In 2011, the State Community Health Services Advisory
Committee (SCHSAC) convened a new standing committee (the
Performance Improvement Steering Committee) to align the
Local Public Health Act performance measures with national
standards. The committee has subsequently introduced new
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measures that align with national standards, and provided
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guidance and training for reporting on them. In 2013,
community health boards (CHBs) began reporting into the Local
Public Health Planning and Performance Reporting
Measurement System (PPMRS) on 35 measures from the national
standards, and on several Minnesota-specific measures related
to workforce competency, organizational quality improvement
(QI), and school health. In 2014, CHBs will continue to report on
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these measures, and will eventually report on the full set of national measures in 2015.
The committee is leading efforts to improve Minnesota’s governmental public health system through the ongoing use of
performance standards, measures and outcome reports that guide quality improvement efforts and decision-making. This system
summary report highlights the following three key findings from PPMRS reporting on the Infrastructure area of responsibility:
1.
2.
3.
CHBs vary widely in capacity;
The system performs well on some measures; and
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There is widespread opportunity to improve, particularly on measures related to planning, workforce and QI.
Figure 1 shows the capacity of Minnesota’s local public health system to meet 35 national measures, as reported into PPMRS
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by all 52 CHBs in 2013. Each horizontal bar corresponds to an individual CHB. The numbers in each bar reflect the number of
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measures that were reported as either fully met, partially met, or not met by each CHB. The 13 CHBs grouped in Quartile 1
(Q1) rank highest in the number of measures they reported being able to fully or partly meet. The 13 CHBs in Quartile 4 (Q4)
rank lowest in the number of measures that they reported being able to fully or partly meet.
 On average, CHBs reported that they can fully meet 13 (37 percent) of 35 national measures, 11 CHBs reported
capacity to fully meet the majority (at least 18) of 35 national measures, and one CHB reported capacity to fully meet
all 35 of them.
 Ten CHBs (29 percent) reported not at all on one third (or more) of the 35 measures, suggesting that many CHBs are
not yet able to even partially meet many of the measures.
 CHBs that reported relatively high or low capacity represented many regions and all types of structures, suggesting
that there is no single best structure or geographic area of the state.
Figure 1. Reported Capacity to Achieve National Measures Reported into PPMRS, Minnesota CHBs, 2012.
Fully Met
0
Q1
Q2
Q3
Q4
5
Single-County CHB
Single-County CHB
Multi-County CHB
Single-County CHB
Multi-County CHB
Multi-County CHB
Single-County CHB
Multi-County CHB
Single-County CHB
Single-County CHB
Single-County CHB
Single-County CHB
Multi-County CHB
35
27
27
25
23
22
21
20
19
18
18
17
17
Single-County CHB
Single-County CHB
Multi-County CHB
Single-County CHB
Single-County CHB
Single-County CHB
Single-County CHB
Single-County CHB
Single-County CHB
Multi-County CHB
Multi-County CHB
Multi-County CHB
Single-County CHB
Single-County CHB
16
16
16
16
16
15
15
15
15
14
14
13
13
13
Single-County CHB
Single-County CHB
Multi-County CHB
Multi-County CHB
Multi-County CHB
Single-County CHB
Multi-County CHB
Single-County CHB
Single-County CHB
Single-County CHB
Multi-County CHB
Single-County CHB
13
12
12
11
10
10
10
9
9
9
8
8
Multi-County CHB
Single-County CHB
Single-County CHB
Single-County CHB
Multi-County CHB
Single-County CHB
Multi-County CHB
Multi-County CHB
Single-County CHB
Multi-County CHB
Single-County CHB
Multi-County CHB
Single-County CHB
7
7
7
6
6
6
5
5
5
4
3
1 20
35
Partially Met
10
15
20
13
11
18
18
18
19
7
17
21
23
23
20
25
17
15
21
9
7
17
16
9
Not Met
17
17
11
7
23
11
15
18
9
15
10
10
10
19
17
15
15
10
16
10
9
25
13
12
13
7
30
10
7
5
35
1
3
5
2
2
7
1
7
5
7
2
4
4
9
5
10
10
10
3
12
4
4
4
7
12
17
8
8
14
9
10
17
8
20
7
19
21
4
12
14
7
7
10
10
15
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Figure 2 shows the performance of the public health system on 35 of the 97 national measures that have been adopted in
Minnesota as LPH Act performance measures. Each bar corresponds to a different measure. The darkest (green) portion of
each bar reflects the percentage of CHBs that reported fully meeting each measure. The more lightly shaded (yellow) portion
of each bar reflects the additional percentage of CHBs that reported partially meeting each measure. Therefore, the combined
height of each bar shows the percentage of CHBs that reported fully or partially meeting each measure.
