1108: How Louisiana Transformed Performance Management

JOHN SHEEHAN:

This is Public Health Review Morning Edition for Thursday April 16, 2026 - I’m John Sheehan with news from the Association of State and Territorial Health Officials.  Today: turning a struggling performance management system into a national standout.  We hear from Anna Bryant, Performance Manager at the Louisiana Department of Health, about how her team went from receiving an action plan after initial accreditation in 2019 to earning top recognition during their 2025 reaccreditation.  Se we’ll hear, there’s an essential connection between performance management and quality improvement, where big-picture strategy and day-to-day problem solving work hand in hand. 

So Anna,what's the relationship between performance management and quality improvement?

ANNA BRYANT:

So when I explain these two things, I actually reference a great metaphor from Amanda McCarthy on another ASTO webinar where she talks about a telescope and a microscope. So PM is your telescope. It helps you look at the big picture and QI is your microscope where it allows you to sort of focus in and drill down on the little things that sort of impact what the overall big picture is. But I would say, you know, if they're going to be done correctly, you really can't separate them. Your PM system

should be set up in a way that your data informs what your quality improvement activities are.

SHEEHAN:

That's a really helpful metaphor. You can't separate the big picture without drilling down into what you're doing day to day.

BRYANT:

Exactly.

SHEEHAN:

The webinar highlights a successful reaccreditation process. Why was that a turning point?

BRYANT:

Yeah, so we, Louisiana Department of Health Office of Public Health, which I work in, we had our initial accreditation in 2019. And as a result, actually, we received an action plan the first time around.

particularly for domains 9.1.2 and 9.1.3, the fab standard and domains. So when we wanted to be re-accredited this time around in 2025, we knew that we didn't just wanna pass without an action plan, but we wanted to create something that would continue to stay cutting edge. It would help us build cloud within the system and help convince people that this is really

what you need to do sort of on a national level in order to stay relevant and in order to ensure that you're picking up on potential quality improvement things. In terms of sort of how we did that reaccreditation, we first started out with, you know, getting a good baseline, figuring out where we stood. We did that using the NACCHO QI assessment and the Public Health Foundation PM self-assessment tool to our leadership and other staff in the organization.

We also conducted semi-structured interviews with all 15 of our bureaus within the Office of Public Health to figure out how they were currently doing performance management, what tools they were using, level of quality improvement expertise, and any strategies that they applied. And those things really created a roadmap for us and figured out, helped us figure out areas of improvement, things that we needed to focus on with our revision.

So when we embarked on our reaccreditation, I knew that we were going to be asking for a behavior change from staff who were already busy and overloaded in a post-COVID surge environment. So we needed to be able to cite best practices to give our efforts a lot of clout. And another thing that I wanted to mention that I feel like isn't really talked about enough is the expense to these systems, which is not negligible.

licenses, software for all of the people who using your system. And our assessment showed us that staff had quite a bit of platform fatigue, so we figured out the best way to roll this out was to use software that our team was already using, whether if in your context, know, it's Microsoft Excel. In our situation, it was Monday.com and Tableau.

And then I think the last thing that I'll mention with our reaccreditation efforts is that my background is not in performance management. I have some program management experience from about 10 years ago in my work in global health, but my position prior to this one was working as a nurse in the emergency department for four years. So I felt like I had the hard skills to create a new system, but it wasn't really clear on the vision. And speaking with other health departments through the FIGTA requests sort of was hugely helpful because it, again,

you know, gave the efforts cloud, we were able to say, this is what this health department's doing and it's working really well for them. And I'm happy to report that in 2025, when we were re-accredited and we had our site visit, our performance management system was actually highlighted as one of the top three strengths of our site visit. So from action plan in 2019 to strength of our health department, I feel like we went a long way.

SHEEHAN:

Yeah, clearly. Could you talk a little bit more about those FIG-TA, the technical assistance connections?

BRYANT:

Yeah, absolutely. So our health department is a FigGrant recipient. when I heard about this, I thought, my God, what a great thing that we are able to leverage this. So over the past, I guess, two and a half years since I've been in the position, there were three specific things that we asked of our partner, which was the ASTO team. The first one was figuring out how to select good customer service indicators, because that's actually a piece of required

documentation in the FAB standard and domains. So we reached out about this. They linked us up with tons of resources and big shout out to the Minnesota Department of Health who's really cutting edge on this subject. With those resources, we were able to create a webinar for our staff. During the webinar, we actually had people real time submitting good customer service indicators. And from that, we have this amazing manual now that people, if they're creating a survey, they can go to different

and pick and choose different customer service questions to help contribute to those indicators. It's now a requirement of our performance management system that each of our 15 bureaus has at least one customer service indicator. And if they didn't have one previously, we worked with them to sort of include that in a new survey or maybe to pull that data from a data source they already had.

