organizational Development, and Director of Organizational Performance Metrics  Activity: Overview of ActiveStrategy Enterprise structure, Balance Scorecard related to Strategic Planning, Baldridge Award as goal, pricing, licensing, training, workshop and project planning framework. Date: 6/20/2012  Step: Conference Call with CEO of ActiveStrategy  Stakeholders: CEO of ActiveStrategy, Director of Organizational Development, and Director of Organizational Performance Metrics Activity: Discuss transition to service delivery with ActiveStrategy, ActiveStart Implementation and Training Package with automation, roles, site visit, and technical resources. Discuss three day administrative training.  Date: 6/27/12-6/27/12  Step: Webcast by CEO of ActiveStrategy with ActiveStrategy Trainer  Stakeholders: CEO of ActiveStrategy, ActiveStrategy Trainer, Director of Organizational Development, Director of Organizational Performance Metrics  Activity: CEO of ActiveStrategy and ActiveStrategy Trainer via webcast presented balanced scorecard and the performance management framework. CEO of ActiveStrategy discussed the principles of cascading scorecards and outcome measures. Review Training plan. Date: 9/14/2012  Step: Strategic Performance Management Workshop Presentation  Stakeholders: CEO of ActiveStrategy, ActiveStrategy Trainer (Webcast from California), Director of Organizational Development, Director of Organizational Performance Metrics Activity: CEO of ActiveStrategy and ActiveStrategy Trainer presented the components of a performance management system including scorecards, measures and initiatives. He also gave an overview of the software and of business reviews. Date: 1/17/2013  Step: Organizational Development ActiveStrategy Meeting  Stakeholders: Director of Organizational Development and Director of Organizational Performance Metrics  Activity: Preliminary training date set for 1/31/2013. Core description information needed, target, source, and data availability. Data entry methods, CSV file, Excel spreadsheet, and direct data entry.  Date: 3/4/13 - 3/8/13  Step: DOH-Broward Performance Management and ActiveStrategy Training  Stakeholders: ActiveStrategy Trainer, Director of Organizational Development, Director of Organizational Performance Metrics, Director of Performance Excellence, IT Director, IT Helpdesk Supervisor, Director of Workforce Development, and Senior Administrative Assistant  Activity: 5 day training on ActiveStrategy for Power user and Administrators. Included tour of system, system features, settings, naming conventions, scorecards, objectives, measures, program groups, presentation objects, and reports. Entered user names, scorecards, and programmatic indicators from the DOH-Broward Indicator Matrix in the live system.  Date: 3/6/2013  Step: Aligned training with the Strategic Objective in the DOH-Broward Strategic Plan  Stakeholders: Director of Organizational Development, Director of Organizational Performance Metrics, Director of Performance Excellence, IT Director, IT Helpdesk Supervisor, Director of Workforce Development.  Activity: Reviewed DOH-Broward Strategic Plan Objective 2.3 Develop and implement a Performance Measurement system for all programs with the ActiveStrategy Power users. Reviewed and aligned Key Activity in DOH-Broward Strategic Plan 2.4.3 Establish indicators to measure key process for all DOH-Broward programs/units.  Date: 3/11/2013  Step: Created scorecard outline. Stakeholders: Director of Organizational Development, Director of Performance Excellence and Director of Organizational Performance Metrics  Activity: Created scorecard outline. Reviewed divisional scorecard legend for appropriate naming convention. Date: 3/12/13 - 5/8/13  Step: Reviewed original Excel DOH-Broward performance metrics by division.  Stakeholders: Director of Organizational Development, Director of Organizational Performance Metrics, Director of Performance Excellence, IT Director, IT Helpdesk Supervisor, Director of Workforce Development and Senior Administrative Assistant  Activity: Reviewed original Excel DOH-Broward performance metrics by division with the Senior Leaders and their Program Managers. Added, updated, or deleted indicators as needed.  Date: 4/9/2013  Step: Initiated the development of the ActiveStrategy Hands on Training Stakeholders: Director of Organizational Development, Director of Performance Excellence, Director of Organizational Performance Metrics, Director of Workforce Development  Activity: Developed draft of agenda, Training User Guide and PowerPoint Presentation for ActiveStrategy hands on training for division leaders, program managers and supervisors. Date: 5/13/13 -5/29/13  Step: Developed ActiveStrategy Hands On Training Schedule  Stakeholders: Director of Workforce Development, Director of Organizational Development Director of Performance Excellence and Senior Administrative Assistant  Activity: Scheduled dates and times for ActiveStrategy hands on training in each division and program group. Date: 6/4/13-6/13/13  Step: ActiveStrategy Divisional Hands On Training  Stakeholders: Director of Organizational Development, Director of Workforce Development, Director of Performance Excellence, Director of Organizational Performance Metrics, IT Director, Senior Leaders, Program Managers, Supervisors  Activity: 4 hour ActiveStrategy Hands On training sessions for each division and program area manager. Training class covers introduction and live hands on entry of data. Date: 7/11/2013  Step: Discussed Performance data bulk uploads.  Stakeholders: Director of Organizational Development, Director of Organizational Performance Metrics and IT Director  Activity: Discussed Performance Data Bulk Upload Template for automation of data. Date: 1/7/14-1/8/14  Step: ActiveStrategy - Automation Training  Stakeholders: ActiveStrategy Trainer, Director of Organizational Development, Director of Performance Excellence, Director of Organizational Performance Metrics, IT Director, Programmer, Systems Administrator, Senior Network System Analyst, Systems Project Analyst, IT Helpdesk Supervisor, and Office Automation Specialist.  