Capacity to fully meet national measures:
 The majority of Minnesota’s CHBs reported they could fully meet eight of the 35 national measures (noted with an
asterisk). Those eight measures span four domains and relate to communicable disease or environmental health
investigations (one measure), emergency response (two measures), governance (three measures), communicating with
the public (one measure), and community engagement (one measure).
 The majority of CHBs reported they could not fully meet the remaining 27 measures (77 percent).
Capacity to fully or partially meet national measures:
 The vast majority of CHBs (more than 90 percent), reported they could fully or partially meet at least one-third of the
measures.
 At least 75 percent of CHBs were able to fully or partially meet two-thirds of the measures.
Figure 2. Capacity to fully or partially meet 35 national measures, Minnesota CHBs, 2012; in descending order.
100%
Partially Met
Fully Met
Percent of CHBs
75%
50%
***
***
**
25%
0%
35 national measures adopted in Minnesota as LPH Act performance measures
For a brief description of each measure number, see the listing on page 6.
 CHBs reported higher capacity for community health improvement planning—a longstanding requirement of the Local
Public Health Act—than strategic planning, workforce planning, or QI. Most CHBs reported that they did not meet—
even partially—three strategic planning and QI measures. A similar percentage of CHBs (54 percent) reported that they
did not meet a national measure which calls for a workforce development plan.
 Current system capacity reflects a natural progression on many measures that mark stages on a continuum. The
majority of CHBs reported meeting the planning measures that relate to QI and strategic planning processes, whereas
markedly fewer CHBs reported capacity to meet the more advanced implementation or evaluation measures. For
example, more than 70 percent of CHBs reported that they fully or partially meet measures to “Conduct a strategic
planning process.” By comparison, many CHBs are in early stages of implementation, as fewer than 50 percent reported
that they have fully or partially met measures to “Implement the department strategic plan.”
Percent of Community Health
Boards
Figure 3. Capacity to meet national standards related to organizational strategic planning, Minnesota CHBs, 2012.
100%
Fully Met
Partially Met
Not Met
80%
58%
60%
40%
42%
39%
31%
46%
30%
20%
25%
12%
17%
0%
5.3.1A Conduct a strategic
planning process
5.3.2A Adopt a strategic plan
5.3.3A Implement the strategic
plan
In addition to the national measures related to QI capacity, CHBs reported on ten Minnesota-specific measures to assess
organizational QI maturity. Though some agreed that their CHB has a high level of capacity to engage in QI efforts (23 percent)
or that their entire CHB is covered by a QI plan (29 percent), the majority of CHBs disagreed with these statements. Many have
directed considerable attention toward integrating QI into their organizations, and there are early signs of improvement. When
the 2012 PPMRS data is compared to previous assessment findings from 2011, there is evidence that organizational QI
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maturity may be increasing system wide.
The most frequently cited workforce strengths were community engagement (54 percent), leadership (35 percent), and policy
development/program planning (33 percent), though each of these areas was also identified by some CHBs as a gap. The most
frequently cited workforce gaps included informatics (65 percent), knowledge of public health sciences (42 percent), and skills
related to analysis and assessment (29 percent). CHBs varied in how they assessed the workforce. The national standards
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emphasize using the Core Competencies for Public Health Professionals Tool. Approximately 30 percent of CHBs reported
using this tool for their workforce assessment.
