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Paul Niven
PACE Performance | Senalosa Group
Contributions | Galen P. Carver & Reid A. Block
Strengthening Public Health Infrastructure
for Improved Health Outcomes with
Enterprise Performance
Management
Executive Summary | The Challenge	 2
Whitepaper Highlights	 3
Key Areas for Public Health Infrastructure Investment	 4
Enterprise Performance Management Definition and Framework	 5
The Building Blocks of Enterprise Performance Management	 6-7
Enterprise Performance Management Design, Execution, and
Overcoming Common Barriers 	 8
CDC—COTPER Success Story	 9
The Benefits to Organizations when Enterprise Performance
Management is Implemented and Common Tools	 10
The Balanced Scorecard	 11-12
The Mississippi State Department of Health Journey to
Enterprise Performance Management 	 13
Summation	 14
The PACE Performance | SENALOSA Group Public Health
Enterprise Performance Management Leadership Team	 15
Table of Contents
2
The Challenge
Public Health Agencies have been primed by the CDC to Strengthen
Public Health Infrastructure for Improved Health Outcomes by becoming
Enterprise Performance Management focused organizations.
The question many Public Health Officials are asking:
“So...how do we do it?”
executive summary:
ASTHO’s recent Profile of State Public
Health Agencies (volume one) states that close
to 40 percent of State Health Agencies identified
“Implementing quality improvement/performance
management” as a top five priority.
Public Health Agencies are fortunate to have
staff experts in such vital areas of Public Health
as: disease analysis, preparedness, monitoring the
health of the state’s population, and health care
reform, but often— experienced business acumen is
missing from the Public Health Agency.
The ASTHO survey illuminates that less than
10 percent of state health officials possesses an
MBA. Of course, in many respects such a skewed
balance is appropriate; Public Health agencies
should be primarily equipped with experts in Public
Health. But in order to fulfill the requirements of
the CDC’s Enterprise Performance Management
and Infrastructure improvement program Public
Health Agencies will need additional performance
management assistance focused on the business and
information technology departments.
Questions to consider while
reading this paper:
• What are the timeless principles that guide
the Agency?
• What is the Agency’s core purpose?
• Does everyone in the organization have a shared
vision of the ideal future?
• Have broad priorities been created that’ll be used to
make important decisions?
• Has strategy been communicated to all
stakeholders and staff?
• Are there strategic metrics that measure the
achievement of the Agency strategic objectives?
• Are all Agency staff aligned with Agency goals?
• Is strategy at the center of everything the
Agency does?
“The goal of the Strengthening Public
Health Infrastructure for Improved Health
Outcomes program is to systematically
increase the performance management
capacity of public health departments in
order to ensure that public health goals
are effectively and efficiently met.” – CDC
3	 Strengthening Public Health Infrastructure For Improved Health Outcomes With Enterprise Performance Management
Highlights
Sebelius announces $42.5 million for public health improvement programs through the Affordable Care Act
“These funds will help health departments around the country to improve the quality and effectiveness of the
critical health services that millions of Americans rely on every day,” said Secretary Sebelius. “Strengthening our
public health system through better coordination and collaboration will help to deliver higher quality health care
more efficiently.”
Questions answered
in this paper:
• What is Enterprise Performance
Management (EPM)?
• How is EPM achieved?
• What are the building blocks of EPM?
• How is EPM measured | reported?
• How is EPM sustained?
Paper Highlights:
• Performance management tools can be applied
simply and seamlessly, providing a positive
impact on Public Health outcomes.
• The Mississippi Department of Health recognized
the power of performance management tools and
is using them to re-invigorate their operations.
• In a recent ASTHO survey, close to 40 percent of
State Health Agencies identified “implementing
quality improvement/performance management”
as a top five priority.
• Many agencies lack the business skills necessary
to implement quality improvement and perfor-
mance management.
• “Mission, values, vision and strategy may be
considered the building blocks of organizat-
ional success.”
• “The PACE Team is a workforce multiplier
that allows my staff to bypass time. Pace’s
understanding of our business and technology
objectives, and our all- consuming technical hurdles
accelerates the implementation of automated pro-
cesses and provides meaningful insight into
our reams of data.” — Marc Wilson | CIO—
Mississippi State Department of Health (MSDH)
• The barriers of strategy execution can be overcome
with the use of simple, yet powerful, communica-
tion and measurement systems.
• These tools allow organizations to fully articulate
their building blocks of success to an employee
audience hungry for such information. As well,
they provide measurements used for accountability,
improved decision-making, and generating align-
ment from top to bottom.
• Seventy-five percent of an organization’s value
is created from intangible assets, thus it’s impera-
tive we identify and track these key enablers of
strategy execution.
4
KeyAreas Infrastructure Investment
“These funds are a down payment on improving public health services across the na-
tion,” said Dr. Judith A. Monroe, CDC’s deputy director for state, tribal, local
and territorial support. “With these funds, we will help our nation’s public health
departments work more effectively and efficiently to detect and respond to public
health problems. This program will strengthen the nation’s public health system and
our ability to improve the health and well being of all Americans.”
In public health, a strong infrastructure provides the
capacity to prepare for and respond to both acute and
chronic threats to the Nation’s health, whether they are
bioterrorism attacks, emerging infections, disparities in
health status, or high rates of chronic disease and injury.
Core public health infrastructure includes continu-
ous performance measurement and quality improvement
capacity to assure that the systems supporting public
health services and programs are; Robust and efficient,
Increasing Workforce capacity and competency,
Improving Laboratory systems, and Maximizing Health
Informatics.
KEY AREAS
• Performance Management
• Policy and Workforce Development
• Public Health System Development/
Redevelopment
• Best Practice Implementation
Health Promotion and
Disease Prevention
• Food- and water-borne disease identification
and prevention
• 	Prevention of healthcare-associated infections
• 	Leading causes of death and, once available, National
Prevention and Health Promotion Strategy priorities
Public Health Policy and
Public Health Law
• 	Capacity to support structural and environmental
changes in the community to promote health
• 	Capacity to assist in changing or enforcing policies,
laws, ordinances, regulations or national standards
that provide for more effective public health practice,
including increased linkage to the health care system
Health IT and Communications
Infrastructure
• 	Vital statistics system (e.g., electronic birth and death
registration and certificates) to describe the health of
populations as well as individuals
• 	Electronic health record/IT systems to improve quality,
safety, decision-making and population-based care
• 	Communications systems and processes (e.g.,
information syndication and social media capacity)
to make populations aware of health promoting
behaviors and clinical interventions
Workforce and Systems
Development
•	Broad-based public health workforce training to
support health reform (e.g., e-learning and other
training, fellowship programs)
•	Laboratory and epidemiologic capacity to enhance
the behavioral, clinical and environmental changes
brought about by health reform
•	Public health program and public health system
transformation (e.g., changes to how the health
department is organized and functioning to provide
for more effective and efficient use of resources
and more effective public health practice, including
increased linkage to the health care system).