We did two other FIG TA requests. I'll just talk about those briefly. The second one was linking up, asking to link up with other health departments who use monday.com and Tableau for their systems. They're both great pieces of software and they have a lot of capabilities and we sort of felt maybe we're not maximizing those. We spoke with staff at the main Department of Health about how they use Tableau for their PM system and we also spoke with the Kentucky Department Health of how they use leveragemonday.com.

for performance management and quality improvement activities. And it was really great to hear that we had some similarities which sort of reaffirmed that we were using it the right way. But I think we all walked away learning from each other and sort of with the hope that we'd keep the conversation going in the future. We're actually still emailing and sharing resources, which is great to see. And then the last TA request that we really took advantage of for the system was asking about how other health departments connected

performance management targets with UI strategies in the system. So you see someone has missed a target for an indicator the last three quarters in a row. What are you going to do about it? You know, we need to correct course because we can't keep going the same way. And I'll say this seems to be an area that health departments haven't really figured out a best practice on when it comes to reporting. So what we did is we created an algorithm in monday.com that you could replicate in Excel or any other software where if a target is missed, the target is appropriate, it's a process problem.

and it's due to internal causes, it sort of quickly flags it as a potential QI area that our team reviews. We say, you know, what kind of QI strategies could be applied here? Maybe this merits a follow-up conversation with the team.

SHEEHAN:

So in addition to the accolades from the site visit, and your team's internal process is running more smoothly. Can you point to any other success stories from that performance management overhaul?

BRYANT:

Sure, I would say that.One success story, we recently created a performance management quality improvement community of practice, which is where our bureau directors from those 15 bureaus and then one to five people from each of them join on, it's now on a quarterly basis. And one thing that we've tried to do to really increase engagement is to frame our performance management system like a quality improvement project. And quality improvement projects, they rely on data and our data in this case is qualitative feedback.

So in every community of practice now we include real-time polling software. We use Menti. We say what's going well? What's not going well? And then in subsequent ones we try to address that in real time. This is how we've incorporated your feedback. And something that was sort of a big win for me was one of the questions we asked was how frequently do you want to meet? Is it yearly? Is it twice a year? Is it quarterly? And an overwhelming majority said quarterly.

That represents, I think, such a big cultural change from the assessment results that we, the assessment that we administered in 2023. The fact that people have a much better understanding of PMQI and also the fact that we, you know, they want to meet, they want to talk about it and people are saying, you know, let's do sort of like a show and tell, let's include, let's make space for bureaus to talk about achievements or maybe something they're struggling with because there might be an opportunity to learn from your co-workers.

in that in that regard. We also had a cohort of green and black belts just this past year and I was on one of the projects and we were able to show that our pharmacy inventory system when we revamped it we saved $284,000 in a single quarter and just having one of those you know huge projects where you can show this you know this quality improvement methodology really works it saves money and it leads to staff being

that much more content. We've sort of carried that through to show staff the utility of these strategies.

SHEEHAN:

Absolutely, that's real money right there.

BRYANT:

Absolutely.

SHEEHAN:

And lastly, so the webinar is being billed as kind of a real world application.

The webinar is kind of showing what happens in real life scenarios when this re-accreditation process goes through. 

Can you make the case for someone who's kind of on the fence about joining the webinar, like why it makes sense for their agency?

BRYANT:

Yes, you absolutely don't want to miss this.

As I mentioned, we started from action plan in 2019 to accolades in 2025. So it helps us go over, we go over the sort of easiest pitfalls when installing a new system, which heavily relies on a change management aspect. And we want to sort of break down how change management, it's a non-negotiable when it relates to performance management and quality improvement. Another thing that we really try to reinforce is that you need to plan before you launch. It's okay if it feels like things are

installing if it feels like you've been in the planning phase for years. We actually spent a year and a half planning before rolling out in a phased approach and last July was when we launched and we heard from staff that what really benefited us was really benefited the system was that we talked about what we were going to do. We you know as I mentioned that phased part just sort of introducing one piece of the new system at a time and that was so much more effective than just dropping a whole new process that required more work and had increased

expectations of staff. I also, know, the fact that we leverage the FIG TA request system throughout the process, Melissa and the ASTHO team, are so helpful and just being able to have that, you know, open communication, that open dialogue with health departments who are always willing to share their resources, always willing to help, and it really creates this like two-way learning street with our colleagues around the country, which is great to see. We also, one thing that we pride

ourselves on with our webinars is we try to make them interactive so hopefully it'll be something that you can engage in rather than just tuning in.

SHEEHAN:

Anna Bryant, thanks so much.

BRYANT:

Thank you so much.

SHEEHAN:

Anna Bryant is Performance Manager at the Louisiana Department of Health.

Stronger public health systems build stronger, healthier communities.
The Public Health Infrastructure Grant (PHIG) website is your go-to hub for tools, resources, and real-world stories that showcase how public health agencies are transforming systems, strengthening partnerships, and driving long-term impact. Explore the site and be inspired. The link is in the show notes.

The ASTHO Leadership Institute (ALI) is a premier cohort-based professional development program designed to support executive-level, governmental public health leaders in driving meaningful change in their organizations and communities.  As ASTHO’s flagship leadership development program, ALI works with experts in executive leadership, nationally recognized public health professionals, and alumni to offer a curated learning program. Participants benefit by gaining access to: A supportive learning environment, Expert-led training sessions, and Opportunities to elevate their careers while advancing the mission of public health.  Learn more at the link in the show notes.

This has been Public Health Review Morning Edition, I’m John Sheehan for the Association of State and Territorial Health Officials.