Healthcare Management
Helpm31990
14713_PPTx_CH14.pptxChapter 14: Managing Performance and Quality
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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
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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
Formative
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
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Defining Quality
A single definition of ‘quality’ does not exist due to varying perspectives of stakeholders
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”
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”
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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.
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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
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Process Map
Process maps can identify 4 types of problems:
Disconnect – poor transfers of work from one group to another
Bottleneck – a point in the process where volume overwhelms capacity
Redundancy – repeated activities at two or more points in the process (may be beneficial if designed)
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.