5 	 Strengthening Public Health Infrastructure For Improved Health Outcomes With Enterprise Performance Management
EPM Defined
Framework
Enterprise Performance Management (EPM) excellence consists of integrated management and analytical
processes | tools that are supported by technology. Enabling organizations to optimize performance by
defining their Mission, Values, and Strategy; linking strategic initiatives | objectives with information to
improve dynamic decision making, and manage performance against predetermined goals.
The rubber hits the road when
EPM is used to determine,
prioritize, measure and ad-
dress significant initiatives for
improvement by everyone in the
organization
The following pages will act as a guide for a Public Health Agency
to implement and maintain Enterprise Performance Management
methodology Management Processes
enterprise performance
management
information systems
Tried and tested
tools, templates, and
processes used to
develop and maintain
EPM Best Practice
The DNA of
a well oiled
enterprise
Systematic and
sustainable proce-
dures for improving
decision making
and performance
Data and Key Performance Indica-
tors focused on providing dynamic
decision making
Solution infrastructure that supports
enterprise monitoring, reporting
and analysis designed to track and
manage information
6
Building Blocks
of EPM
Let’s use the diagram as a guide to some of our
proven tools in Enterprise Performance Management.
The top four items – Mission, Values, Vision, and
Strategy – may be considered the building blocks of
organizational success. Without these foundational
items in place it’s difficult to derive the maximum
Public Health benefits from the tools that follow them
in the pyramid. In the paragraphs below we outline
each of these critical enablers.
The mission describes the core purpose of the
Agency; why it exists, and reflects employees’
motivation for engaging in the organization’s work.
Unlike strategies and goals, which may be achieved
over time, agencies never truly fulfill the mission. It
acts as a beacon for the work, constantly pursued but
never quite reached.
A key theme to consider when discussing
Performance Management is translation – as
we travel down each layer in the pyramid we’re
translating what lies above, making it more granular
and amenable to daily action through measurement,
monitoring, and ongoing feedback. Thus, the Mission
may be the most vital piece of the puzzle, as all other
components of the system should reflect a linkage to
the organization’s ultimate purpose.
Values are the timeless principles that guide the
Agency. They represent the deeply held beliefs within
the organization and are demonstrated through the
day-to-day behaviors of all employees.
An organization’s values make an open proclama-
tion about how it expects everyone to behave. No
universal set of right or wrong values exist, instead
each organization must determine or discover the core
values which comprise its essence and hold importance
to those within it. As with the mission statement before
it, we will find values translated into action in the tools
that trail it in the Performance Management pyramid.
Mission
Core purpose of
the organization
values
Timeless guiding principles
vision
World picture of the ideal future
strategy
Your “game plan” for success
strategy map
Graphical presentation of key objectives
balanced scorecard
Performance measures, targets and initiatives
cascading measures
Performance measures for all departments/individuals that align with overall goals
strategic management system
Linking the Balanced Scorecard to processes such as budgeting, reporting and compensation
What is the Agency’s
core purpose?
What are the timeless
principles that guide
the Agency?
“The 5-year cooperative agreement program entitled, Strengthening
Public Health Infrastructure for Improved Health Outcomes, will pro-
vide health departments with needed resources to make fundamental
changes in their organizations and practices, so that they can improve
the delivery of public health services” -Secretary Katherine Sebelius
7 	 Strengthening Public Health Infrastructure For Improved Health Outcomes With Enterprise Performance Management
The EPM
Foundation
The Mississippi Department of Health recognized the power
of performance management tools and is using them to re-
invigorate their operations.
Moving down the pyramid, next we find Vision.
A vision statement provides a word picture of what
the Agency intends ultimately to become – which
may be five, ten, or fifteen years in the future. This
statement should not be abstract – it should contain as
concrete a picture of the desired state as possible, and
also provide the basis for formulating strategies and
objectives. A powerful vision provides everyone in
the organization with a shared mental framework that
helps give form to the often abstract future that lies
before us.
As mentioned above, when we descend the
pyramid we become more granular and specific. The
Vision is a good example of this principle, as it states
in verifiable fashion the measurable goals of the
organization in the medium and long-term.
The final building block to organizational success
is strategy – a concept that has only been with us in
any formal way for about fifty years but in that time
has spawned a dizzying array of books, articles, and
schools of schools, that frequently result in trips to
the nearest container of Tylenol. For strategy to be
effective it must be de-mystified, and the first order of
business is finding a simple and easy to communicate
definition of the term.
We define Strategy as the broad priorities adopted
by an organization in recognition of its operating
environment and in pursuit of its mission. When these
broad priorities are adopted and shared widely it
allows all employees to make more informed decisions
relating to scarce resources, and align themselves in a
common purpose towards the mission. And as Sun Tzu
reminds us in The Art of War, seemingly a prerequisite
for any student of strategy, “He whose ranks are united
in purpose will be victorious.”
Mission
Core purpose of
the organization
values
Timeless guiding principles
vision
World picture of the ideal future
strategy
Your “game plan” for success
strategy map
Graphical presentation of key objectives
balanced scorecard
Performance measures, targets and initiatives
cascading measures
Performance measures for all departments/individuals that align with overall goals
strategic management system
Linking the Balanced Scorecard to processes such as budgeting, reporting and compensation
Does everyone in the
organization have a
shared vision of the
ideal future?
Have broad priorities
been created that’ll
be used to make
important decisions?
Has strategy been com-
municated to all 	
stakeholders and staff?
Are there metrics that measure
the outcomes of strategic 	
objectives-Actual vs. Target?
Are all agency staff 	
aligned with Agency goals?
Is strategy at the 	
center of everything
the Agency does?
8
EPM
Design
Execution
For these efforts, Dr. Gerberding recognized our leaps towards
achieving our objectives of becoming an enterprise performance
managed agency and showcased our accomplishments to all of HHS.
-Galen P. Carver
Overcoming Barriers
The remaining levels in the pyramid represent
a shift from planning and design to execution.
