Planning for Performance Improvement

8/14/2019 Planning for Performance Improvement

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Performance Measurement andImprovement

Planning


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Quality Management Trilogy

Revisited

o Quality Planning

o Quality Control

o Quality Improvement


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The Quality Management Trilogy

o Quality Planning includes:

o Identifying and tracking customers, their needs andexpectations.

o Designing new or redesigning systems, services, orfunctions based on customer needs and expectations.

o Identifying function and process issues critical toeffective outcomes; and developing new processescapable of achieving the desired outcome.

o Setting quality improvement objectives based on

strategic goals.


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o Quality Control/Measurement includes:

o Developing process and outcome performancemeasures.

o Measuring actual performance and variance fromexpected.

o Summarizing data and performing initialassessment/ analysis.

o Measuring and describing process variability.


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Quality Control/Measurement includes: cont..

o Measuring and tracking outcomes of populations.

o Performing intensive assessment as data dictates.

o Providing accurate, timely feedback.

o Using the data to manage, evaluate effectiveness,maintain Quality Improvement gains, and facilitateQuality Planning.


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o Quality Improvement includes:

o Collaboratively studying and improving selectedexisting processes and outcomes in governance,management, clinical, and support activities;

o Analyzing causes of process failure, dysfunction,and/or inefficiency;

o Systematically developing optimal solutions tochronic problems;

o Analyzing data/information for better or best practice.


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Quality ImprovementProcess


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The essential elements for improvement

Will, ideas, and execution.

You must have the will to improve,You must have ideas about alternatives to the

status quo

You must make it realexecution.

The Institute for Healthcare Improvement (IHI)

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The QI Process


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Define Desired Performance

o In order for people to perform well, they must know whatthey are supposed to do.

o Performance standards need to be set.

o Staff must know not only what their job duties are but also

how they are expected to perform them.

o Desired performance should be realistic and based on theshared vision, the expectations of the community and theresources at your site.


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Assess Performance

o Your team will need to continually assess how they

are performing compared to how they are expected toperform.

o This assessment can be done on an ongoing basisinformally, or more formally on a periodic basis byobserving staff, conducting self-assessments orobtaining feedback from clients.


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Find Causes of Performance Gaps

o A performance gap exists if your team finds that what isactually occurring does not meet the performancestandards that have been set.

o If you find that this is the case, then you need to carefullyexplore with staff why the gap is occurring what is

hindering desired performance.

o Sometimes the reasons for poor performance are notimmediately obvious and it may take some time to find

the real cause.


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Select and Implement Interventions

o Once the causes of the performance gap have beendetermined, you and your staff will need to identify, putin order of priority, plan and implement interventions toimprove performance.

o These interventions can be directed at improving theknowledge and skills of staff, or they can be directed atimproving the environment or support systems thatenable staff to perform well.

o There are many different types of interventions that can beput in place to improve worker performance. To saveresources, it is important to select the correct ones.


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Monitor and Evaluate Performance

o Once interventions have been implemented, it is importantto determine if interventions have had the desired result.

o Did the intervention cause performance to improve?

o Did it move you closer to meeting the established standards?

o If not, your team will need look at what is hinderingperformance to make sure that the interventions are beingtargeted appropriately at the real cause of the performancegap.

o If performance has improved it is important to continuemonitoring to make sure that the desired level ofperformance is maintained.


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Criteria Used To Set Improvement Priorities

o Probability of success

o Timeo Cost

o Impact on vision or mission and strategic planning

o Impact on customer satisfactiono Acceptance by people involved


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Priority Decision Making

Prioritizing involves decisions concerning which:o Important governance, management, clinical, or support

functions and processes to emphasize;

o Performance measures to use;

o Issues to analyze more intensively;

o Processes or outcomes to improve.


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Prioritizing Process

Pareto Rules

o Once data is aggregated and prioritized:

o 20% of problems will have 80% of the impact;

o 20% of activities will bring 80% of the results.


