HHS Research Initiative Regarding Transformations in Health and Human Services: Report of the Working Group. Performance Measures


Needs in Relation to Assessing Transformations

The transformations also underscore the need for the Department to expand its leadership role in developing and applying better performance measures in connection with health services and human services. As incremental decentralization of policy-making proceeds, the strategies and operational details associated with service programs are becoming ever-more diverse. The resulting diversity cannot be captured readily with traditional process measures that presume procedural uniformity. Instead, diversity demands increased attention to results and the concomitant development of outcome measures that are unambiguous, quantifiable, and acceptable to all major stakeholders. A crucial component of the move toward outcome-based assessments of health/human services is the development of better indicators of the well-being of individuals, families, and communities.

Devolution already has added a new dimension to the need for better definitions and measures of performance. Achieving broad-based consensus around desired outcomes and milestones is likely to become an imperative in virtually every case where the federal government shares responsibility for a particular health service or human service with state governments, local governments, commercial health-care providers, or philanthropies. For example, a central goal of the Department's Performance Partnerships is to identify performance measures that, once accepted by all the stakeholders, will become management guideposts for the states as they assume functions previously performed by the federal government.

Consensus on performance measures -- both outcome measures and process measures -- also is likely to be a condition precedent for effective data-sharing across levels of government and between governments and private- sector organizations. When collaborating parties agree on what should be measured and why, development of measures governing the definitions, measurement conventions, and representations of the resulting data is facilitated considerably.


Section C of Appendix 1 highlights a variety of instances where DHHS agencies and offices are active participants in promoting the development and use of performance measures related to health/human services and the identification of indicators with which to characterize the well-being of Americans, especially members of vulnerable populations. Efforts to develop quality- assurance measures within the health-care industry, score-cards to help consumers rate the services they receive, and indicators of children's well-being illustrate the breadth of interest within the Department. Although the details differ considerably from one activity to another, they share a fundamental premise -- i.e., that service programs ought to be managed and evaluated primarily on the basis of outcomes rather than procedural compliance.

These activities also are likely to reinforce and be reinforced in turn by activities undertaken in response to the Government Performance and Results Act (GPRA). The Office of the Assistant Secretary for Management and Budget (OASMB), through the GPRA Roundtable, is coordinating DHHS-wide efforts to develop performance measures. Moreover, OASMB co-sponsors a government-wide Research Roundtable, which already has proposed a performance-measure model for scientific research programs. OASMB is working closely with programs throughout the Department as they strive to develop performance measures that are effective in characterizing the results of program operations and thereby are useful in guiding determinations of data needs and data- collection efforts.


The Secretary should ensure that the several efforts within the Department now examining performance measures in various contexts give coordinated attention to measures related to monitoring and assessing transformations in health/human services -- especially measures that the HHS Data Council and its collaborators might find useful for the development of national data standards.