2f4 GOVERNING Case Study:4ouenture
Developing a government business culture based on performance management.
f YOU serve thousands ofpeople
and come in under budget, are
YOU running a successful govern-
ment program?|t'shan1tote||un|ess
you measure what the program actually
achieves.
"YOU can monitor the dollars you
spend, or the number of people who
come in the door, and really have nn
idea if You're meeting needs inaway
that iscost-effident.° said Melissa
Pullin, Director ofEHSResu|is.a pro-
gram nf the Massachusetts Executive
Office ofHealth and Human Services
(EOHHS)�
For the agencies that make up
EOHH6. the real needs that their pro-
grams meet are nu longer amystery,
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Thanks tn its EHSReguksinitiative,
which began inZ007.EOHHSis devel-
oping a business culture that focuses
not just ou budgets and processes, but
also on performance management and
measurable results.
Managing performance has been a
tough challenge in the past for EOHHS.
in part because the Secretariat issuch
a large enterprise. Composed of 17
agencies, EOHHS has approximately
Z3.0U0 employees and anannual
budget of$13.5 billion. |tserves
more than I.5million Massachusetts
residents through hundreds ofpro'
grams' delivered by the agencies
themselves and through community-
based serx(ceprovide/a.
Operating on this scale has made
it hard for 0HHSto coordinate strate-
gies'avoiddup|icationandmakesu/e
agencies' programs complement one
another. "There were a lot of opportuni-
ties therethatwedidn'twonttomiss."
Pullin said. "Without reliable perfor-
mance meosures."ghe'a4ded.^such
opportunities often slipped away.^
E0HHS had made previous attempts
to report un outcomes and do cross-
agency planning. But those initiatives
were narrow in scope and tended |n
arise ad hoc, rather than emerge from
a coordinated strategy, Problems
obtaining data (o support outcome-
based decision-makinga|sohampered
those efforts.
Data Supports Decision
The transition (oa truly pedop
manoe'basedcu1tuogartedin
January 2007. when Dr. JudyAnnDigby
arrived as the new Secretary ufEOHHS.
^| found there was a need for our
priorities, budget decisions and pro-
gram iniLiaUvestnbeguidedbydata.^
she said.
|n the fall nf that year, with help
from Accen1ure.E0HHSlaunched
a business transformation program
designed to make performance- based
decision-making the standard operat-
ing pnxedurethmu8huutthe
Secretariat, The initial step was to iden-
tify performance goals and create tools
for measuring progress.
As they launched the EHSResu|\s
initiative, officials atEOHHS defined six
major goal areas� Building Safe
Communities, Educating Kids inOur
[are, PromntingSe|f'Sufficiency
Through Employment, Improving
Wellness and Quality ofHealth [are'
Putting Community First and Support-
ing Effective Government. Secretary
8igby formed six cross-agency working
groups 10 tackle those areas, assigning
senior-ranking representatives ufthe
Secretariat bu head each group.
Members used the working groups
to define the outcomes they wanted
io achieve, and develop measures to
reflect the extent tu which their targets
were met. The groups divided broader
goals into subgua|sto ensure that they
identified goals they could reasonably
measure success with, using approxi-
mately thceetpfiveoutcomemeasures,
For example, the Promoting Self-
ADvsml|NGSUpPuMEMr
Sufficiency ThmughEmploymenLgrnup
created asubgna|: to maximize the
number of targeted adults who get jobs
with health-care benefits. Agencies that
provide employment services track the
progress of their clients who get jobs
with health-care benefits.
Tom Priority for Leadership
"One uf the main cho|lenges.^
Pullin said, "was that many agency
leaders had difficulty making time (o
participate in working 8rnups.,But
measures, EDHH5 worked with
Acceniurctn organize those elements
into strategy maps. "The strategy maps
are the backbone of the work wedo'"
said Pullin. "They're the articulation of
the strategy."
The maps, in turn, provided the
foundation for performance dash-
boaus. Based nndata entered
manually by staff at the agencies, the
dashboards give a quick, easy view of
outcome measures, both current and
historical. A user can see, for example,
the percentage cf adults and children
"I found there was a need for our priorities,
*budget decisions and program initiatives to
ble guided by data."
—Dr, JudyAnn Bigby, secretary, Massachusetts Executive Office of Health and Human Services
top priority, and she expected senior
executives to get behind it. "She was
constantly messaging that this was
very important toher,~ Pullin said.
While support from the top was
essential, EHSResu|tsa|on needed
commitment from the operational staff.