This is a vital transition, as research suggests the
vast majority of organizations fail to execute their
strategies, and therefore fall short in their efforts
of realizing their visions, living their values, and
pursuing their mission.
Some estimates peg the execution failure rate
as high as ninety percent, and blame this dismal
figure on a number of barriers organizations have
great difficulty surmounting, including: effectively
communicating the mission, values, vision, and
strategy; measuring progress with discipline and
rigor, assessing feedback to learn about strategy,
and allocating resources in a way that reflects
strategic priorities.
Barriers can be overcome with the use of simple,
yet powerful, communication and measurement
systems. This allows organizations to fully articulate
their building blocks of success to an employee
audience hungry for such information. As well,
they provide measurements used for accountability,
improved decision-making, and generating align-
ment from top to bottom.
Once MISSION, VALUES,
VISION, and STRATEGY
have been defined the
heavy lifting begins.
In order to achieve Enterprise
Performance Management excellence;
Management Processes | Technology Tools |
Infrastructure must be in place to support
the ongoing and ever-iterating EPM
initiatives, and provide meaningful
information for dynamic decision making.
Like the gears of a well oiled machine
when these components are working
together the enterprise will have greater
success achieving operational excellence.
• EPM initiatives must deliver value to
management teams in order to survive.
• It is more important to deliver value than
it is to implement every facet of EPM.
• Senior Executive commitment is as
important to sustain the program as it is
to build the program. The support has to
come from the entire executive team.
• Information Technology (IT) must be
structured and funded sufficiently to
maintain & evolve the Business
Decision infrastructure.
9 	 Strengthening Public Health Infrastructure For Improved Health Outcomes With Enterprise Performance Management
CDC Implementation
Success Story
CDC | COTPER
Having used the Balanced Scorecards for some
years with Department Of Navy, I had experience
in the group dynamics and effort required to make it
a success. Dr. Gerberding, (then the CDC Director)
asked me to take the lead on establishing Balanced
Scorecards for CDC. I established an overall team
for the CDC enterprise effort and started with a pilot
in my own organization (COTPER).
By working backwards from a year out on my
time line, we phased the training, development,
cascading, etc., layer by layer to ensure the
process was well communicated and visible across
COTPER. Using this as the model, we briefed the
CDC Executive Board as we progressed during
significant milestones.
Dr. Gerberding used this model and pilot to
establish CDC’s Balanced Scorecard which she
named the CDC Organizational Excellence Assess-
ment. We engaged Paul Niven early in the process
of the COTPER pilot and used his benchmarking
and tutelage to ensure we were in line with the
EPM concept, approach and process. For these
efforts, Dr. Gerberding recognized our leaps towards
achieving our objectives of becoming an enterprise
performance managed agency and showcased our
accomplishments to all of HHS.
-Galen P. Carver
Chief Management Official
CDC – COTPER (Ret.)
Performance management tools can be applied simply
and seamlessly, providing a positive impact on Public
Health outcomes.
10
EPM
Benefits
Senior Executive commitment is as important to sustain the
program as it is to build the program. The support has to
come from the entire executive team.
EPM will empower an
Agency with:
• 	Defined, Aligned & Communicated
		 • Mission
		 • Values
		 • Vision
		 • Strategy
• 	Alignment of operations, projects and processes to
strategic objectives
• 	Focused and aligned key performance indicators
• 	Ability to monitor and analyze performance
to plan
• 	Better Structured management meetings
• 	Increased Team Collaboration
COMMON EPM tools:
• 	Balanced Scorecards | Strategy Maps
• 	Operational Scorecards | Dashboards
• 	Automated Monitoring and Analytics
• 	Collaboration Portals
With an operational EPM
system an agency can expect
the following benefits:
• Focus	 • Stewardship
• Alignment	 • Prioritization
• Visibility
With EPM—meaningful
information will flow:
UP: Performance results flow up from the
“field” to senior management.
Down: Business objectives flow down
from senior management to guide
employee activities.
Informatics:
Objectives: What does the Agency want
to achieve?
Priorities: Which objectives (or tasks)
are the most important to achieve?
Expectations: What activities should
be performing and what are the perfor-
mance target?
Performance: How has the agency
performed | Actuals vs. Plan?
Status: What is the current condition of
the task or objective?
Measurement: KPI’s that measure the
achievement of strategic objectives.
Constant Improvement: Improved
measurement and feedback loops to enable
constant improvement.
Communication: Increased Collabora-
tion and communication channels.
11 	 Strengthening Public Health Infrastructure For Improved Health Outcomes With Enterprise Performance Management
The barriers of strategy execution can be overcome with the use of simple, yet powerful, communication
and measurement systems.
This allows organizations to fully articulate their building blocks of success to an employee audience
hungry for such information. As well, they provide measurements used for accountability, improved
decision-making, and generating alignment from top to bottom.
EPM Tools
Balanced Scorecard
The Balanced Scorecard, a framework that chal-
lenges an organization to translate its foundational
elements of mission, values, vision, and strategy
into objectives and measures scattered across four
balanced perspectives of performance: Customer,
Internal Processes, Employee Learning and Growth,
and Financial.
The Balanced Scorecard may be considered a
‘system’ and a critical component of that system is
the Strategy Map - a one page graphical representa-
tion of what the organization must do well in order to
execute its strategy. The power of the Map lies in its
ability to banish confusion around strategic priorities
by communicating the essence of the organization’s
strategy in a vivid and compelling fashion.
Of course the Balanced Scorecard is not alone,
there are any number of Dashboards and Scorecards
an organization may employ in its pursuit of distinc-
tion. What all of these tools share as a common
denominator is the necessity of translating high-level
goals into measures that can be used to track strategy
execution, learn what works and what doesn’t, and
ultimately demonstrate to stakeholders how the
organization is in fact moving forward on a path of
performance improvement and enhanced public
health outcomes.