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Setting priorities should be based on:

o Potential impact on efficiency, effectiveness, and/orcost of care delivery;

o The greatest potential for improvement in patientcare or outcome;

o Frequency, duration, and complexity of the problem;

o Number of functions, services, programs, or unitsinvolved;


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o Effort, staff time, and associated costs involved in themonitoring and/or problem-solving process;

o Staff and administrative commitment to monitoring the

area or resolving the problem;


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o High volume, high cost, high risk, problem-prone

issues with significant (real or potential) impact onpatients or staff/practitioners;

o The organization's mission, vision, and values.

Developing Performance Improvement


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Developing Performance ImprovementAction Plans

o Systematic approach

o Identify potential improvements

o Include all stakeholders

o Identify action

o Take action TIPOrganizations need to take a systematic

approach to increase opportunities

for successful improvement


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Actions for Identified Problems

o Systems

o Knowledgeo Performance

o Ensuring performance

o Monitoring performance

The Written Quality Plan


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The Written Quality PlanRequirements For Written Plans

o Written plans generally describe quality management,

utilization management, and risk management functionsand govern their operations.

o The plans may be separate or integrated.

o All organizationwide Plans related to the provision ofpatient care and services must be approved byadministration, the governing body, and, in hospitals, bythe medical/ professional staff.

o The people in the organization cannot be asked to committo, or be held accountable for, what is not put in writing.

Q alit Plan Sample Content O tline For Pro ider


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Quality Plan Sample Content Outline For Provider

Organizations

o Introduction

o Purpose:

o Guiding Statements

oMission Statement

oVision Statement

oCore Values and/or

oGuiding Principles -

oDefinition of Quality

o Goals and Objectives



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Organizations

o Overview and Planning

o Identified Customers

o Important Organizationwide Functions (List)

oPatient-Focused Functions

oOrganization Functions

o Dimensions of Performance

o Prioritization for Performance Improvement (i.e.,

rationale for selection)



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Organizations

o Structure and Design

o Quality Management/Performance ImprovementInfrastructure (QM/PI Information Flowchart)

o Quality Council

o Links to governing body, medical staff or physician

groups, administrationo Team structure

o QM/PI Education links

o QM/Pi support staff ('Resource Center)

o Information flow and reporting; link to customers


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Organizations

o Approach and Methodology

o Documentation and Communication

o Documentation: Description of standardized format andforms

o Reporting/Communication

o Confidentiality and Conflict of Interest

o Program Evaluation

o Description of mechanism

o Reporting process, responsibility, and time frame(usually annual)



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Organizations

o Appendices

o Quality Objectives

o OM/PI Information Flowchart

o Administrative Organizational Chart(s)

o Medical Staff Organizational Chart (if applicable)

o Strategic Quality Initiatives

o List Current QI/PI Projects List

o Approvals

o Chief executive officer,Chair, Quality Council

o Chief of medical staff & Chair of governing body

Q lit i t (QI) d l


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Quality improvement (QI) models

Four basic steps that comprise a systematicapproach for quality improvement:

o Identify a potential improvement

o Test the strategy for changeo Assess data to determine if

performance improved

o Implement improvement system wide

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P D C A (Shewhart cycle)

In the 1920s, Walter Shewhart, developed theShewhart cycle, known (PDCA). This four stepprocess is designed to continuously improve

Plan. Recognize an opportunity for improvement and plan a

change.

Do. Make changes on an experimental, pilot basis.

Check. Measure outcomes compared to predicted outcomes.

Act.Implement the changes on a broad scale.