There are many hopeful signs that CHBs are making progress toward the national standards. More than 90 percent of CHBs
reported capacity to fully or partially meet one-third of the 35 national measures included in 2012 PPMRS reporting. Though
relatively few CHBs reported capacity to meet measures related to strategic planning and QI, this baseline reflects the concerted
action already underway within the state-local partnership to improve in these areas. It is important to note that each of the 35
national measures is fully met by at least one, and in many cases several CHBs. This finding underscores the opportunity to
capitalize on mounting capacity and leadership within the system. Further system-wide progress toward the national standards
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will promote efficiency and effectiveness, and will also facilitate preparation for voluntary national accreditation.
This is a starting point and we recognize there are limitations. All reporting is self-report. In 2013, all CHBs began reporting on
new infrastructure performance measures, and some multi-county CHBs reported together for the first time. MDH consulted
with the committee on training and reporting guidance to ease the transition and standardize reporting. Though this summary
report represents an important milestone, as CHBs become more familiar with the measures, and more consistently use
reporting guidance, MDH can be more confident that findings accurately reflect “true” system capacity.
On the infrastructure measures discussed here, multi-county CHBs were directed to report on the lowest level of capacity
among the individual health departments of the CHB. Since capacity and services vary within many multi-county CHBs, the
capacity of an individual local health department may exceed that of the overall CHB.
This summary report marks a progression in the cycle of performance management from Measurement to Monitoring and
Communicating Progress. To realize the full cycle of performance management, the committee is using this 2012 baseline data
to make recommendations for system improvement. Sound decision-making for this performance management system hinges
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on quality data. The committee urges consistent use of reporting guidance and standard reporting by all CHBs.
For more information, please contact Becky Buhler by phone (651-201-5795) or email ([email protected]).
A comprehensive data book (Communicating Progress on Minnesota’s Local Public Health Act Performance Measures:
2012 Data Book) features graphs and tables reviewed by the committee. This resource is available at
www.health.state.mn.us/ppmrs for those who want more detailed information for each local public health performance measure,
including findings for other areas of responsibility.
This report was supported by funds made available from the Centers for Disease Control and Prevention, Office for State, Tribal,
Local and Territorial Support, under grant no. 5U58CD001287. The content in this report is that those of the authors and does not
necessarily represent the official position of or endorsement by the Centers for Disease Control and Prevention.
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SCHSAC Performance Improvement Steering Committee. (2012). New Local Public Health Act Performance Measures for the Planning and
Performance Measurement Reporting System (PPMRS) (PDF: 911KB / 34 pages).
2
To view the webinar recording or access reporting guidance, refer to: PPMRS: 2013 LPH Act Performance Measures.
3
In 2014, CHBs will report again on these infrastructure measures, and will begin reporting on new service measures in the other areas of
responsibility. In 2015 (and every five years thereafter), CHBs will report on the full set of national measures. For more information on new
measures to be introduced in 2014, refer to: PPMRS: 2014 LPH Act Performance Measures. For more information on longstanding measures
of health informatics, which continue to be included in the Infrastructure area of responsibility, refer to: Minnesota e-Health Assessment
Reports, Factsheets and Briefs: Local Public Health.
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A comprehensive data book (Communicating Progress on Minnesota’s Local Public Health Act Performance Measures: 2012 Data Book)
features graphs and tables reviewed by the Committee. This resource is available online for those who want more detailed information for
each local public health performance measure, including findings for other areas of responsibility.
5
On January 1, 2013, the Redwood-Renville CHB split, Redwood joined Southwest HHS, Renville joined Kandiyohi to become KandiyohiRenville, and Polk joined Norman-Mahnomen to become Polk-Norman-Mahnomen. Thus, as of this date, 50 CHBs exist in Minnesota.
However, because reporting that occurred in 2013 was on 2012 data, the CHBs noted above reported as their pre-2013 entities, and thus 52
CHBs reported on 2012 data in 2013.
