The challenges of employing performance monitoring in public health community-based efforts: a case study

The development of community-based coalitions has acquired great popularity as a health promotion strategy. The Institute of Medicine recommends that community-based health coalitions employ a performance monitoring process in their efforts. The results of the current study indicate that in the community setting, implementing a performance monitoring process and sustaining the specialized functions entailed in this strategy are challenging. Many of the challenges result from fundamental differences between the organizational environment of bureaucracies--in which these techniques are developed, supported, and greatly successful--and the realities of the loosely-structured and resource-limited community environment. The performance monitoring process is measurement-driven. One challenge of implementing this process at the community level is that public health problems of local concern are not always documented in current surveillance systems and thus a performance monitoring strategy is not always, or immediately, applicable. When data which document a health problem of local concern are available, a second challenge facing community-based coalitions is acquiring the resources, especially the wide-range of specialized expertise, required to fully implement and sustain the performance monitoring process. These issues are examined in the context of the Massachusetts Department of Public Health's Community Health Network Area (CHNA) Initiative which entails the formation of coalitions of local health service providers. The CHNA initiative is a statewide project in which health service providers in specified geographic regions work collaboratively on health improvement projects.