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The CRC vision is our starting point for the development of a performance management framework for public health in Ontario. Walk through model and note that we are starting with the public report (as we need to start somewhere!!) Note: current projects underway with ICES are: 1. The identification of sentinel public health indicators at the provincial and local levels. These would be used for risk management assessment purposes and would likely trigger further analysis and investigation. They could be process or outcome indicators that may or may not be within the control and mandate of the public health units or government. 2. An evaluation of the efficacy of traditional public health interventions e.g. do food premise inspections have an effect on decreasing the rates of food-borne illnesses? It would be necessary to narrow the scope of the literature search to a small number of representative interventions, rather than trying to assess the full spectrum. 3. An interjurisdictional analysis of effective performance management within the public health system. How other jurisdictions are managing this issue e.g. inspections, assessments, mandatory reporting. How are other jurisdictions reporting publicly on public health performance e.g. report cards, balanced scorecards? What correlations have been identified in other jurisdictions between effective public health performance and other factors, such as funding, leadership, organization, accreditation?
Public Health Funding Review and Performance Management ...
Public Health Funding Review and Performance Management Initiatives Presentation to alPHa’s “Back to Business” Conference Public Health Practice Branch February 25, 2010
Contents <ul><li>Public Health Funding Review </li></ul><ul><li>Public Health Performance Management </li></ul>
Overview <ul><li>The MOHLTC is in the midst of developing a process and proposal for reviewing the provincial funding provided to public health units under Program-Based Grants. </li></ul><ul><li>The funding review is expected to take a holistic approach to public health unit funding and will examine the funding for mandatory programs and related programs (i.e., unorganized territories). </li></ul><ul><li>This review will determine: </li></ul><ul><ul><li>current levels and sources of funding </li></ul></ul><ul><ul><li>current expenses and cost pressures </li></ul></ul><ul><ul><li>variances among public health units </li></ul></ul><ul><ul><li>potential models for funding, risk/impact analysis, and implementation approaches </li></ul></ul>
Assumptions <ul><li>Funding inequities likely exist due to historical funding patterns that have been maintained through across-the-board increases. </li></ul><ul><li>The new funding model must be: </li></ul><ul><ul><li>transparent </li></ul></ul><ul><ul><li>equitable </li></ul></ul><ul><ul><li>stable (allowing for multi-year planning) </li></ul></ul><ul><ul><li>amendable to year-by-year adjustments based on updated information </li></ul></ul><ul><ul><li>related to performance outcomes as defined in Accountability Agreements </li></ul></ul><ul><ul><li>flexible enough to address unexpected pressures </li></ul></ul><ul><li>No new funding will be available as a result of this review. </li></ul><ul><li>Existing funding will not be reallocated or redistributed as a result of the review. </li></ul><ul><li>Any funding adjustments would be implemented on an incremental basis using increases to overall provincial funding envelope. </li></ul>
Key Elements to be Considered <ul><li>Prior reviews (1996 and 2001) have looked at a two or three component funding formula. </li></ul><ul><ul><li>Base funding to support public health unit infrastructure </li></ul></ul><ul><ul><ul><li>Allocation based on per capita funding – with possible adjustment for demographics (i.e., dependent populations) </li></ul></ul></ul><ul><ul><li>Adjustment for service cost variables such as geographic dispersion (to reflect costs of travel/multiple offices) and home language (to reflect costs of serving multicultural populations and Francophones) </li></ul></ul><ul><ul><li>Equity Factors </li></ul></ul><ul><ul><ul><li>Socio-economic determinants of health (i.e., education, low income) </li></ul></ul></ul><ul><ul><ul><li>Population health status (i.e., premature deaths) </li></ul></ul></ul><ul><ul><ul><li>Health behaviors (i.e., smoking, physical inactivity, obesity, heavy drinking) </li></ul></ul></ul>
Timeline Coincides with implementation of Accountability Agreements Coincides with negotiations with Boards of Health about Accountability Agreements Internal Data Gathering and Analysis (November 2009 to March 2010) Meetings of Funding Review Working Group (March to June 2010) Field Consultation (Summer 2010) Finalization of Report and Recommendations (Fall 2010) Implementation of new model (January, 2011) Process Evaluation (Fall, 2011)
Objectives <ul><li>The Performance Management framework is driven by the following objectives, which are based on the Capacity Review Committee (CRC) vision: </li></ul><ul><ul><li>To enable the provincial government and the public health sector: </li></ul></ul><ul><ul><ul><li>To assess and demonstrate the extent to which Ontario’s public health system achieves success efficiently and effectively; </li></ul></ul></ul><ul><ul><ul><li>To ensure that Ontario’s public health system meets standards and expectations; and </li></ul></ul></ul><ul><ul><ul><li>To promote continuous quality improvement in Ontario’s public health system. </li></ul></ul></ul><ul><li>Additionally, it is important that the performance management strategy demonstrate the contribution of public health to the health care sector </li></ul>
Organizational Standards <ul><li>CRC recommended introduction of organizational standards to support organizational accountability and capacity. </li></ul><ul><li>Organizational standards provide a baseline of expectations that allows for an assessment of the functioning the whole system – HR capacity, governance practices, planning skills, identification of priority populations, responding to change over time, etc. </li></ul><ul><li>The standards contain expectations of both the elected board of health as the governing body and the public health unit as the administrative arm of the organization. </li></ul><ul><li>Because these standards reflect current thinking on best practices, it is assumed that achievement of the standards will not be onerous since mature, well functioning boards of health are likely to already be adhering to practices that are in line with the standards. </li></ul>
Proposed Consultation & Communication Process on Organizational Standards Discussions with PMWG (Oct/Nov) Fall 2009/Winter 2010 Winter/Spring 2010 Focus Group (March) issue-specific discussions Spring/Summer 2010 Communications/ Education with Field Internal Government Approval Process of Final Draft 1 st Draft of Standards Standards Implemented (Jan 2011) Review of 1 st Draft by PMWG Final Draft of Standards Consultation 2 nd Draft of Standards E-Survey (April) Summer/Fall 2010
Accountability Agreements <ul><li>Accountability Agreements will incorporate existing Program-Based Grants Terms and Conditions and Performance Management for mandatory and related programs. </li></ul><ul><li>Accountability Agreements may include additional programs funded by MOHLTC, Ministry of Health Promotion and Ministry of Children and Youth Services. </li></ul><ul><li>A Joint Board of Health/Ministries Committee will be convened in spring 2010 to review/revise the Accountability Agreement content and scope. </li></ul><ul><li>Accountability Agreements are to come into effect for January 1 st , 2011. </li></ul><ul><li>Agreements will set out obligations of the ministry and boards of health for a 3-year period, with an annual refresh of performance expectations and financial data. </li></ul><ul><li>Accountability Agreements scope and content are expected to evolve over time. </li></ul>
Accountability Agreements (cont’d) <ul><li>Accountability Agreements will also set out performance measures for key priority areas. </li></ul><ul><li>Where data are available, performance targets will be negotiated to help move health units from “good” to “better”. </li></ul><ul><li>Additional measures may be incorporated in Accountability Agreements to address issues specific to certain health units. </li></ul><ul><li>Individual meetings between boards and the ministry will be conducted to finalize Accountability Agreements in fall 2010 once the Joint Board of Health/Ministries Committee approves the template. </li></ul>
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