pullin

Commonwealth of MassachusettsExecutive Office of Health and Human Services

Overview Presentation by

Melissa Pullin, Director of EHSResults

November 2009

Managing Performance. Focused on Results.

http://www.usembassy.de/usa/stateimages/massachsuettsseal.jpg

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EHSResults!Context: Overview of EOHHS

EHSResults Overview 10/09

Massachusetts Executive Office of Health and Human Services (EOHHS) is comprised of 16 state agencies, including …

Medicaid (MassHealth) Mental Health

Public Health Elders

Transitional Assistance Veterans

Developmentally Disabled Blind; Deaf & Hard of Hearing

It has an annual budget of approximately $13.5B, or about half of the Commonwealth of Massachusetts budget

It employs about 23,000 employees and contracts with approximately 1,000 human service providers

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EHSResults!EOHHS Call to Action

“We need to transform to a culture that is outcomes-focused, not just budget- or process- focused. We need to talk more often and openly about what our policy and program goals are, and use performance information that communicates how well we are achieving those goals as the starting point for our management discussions, rather than an after-the-fact reporting requirement. This change in culture is not easy, and will take several years.”

Dr. JudyAnn BigbySecretary, Executive Office of Health & Human ServicesNovember 2007


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EHSResults!Why (and How) Performance Management?

The National Performance Management Advisory Commission recently identified three fundamental government challenges that are addressed through the use of performance management:

Need to focus the organization on results that are important to stakeholders

Need to improve results within resource constraints

Need to gain and keep the public’s trust and confidence

They also summarized the three main approaches that governments may choose from in defining their performance management process:

“Stats” approach (think CompStat program in NYC; CitiStat program in Baltimore)

Balance Scorecard (think Kaplan and Norton approach)

Strategic planning cascading system of objectives, strategies & measures (think EHSResults)

Source: National Performance Management Advisory Commission“A Performance Management Framework for State and Local Government: From Measurement & Reporting to Management & Improving”Public Review Draft, July 2009


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EHSResults!Our Approach & Main Work Streams

At the beginning of the Patrick Administration, EOHHS began an exciting initiative called EHSResults

EHSResults takes an innovative approach to performance management, aiming to foster transparency, accountability, creativity and cross-agency collaboration

Four Main Work Streams Support Our Approach:

Strategic Goal Area Maps & Associated Outcomes

Intranet-Based Dashboard Reporting Tool

Associated Performance Management Activities

Public Awareness of Our Strategic Goals and Performance


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EHSResults!Strategic Goal Area Maps







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EHSResults!Approach to Strategic Goal Area Maps

The strategic goal area maps identify cross-agency, Secretariat wide goals and sub-goals that address the question, “What should EOHHS deliver to Massachusetts residents?”

Supporting outcome measures identified from agency programs provide indicators of how well EOHHS is meeting its goals, and answer the question, “How does EOHHS know if it is accomplishing its goals?”


EOHHS’ strategic goal area map development was lead by cross-agency leadership identified by Secretary Bigby

Strategy “maps” were developed for each of the EHSResults strategic goal areas

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EHSResults!Strategic Goal Areas Compliment the Administration’s Work

EffectiveGovernment

Jobs & Self Sufficiency

Safe Communities

Educating Kids in

Our Care

CommunityFirst

Civic Engagement

AffordableHousing

Clean EnergyAnd Housing

EfficientTransportation &

Mobility

SafeCommunities

Economic Growth andJob Creation

Effective Government

Quality, Affordable Health

Care for All

World Class Education

MassGOALS Reporting Areas

Wellness andQuality

Of Health Care

EOHHS’ strategic goal framework is rooted in the Patrick Administration’s original priority areas

EOHHS’ Strategic Goal Areas


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EHSResults!Strategic Goal Areas Highlight our Agencies’ Important Work

• Ensure access to education related programming, services & opportunities for children & youth in EOHHS care• Maximize school attendance and engagement for children & youth in EOHHS care• Maximize stability in education programs for children & youth in EOHHS care• Maximize educational success for children & youth in EOHHS care

• Provide client-centered customer service• Develop & maintain a high performance workforce• Improve internal efficiencies• Increase efficiencies and quality of the POS system

• Surveillance – Monitor key indicators of safe communities• Preparedness – Develop infrastructure to support safe communities• Prevention – Deliver proactive & targeted services to individuals, families & communities• Intervention – Intervene where needed to ensure safety of individuals, families & communities

• Ensure access to care• Advance health care quality• Contain health care costs• Promote individual wellness• Promote healthy communities

• Increase accessibility & diversity of available jobs for targeted residents through policy & employer outreach• Provide employment support services for targeted adults• Maximize number of targeted adults who move toward self-sufficiency and independence through employment• Successfully transition EOHHS youth entering the workforce



