Assignment

4633 CQI

Module IV

Developing Measures to Monitor Performance

Terminal Objective:

Upon completion of this unit, the student should be able to identify and develop measures to monitor performance.

Enabling Objectives:

Upon completion of this module, the student should be able to:

• Identify methods for developing measures to monitor performance.
• Explain the importance of feedback in measuring the effectiveness of CQI.
• Identify key cross-functional processes that impact customer perception.
• Describe methods for measuring quality.
• Discuss how involvement and perceptions of staff affect the identification, measurement, and collection of data.
• Identify essential elements in measuring performance.
• Describe the advantages and pitfalls of reporting results and providing feedback.
• Identify the four ways to share management results with staff.
• Describe three ways to make priority decisions.
• Define process.
• Cite reasons for improving process rather than people.
• Describe the four phases of the PDCA model for process improvement.

The Importance of Feedback

At this point, processes needing improvement have been identified and things are going smoothly. This is when the term “continuous” comes into consideration. Without the mechanisms in place to continually monitor changes and their effectiveness, processes may deteriorate further into problems that are much worse than before changes were made.

In order to measure performance, feedback has to be collected that represents not only customer perceptions, but also reflects concrete performance outcomes. Feedback from customers is the key component of performance measurement. This measurement provides control of performance and allows you to set limits.  If you don't find out how your processes are working, then you will be right back where you started with inefficient work days, disgruntled employees, and customers who don't come back.

Control through Measurement

To get feedback, you have to measure, measure, and measure.  Measurement fulfills several critical purposes:

• Lets us manage by facts, not opinions.
• Tells us how we're doing and motivates improvements.
• Makes accountability for CQI possible and illuminate decision making by enabling us to set improvement priorities based on information rather than impulse or instinct.
• Settles differences of opinion among staff about performance.
• Provides information/evidence.

Without measurement, there is no control, no way to provide a scorecard or report card.  When operational performance is measured, you can track variation and determine its acceptability.  Then an attempt can be made to reduce the sources of variation that interfere with consistent performance.

Step 4 (continuation of the startup steps in module 3): Decide on Outcomes and Process Measures

Anyone can develop measures of outcome and operational performance.  You don't have to be an expert, nor do you have to be the boss.  The following figure shows the measurement pyramid divided into three sections: overall customer satisfaction, outcomes related to key quality attributes, and performance of key processes.

 

With this pyramidal structure, performance as key processes provides the base or support structure. At the mid-level, the kinds of things exist that affect the customer's perceptions, and which lead to the top or apex of the pyramid - overall the entire structure will "crumble" if the base is not solid. This pyramid describes measurement for the entire organization; the figure below represents a departmental pyramid.

 

Department Level Measures

What are the key indicators of performance measure?  The Joint Commission describes performance indicators as valid and reliable quantitative processes or outcomes measures related to one or more dimensions of performance. 

Types of Indicators

• Sentinel Event - an event that is important enough to warrant review each time it happens.  Usually, these are undesirable and are infrequent such as a total breakdown of equipment during an exam or electrical blackouts.
• Aggregate Data - an event that is related to many situations and may occur frequently.  It may be desirable or undesirable such as the availability of charts from a specific floor.

Performance indicators should be based on the following:

• Appropriateness of care - whether the type of care is necessary
• Continuity of care- the degree to which the care is coordinated among practitioners and/or organizations
• The effectiveness of care - the level of benefit when services are rendered under ordinary circumstances by average practitioners for typical patients
• Efficacy of care - the level of benefit expected when health care is applied under ideal conditions and circumstances
• The efficiency of care - the highest quality of care given in the shortest amount of time with the least cost and highest outcome for the patient
• Safety - the extent to which patients are safe with regard to equipment, universal precautions, and staff competency
• Timeliness of care - delivery of care within a reasonable amount of time
• Cost - reasonable within current market circumstances
• Availability - availability at the site that will meet patient needs

How to Measure

The most important thing to remember about how to measure quality is that you focus on one expectation and standard at a time. A common mistake in measurement is trying to look at several different problems at a time.