Public Health Informatics Strategy Map
Financial
Provide Information to
Various Stakeholders
4 Support Agency
Operating Efficiency
12
Support Health Officer’s
Pro-Active Decisions to
Improve State Health
8
Facilitate
Data Analysis
9 Constantly Improve the
IT Infrastructure
10
Provide a Robust
Infrastructure to Support
Agency Strategy
13
Develop an Enterprise
Data Environment
6 Standardize &
Consolidate IT Infrastructure
3
Leverage Our
People’s Skills
Participate
in Agency
Governance
2
Leverage ITS
Infrastructure
Anticipate &
Validate
Customer Needs
Develop a
Reliable, Relevant
Responsive Culture
7 11 5 1
Manage Within
Our Budget
15 Develop a Financial
Plan For Inventory Refresh
14
Stakeholders
Internal
Learning &
Growth
12
Balanced Scorecard
Perspectives
The Balanced Scorecard, a framework that challenges an organization
to translate its foundational elements of mission, values, vision, and
strategy into objectives and measures scattered across four balanced
perspectives of performance: Customer, Internal Processes, Employee
Learning and Growth, and Financial.
Customer
“What do our customers expect or demand from
us?” is a question a public health agency can use to
help populate the Customer perspective, as it forces
the consideration of operations from the customer’s
point of view.
internal
In the Internal Process perspective an agency
must determine critical processes at which they
must excel in order to drive value for their custom-
ers. This journey into the inner-workings of the
organizational machine will undoubtedly yield
insights that lead to both quick wins and longer-
term strategic victories.
learning & growth
The Employee Learning and Growth perspective
provides an opportunity to identify the intangible
assets (human capital, Information technology)
used to produce tangible benefits for customers and
other stakeholders.
The Brookings Institution estimates that
seventy-five percent of an organization’s value
is created from intangible assets, thus it’s impera-
tive we identify and track these key enablers of
strategy execution.
financial
Finally, no Scorecard is complete without a
Financial perspective documenting attempts to bal-
ance effectiveness with efficient fiscal stewardship.
13 	 Strengthening Public Health Infrastructure For Improved Health Outcomes With Enterprise Performance Management
In order to achieve Enterprise Performance Management excellence;
Management Processes | Technology Tools | Infrastructure must be in
place to support the ongoing and ever-iterating EPM initiatives, and
provide meaningful information for dynamic decision making.
MSDH
Success Story
“The PACE Team is a workforce multi-
plier that allows my staff to bypass time.
Pace’s understanding of our business and
technology objectives, and our all-con-
suming technical hurdles accelerates the
implementation of automated processes
and provides meaningful insight into our
reams of data.”
-Marc Wilson | CIO—Mississippi State 	
	 Department of Health (MSDH)
the mississippi department
of health journey
The Mississippi Department of Health (MSDH)
had become burdened with an aged environment,
outdated systems and processes, and poor measure-
ment systems that provided little visibility into
performance across the organization. This was the
sobering reality faced by a new management team
challenged with reinvigorating MSDH and trans-
forming the agency into a Performance Manage-
ment focused and automated department of health.
Their goal: “To become the standard by which other
health departments are measured.”
With our team at their side, the MSDH Health
Informatics Team, began this daunting task by
focusing on capturing the strategic objectives in a
Balanced Scorecard then the communication of the
strategy – ensuring everyone was on the same page
regarding the road ahead.
To communicate the new direction a Strategy
Map of objectives was created and acted as the
roadmap for the transformation. In the months that
followed processes and projects were mapped to
the new objectives, identifying strategic alignment
and eliminating redundancies, measurements
were established, and the industry-leading ZEUS
Enterprise Performance Management system was
implemented to provide a technology platform that
will enable automation and provide meaningful
insight into the health of all objectives.
Using ZEUS MSDH HR is implementing an
Employee Lifecycle Management solution that will
provide automation and insight into employee status
| learning & Growth from intake to exit. This will
also support the agencies investment in policy and
workforce development.
Results have been steady and beneficial.
Redundancy of data is being reduced, objectives are
regularly reviewed allowing for feedback and learn-
ing about the agency’s strategy, and automation is
allowing a workforce once drowning in paper to
quickly and easily spot trends and focus on what
really matters: improving public health in the state.
-Marc Wilson
	 CIO MSDH
14
Summing Up
“Investing in public health builds a foundation for a strong and
healthy society and contributes to lowering the cost of health
care. Investing in proven preventive services and strong policies
helps us to avoid unnecessary costs later,” said CDC Director
Thomas R. Frieden, M.D., M.P.H.
Over 150 years ago William Thompson
(Lord Kelvin) presciently noted: “When you can
measure what you are speaking about, and express
it in numbers, you know something about it; but
when you cannot measure it, when you cannot
express it in numbers, your knowledge is of a
meager and unsatisfactory kind.”
In public health, a strong infrastructure
provides the capacity to prepare for and respond
to both acute and chronic threats to the Nation’s
health, whether they are bioterrorism attacks,
emerging infections, disparities in health status, or
high rates of chronic disease and injury.
Core public health infrastructure includes
continuous performance measurement and quality
improvement capacity to assure that the systems
supporting public health services and programs
are ; Robust and efficient, Increasing Workforce
capacity and competency, Improving Laboratory
systems, and Maximizing Health Informatics.
In order to strengthen public health infrastruc-
ture for improved health outcomes; whether an
Agency is focusing primarily on Performance
Management, Policy and Workforce Development,
Public Health System Development | Redevelop-
ment, or Best Practice Implementation, there
needs to be a robust performance management and
measurement system to gauge the progress and
quantify the fact that Agencies are indeed improv-
ing Public Health outcomes.
EPM initiatives must deliver value to
management teams and field staff in
order to survive.
It is more important to deliver value than
it is to implement every facet of EPM.
Senior Executive commitment is as
important to sustain the program as it is
to build the program. The support has to
come from the entire executive team.
Information Technology (IT) must be
structured and funded sufficiently to
maintain & evolve the Business Decision
infrastructure.
15	 Strengthening Public Health Infrastructure For Improved Health Outcomes With Enterprise Performance Management
“Dr. Gerberding, (then the CDC Director) asked me to take the lead on establishing Balanced Scorecards
for CDC.I established an overall team for the CDC enterprise effort and started with a pilot in my own
organization (COTPER).” -Galen P. Carver
Public Health
Leadership Team
Working with clients throughout the public sector,
including a nationally recognized implementation
at CDC’s COTPER organization, our team has
developed a step-by-step program that will guide you
through the entire spectrum of Performance Manage-
ment activities. The tools and techniques we employ
have been honed from over a decade of consulting,
research, and writing experience in the field.
Paul Niven, Strategy and Enterprise Performance
Management Thought Leader, author of this paper,
his books to the right have now been translated in
over fifteen languages.
You’ll also benefit from the experience and
wisdom of Galen P. Carver, former Chief Manage-
ment Official with COTPER | Director of HR CDC,
and a veteran of over 28 years of federal service.