Activity: Training for Power users provided on Automation for two days by the ActiveStrategy Trainer. Ongoing automation of metrics with program managers.  Date: 4/11/2014  Step: Business reviews initiated using ActiveStrategy.  Stakeholders: DOH-Broward Director, Expanded Leadership and Section Directors.  Activity: Comprehensive business review process using ActiveStrategy Enterprise  Date: 6/9/2014  Step: Programmer presented Data Automation Model  Stakeholders: Programmer, IT Directors, Director of Organizational Development, Director of Organizational Performance Metrics  Activity: Programmer presented the Active Data Integration model and documentation. Worked along with IT on automating metrics with program managers.  Date: 6/20/14 - 8/1/14  Step: Comprehensive review and target setting of all ActiveStrategy metrics.  Stakeholders: DOH Broward Director, Senior Leaders and Program Managers  Activity: Comprehensive review of all ActiveStrategy metrics and target setting with the DOH-Broward Director, Senior Leader and Program Manager. Comments made up to date for existing measures have been addressed. Measures are being automated as they are created, reviewed and validated. Objective 1) Deploy a performance management system across all programs and areas. The 2008 DOH-Broward Strategic Plan identified that the organization lacked a centralized comprehensive performance management system to measure, analyze and improve organizational performance. The organization had a fragmented system with minimal accountability and data owners.  DOH-Broward was previously using a Microsoft Excel spreadsheet to capture monthly metrics for several programs. The spreadsheet did not include scorecards by programs nor did any metrics rollup or cascade to other scorecards. A comprehensive multi-level business review process was not systematically conducted. Alignment of programmatic performance indicators to core business indicators was not in place. The Director of Organizational Development researched numerous commercial performance management systems. During monthly meetings with the Senior Leadership staff he presented his findings. In January 2012 the Senior Leadership team decided to institute an effective process to measure their performance with a proven performance management system. After careful consideration, ActiveStrategy Enterprise application was selected in April 2012 as our performance management system for the following reasons: any user can view most up-to-date information tailored to their needs; minimized the need to collect manual data; format spreadsheets; distribute reports; brings relevant data from all existing sources; provides strategic context; and transforms data points into actionable information; track historical information so that trends can be identified; ability to be used during a “live” business review and any information can be viewed and printed as a PDF; drive organizational alignment through communication of strategic plans, setting expectations; identifying responsibilities; achieving goals; creating a cascading framework that aligns programmatic metrics and scorecards to organizational performance; goals; objectives; and initiatives. ActiveStrategy also is used to manage cross functional metrics and scorecards, understand cause and effect relationships, tie strategic goals to operations, align the employees to the strategy of the organization, and clarifies who is responsible at every level of the organization. DOH-Broward contacted ActiveStrategy and discussed the overview of the system, balance scorecards concept, pricing, workshops and deployment of the system. A DOH-Broward ActiveStrategy facilitation team was created to facilitate the deployment of the application that consisted of the Director of Organizational Development, Director of Organizational Performance Metrics, Director of Performance Excellence, IT Director, IT Helpdesk Supervisor, and the Director of Workforce Development. The team was initially trained by the Active Strategy trainers and reviewed all existing organizational metrics. The team created a framework in ActiveStrategy that consisted of the creation cascading scorecards consisting of divisions, programs and sites/units. The existing metrics in the Excel spreadsheet were entered in the system by division and program with their targets and descriptions. Initial and subsequent meetings were conducted with Senior Leaders, Program Managers, Supervisors to update or refine metrics with targets and descriptions. Each senior leader along with their program managers and supervisors were included in each meeting. Programmatic reports from their areas and from their stakeholders were reviewed and used to update the divisional and programmatic metrics and establish targets. New indicators were added and unnecessary indicators were removed. Sources for the indicators are derived from indicators monitored by Federal Programs such as the Refugee Health Assessment Program, Tuberculosis Program or the WIC/Nutrition program, program bureaus from the Department of Health in Tallahassee such as Immunization, community assessments such as the Community Health Assessment, and internal processes such as Fleet Management or Custodial Services. Trainings of program managers, managers, and supervisors were conducted to familiarize them with the system and to enter the historical data. The continuous monitoring of the metrics by the team and the initiation of business reviews led to increase awareness at all levels that the organization was managing processes with data. The next step in innovation was to hire a programmer to automate the data entry of the metrics and pull data into ActiveStrategy from other sources such as Excel spreadsheets and multiple data bases. There are two indicators that measure the results of the performance management system, 1) Scorecard Metrics Submitted by Due Date and 2) Scorecard Metrics that Met Target. The Scorecard Metrics Submitted by Due Date increased from less than 50% in June 2012 to 92% in September 2014. The Scorecard Metrics that Met Target increased from 78.8% in July 2014 to 82.2% in September 2014. 