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Lecture given on April 2, 2014 - PSQUA - Performance Management System in the Hospital
Citation preview
Experiences inPerformance Management System
in a Private Hospital Setting: TPORs of a Consultant-Adviser
Reynaldo O. Joson, MD, MHA, MHPEd, MSc SurgConsultant-Adviser
Manila Doctors HospitalCiudad Medical Zamboanga
Experiences inPerformance Management System
in a Private Hospital Setting: TPORs of a Consultant-Adviser
Define
•Context •Limit of Scope
Experiences inPerformance Management System
in a Private Hospital Setting: TPORs of a Consultant-Adviser
Experience
• experience of a hospital – PMS
• my personal experiences – consultant-adviser on PMS
Experiences inPerformance Management System
in a Private Hospital Setting: TPORs of a Consultant-Adviser
Experience
• experience of a hospital – PMS
• my personal experiences • Thoughts, Perceptions, Opinions, and
Recommendations (TPORs) – consultant-adviser on PMS of 2 private hospitals
Experiences inPerformance Management System
in a Private Hospital Setting: TPORs of a Consultant-Adviser
Private Hospital Setting
•Manila Doctors Hospital – 1999
•Ciudad Medical Zamboanga – 2009
TPORs – Thoughts, Perceptions, Opinions and Recommendations from experience with MDH and CMZ as consultant-adviser
Experiences inPerformance Management System
in a Private Hospital Setting: TPORs of a Consultant-Adviser
Performance Management System
• PMS in hospital system – not part of presentation •PMS in a stand-alone hospital and its units – focus of presentation• PMS for hospital clinician-physicians and PMS
for hospital clinical and administrative staff – not part of presentation
Experiences inPerformance Management System
in a Private Hospital Setting: TPORs of a Consultant-Adviser
Define
•Context •Limit of Scope
Experiences inPerformance Management System
in a Private Hospital Setting: TPORs of a Consultant-Adviser
Contents:
TPOR1: Journey towards performance excellence of MDH and CMZ
TPOR2: Tools for evaluation of performance management system (whole hospital)
TPOR3: Starting and continuing journey towards performance excellence for private hospitals
TPOR1: Journey towards performance excellence of MDH and CMZ
TPOR1: Journey towards performance excellence of MDH and CMZ
TPOR1: Journey towards performance excellence of MDH and CMZ
TPOR1: Journey towards performance excellence of MDH and CMZ
Just look for and focus on the similarities!
TPOR1: Journey towards performance excellence of MDH and CMZ
Just look for and focus on the similarities!
• Strategic Planning • Balanced Scorecard• Baldrige / PQA Criteria for
Performance Excellence• PhilHealth Benchbook
TPOR1: Journey towards performance excellence of MDH and CMZ
TPOR1: Journey towards performance excellence of MDH and CMZ
TPOR1.1The journey towards performance excellence is long and tedious.
It may take at least 10 years even with good planning, commitment and support from top management, and perseverance.
Recommendation: Allot 10 years!
Macro-indicators of Performance Excellence (Baldrige):
Integrated approach to organizational performance management that results in (1) delivery of ever-improving value to customers and
stakeholders, contributing to organizational sustainability
(2) improvement of overall organizational effectiveness and capabilities
(3) organizational and personal learning
GOAL (short-/long-term)
3 Macro-indicators of Excellent Hospital (ROJoson):
• Contributing to achievement of targeted health outcomes in its catchment community
• Providing value-based health care services
• Sustainable while providing excellent services
GOAL (short-/long-term)
Performance Excellence• Five performance outcomes to monitor and
evaluate:• Product and process outcomes• Customer-focused outcomes• Workforce-focused outcomes• Leadership and governance outcomes• Financial and market outcomes
TPOR1: Journey towards performance excellence of MDH and CMZ
TPOR1.2There are no absolute end-points in the
journey. It is a continuous journey.