The third member of our leadership team is Reid
Block, CEO of the PACE Performance Group. Reid is
a seasoned Business Intelligence/Enterprise Perfor-
mance Management Professional, specializing in
leading Global Enterprise Performance Management
and Business Intelligence implementations.
Please contact us for a complimentary Second
Edition of Paul Niven’s book, “Balanced Scorecard |
Step by Step:for Government and Nonprofit Agencies”,
and to review your work plan strategy, share best
practices, and address the agencies questions on how
to Implement an Enterprise Performance Management
solution that will strengthen the public health
infrastructure for improved health outcomes.
Contact:
Reid A Block
rablock@pacepg.com
503.764.1544
PACE Performance | Senalosa Group
16
Notes
contact:
Pace performance group
info@pacepg.com	
715 NW Hoyt Street	
#6707
Portland, OR 97208
503.764.1544
PACE Performance | Senalosa Group

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Improving Public Health Outcomes W Epm

  • 1. Paul Niven PACE Performance | Senalosa Group Contributions | Galen P. Carver & Reid A. Block Strengthening Public Health Infrastructure for Improved Health Outcomes with Enterprise Performance Management
  • 2. Executive Summary | The Challenge 2 Whitepaper Highlights 3 Key Areas for Public Health Infrastructure Investment 4 Enterprise Performance Management Definition and Framework 5 The Building Blocks of Enterprise Performance Management 6-7 Enterprise Performance Management Design, Execution, and Overcoming Common Barriers 8 CDC—COTPER Success Story 9 The Benefits to Organizations when Enterprise Performance Management is Implemented and Common Tools 10 The Balanced Scorecard 11-12 The Mississippi State Department of Health Journey to Enterprise Performance Management 13 Summation 14 The PACE Performance | SENALOSA Group Public Health Enterprise Performance Management Leadership Team 15 Table of Contents
  • 3. 2 The Challenge Public Health Agencies have been primed by the CDC to Strengthen Public Health Infrastructure for Improved Health Outcomes by becoming Enterprise Performance Management focused organizations. The question many Public Health Officials are asking: “So...how do we do it?” executive summary: ASTHO’s recent Profile of State Public Health Agencies (volume one) states that close to 40 percent of State Health Agencies identified “Implementing quality improvement/performance management” as a top five priority. Public Health Agencies are fortunate to have staff experts in such vital areas of Public Health as: disease analysis, preparedness, monitoring the health of the state’s population, and health care reform, but often— experienced business acumen is missing from the Public Health Agency. The ASTHO survey illuminates that less than 10 percent of state health officials possesses an MBA. Of course, in many respects such a skewed balance is appropriate; Public Health agencies should be primarily equipped with experts in Public Health. But in order to fulfill the requirements of the CDC’s Enterprise Performance Management and Infrastructure improvement program Public Health Agencies will need additional performance management assistance focused on the business and information technology departments. Questions to consider while reading this paper: • What are the timeless principles that guide the Agency? • What is the Agency’s core purpose? • Does everyone in the organization have a shared vision of the ideal future? • Have broad priorities been created that’ll be used to make important decisions? • Has strategy been communicated to all stakeholders and staff? • Are there strategic metrics that measure the achievement of the Agency strategic objectives? • Are all Agency staff aligned with Agency goals? • Is strategy at the center of everything the Agency does? “The goal of the Strengthening Public Health Infrastructure for Improved Health Outcomes program is to systematically increase the performance management capacity of public health departments in order to ensure that public health goals are effectively and efficiently met.” – CDC
  • 4. 3 Strengthening Public Health Infrastructure For Improved Health Outcomes With Enterprise Performance Management Highlights Sebelius announces $42.5 million for public health improvement programs through the Affordable Care Act “These funds will help health departments around the country to improve the quality and effectiveness of the critical health services that millions of Americans rely on every day,” said Secretary Sebelius. “Strengthening our public health system through better coordination and collaboration will help to deliver higher quality health care more efficiently.” Questions answered in this paper: • What is Enterprise Performance Management (EPM)? • How is EPM achieved? • What are the building blocks of EPM? • How is EPM measured | reported? • How is EPM sustained? Paper Highlights: • Performance management tools can be applied simply and seamlessly, providing a positive impact on Public Health outcomes. • The Mississippi Department of Health recognized the power of performance management tools and is using them to re-invigorate their operations. • In a recent ASTHO survey, close to 40 percent of State Health Agencies identified “implementing quality improvement/performance management” as a top five priority. • Many agencies lack the business skills necessary to implement quality improvement and perfor- mance management. • “Mission, values, vision and strategy may be considered the building blocks of organizat- ional success.” • “The PACE Team is a workforce multiplier that allows my staff to bypass time. Pace’s understanding of our business and technology objectives, and our all- consuming technical hurdles accelerates the implementation of automated pro- cesses and provides meaningful insight into our reams of data.” — Marc Wilson | CIO— Mississippi State Department of Health (MSDH) • The barriers of strategy execution can be overcome with the use of simple, yet powerful, communica- tion and measurement systems. • These tools allow organizations to fully articulate their building blocks of success to an employee audience hungry for such information. As well, they provide measurements used for accountability, improved decision-making, and generating align- ment from top to bottom. • Seventy-five percent of an organization’s value is created from intangible assets, thus it’s impera- tive we identify and track these key enablers of strategy execution.