This section reminds you of two things:

1. You already have the means at your disposal to begin measurements (i.e. Log sheets, patient contact, etc.).
2. Don't do this alone. The involvement you have with others allows for a broader scope.

Some issues to remember are:

• Feasibility - Is your current staff sufficient?
• Affordability- Is your funding sufficient?
• Simplicity- Is your task almost too difficult for you to follow?  If it is, then it most likely will be for others.
• Validity - Does it measure what you want it to?  If you are measuring waiting times, but what you really want to know is the perception of waiting times, then you have to be careful not to leave out important questions.
• Mathematically sound - Statistics are very easily manipulated.  Make sure you are using your data correctly.
• Reliable - Does the outcome change every time you use a tool?  For example, if you are using a chart that changes every time you put data into it, it may be an unreliable tool.

Involve Your Staff

The key to measuring performance is the support and participation of the staff.  Nothing will be discovered and effectively changed if the staff either fights the process or refuses to be involved.

People like to not only feel useful but to be useful.  Involving staff in a positive way invites a sense of ownership.  The more the staff feels they "own" the department and its workings, the more likely they are to participate and be interested in improving departmental performance.  

Staff Perceptions

Staff meetings are an excellent way to identify process problems and generate possible solutions.  Who knows better about what the problems are?  In addition, staff members usually have opinions about what the solutions are.  It’s just that those opinions are rarely shared in a positive manner, nor does the staff generally think their opinions are perceived as important.  By encouraging positive discussion in a staff meeting or with a specified problem-solving group, the perception of ownership grows and so will participation.  It is a very effective way to get input on current service levels versus customer expectations, as well show respect for staff experience and observations.  The end result may be a refocusing of the staff on those things that are truly important to the customers.

Involving Staff in Data Collection

These days, everyone is incredibly busy; you cannot effectively gather all the data yourself.  If you are running a survey on wait times then the receptionists and staff need to administer and gather the surveys.  This is easily done during the course of their regular duties.  By gathering the data, the staff becomes aware of problems and needs.  This experience can serve as motivation to find out more or produce solutions.

Involving the staff builds the foundation for solid departmental performance and allows you to monitor progress and see the benefits.

Use Data to Target Improvement Needs

You are now equipped with the knowledge and some of the tools to begin a proactive rather than reactive continuing improvement process. It is vital that you pay attention to the phrase "cumulative effect".  A cumulative effect is one that manifests itself over a long period of time and is the result of effects of processes on processes, workflow, attitudes, etc. Don't expect overnight success, it takes time and a great deal of "Sticktuitiveness".

Planning Measurement

From Module 3 we learned that the cyclical steps (steps 5- 8) are concerned with the implementation of decisions made in steps 1- 4. These steps are the "do" part of the process. These involve things that need to be done to satisfy steps 1-4.

Step 5: Measure Performance

Schedules and timelines or master plans are essential. Knowing what to measure when is the key. Careful decisions have to be made so that the appropriate things are measured at the appropriate time.  The closer you are to the customer, the more often you should measure so that you can make immediate corrections.  Who is closest to the patient?  Receptionists, transporters, and technologists are most likely to realize the customer's needs.  With the participation and commitment of those people, you have an effective team to gather the information.  But what happens to the information after it is gathered?  When will everyone see the results? Many times, it is the departmental or organizational administration tabulating and reporting results--often only to each other.  So effective, timely reporting has to be in place. Because CQI is most effective organization-wide, it is well worth the effort to assist other management levels by constructing a realistic, workable time table or measurement plans worksheet.

Example:

Management Plan-Worksheet

Measurement Plan for_______________________                                             Customer Group
Satisfaction Indicators	Responsible manager/supervisor	Data collected-how often?	Data collected by whom?	Data summarized by whom?	Tools needed	Notes
Process Indicators

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