| Background:As the government performance management theory and practice advances, the performance management of the centers for Disease control and prevention (CDCs) which provide public service has drawn a great deal of attention. In December 2008, Bureau of the Disease Control and Prevention, Ministry of Health, issued "the basic functions of Centers for Disease Control and Prevention at all levels" and "the performance evaluation indicator system of Disease Control and Prevention system" (by Bureau of the disease control and prevention, Ministry of Health (2008) No.68), which kicked off the performance evaluation of the CDCs. However, performance evaluation is only the first step of performance management. More important is the following performance diagnosis and sustainable improving. So, how to put the evaluation in place? How can the evaluation not only encourage the advanced, but also keep the enthusiasm of the laggard? How to avoid the evaluation into blind comparison and rotta? These are all the questions needed to be answered soon. The county-level CDCs is the bottom the Disease Control and Prevention system doing a lot of specific work, whose performance improving will surely promote the whole Disease Control and Prevention career of our country.Benchmarking management is a process which aims at improving the performance of an organization by looking for and carrying out the best practices, finding the gap to improve the method of management. Systematically review the research on benchmarking, we found that foreign scholars’ researches on benchmarking were relatively mature and it was regarded a useful tool for performance diagnosis and improvement. As the theory of the western public management being introduced to China, benchmarking management came to China. However, it is rarely applied in CDCs, mainly in medical institutes.Goals and contents: Goals of the study:With the concept of benchmarking management, this study selected the county-level CDCs of certain province in East China as a sample to explore the institution operating law, on the basis of which we carried out the research on performance diagnosis and improving of county-level CDCs in regional and institutional perspectives, providing a methodological way for the performance diagnosis and sustainable improving.Contents of the study:1. Explore the institution operating law, realizing the relationship among the resource allocated, ability construction and the function implement.2. Create a multi-dimensional benchmarking to give performance diagnosis and find improving methods of county-level CDCs and classical institutions.3. Compare the performance of the county-level CDCs in 2010 and 2012, knowing the effects of the performance diagnosis and improving.4. On the basis of the summarizing the research on performance diagnosis and improving methods, we created the "Guideline of performance diagnosis and improving methods for county-level CDCs".Materials and Methods:1. Under the guidance of the law-"structure-process-result" using the data of function complement, human resource, expenditure, housing and equipment, etc. we discussed the relationship among the resource allocated, ability construction and the function implement.2. With the method of standard gap analysis, comparing the accomplishment status of the county-level CDCs nationwide, east area of China and the East China, we realized the gap between the current level of the county-level CDCs selected with the multi-dimensional benchmarking, so as to do performance diagnosis and improving research.3. Using the longitudinal comparison method, we compared the data of function fulfillment, human resource, expenditure, housing and equipment, etc. in 2010 and 2012, finding the improvement in the 2 years-time.Main Results:1. Exploring the operational law of county-level CDCsOn the basis of descriptive analysis of the performance of county-level CDCs in a certain East-China province in 2010, using the methods, such as simple relative analysis, principal component analysis, regression analysis, etc. we analyzed the key indicators in 3 aspects (resource allocation, capacity construction and function implementation). The result shows that county-level CDCs obey the law of "structure-process-result", which means the resource indicators such as human resource quantity and quality, budget input, equipment allocation, etc. greatly influence the implementation of the institutional function. So when using benchmarking method to choose the "best practice", we should take the resource allocation level into consideration.2. Performance diagnosis and improving research of county-level CDCs in a certain East-China provinceFirstly, choose the multi-dimensional benchmarking:① virtual benchmarking: On the basis of the law of "structure-process-result", we classify the county-level CDCs, according to their resource allocation level, and choose the first 10% as the virtual benchmarking.② common benchmarking:Considering the regional administration division and longitudinal changes as time goes by, we created the horizontal benchmarking (national level, district level and standard level) and the longitudinal benchmarking (the best performance over the years).Then, use radar chart to do multi-dimensional performance diagnosis of the county-level CDCs in 2010. ① Regional aspect:the performance accomplishment degree of the county-level CDCs selected is higher than the average of the national and eastern county-level CDCs, but still has a certain gap with the highest level benchmarking nationwide and also the eastern area of China, the standard level benchmarking and the virtual benchmarking; ②Institutional aspect:The performance accomplishment degree of the classic institutions is higher than the mean of county-level CDCs nationwide, east area and the data in 2009. However, it has a big distance with the virtual level, standard level and the highest level of nationwide, east area, with the largest gap of 12.7%.At last, do performance improving research on 2 aspects (function implementation and ability construction), carried out in regional and institutional levels. In the aspect of function implementation ①regional level:Functions of technical guidance and application, public health emergency disposition and health hazard monitoring and control need to be improved;② institutional level:Functions of technical guidance and application, disease control and prevention, public health emergency disposition need more attention. In the aspect of ability construction, set the ability of public health emergency disposition ability as example: ① regional level: the simulation practice work goes well, while the relevant information network direct reporting rate、incident reported in time,standard resolution rate, pre-arranged planning and the material reserve for emergency need to be strengthened;② institutional level:the relevant information network direct reporting rate、incident reported in time,standard resolution rate, pre-arranged planning and simulation practice work are good, but the material reserve for emergency is far below the standard, needed to be strengthened.3. A proven example of performance diagnosis and improving effectsBy comparing the data of resource allocation, ability construction and function implementation of county-level CDCs between 2010 and 2012, we found that both the resource allocation and ability construction had improved a lot, and ability construction improved more. Each function had improved, with the average completion degree improving from 84.4% to 92.2%.With the method of standard gap analysis, we found the distance with the benchmarking both regional level and institutional level had decreased:① regional level:There were a large decrease in public health emergency disposal, health hazard surveillance and control, technical instruction and research application;② institutional level:The gap between total performance completion degree and the benchmarking decreased a lot, but the gap between the information management and health hazard surveillance and the benchmarking increased, which need more attention.4. A summary of performance diagnosis and improvement methodUsing the concept of benchmarking management, this part tries to summarize the methodological thinking of performance diagnosis and improvement method, which includes multi-dimensional benchmarking, performance diagnosis and sustainable improvement. On the basis of it, we created the model of "Guideline of performance diagnosis and improving methods for county-level CDCs".Discussion:With the aim of finding the performance diagnosis and improving method of county-level CDCs, we created the model called "Guideline of performance diagnosis and improving methods for county-level CDCs", which will be an important tool helping the performance improving of county-level CDCs.① we confirmed that the county-level CDCs follow the operating law of "structure-process-result",which indicates that we should not merely evaluate the performance by ranking. However, we should set up virtual benchmarking according to the amount of resource they have. ② we created multidimensional benchmarking, including the virtual and common benchmarking, while the common benchmarking includes the Horizontal(national level, district level and standard level) and the longitudinal benchmarking. It laid a foundation for multidimensional performance diagnosis and improving.③we created the model called "Guideline of performance diagnosis and improving methods for county-level CDCs", which includes the current status evaluation, performance diagnosis, performance improving and specific indicator accomp lishment. It can be an effective tool for performance diagnosis and improving.However, there are still several shortcomings needed to be improved in research: ① the data comes only from the performance evaluation platform, not combining with the regional or institutional current situation;② in the aspect of performance improving, by comparing the indicator with the standard, we know the weakness we have, realizing the direction of the future efforts, but no detailed improving method; ③ aiming to provide performance diagnosis and improving method in a macro-level, the "Guideline of performance diagnosis and improving methods for county-level CDCs" is universal, but it does not give the specific operational process for performance diagnosis and improving. |
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