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Definitions for fully, partly and not meeting each measure are included in reporting guidance available at: PPMRS: 2013 LPH Act Performance
Measures.
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Some caution should be used in comparing 2011 and 2012 data, due to differences in reporting between the two time frames.
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For more information, refer to: Public Health Foundation: Competency Assessments for Public Health Professionals.
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SCHSAC Performance Improvement and Accreditation Workgroup. (2010). National Public Health Standards and Voluntary Accreditation:
Implications and Opportunities for Public Health Performance Improvement in Minnesota (PDF: 725KB / 56 pages).
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To view the webinar recording or access reporting guidance, refer to: PPMRS: 2013 LPH Act Performance Measures.
The numbers associated with each measure reflect the numbering system used by the Public Health Accreditation Board
(PHAB), and correspond to the measure numbers in Figure 2.
1.1.3 A
Ensure that the community health assessment is
accessible to agencies, organizations, and the
general public
7.1.3 A
Identify gaps in access to health care services
7.2.2 A
Collaborate to implement strategies to increase
access to health care services
1.2.1 A
Maintain a surveillance system for receiving reports
24/7 in order to identify health problems, public
health threats, and environmental public health
hazards
7.2.3 A
Lead or collaborate in culturally competent
initiatives to increase access to health care services
for those who may experience barriers due to
cultural, language, or literacy differences
1.3.2 L
Provide public health data to the community in the
form of reports on a variety of public health issues,
at least annually
8.2.1 A
Maintain, implement and assess the health
department workforce development plan that
addresses the training needs of the staff and the
development of core competencies
9.1.1 A
Engage staff at all organizational levels in
establishing or updating a performance
management system
9.1.2 A
Implement a performance management system
9.1.3 A
Use a process to determine and report on
achievement of goals, objectives, and measures set
by the performance management system
9.1.4 A
Implement a systematic process for assessing
customer satisfaction with health department services
9.1.5 A
Provide staff development opportunities regarding
performance management
9.2.1 A
Establish a quality improvement program based on
organizational policies and direction
9.2.2 A
Implement quality improvement activities
1.4.2 T/L Develop and distribute tribal/community health
data profiles to support public health improvement
planning processes at the tribal or local level
2.1.4 A
Work collaboratively through established
governmental and community partnerships on
investigations of reportable/disease outbreaks and
environmental public health issues
2.2.3 A
Complete an After Action Report following events
2.4.2 A
Implement a system to receive and provide health
alerts and to coordinate an appropriate public
health response
3.1.1 A
Provide information to the public on protecting
their health
3.1.2 A
Implement health promotion strategies to protect
the population from preventable health conditions
4.1.1 A
Establish and/or actively participate in partnerships
and/or coalitions to address specific public health
issues or populations
5.2.1 L
Conduct a process to develop community health
improvement plan
5.2.2 L
Produce a community health improvement plan as
a result of the community health improvement
process
5.2.3 A
Implement elements and strategies of the health
improvement plan, in partnership with others
5.2.4 A
Monitor progress on implementation of strategies
in the community health improvement plan in
collaboration with broad participation from
stakeholders and partners
5.3.1 A
Conduct a department strategic planning process
5.3.2 A
Adopt a department strategic plan
5.3.3 A
Implement the department strategic plan
6.3.4 A
Determine patterns or trends in compliance from
enforcement activities, and complaints
10.1.1 A Identify and use applicable evidence-based and/or
promising practices when implementing new or
revised processes, programs and/or interventions
11.1.3 A Maintain socially, culturally, and linguistically
appropriate approaches in health department
processes, programs, and interventions, relevant to
the population served in its jurisdiction
12.2.1 A Communicate with the governing entity regarding
the responsibilities of the public health department
12.2.2 A Communicate with the governing entity regarding
the responsibilities of the governing entity
12.3.1 A Provide the governing entity with information about
important public health issues facing the health
department and/or the recent actions of the health
department
12.3.3 A Communicate with the governing entity about
assessing and improving the performance of the
health department