100% of DOH-Broward employees have individual metrics that are aligned to a programmatic indicators or high level scorecards. ActiveStrategy is utilized by some of 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 ranging from the highest organizational level to the individual employee. Objective 2) Create cascading scorecards from the top level down to the employee level. DOH-Broward used the centerpiece of the performance management system, ActiveStrategy, 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. Several 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. This 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, evaluate performance monthly and annually. The application includes indicators that are linked to employee’s SMART metrics on their performance expectations. Objective 3) Create metrics for employees that are linked to their performance evaluations. Leaders at various levels of the organization create employee SMART metrics which are shared and reviewed 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. Objective 4) Establish a comprehensive multi-level scorecard business review process. 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 managing processes.2) Staff  responsible for implementing those processes.3) External stakeholders who have an interest in the outcome of those 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 practice was deployed over a two year period starting in January 2012 and 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. 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 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 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 initial software cost was $60,000 with annual $10,000 license renwal fee. Training and implementation was done internally. DOH-Broward Management Information System team installed software on staff computers and oversee the maintenance and updates of the system.
Objective 1) Deploy a performance management system across all programs and areas.Objective 2) Create cascading scorecards from the top level down to the employee level. Objective 3) Create metrics for employees that are linked to their performance evaluations.Objective 4) Establish a comprehensive multi-level scorecard business review process. 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 implementing a standardized mechanism to evaluate performance based on metrics, 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.  In addition, by aggregating the performance of lower level scorecards to high level scorecards, a culture of shared accountability is created.  That is to say, managers are directly responsible for the performance of their staff, and employee performance determines the manager’s performance evaluation score.  Prior to implementing the performance management system, the organization was reliant on statewide systems that only reported data on an annual basis.  This did not provide an opportunity to make periodic adjustments throughout the year and led to a pass/fail process for meeting targets.  The segmentation of metrics into data points that are sampled more frequently than annually, and subsequent review at the monthly business review meetings, provide the organization the opportunity to make adjustments to underperforming metrics throughout the year as well as highlight metrics that exceed established targets. Primary data sources: My Florida Market Place (MFMP) – Accounts Payable Supervisor - Report Financial Information Resource System (FIRS) Accounts Payable Supervisor – Report PRISM FLAIR Peoples First TRAIN Q-FLOW FLORIDA WISE Health Management System EMDEON FootPrints Secondary data sources: Performance measures used: Based on analysis, 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 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.  Prior to the implementation of the ActiveStrategy performance management system, in 2013, 42% of metrics established by the Florida Department of Health to measure county health department performance met target.  After implementation, 73% of those metrics met target, representing a 31 percentage point increase which is a 75% improvement overall in 2014.  From January, 2014 to July, 2014, the employee evaluations averaged a score of 4.5 out of a possible 5. Scorecard Metrics submitted by due date was 53% as of April, 2014, and increased to 92% by September, 2014.  Scorecard metrics that “Met Target” increased from 78.8% in July, 2014, to 82.2% in September, 2014.  After six months of data collection the agency undertook a comprehensive analysis that resulted in the refinement of all metrics in the ActiveStrategy performance management system. Participation included subject matter experts, Senior Leaders, and Program Managers. As a result of this analysis metrics were better aligned with programmatic objectives.
The lesson learned is “What gets measured gets done”. The implementation of a centralized performance management system allows the organization to integrate multiple scorecards and metrics into cascading scorecards enabling it to measure, analyze and improve organizational performance. This has eliminated the need for multiple independent external applications to track and enter performance measures as well as the creation of charts and graphs. 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. Managers and supervisors do not have to create separate and standalone systems to manage employee or program measures. The ability to have a comprehensive scorecard system that cascades to different levels of the organizations enables the user to better monitor performance of the program and employee. Performance reviews are used to present information to the program as well as to the community partners. The organization is committed in continuing to utilize ActiveStrategy as 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 was a one-time cost. Without any substantial budgetary cuts the agency will be able to sustain the $10,000 annual licensing fee. 
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