"We have worked very hard toinvolve
business representatives—people in
the agencies who are doing the pro-
grammatic work'" PuUinsaid-
ThroughoutthepmXram.theEHS-
Resu|tsteam emphasized its own role
asafacilitator, not direciur. ''VVe
are constantly reinforcing with our
programs, operations and leadership
teams that they're the experts," Pullin
said, "We're here tu help provide a
strategic alignment structure, central-
ize 1beoutzomedataandpmvidetonb
tu evaluate perhormanoe,"
Pullin and her staff have gone out
of their way to show how performance
management helps agency employees
succeed in their jobs, ''|t's pretty easy to
make this just another layer of work—
another person to report to—as opposed
W something that could really beuseful
and helpful tothem.~ Pullin said.
Once the working 'groups identified
their goals and more than 47Qoutcome
who visited the dentist in the past year,
and how the current number compares
with figures collected over the last few
years. The user can also see an expla-
nation ofihetendinthatmeasure
from the agencies that supplied the
data. "You also see the target we're
trying to meet," Pullin said.
The dashboards offer much detail
and multiple viewing options. For
example, a smoking cessation clash-
board beakodownthepercentageof
adults and students who are smok
oo^andwithindatgroupwh|chae
pregnant women o/ adults with serious
psychological stress, Users can see the
dashboard numbers for the entire state
m specifically for Medicaid ormental
health inpatients. Also, the dashboards
let users view outcomes within one
agency, or see data from multiple
agencies merged into a single view.
E0HHS first developed dashboards
in two goal areas: Promoting Self-
Sufficiency Through Employment,
and Supporting Effective Government.
After working out the details in
those pilots, EDHHS added Putting
Community First, and Improving
Wellness and Quality of Health Care.
Eventually E0HHS will add dashboards
for Building Safe Communities and
Educating Kids in Our Care.
Besides using the data internally,
EOHHS recently incorporated informa-
tion from the dashboards into a new
public Web site, to let residents see how
the state is performing on 45 measures,
including academic achievement for
youth in its care and transitioning indi-
viduals with disabilities from institutions
to communities of their choice. This site
will display a graph representing each
measure; it also will explain why each
measure is important and how the state
is progressing toward that goal. Early
plans call for EOHHS to update the Web
site with new data annually.
"Our goal in launching a public -
facing EHSResults Web site is to
make the work of state government
more transparent, so that consumers,
stakeholders, legislators and policy -
makers have access to concrete data
about our work," Bigby said.
Culture Change
Although the dashboards provide deep
insight into program performance at
EOHHS, the Secretariat's work on perfor-
mance management doesn't end there.
"Throughout the process, we recognized
that the strategy maps and dashboards
weren't going to give us all the cultural
change we needed," Pullin said. EOHHS
is also using performance management
to ultimately govern more effectively.
For example, the Secretariat has
started using outcome measures in
some employees' individual perfor-
mance evaluations. "We have made
a tie between the strategic goals that
come out of EHSResults and senior
managers' individual goals for the
year," Pullin said.
EOHHS is also using the measures
as a basis for setting program priorities
and budgets. Performance data helps
to show which programs are working
and which merit investment.
All this helps make EOHHS more
successful in its work. "EHSResults
allows EOHHS and its diverse agencies
to track our effectiveness, and improve
Percentage of Uninsured Massachusetts Residents
15% .._
10%
.%
.7%
5% o
.7%
0%
2007 2008 2009
EHSResults shows that Massachusetts' current uninsured rate is less
than half the rate of 2007. The state credits this reduction to health
insurance reform in the state.
services and supports on behalf of
our consumers," Bigby said.
While it has brought important
improvements to EOHHS, the
EHSResults program also has
brought a few surprises. One involves
the true nature of the initiative. "We
Pullin didn't expect that she would
need to publish these reports, but they
have turned out to be the most effec-
tive way to get relevant outcome data
to executives on a regular basis. "It
was not realistic to expect them to
log in," she said.
"Our goal in launching a public- facing
EHSResults Web site is to make the work-
of state government more transparent, so
that consumers, stakeholders, legislators
and policymakers have access to concrete
data about our work."
—Dr. JudyAnn Bigby, secretary, Massachusetts Executive Office of Health and Human Services
originally thought it was a technology
project," Pullin said. "It's really not; it's
a business project." Emphasizing busi-
ness processes has kept EOHHS on track
in its quest to develop a performance -
based culture.
Although managers can access a
wealth of performance data through
the dashboards, the EHSResults office
also publishes reports for many execu-
tives. Each presentation is tailored to
each recipient's needs and e- mailed
as a PDF attachment.
However they're delivered, outcome
measures have become an essen-
tial part of the cultural fabric at the
EOHHS. "As Secretary of Health and
Human Services, I use the EHSResults
performance management system
regularly in my meetings with agency
leaders to help guide their priorities,
policies and programs," Bigby said.
"That has made for a forum for good
conversations," Pullin said. "And all of
that flows through to better results for
state residents."
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