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PDCA CYCLE


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PDCA CYCLE

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Steps of Quality Improvement in Juran Model

Step 1: Identify a project (problems or area forimprovement)

Step 2: Establish the project

Step 3: Diagnose the Cause

Step 4: Remedy the cause

Step 5: Hold the Gains

Step 6: Replicate results and Nominate newprojects

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Focus-PDCA developed by Hospital Corporation


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Focus PDCA developed by Hospital Corporationof America

o Find a process to improveo Organize a Team that knows the process

o Clarify current knowledge

o Understand the variation

o Select a potential process improvemento Plan

o Do

o Check

o Act

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LEAN


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LEAN

There are five essential steps in lean:

1. Identify which features create value.2. Identify the sequence of activities called

the value stream.3. Make the activities flow.

4. Let the customer pull product or servicethrough the process.5. Perfect the process.

The essence of Lean is ELIMINATING waste whileimproving process flow to achieve speed and agility atlower cost.

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Si Si


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Six Sigma

o At the heart of the methodology is the DMAIC

model for process improvement. DMAIC iscommonly used by Six Sigma project teams andis an acronym for:

oDefine opportunity

oMeasure performance

oAnalyze opportunity

oImprove performance

oControl performance.

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Strategic Quality Initiatives As Part Of The Strategic Planning


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Strategic Quality Initiatives As Part Of The Strategic PlanningProcess

o As a part of the strategic quality planning process and thedevelopment of explicit objectives (or possibly critical success

factors), the organization leaders should identify and prioritizecertain service lines, important organization-wide functions-orkey processes that support these functions-for improvement.

o Strategic Quality Initiatives serve to "roll out" certain strategic

goals or achieve particular critical success factors; that is, astrategic goal (or critical success factor) relevant to performanceimprovement is supported by one or more Strategic QualityInitiatives.

o Each Strategic Quality Initiative includes a statement of theintent (improvement statement), outcome objectives, andperformance measures, once these are determined by theselected team.

STRATEGIC QUALITY INITIATIVES


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STRATEGIC QUALITY INITIATIVESDefinition and Description

o A Strategic Quality Initiative is a statement of intent and a

strategy to improve care and services in a specific way.

o It is a high-level, leadership-driven, organization-widedecision, resulting from, or incorporated into, theorganization's strategic planning process.

o Each Strategic Quality Initiative is linked to one or moreidentified and approved strategic goals


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Sample initiati e topics


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Sample initiative topics

Management:

o Timely performance evaluationso Computerization of outcome measures

o QI education and training

o Information management education and training

Governance:o Board self-evaluation

o QI Program development in a new Integrated DeliverySystem

o Financial performance measures



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Sample initiative topicso Patient care:

o Patients with diabetes

o Outcome measures for patients requiring CABGo Patients receiving chemotherapyo Development of case management process

o Operations:

o Construction of new facility to house ambulatoryserviceso Physical plant managemento New customer service programo Integration of clinical and financial information

systemso Redesign of behavioral health services for managed

careo Redesign of QI/PI activities from departmental to

functional



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Cost management:

o Negotiation of capitated provider contracts - Five-year energy plan

o Productivity standards

o Renegotiation of purchased service contracts

Marketing:

o Reprioritized marketing of services based onidentified community needs

o Expansion of services available for seniors

Four Questions to Evaluate the Effectiveness of


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Your PI Program

Is it planned, systematic, and organizationwide?

Is it collaborative?

Does approach need redesigning to accommodatechanges in strategic plan?

Has the program been effective in improvingorganizational performances?

Common PI Program Problems Identified


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Common PI Program Problems Identified

o Lack of commitment by

managemento Lack of involvement

o Insufficient resources

o Team meeting

frequency not adequate

o Lack of data analysis

o Lack of tracking team

performanceso Scope too broad or too

narrow

o Confusion about who

owns a processo Choosing irrelevant or

meaningless indicators

QM Role in PI Program Appraisal


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QM Role in PI Program Appraisal

o Evaluate progress/effectiveness of performance

improvement activities;o Inform management when systems are not in place;

and

o Coordinate, plan and conduct annual appraisals

Documents

Planning for Performance Improvement