Recommended initial end-points:1. Being given the highest recognition from
the Philippine Quality Awards2. With at least 25 documented best
practices
TPOR1: Journey towards performance excellence of MDH and CMZ
“Best Practice”- a formally documented method or
technique that has been institutionalized in the hospital and
- that has consistently shown performance excellence results at least if not yet proven superior to those achieved with other means and
- which can be or is being used as a benchmark by other hospitals
TPOR1: Journey towards performance excellence of MDH and CMZ
With at least 25 documented best practices distributed as follows:
PQA Categories (6)• Leadership• Strategic Planning• Customer Focus• Measurement, Analysis, Knowledge
Management • Workforce Focus• Operations Focus
TPOR1: Journey towards performance excellence of MDH and CMZ
With at least 25 documented best practices distributed as follows:
International Hospital Health Care Standards (8):• Access to Care and Continuity of Care• Patient and Family Rights• Assessment of Patients• Care of Patients• Anesthesia and Surgical Care• Medication Management • Patient and Family Education• Hospital Infection Control
TPOR1: Journey towards performance excellence of MDH and CMZ
With at least 25 documented best practices distributed as follows:
ROJ Recommended Steadfast Strategic Objectives for Hospitals (10):• Systems perspective in governance • Integrated value-based health care service• Physician engagement • Maximal utilization of services with controlled
expenses and losses• Customer delight • Full compliance with the quality and performance
standards (local and international) • Integrated IT-enabled operations system • Staff engagement• Learning organization• CSR program with tangible social impact
TPOR1: Journey towards performance excellence of MDH and CMZ
With at least 25 documented best practices distributed as follows:
ROJ Recommended Steadfast Strategic Objectives for Hospitals (10):• Systems perspective in governance • Integrated value-based health care service• Physician engagement • Maximal utilization of services with
controlled expenses and losses• Customer delight
TPOR1: Journey towards performance excellence of MDH and CMZ
With at least 25 documented best practices distributed as follows:
ROJ Recommended Steadfast Strategic Objectives for Hospitals (10):
• Full compliance with the quality and performance standards (local and international)
• Integrated IT-enabled operations system • Staff engagement• Learning organization• CSR program with tangible social impact
TPOR1: Journey towards performance excellence of MDH and CMZ
With at least 25 documented best practices distributed as follows:ROJ Additional Recommended Must-Have Management System or Program for Hospitals (1):
• Communication Management System
TPOR1: Journey towards performance excellence of MDH and CMZ
TPOR1.3Although helpful, one does not have to get formal accreditation by all the available standards-accrediting bodies.
Be COMPLIANT with the standards and criteria without going for formal accreditation! (through self-directed learning and improvement!)
TPOR1: Journey towards performance excellence of MDH and CMZ
TPOR1: Journey towards performance excellence of MDH and CMZ
TPOR1.3Going for formal accreditation - depends on your need and situation!
Need - to participate in National Health Insurance Program and get benefits – go for PhilHealth Accreditation!Need - to participate in medical tourism program and get benefits – go for international accreditation (JCI / ACI / NABH)
TPOR1: Journey towards performance excellence of MDH and CMZ
TPOR1.3Going for formal accreditation - depends on your need and situation!
Need – to satisfy requirement of corporate accounts – go for accreditation! Need – to satisfy expectations of the community – go for accreditation!
TPOR1: Journey towards performance excellence of MDH and CMZ
TPOR1.3Going for formal accreditation - depends on your need and situation!
Situation – to be with the trend of having an international accreditation (not to be left out – strong community expectation) – go for accreditation!
TPOR1: Journey towards performance excellence of MDH and CMZ
TPOR1.3Going for formal accreditation - depends on your need and situation!
Situation – want to fast-track improvement of quality and safety of operations and services with accreditation – go for accreditation (assessment, training, improvement, evaluation)!
Integrating Hospital Quality and Performance Standards• Baldrige Health Care Criteria for
Performance Excellence / Philippine Quality Award Criteria for Performance Excellence
• ISO Quality Management System• PhilHealth Benchbook (including PH
statutory and regulatory requirements)• Joint International Commission,
Accreditation Canada International • Investors in People
*Compliant but NOT necessarily going for accreditation to all standards, except PhilHealth Benchbook and Philippine Quality Awards for Performance Excellence
Performance Excellence
• Business Development• Efficiency• Learning
Integrating Hospital Quality and Performance Standards• Baldrige Health Care Criteria for
Performance Excellence / Philippine Quality Award Criteria for Performance Excellence
• ISO Quality Management System• PhilHealth Benchbook (including PH
statutory and regulatory requirements)• Joint International Commission,
Accreditation Canada International • Investors in People
*Compliant but NOT necessarily going for accreditation to all standards, except PhilHealth Benchbook and Philippine Quality Awards for Performance Excellence
Performance Excellence
Increase in utilization of
services
Increase in corporate
accounts andpatient-clients
TPOR2: Tools for evaluation of performance management system (whole hospital)
TPOR2: Tools for evaluation of performance management system
2 goals of PMS
• To promote performance excellence in the hospital.
• To evaluate whether the hospital has achieved performance excellence.