  • 5. 4 KeyAreas Infrastructure Investment “These funds are a down payment on improving public health services across the na- tion,” said Dr. Judith A. Monroe, CDC’s deputy director for state, tribal, local and territorial support. “With these funds, we will help our nation’s public health departments work more effectively and efficiently to detect and respond to public health problems. This program will strengthen the nation’s public health system and our ability to improve the health and well being of all Americans.” In public health, a strong infrastructure provides the capacity to prepare for and respond to both acute and chronic threats to the Nation’s health, whether they are bioterrorism attacks, emerging infections, disparities in health status, or high rates of chronic disease and injury. Core public health infrastructure includes continu- ous performance measurement and quality improvement capacity to assure that the systems supporting public health services and programs are; Robust and efficient, Increasing Workforce capacity and competency, Improving Laboratory systems, and Maximizing Health Informatics. KEY AREAS • Performance Management • Policy and Workforce Development • Public Health System Development/ Redevelopment • Best Practice Implementation Health Promotion and Disease Prevention • Food- and water-borne disease identification and prevention • Prevention of healthcare-associated infections • Leading causes of death and, once available, National Prevention and Health Promotion Strategy priorities Public Health Policy and Public Health Law • Capacity to support structural and environmental changes in the community to promote health • Capacity to assist in changing or enforcing policies, laws, ordinances, regulations or national standards that provide for more effective public health practice, including increased linkage to the health care system Health IT and Communications Infrastructure • Vital statistics system (e.g., electronic birth and death registration and certificates) to describe the health of populations as well as individuals • Electronic health record/IT systems to improve quality, safety, decision-making and population-based care • Communications systems and processes (e.g., information syndication and social media capacity) to make populations aware of health promoting behaviors and clinical interventions Workforce and Systems Development • Broad-based public health workforce training to support health reform (e.g., e-learning and other training, fellowship programs) • Laboratory and epidemiologic capacity to enhance the behavioral, clinical and environmental changes brought about by health reform • Public health program and public health system transformation (e.g., changes to how the health department is organized and functioning to provide for more effective and efficient use of resources and more effective public health practice, including increased linkage to the health care system).
  • 6. 5 Strengthening Public Health Infrastructure For Improved Health Outcomes With Enterprise Performance Management EPM Defined Framework Enterprise Performance Management (EPM) excellence consists of integrated management and analytical processes | tools that are supported by technology. Enabling organizations to optimize performance by defining their Mission, Values, and Strategy; linking strategic initiatives | objectives with information to improve dynamic decision making, and manage performance against predetermined goals. The rubber hits the road when EPM is used to determine, prioritize, measure and ad- dress significant initiatives for improvement by everyone in the organization The following pages will act as a guide for a Public Health Agency to implement and maintain Enterprise Performance Management methodology Management Processes enterprise performance management information systems Tried and tested tools, templates, and processes used to develop and maintain EPM Best Practice The DNA of a well oiled enterprise Systematic and sustainable proce- dures for improving decision making and performance Data and Key Performance Indica- tors focused on providing dynamic decision making Solution infrastructure that supports enterprise monitoring, reporting and analysis designed to track and manage information
  • 7. 6 Building Blocks of EPM Let’s use the diagram as a guide to some of our proven tools in Enterprise Performance Management. The top four items – Mission, Values, Vision, and Strategy – may be considered the building blocks of organizational success. Without these foundational items in place it’s difficult to derive the maximum Public Health benefits from the tools that follow them in the pyramid. In the paragraphs below we outline each of these critical enablers. The mission describes the core purpose of the Agency; why it exists, and reflects employees’ motivation for engaging in the organization’s work. Unlike strategies and goals, which may be achieved over time, agencies never truly fulfill the mission. It acts as a beacon for the work, constantly pursued but never quite reached. A key theme to consider when discussing Performance Management is translation – as we travel down each layer in the pyramid we’re translating what lies above, making it more granular and amenable to daily action through measurement, monitoring, and ongoing feedback. Thus, the Mission may be the most vital piece of the puzzle, as all other components of the system should reflect a linkage to the organization’s ultimate purpose. Values are the timeless principles that guide the Agency. They represent the deeply held beliefs within the organization and are demonstrated through the day-to-day behaviors of all employees. An organization’s values make an open proclama- tion about how it expects everyone to behave. No universal set of right or wrong values exist, instead each organization must determine or discover the core values which comprise its essence and hold importance to those within it. As with the mission statement before it, we will find values translated into action in the tools that trail it in the Performance Management pyramid. Mission Core purpose of the organization values Timeless guiding principles vision World picture of the ideal future strategy Your “game plan” for success strategy map Graphical presentation of key objectives balanced scorecard Performance measures, targets and initiatives cascading measures Performance measures for all departments/individuals that align with overall goals strategic management system Linking the Balanced Scorecard to processes such as budgeting, reporting and compensation What is the Agency’s core purpose? What are the timeless principles that guide the Agency? “The 5-year cooperative agreement program entitled, Strengthening Public Health Infrastructure for Improved Health Outcomes, will pro- vide health departments with needed resources to make fundamental changes in their organizations and practices, so that they can improve the delivery of public health services” -Secretary Katherine Sebelius
  • 8. 7 Strengthening Public Health Infrastructure For Improved Health Outcomes With Enterprise Performance Management The EPM Foundation The Mississippi Department of Health recognized the power of performance management tools and is using them to re- invigorate their operations. Moving down the pyramid, next we find Vision. A vision statement provides a word picture of what the Agency intends ultimately to become – which may be five, ten, or fifteen years in the future. This statement should not be abstract – it should contain as concrete a picture of the desired state as possible, and also provide the basis for formulating strategies and objectives. A powerful vision provides everyone in the organization with a shared mental framework that helps give form to the often abstract future that lies before us. As mentioned above, when we descend the pyramid we become more granular and specific. The Vision is a good example of this principle, as it states in verifiable fashion the measurable goals of the organization in the medium and long-term. The final building block to organizational success is strategy – a concept that has only been with us in any formal way for about fifty years but in that time has spawned a dizzying array of books, articles, and schools of schools, that frequently result in trips to the nearest container of Tylenol. For strategy to be effective it must be de-mystified, and the first order of business is finding a simple and easy to communicate definition of the term. We define Strategy as the broad priorities adopted by an organization in recognition of its operating environment and in pursuit of its mission. When these broad priorities are adopted and shared widely it allows all employees to make more informed decisions relating to scarce resources, and align themselves in a common purpose towards the mission. And as Sun Tzu reminds us in The Art of War, seemingly a prerequisite for any student of strategy, “He whose ranks are united in purpose will be victorious.” Mission Core purpose of the organization values Timeless guiding principles vision World picture of the ideal future strategy Your “game plan” for success strategy map Graphical presentation of key objectives balanced scorecard Performance measures, targets and initiatives cascading measures Performance measures for all departments/individuals that align with overall goals strategic management system Linking the Balanced Scorecard to processes such as budgeting, reporting and compensation Does everyone in the organization have a shared vision of the ideal future? Have broad priorities been created that’ll be used to make important decisions? Has strategy been com- municated to all stakeholders and staff? Are there metrics that measure the outcomes of strategic objectives-Actual vs. Target? Are all agency staff aligned with Agency goals? Is strategy at the center of everything the Agency does?
