Problem Identification:
It is difficult to measure and evaluate the Department’s effectiveness in managing Baltimore’s public health needs.

Recommended Action:
Translate the Department’s well-conceived five-year strategic plan and annual operating plan into actionable agendas that connect the City’s public health objectives to desired outcomes and issue an annual Department “report card” detailing progress toward meeting established measurable goals.

Organizational, Service Improvement

Functional/Operational Area:
All Departmental Operations

Estimated Annual Impact:
Cannot be Estimated

Estimated Implementation Cost:

Barriers to Implementation:

Projected Implementation:
30 Days

Next Steps:
The Department’s senior management team should convene to set quantifiable performance goals for each of the major strategies and initiatives included in its 2000-2004 Five-Year Strategic Plan and its FY2001 Annual Operating Plan. In addition to establishing goals, specific Departmental managers should be identified as being responsible for each of the performance goals.

Throughout the course of the Greater Baltimore Committee/Presidents’ Roundtable Management and Efficiency Review of the Health Department, the project team and its subcommittees grappled with determining what constituted success when managing public health needs in an urban environment. Struggles with this issue prompted the project team to collaborate with the Milbank Fund, a New York-based foundation focused on the improvement of public health, in hosting a forum of leading public health professionals from around the country at the Baltimore campus of the University of Maryland Medical Systems. In all, public sector health professionals from around the country, including Chicago, Houston, Milwaukee, Nashville, and San Diego, participated in a series of meetings with the project team and the Health Department’s senior management team.

The overwhelming conclusion was that while the public health challenges of American cities may vary, there exists a universal need for urban health professionals to establish a clear vision for improving public health in their communities. This vision must move beyond the typically reactionary focus of public health and include quantifiable metrics and goals that together provide specified criteria against which to measure progress and success.

During the summer of 1999, the Department embarked on a comprehensive planning process that culminated with the issuance of a five-year strategic plan covering the years 2000-2004. The plan, divided into programmatic areas, identified strategies, key performance indicators, and operational activities ‘to ensure all Baltimoreans access to comprehensive, quality health services and care, as well as to ensure a healthy environment.’ This plan was followed by the development of an operating plan for FY2001.

The Greater Baltimore Committee/Presidents’ Roundtable Health Department project team believe that these documents are indicative of a desire by the Department’s management team to not only articulate a comprehensive vision for promoting public health in Baltimore, but also to provide a context and framework within which the effectiveness of the Department’s initiatives can be regularly evaluated. However, the real value of these documents is inextricably linked to the Department’s efforts to translate these plans into actionable agendas where quantifiable goals are established, performance is continually evaluated, and the extent of progress is regularly reported.

San Diego County has adopted an approach to these issues that the Health Department should consider replicating. Through the issuance of an annual ‘report card,’ San Diego’s Health and Human Services Agency is taking steps to link local health and human service indicators in areas such as safety, economics, education, health, and access to service to its own organizational performance measures in an effort towards developing true public accountability.