Macro-indicators of Performance Excellence (Baldrige):
Integrated approach to organizational performance management that results in (1) delivery of ever-improving value to customers and
stakeholders, contributing to organizational sustainability
(2) improvement of overall organizational effectiveness and capabilities
(3) organizational and personal learning
GOAL (short-/long-term)
3 Macro-indicators of Excellent Hospital (ROJoson):
• Contributing to achievement of targeted health outcomes in its catchment community
• Providing value-based health care services
• Sustainable while providing excellent services
GOAL (short-/long-term)
3 Macro-indicators of Excellent Hospital:
• Contributing to achievement of targeted health outcomes in its catchment community
• Providing value-based health care services
• Sustainable while providing excellent services
GOAL (short-/long-term)
Formal - Objective - Stringent Assessment(Internal & External)
3 Macro-indicators of Excellent Hospital:
• Contributing to achievement of targeted health outcomes in its catchment community
• Providing value-based health care services
• Sustainable while providing excellent services
GOAL (short-/long-term)
Formal - Objective - Stringent Assessment(Internal & External)
Internal Auditors
with Checklists-Rating Scales
External AuditorsPQA
PhilHealthDOH
Others (Int’l)
Macro-indicators of Performance Excellence:• Integrated approach• Delivery of ever-improving value
to customers and stakeholders, contributing to organizational sustainability
• improvement of overall organizational effectiveness and capabilities
• Organizational and personal learning
GOAL (short-/long-term)
Formal - Objective - Stringent Assessment(Internal & External)
Internal Auditors
with Checklists-Rating Scales
External AuditorsPQA
PhilHealthDOH
Others (Int’l)
TPOR2: Tools for evaluation of performance management system (whole hospital)
TPOR2.1 Use management reviews regularly.
TPOR2.2 Use internal and external independent audits for evaluating PMS at planned intervals.
TPOR2.3 Use integrated evaluation checklists when using several standards.
TPOR2.4 Make Baldrige / PQA Criteria for Performance Excellence as the motherhood standard or framework when using several standards.
TPOR2.5 Use a checklist, rating scale or dashboard such as a balanced scorecard to guide, align and integrate all units, track and assess PMS.
Integrating Hospital Quality and Performance Standards• Baldrige Health Care Criteria for
Performance Excellence / Philippine Quality Award Criteria for Performance Excellence
• ISO Quality Management System• PhilHealth Benchbook (including PH
statutory and regulatory requirements)• Joint International Commission,
Accreditation Canada International • Investors in People
*Compliant but NOT necessarily going for accreditation to all standards, except PhilHealth Benchbook and Philippine Quality Awards for Performance Excellence
Performance Excellence
Use integrated checklists
A – ApproachD – DeploymentL – Learning I – Integration
L – LevelT – TrendC – ComparisonI – Integration
TPOR2: Tools for evaluation of performance management system
TPOR2.5 Use a checklist, rating scale or dashboard such as a balanced scorecard to guide, align and integrate all units, track and assess PMS.
What is a balanced scorecard?A balanced scorecard is a scorecard, a blueprint, or a report card
formulated by an organization to be used as a guide and reference
for the implementation of strategies and tactical objectives, monitoring the implementation, and evaluation of results of implementation.
Integration refers to the extent to which
• your results measures (often through segmentation) address important customer, product and service, market, process, and action plan performance requirements identified in your Organizational Profile and in Process Items• your results include valid indicators of future
performance• your results are harmonized across processes and
work units to support organization-wide goals
BSC Framework Translate to Function Level Scorecards (Corporate, Unit, Individual)
Corporate BSC – formulated by the Senior Management Team and approved by Top Management.
Unit BSC – formulated by all medical or non-medical specialty units in the hospital (divisions, departments, committees, offices) cascaded from / guided by the corporate BSC.
Individual BSC – formulated by an individual staff on how he/she will contribute to the unit BSC.
BSC Framework
Translate to Function Level Scorecards (Corporate, Unit, Individual)
Contents of BSC
• Perspectives (5) • Goals (Strategic Intent – General Objectives)• Tactical Objectives (Specific Objectives – Key Result Areas) • Performance Measures: Outcome and Target (Key Performance Indicators) • Initiatives (Programs, Projects, Tasks, Activities) • Action Registers / Action Plans of Initiatives • Resources / budget• Timetable (Timelines or Gantt charts)• Person-in-Charge (Champeons, Task Forces)
BSC Framework
Translate to Function Level Scorecards (Corporate, Unit, Individual)
Tabular Presentation of the Main BSC(Scorecard with identification of “Initiatives”)
Perspective Goals
(Strategic Intent – General Objectives)
Tactical Objectives
(Specific Objectives – Key Result Areas)
PerformanceMeasures: Outcome /Target
(KeyPerformance Indicators)
Initiatives
(Programs, Projects, Tasks, Activities)
BSC Framework
Translate to Function Level Scorecards (Corporate, Unit, Individual)
Tabular Presentation of the Main BSC(Scorecard with performance data and analysis)
Perspective Goals
(Strategic Intent – General Objectives)
Tactical Objectives
(Specific Objectives – Key Result Areas)
PerformanceMeasures: Outcome /Target
(KeyPerformance Indicators)
Status (Q1/Q2/Q3/Q4)
Data:Analysis: Variance - achieved / NOTachievedResolutions for negative variance:
What is a sample of a BSC of a hospital unit?