  • 9. 8 EPM Design Execution For these efforts, Dr. Gerberding recognized our leaps towards achieving our objectives of becoming an enterprise performance managed agency and showcased our accomplishments to all of HHS. -Galen P. Carver Overcoming Barriers The remaining levels in the pyramid represent a shift from planning and design to execution. This is a vital transition, as research suggests the vast majority of organizations fail to execute their strategies, and therefore fall short in their efforts of realizing their visions, living their values, and pursuing their mission. Some estimates peg the execution failure rate as high as ninety percent, and blame this dismal figure on a number of barriers organizations have great difficulty surmounting, including: effectively communicating the mission, values, vision, and strategy; measuring progress with discipline and rigor, assessing feedback to learn about strategy, and allocating resources in a way that reflects strategic priorities. Barriers can be overcome with the use of simple, yet powerful, communication and measurement systems. This allows organizations to fully articulate their building blocks of success to an employee audience hungry for such information. As well, they provide measurements used for accountability, improved decision-making, and generating align- ment from top to bottom. Once MISSION, VALUES, VISION, and STRATEGY have been defined the heavy lifting begins. In order to achieve Enterprise Performance Management excellence; Management Processes | Technology Tools | Infrastructure must be in place to support the ongoing and ever-iterating EPM initiatives, and provide meaningful information for dynamic decision making. Like the gears of a well oiled machine when these components are working together the enterprise will have greater success achieving operational excellence. • EPM initiatives must deliver value to management teams in order to survive. • It is more important to deliver value than it is to implement every facet of EPM. • Senior Executive commitment is as important to sustain the program as it is to build the program. The support has to come from the entire executive team. • Information Technology (IT) must be structured and funded sufficiently to maintain & evolve the Business Decision infrastructure.
  • 10. 9 Strengthening Public Health Infrastructure For Improved Health Outcomes With Enterprise Performance Management CDC Implementation Success Story CDC | COTPER Having used the Balanced Scorecards for some years with Department Of Navy, I had experience in the group dynamics and effort required to make it a success. Dr. Gerberding, (then the CDC Director) asked me to take the lead on establishing Balanced Scorecards for CDC. I established an overall team for the CDC enterprise effort and started with a pilot in my own organization (COTPER). By working backwards from a year out on my time line, we phased the training, development, cascading, etc., layer by layer to ensure the process was well communicated and visible across COTPER. Using this as the model, we briefed the CDC Executive Board as we progressed during significant milestones. Dr. Gerberding used this model and pilot to establish CDC’s Balanced Scorecard which she named the CDC Organizational Excellence Assess- ment. We engaged Paul Niven early in the process of the COTPER pilot and used his benchmarking and tutelage to ensure we were in line with the EPM concept, approach and process. For these efforts, Dr. Gerberding recognized our leaps towards achieving our objectives of becoming an enterprise performance managed agency and showcased our accomplishments to all of HHS. -Galen P. Carver Chief Management Official CDC – COTPER (Ret.) Performance management tools can be applied simply and seamlessly, providing a positive impact on Public Health outcomes.
  • 11. 10 EPM Benefits Senior Executive commitment is as important to sustain the program as it is to build the program. The support has to come from the entire executive team. EPM will empower an Agency with: • Defined, Aligned & Communicated • Mission • Values • Vision • Strategy • Alignment of operations, projects and processes to strategic objectives • Focused and aligned key performance indicators • Ability to monitor and analyze performance to plan • Better Structured management meetings • Increased Team Collaboration COMMON EPM tools: • Balanced Scorecards | Strategy Maps • Operational Scorecards | Dashboards • Automated Monitoring and Analytics • Collaboration Portals With an operational EPM system an agency can expect the following benefits: • Focus • Stewardship • Alignment • Prioritization • Visibility With EPM—meaningful information will flow: UP: Performance results flow up from the “field” to senior management. Down: Business objectives flow down from senior management to guide employee activities. Informatics: Objectives: What does the Agency want to achieve? Priorities: Which objectives (or tasks) are the most important to achieve? Expectations: What activities should be performing and what are the perfor- mance target? Performance: How has the agency performed | Actuals vs. Plan? Status: What is the current condition of the task or objective? Measurement: KPI’s that measure the achievement of strategic objectives. Constant Improvement: Improved measurement and feedback loops to enable constant improvement. Communication: Increased Collabora- tion and communication channels.
  • 12. 11 Strengthening Public Health Infrastructure For Improved Health Outcomes With Enterprise Performance Management The barriers of strategy execution can be overcome with the use of simple, yet powerful, communication and measurement systems. This allows organizations to fully articulate their building blocks of success to an employee audience hungry for such information. As well, they provide measurements used for accountability, improved decision-making, and generating alignment from top to bottom. EPM Tools Balanced Scorecard The Balanced Scorecard, a framework that chal- lenges an organization to translate its foundational elements of mission, values, vision, and strategy into objectives and measures scattered across four balanced perspectives of performance: Customer, Internal Processes, Employee Learning and Growth, and Financial. The Balanced Scorecard may be considered a ‘system’ and a critical component of that system is the Strategy Map - a one page graphical representa- tion of what the organization must do well in order to execute its strategy. The power of the Map lies in its ability to banish confusion around strategic priorities by communicating the essence of the organization’s strategy in a vivid and compelling fashion. Of course the Balanced Scorecard is not alone, there are any number of Dashboards and Scorecards an organization may employ in its pursuit of distinc- tion. What all of these tools share as a common denominator is the necessity of translating high-level goals into measures that can be used to track strategy execution, learn what works and what doesn’t, and ultimately demonstrate to stakeholders how the organization is in fact moving forward on a path of performance improvement and enhanced public health outcomes. Public Health Informatics Strategy Map Financial Provide Information to Various Stakeholders 4 Support Agency Operating Efficiency 12 Support Health Officer’s Pro-Active Decisions to Improve State Health 8 Facilitate Data Analysis 9 Constantly Improve the IT Infrastructure 10 Provide a Robust Infrastructure to Support Agency Strategy 13 Develop an Enterprise Data Environment 6 Standardize & Consolidate IT Infrastructure 3 Leverage Our People’s Skills Participate in Agency Governance 2 Leverage ITS Infrastructure Anticipate & Validate Customer Needs Develop a Reliable, Relevant Responsive Culture 7 11 5 1 Manage Within Our Budget 15 Develop a Financial Plan For Inventory Refresh 14 Stakeholders Internal Learning & Growth
  • 13. 12 Balanced Scorecard Perspectives The Balanced Scorecard, a framework that challenges an organization to translate its foundational elements of mission, values, vision, and strategy into objectives and measures scattered across four balanced perspectives of performance: Customer, Internal Processes, Employee Learning and Growth, and Financial. Customer “What do our customers expect or demand from us?” is a question a public health agency can use to help populate the Customer perspective, as it forces the consideration of operations from the customer’s point of view. internal In the Internal Process perspective an agency must determine critical processes at which they must excel in order to drive value for their custom- ers. This journey into the inner-workings of the organizational machine will undoubtedly yield insights that lead to both quick wins and longer- term strategic victories. learning & growth The Employee Learning and Growth perspective provides an opportunity to identify the intangible assets (human capital, Information technology) used to produce tangible benefits for customers and other stakeholders. The Brookings Institution estimates that seventy-five percent of an organization’s value is created from intangible assets, thus it’s impera- tive we identify and track these key enablers of strategy execution. financial Finally, no Scorecard is complete without a Financial perspective documenting attempts to bal- ance effectiveness with efficient fiscal stewardship.
