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.