Management of Health Care Organizations: Assignment Week 6
Chapter 14: Managing Performance and Quality
Objectives
• Understand the importance of improving organizational performance through performance management, program evaluation, and continuous quality improvement (CQI)
• Be able to explain the Turning Point model of performance management
• Be able to explain a logic model and how it can be used to evaluate and improve programs
Objectives (continued)
• Be able to define quality from the perspective of health care delivery and from the perspective of public health
• Understand CQI methods and techniques such as process maps, the Plan-Do-Check-Act cycle, Lean, and Six Sigma
Outline
• Performance Management
• Evaluating Programs
• Continuous Quality Improvement
• Defining Quality
• Overview of Quality in the United States
• Six Sigma
• Lean
• Plan-Do-Check-Act
Performance Management
Defined as “a framework for organizational evaluation and improvement.” Used widely in both the public health and private health sectors.
Performance Management in Public Health
• Turning Point model:
– Performance standards
– Performance measurement
– Quality improvement process
– Reporting progress
Performance Management in Health Services Delivery
• Accreditation (Joint Commission) standards
• Baldrige Criteria for Performance Excellence
– Awards the Malcolm Baldrige National Quality Award, the highest level of national recognition for performance improvement
– Criteria include: leadership; strategic planning; customer focus; measurement, analysis, and knowledge management; workforce focus, process management, and results
Performance Management System
• Uses performance standards, measures employee performance and output, regularly reports progress, and includes a quality improvement program
• Example of measures: balanced scorecard –
• employee satisfaction
• financial outcomes
• internal efficiency and quality
• client satisfaction
Evaluating Programs
• Systematic assessment of the operation and/or outcomes of a program, compared to a set of standards, in order to improve the program
• Two types of evaluation
1. Formative
2. Summative
Formative Evaluation
• Used to determine whether a service or program is evolving as intended
• Involves the collection of evidence during the creation and implementation of a program
• Allows for revision that can improve a program as it is in the development phase
Summative Evaluation
• Directed towards a general assessment of the degree to which the outcomes have been attained over the entire course of the program
• Used to determine the merit of a program by evaluating it when at full strength
• Results in a final judgment about a program
Framework for Program Evaluation
Program Evaluation Framework (Centers for Disease Control and Prevention):
Assess
• Program Implementation: what took place?
• Program Effectiveness: did it improve health outcomes?
• Program Accountability: cost-benefit, cost effectiveness
Logic Models
• A logic model is a graphical representation of the logical relationships among the resources that go into a program, the activities the program undertakes, and the benefits or changes that occur.
• Depicts how program goals, activities, and expected outcomes link together in a chain of reasoning
Continuous Quality Improvement
• Use of deliberate improvement techniques, responding to health needs, and focusing on activities that improve health
Underuse, Overuse, and Misuse
Underuse: program or service has not been fully or optimally utilized
Overuse: program or service in which demand exceeds supply, or when potential risks outweigh potential benefits
Misuse: otherwise appropriate program or service is provided in ways that result in undesirable complications or outcomes
Defining Quality
A single definition of ‘quality’ does not exist due to varying perspectives of stakeholders
1) Institute of Medicine: “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”
2) US DHHS: “the degree to which policies, programs, services, and research for the population increases desired health outcomes and conditions in which the population can be healthy”
Defining Quality (continued)
6 Aims of the Health Services Delivery System (STEEEP)
•Safe (S)
•Timely (T)
•Effective (E)
•Efficient (E)
•Equitable (E)
•Patient-centered (P)
9 Aims of the Public Health System •Population-centered •Equitable •Proactive •Health promoting •Risk-reducing •Vigilant •Transparent •Effective •Efficient
Process
• All quality improvement systems analyze the processes followed in order to improve them
• A process is a series of steps designed to produce activities associated with a desired outcome. A process has a beginning and end.
Process Map
• Process Map – visual diagram that reflects the steps associated with a process or activity
– Process maps do not intend to show all steps but only those that have the greatest influence on a process
Process Map
Process maps can identify 4 types of problems:
1) Disconnect – poor transfers of work from one group to another
2) Bottleneck – a point in the process where volume overwhelms capacity
3) Redundancy – repeated activities at two or more points in the process (may be beneficial if designed)
4) Rework – occurs when work must be repeated.
Overview of Quality in the U.S.
• CQI experts estimate only 15 percent of quality problems can be attributed to people; the rest are due to flawed processes
• Health services often fail to deliver potential benefits
• Public health services, while underfunded relative to clinical services (97% of health care expenditures are devoted to treating sick people; 3% on primary prevention), can benefit from quality improvement as well
Overview of Quality in the U.S. (continued)
• CQI was introduced in U.S. clinical health care in the 1990s
• CQI is relatively new in public health
• Core processes vs. support processes
Six Sigma
• An approach designed to reduce the incidence or number of defects or errors associated with a process, with a goal of 3.4 errors per 1 million operations
• 5 Steps: – Define
– Measure
– Analyze
– Improve
– Control
Lean
• A method intended to eliminate waste in processes
• Also known as Toyota Production System
• Gets rid of work that does not add value; minimizes downtime and smooths work flow
Plan-Do-Check-Act
• A common QI method used to implement quality improvement projects
• Plan- Gather and analyze specific data and observations.
• Do- Test appropriate solutions to the situation.
• Check- Compare results of tests through measurements and analysis.
• Act- Make the change permanent. Be prepared to go through PDCA again if needed.