Safe Communities

Wellness & Quality of Health Care

EducatingKids inOur Care

• Help individuals transition from institutional care• Expand access to community-based long-term support• Improve the capacity and quality of community-based long-term supports• Promote awareness of long-term supports

Community First


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Cross-agency development of the Strategic Goal Area Maps resulted in Secretariat-wide goal statements that are supported by agency-specific outcome metrics

EHSResults! Approach to Identifying Goals and Outcomes

Provided supporting agency level outcomes to track success at meeting goals

Identified multiple sub-

goals necessary to deliver highest

level goals

Defined EOHHS’ highest level goals, ensuring alignment within and between agencies & EOHHS

Example within Jobs and Self Sufficiency Goal Area:

Goal

Sub-Goal

Outcome MeasureOutcome Measure

Outcome Measure

Maximize number of targeted adults who move toward self-sufficiency and independence through employment

Maximize number of targeted adults who obtain health benefits from employers

Percent of individuals with disabilities with employer sponsored health benefits at time of employment

Sub-GoalSub-Goal


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EHSResults!Strategic Goal Area Map Example

EHSResults Overview 10/09(Strategic goal area map showing illustrative example)

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EHSResults!Major Strategic Goal Area & Outcome Accomplishments to Date

EOHHS Strategic Goal Areas and Outcome Measures

EffectiveGovernment


Safe Communities

Educating Kids in

Our Care

CommunityFirst

Wellness andQuality

Of Health Care


Strategic goal area maps have been developed for each of the six goal areas, resulting in

25 major goal statements

About 75 subgoal statements

Approximately 50 - 100 associated outcome measures per map

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EHSResults!Executive-Level, Intranet-Based Dashboards







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EHSResults!

We’ve started developing “dashboard” reporting for EOHHS executives


EffectiveGovernment


Safe Communities

Educating Kids in

Our Care

CommunityFirst

Wellness andQuality

Of Health Care

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EHSResults!Internal Reporting Promotes our Goals & Helps Us Evaluate Performance

EOHHS is focused on our strategic goals and measuring our success; We’re developing internal reporting on our goals & measures, available to EOHHS leadership

Jobs &Self Sufficiency

Safe Communities

Wellness and Quality

Of Health Care

Educating Kids in

Our Care



Goal Area Summaries Outcome Measure Details

Community First

EHSResults Overview 10/09(Summary & detail are illustrative examples)

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EHSResults!

Agency Outcome Measures

Agency specific outcome measures provide another way to view strategic goal measures and include agency identified indicators that monitor how well each agency is meeting its own goals

CHE DMH

MCBHCF MRC VET

DYSDPHDDS

ELD MCDHLY ORI

EHSDTADCF



EHSResults Overview 10/09(Summary & detail are illustrative examples)

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In addition to its executive-level dashboard reporting, EHSResults produces “paper” reports and emails them to executives for regularly scheduled meetings and ad hoc uses

EHSResults!Pushing Reports to Executives

EHSResults Overview 10/09(Report data are illustrative examples)

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EHSResults!Dashboard Reporting Accomplishments to Date

CHE DMH

MCBHCF MRC VET

DYSDPHDMR

ELD MCDHLY ORI

EHSDTADCF



EffectiveGovernment


Safe Communities

Educating Kids in

Our Care

CommunityFirst

Wellness andQuality

Of Health Care


Dashboard reporting has been developed for four of our six strategic goal area maps representing

Approximately 500 EOHHS strategic goal area outcome measures

Around 80 agency-specific outcome measures

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EHSResults!Other Performance Management Activities







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EHSResults!Associated Performance Management Activities


Examples of other performance management activities at EOHHS include:

Fiscal year priority development for 2009Last year, EOHHS identified three FY priority initiatives; For each of those

areas we developed business plans (including things like ROI’s, competitive environment analyses, etc.), milestones and outcome measures for reporting

Recurring EHSResults “spotlight” in weekly HR newsletter to all employees

Individual manager performance objectives tied to EOHHS strategic goals Completed for FY09 cycle with higher level managers ; Each

manager identified 3 – 5 performance objectives using EHSResults goal area structure

FY09 and FY10 “Results Plans” (f/k/a budget spending plans) tied to ResultsAgencies were asked to identify their top 3 – 5 priorities including associated performance measures, caseload and spending

estimates

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EHSResults!Public Awareness of Our Work







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EHSResults!We’re Going Public


We will soon be promoting our work publicly through our mass.gov/eohhs internet site and other channels

Goal is to launch first version of web presence in January 2010

Content will be relatively static but help promote EOHHS’ use of performance management & our high-level strategic goals & performance measures

Content & design work currently underway

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EHSResults!