  • 14. 13 Strengthening Public Health Infrastructure For Improved Health Outcomes With Enterprise Performance Management In order to achieve Enterprise Performance Management excellence; Management Processes | Technology Tools | Infrastructure must be in place to support the ongoing and ever-iterating EPM initiatives, and provide meaningful information for dynamic decision making. MSDH Success Story “The PACE Team is a workforce multi- plier that allows my staff to bypass time. Pace’s understanding of our business and technology objectives, and our all-con- suming technical hurdles accelerates the implementation of automated processes and provides meaningful insight into our reams of data.” -Marc Wilson | CIO—Mississippi State Department of Health (MSDH) the mississippi department of health journey The Mississippi Department of Health (MSDH) had become burdened with an aged environment, outdated systems and processes, and poor measure- ment systems that provided little visibility into performance across the organization. This was the sobering reality faced by a new management team challenged with reinvigorating MSDH and trans- forming the agency into a Performance Manage- ment focused and automated department of health. Their goal: “To become the standard by which other health departments are measured.” With our team at their side, the MSDH Health Informatics Team, began this daunting task by focusing on capturing the strategic objectives in a Balanced Scorecard then the communication of the strategy – ensuring everyone was on the same page regarding the road ahead. To communicate the new direction a Strategy Map of objectives was created and acted as the roadmap for the transformation. In the months that followed processes and projects were mapped to the new objectives, identifying strategic alignment and eliminating redundancies, measurements were established, and the industry-leading ZEUS Enterprise Performance Management system was implemented to provide a technology platform that will enable automation and provide meaningful insight into the health of all objectives. Using ZEUS MSDH HR is implementing an Employee Lifecycle Management solution that will provide automation and insight into employee status | learning & Growth from intake to exit. This will also support the agencies investment in policy and workforce development. Results have been steady and beneficial. Redundancy of data is being reduced, objectives are regularly reviewed allowing for feedback and learn- ing about the agency’s strategy, and automation is allowing a workforce once drowning in paper to quickly and easily spot trends and focus on what really matters: improving public health in the state. -Marc Wilson CIO MSDH
  • 15. 14 Summing Up “Investing in public health builds a foundation for a strong and healthy society and contributes to lowering the cost of health care. Investing in proven preventive services and strong policies helps us to avoid unnecessary costs later,” said CDC Director Thomas R. Frieden, M.D., M.P.H. Over 150 years ago William Thompson (Lord Kelvin) presciently noted: “When you can measure what you are speaking about, and express it in numbers, you know something about it; but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meager and unsatisfactory kind.” In public health, a strong infrastructure provides the capacity to prepare for and respond to both acute and chronic threats to the Nation’s health, whether they are bioterrorism attacks, emerging infections, disparities in health status, or high rates of chronic disease and injury. Core public health infrastructure includes continuous performance measurement and quality improvement capacity to assure that the systems supporting public health services and programs are ; Robust and efficient, Increasing Workforce capacity and competency, Improving Laboratory systems, and Maximizing Health Informatics. In order to strengthen public health infrastruc- ture for improved health outcomes; whether an Agency is focusing primarily on Performance Management, Policy and Workforce Development, Public Health System Development | Redevelop- ment, or Best Practice Implementation, there needs to be a robust performance management and measurement system to gauge the progress and quantify the fact that Agencies are indeed improv- ing Public Health outcomes. EPM initiatives must deliver value to management teams and field staff in order to survive. It is more important to deliver value than it is to implement every facet of EPM. Senior Executive commitment is as important to sustain the program as it is to build the program. The support has to come from the entire executive team. Information Technology (IT) must be structured and funded sufficiently to maintain & evolve the Business Decision infrastructure.
  • 16. 15 Strengthening Public Health Infrastructure For Improved Health Outcomes With Enterprise Performance Management “Dr. Gerberding, (then the CDC Director) asked me to take the lead on establishing Balanced Scorecards for CDC.I established an overall team for the CDC enterprise effort and started with a pilot in my own organization (COTPER).” -Galen P. Carver Public Health Leadership Team Working with clients throughout the public sector, including a nationally recognized implementation at CDC’s COTPER organization, our team has developed a step-by-step program that will guide you through the entire spectrum of Performance Manage- ment activities. The tools and techniques we employ have been honed from over a decade of consulting, research, and writing experience in the field. Paul Niven, Strategy and Enterprise Performance Management Thought Leader, author of this paper, his books to the right have now been translated in over fifteen languages. You’ll also benefit from the experience and wisdom of Galen P. Carver, former Chief Manage- ment Official with COTPER | Director of HR CDC, and a veteran of over 28 years of federal service. The third member of our leadership team is Reid Block, CEO of the PACE Performance Group. Reid is a seasoned Business Intelligence/Enterprise Perfor- mance Management Professional, specializing in leading Global Enterprise Performance Management and Business Intelligence implementations. Please contact us for a complimentary Second Edition of Paul Niven’s book, “Balanced Scorecard | Step by Step:for Government and Nonprofit Agencies”, and to review your work plan strategy, share best practices, and address the agencies questions on how to Implement an Enterprise Performance Management solution that will strengthen the public health infrastructure for improved health outcomes. Contact: Reid A Block rablock@pacepg.com 503.764.1544 PACE Performance | Senalosa Group
  • 18. contact: Pace performance group info@pacepg.com 715 NW Hoyt Street #6707 Portland, OR 97208 503.764.1544
  • 19. PACE Performance | Senalosa Group