PERSPECTIVE
Key Result
Areas/ Goals
Tactical
Objective
Measures Action Plans
Key Performance Indicators
CUSTOMER
Customer delight
Provide quality service
1. External and internal customer satisfaction rating >80% 2. No. of complaints / incident report < 6 per year
Orient and train AU staff on revised/ upgraded Operations Manual
What is a sample of a BSC of a hospital unit?PERSPECTI
VE
Key Result
Areas/ Goals
Tactical
Objective
Measures Action Plans
Key Performance Indicators
PEOPLE Staff engagement
Promote aligned, motivated, empowered and contented workforce
Absenteeism < 10%Tardiness < 10%Staff satisfaction rating > 80%
1. Create a human resource management and development program for the Admitting Unit aligned and integrated with that of the whole hospital. 2. Maintain a conducive and safe working place for the AU staff.
BSC and Baldrige /PQA HCC BSC’s perspectivesFinancial
CustomerProcessLearning and Growth
Results
Baldrige / PQA HCCLeadershipStrategic PlanningCustomer-FocusedProcess ManagementWorkforce-FocusedMeasurements,
Analysis, Knowledge Management
Results
SET of KEY FACTORS / DRIVERS FOR ORGANIZATIONAL. PERFORMANCE
2013-2015 Strategic Objectives
STRATEGIC OBJECTIVES (2013-2015)
PERSPECTIVES OBJECTIVESGovernance, Service, and Finance
1 Systems perspective in governance
2 Integrated value-based health care service
3 Physician engagement (patronage and loyalty)
4 Maximal utilization of services with controlled expenses and losses
Customer 5 Customer delightProcess 6 Fully compliant with the quality and
performance standards (local and international)
7 Integrated IT-enabled operations systemLearning and Growth of People
8 Staff engagement
9 Learning organizationCSR 10 CSR program with tangible social impact
TPOR3: Starting and continuing journey towards performance excellence for private
hospitals
TPOR3: Starting and continuing journey towards performance excellence for private
hospitals
2 goals of PMS
• To promote performance excellence in the hospital.
• To evaluate whether the hospital has achieved performance excellence.
TPOR3: Starting and continuing journey towards performance excellence for private
hospitals
TPOR3.1 Key drivers for successful journey
•Strategic planning•Commitment •Perseverance
TPOR3: Starting and continuing journey towards performance excellence for private
hospitals
CMZ’ Overall Direction and Goal for Next 3 Years, 6 Years and to Infinity and Beyond
Commitment, Support, Engagement, Involvement, Alignment, Coordination, Collaboration, Integration
Top Management
Middle Management
SeniorManagement Personnel
TPOR1: Journey towards performance excellence of MDH and CMZ
TPOR1: Journey towards performance excellence of MDH and CMZ
Just look for and focus on the similarities!
• Strategic Planning • Balanced Scorecard• Baldrige / PQA Criteria for
Performance Excellence• PhilHealth Benchbook
Strategic Planning Conferences
Strategic Planning Conferences
Strategic Planning Conferences
Strategic Planning Conferences
Strategic Planning Conferences
Strategic Planning Conferences
TPOR3: Starting and continuing journey towards performance excellence for private
hospitalsTPOR3.2 Creation of Hospital Teams and Identification of Champions
Task TeamsMDH Quality Management Officer / QMR / Internal AuditorsCMZ Task Team Corporate Planning / QC
TPOR3: Starting and continuing journey towards performance excellence for private
hospitalsTPOR3.3 Assistance from an external
facilitator until a Learning Management System is in place.
Facilitator:• Familiar with and committed to help in the
journey to performance excellence• Educator – innovator in facilitating learning
and development of best practices in hospitals
TPOR1: Journey towards performance excellence of MDH and CMZ
Experiences inPerformance Management System
in a Private Hospital Setting: TPORs of a Consultant-Adviser
Reynaldo O. Joson, MD, MHA, MHPEd, MSc SurgConsultant-Adviser
Manila Doctors HospitalCiudad Medical Zamboanga
For queries and feedback:0918-804-03-04