Public Health Services of the County of San Diego

Innovation, Accountability, and Alignment to Help All Residents Live Well in San Diego

Summary of Client Results:

• Scorecard allows Public Health Services (PHS) of the County of San Diego to easily convey progress on key objectives to stakeholders and partners
• Recently enhanced Scorecard functionality allows PHS to demonstrate cross-agency alignment, resulting in rapid adoption of the Live Well San Diego shared vision.
• Scorecard helps PHS build a performance-based culture and ensure performance-based decision-making
• Equity Scorecards help support efforts to increase birth weight, reduce pre-term births, and increase breastfeeding in the African-American community

Why Consider Scorecard Over Other Solutions?

PHS, of the County of San Diego Health and Human Services Agency, needed an easier way to display and share performance data to mark progress and advance Live Well San Diego. This framework is a vision and initiative the Board of Supervisors adopted to help every resident become healthy, safe and thriving. This collective impact effort engages the entire county, including all county departments, six regions, and an array of more than 500 cross-sector partners (i.e., governments, businesses, schools, faith- and community-based organizations).

Several factors illuminated a need for operational and program performance data to be at-the-ready. There was also a strong need to analyze the relationship between performance data and outcomes, report on population indicators, and demonstrate positive impact across the community. All this information needed to be easily sharable with the Board of Supervisors, the Agency Executive Office, and PHS leadership and staffs. Enter, Clear Impact Scorecard, an all-in-one performance reporting tool that conveys and displays performance data.

How Does Scorecard Bring Value?

• Scorecard Facilitates Data Distribution and Transparency

When asked why Scorecard provides value, agency staff shared that: the value in Scorecards is that they effectively display progress and allow for immediate report distribution through website embeds for any desired audience to access. Scorecards are essential to building a performance-based culture and to ensuring performance-based decision-making.

• Scorecard Drives Innovation

Scorecard provided the tools that PHS needed to start “Strategic Plan Performance Dialogues” to encourage Branches and their teams to talk about metrics regularly to inform decision-making.

• Scorecard Supports a Culture of Accountability

Due to an enhanced need for rapid decision-making, COVID-19 has helped to strengthen the performance culture, according to agency staff. While the Scorecards only capture some measures that are related to or impacted by COVID, the data-informed, performance-based culture is stronger than ever.

• Scorecard Creates Alignment

Alignment is critically important to PHS, since the Department is part of a large County government and a larger community that has adopted the shared vision of Live Well San Diego. Consequently, the enhanced functionality in Scorecard to show alignment has been key in its adoption. By integrating the appropriate colors for each of the components of Live Well San Diego (Building Better Health, Living Safely, Thriving, and Operational Excellence), the display conveys where things fit in the overall County strategy. The colors are shown below and appear throughout all the Scorecards.

Details for Your Inspiration: Using Scorecard to Align Efforts

PHS builds Scorecards to meet different needs and communicate to different audiences. The Priority Measures Scorecard monitors around 20 measures that appear in the County budget (or operational plan) and are updated quarterly and shared with the public. Because of the keen interest in progress on these measures, a “Performance Flash Report” is generated, using the report function, each quarter and sent to all Public Health Department staff. In 2021, Health Equity objectives were added to the PHS Strategic Plan to give greater visibility to equity issues and progress.

Each branch of the local health department maintains a Strategic Plan Scorecard with all the measures that track with the PHS Strategic Plan See PHS Strat Plan 2019-2021 FINAL-9-28-20.pdf (sandiegocounty.gov). Results are typically shared internally as a way of gauging progress in implementing PHS Branch plans.

San Diego County is uniquely organized into six health and human services operational areas or regions to respond to local community needs. Each Region has developed a Scorecard to track their contributory Live Well San Diego Regional Community Enrichment Plan—See 2019-21 Community Health Improvement Plan and Regional Enrichment Plans Final.pub (sandiegocounty.gov). Community Leadership Teams in each of five Regions guide community planning (two Regions share one Leadership Team and Enrichment Plan). Currently, partners are fully engaged in COVID-19 response, but these Regions can access Scorecards once they return to broader community planning work.

Finally, PHS is beginning to use the Scorecard to tie together it’s programmatic work to population change through the Perinatal Equity Initiative (PEI). This initiative aims to improve outcomes for mothers, fathers, and infants given the higher mortality rates among African- American infants. Population metrics monitored include birth weight, pre-term births, and breastfeeding. The interventions involve getting fathers and partners more involved and addressing implicit bias among health care providers. A very strong focus on engaging the local community has yielded an active Community Advisory Board and an effective public awareness campaign that are truly unique and convey that this initiative is community-driven rather than a typical county or government endeavor—see Community – Black Legacy Now – San Diego Perinatal Equity Initiative (blacklegacynowsd.com). The PHS Maternal, Child & Family Health Services Branch maintains the PEI Scorecard along with several contractors who are engaged in the project.

A Bright Future with Scorecard

For the future, PHS intends to use Scorecards to capture more comprehensive initiatives like the Perinatal Equity Initiative.

PHS envisions that Scorecard can be an effective way of reaching out and communicating with partners and the public at large. Future plans include displaying a Dashboard on the PHS website reporting key outcome measures for each Branch. PHS will then go deeper by tying measures to program activities and corresponding progress data. With Scorecard, the possible applications are endless. PHS will exercise caution to ensure that the data are shared in a responsible way that reflects what the County and its partners can reasonably influence. At the same time, they will keep partners energized by maintaining focus on progress toward building communities where every resident lives well.