The Holy Grail


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EHSResults!Tying Outcomes to Budget


Our research has shown that a few (but not many) larger government entities in North America are making a strong tie between performance management & their budget process

Notable examples include the Commonwealth of Virginia (Virginia Performs program), the Ontario Ministry of Health and Long Term Care, and Washington State (GMAP)

Most successful outcome-to-budget ties seem to be centered around providing useful information, not creating a punitive environment; Most took several years to set up

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For EOHHS, tying performance outcomes to budget would have many benefits, including

Providing a fact basis for what programs are delivering desired results

Understanding the relationship between $$ and outcomes and using this data to drive investment decisions

Providing data points for setting priorities in budget cutting environments

Better informing the public about how and why we spend our $$

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We have taken several passes at making “the tie” but have encountered stumbling blocks

Our EHSResults approach using strategic goals was meant to encourage creative thinking and participation, not shoe-horn our activities into spending buckets

Programs are often not designed around single outcomes and, by design, they often combine multiple outcomes to best meet client needs

A budget “unit” is not consistently defined within and across EOHHS

Monitoring a budget / performance tie requires lots of resources

Cultural resistance (to target setting and linking outcomes to $$s) is real and needs to be factored into systematic changes

Our goals and measures do not represent everything we do

Because of those challenges, EOHHS is taking an incremental approach to starting the outcome-to-budget tie by using the spending plan process


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Departments identify 3 – 5 strategic priorities for the FY. For each strategic priority they provide:

A brief overview for each, including things like changes from last FY, milestones, challenges / risks, populations served & caseload estimates

Estimated spending / funding and clients or units of service in order to derive a spending per client or unit of service estimate

Three to five associated outcome measures, including targets and prior year actuals

EHSResults!Using the Spending Plan Process as Step 1


EOHHS uses its spending plan process to request priorities, outcomes and strategic ties from Agencies …

… This type of strategic priority information is the basis for much of the agency spending plan conversation with the Secretary

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EHSResults!

Lessons Learned


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EHSResults!Lessons Learned: Our Overall Approach

What started out as a technology project isn’t that at all

In the concept stage, we were an 80:20 technology to business resource split. In reality, we are a 75:25 business to technology split.

Outcomes, metrics, measures… We can use the same words & mean different things

Different organizations & approaches use the same words in different ways. We check with users to ensure our vocabulary is understood & matches our intent.

Both program managers & leaders often default to identifying process measures

Caseload & dollars are traditional measures. We are constantly reminding staff and ourselves that we need to focus on client results / outcomes.

We maintain credibility by remaining facilitators; we’re not subject matter experts

The agencies and EOHHS leadership know their programs, data and environment. Our goal is to facilitate change & empower others to use it.

Top dog EOHHS support and agency champions are necessary for our success

Our Secretary promotes & requires participation; our agency “business representatives” keep projects moving.


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EHSResults!Lessons Learned: Dashboard Reporting

Most (all?) of our executives don’t know their passwords and don’t want to log on

In our culture, we need to email and promote “canned” (.pdf) reports. Our initial expectation that executives would log on to see data was unrealistic.

Targets make some people uncomfortable and some people downright cranky

Our reporting compares actuals to targets. Some agencies did not have or resisted setting targets, some did not feel directly responsible for the result.

Sometimes we take the Big Brother approach to changes and enhancements

Optimally, business users would request new functionality. When they don’t, we make educated guesses about what might be helpful.

Users prefer to see only measures they “own”, not by EOHHS strategic goal area

Although we report by agency view, we also report by goal area so enterprise-wide policy implications & cross-agency comparisons are visible.

What to measure? Check. How to get to data? Check. Now what do we DO with it?!

Identifying, capturing, providing context & reporting the data is big. But figuring out how to use the data and analysis is the real bugaboo…


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EHSResults!Lessons Learned: Non-Reporting Activities

We exploit all reasonable opportunities to embed ourselves into on-going activities

Whether it’s budget exercises or leadership meeting agendas or HR employee communications, we try and embed our work into people’s daily work in order to promote performance management at EOHHS & increase name recognition.

A lot of our unit’s time is required to communicate our messages

EOHHS employees, dashboard users, data owners, the public, clients, advocacy groups… yipes! We try to segment stakeholders & communication strategies

Leadership’s use of our reporting in on-going meetings is vital

Our Secretary made our reports a mandatory agenda item at her regular meetings with Commissioners. Guess what? People now pay more attention.

We strive to be an operational unit & not perceived as administration-based

We previously used consultants but are switching to an FTE-only staffing model. We hope this promotes stability, saves money & limits our exposure to funding cuts. We constantly reinforce the message that we are here to stay…


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EHSResults!

Questions? Comments? Ideas? Advice?


Melissa Pullin

Director, EHSResults

[email protected]

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