Streamline PI program to cut costs, improve quality

Agency did a PI project on its PI program

Sometimes the best performance improvement (PI) program is one that revamps the entire PI process. At least that’s the philosophy this year at MCH Services/Pediatric Nursing Specialists in Indianapolis.

The agency, which serves central Indiana, regularly has PI projects on customer satisfaction, infection control, risk management, and safety. But what managers really wanted to know in 2000 was whether those PI projects were using the most efficient PI process to obtain better quality, or could the process be sliced and diced and still achieve all its goals?

"We found that we were spending a lot of time in meetings and not getting a lot accomplished," says Shari Paige, RN, director. "So we tried to streamline it because in home care, we need to do more with less."

The agency has had to make administrative and field staff cuts, as have many others in recent years, so all remaining employees have been forced to become more efficient, spending time wisely. Unnecessary meetings did not appear to be a good use of their time.

Managers began by looking at the agency’s PI goals and the task forces established to help meet those goals. There was a task force for each PI project area, and each task force met separately. Some met monthly, and others quarterly. Still others used focus groups within the task forces, and those also met separately.

"Some of these were very long meetings, and we felt too much time was spent in meetings," Paige says.

Managers met with the task force chairpersons, and together they decided to merge the various task forces into one committee. Each person on the committee would be responsible for monitoring one of the special PI projects. That task involves other staff when necessary, reporting to the committee about problems and progress and discussing improvements that need to be made.

Staff didn’t mind PI process changes

"The change was a relief to some of the chairs because they all had jobs other than this particular project, and they also were feeling stressed," Paige recalls. "We wanted a good PI program and have put a lot of effort into it, but it took away from the other jobs they had to do."

To make sure there were no hurt feelings over the change, committee members told staff the committee didn’t want to take away their involvement in PI projects but needed to be sensitive to their time constraints with regard to patient visits and other duties. As a solution, staff who help out with PI projects are not required to attend PI meetings. Instead, they are represented by the committee members at the meetings.

"We said that we would no longer require regular PI meetings of all the staff involved," Paige says. "There might be a brief meeting, but not a routine committee requirement."

Committee named hot topics’ for 2000

Here’s how the agency developed the new, streamlined PI process:

1. Identify PI ideas. "We started by identifying the ideas we wanted to monitor for 2000 and any specific incidents in those areas," Paige says.

They came up with five distinct PI project areas to address:

Recruitment and retention: The committee tracks the number of hours it takes to recruit and train employees.

"We’re tracking our new hires as relates to the ads we put in the paper, and we track our percentage of new hires compared to the number of people who responded to that ad," Paige says. "So if 20 people called, and we hired five people, why is that?"

The committee also tracks turnover costs and the turnover percentage and continually tries to identify ways to recruit and retain nurses.

There’s even a formula the agency uses to estimate turnover costs. The formula, obtained from a human relations agency, enables the agency to keep track of the cost per new hire in terms of the orientation cost, and the cost of replacement when that employee leaves.

Safety: This year, the committee decided it wanted to focus on durable medical equipment (DME) in its safety project. The committee monitors the agency’s DME program to check on preventative maintenance, staff and caregiver education on using the equipment, and any incidents that occur with DME use.

Risk management: The committee tracks all incidents related to medication errors and any other risk problems, including patient falls or injuries.

Staff development: "We’re monitoring to assure competency assessments for staff nurses," Paige says. "It was identified in our customer satisfaction survey with staff nurses that they needed more inservice opportunities." As a result, the committee developed an inservice program and has tracked participation in it.

Infection control: The committee tracks any patient infections that are related to the patient’s hospitalization or cross-contamination within home care, although the latter occurrence is very rare.

2. Discuss committee members’ duties. The committee has one person monitoring each PI area, except for recruitment and retention, which has two people assigned to it.

Committee members are expected to meet at the beginning of each year to discuss the PI projects, their accomplishments, and any necessary changes. They also discuss the specific items they want to monitor. Each member is responsible for writing a plan about the particular PI area to which he or she is assigned. The plans include information about data collection from the field staff, tracking tools to be used, areas that need improvement, and the additional staff needed to make any improvements.

"They can recruit staff to help them, but we generally don’t obtain an ongoing commitment from additional people," Paige says.

Monitoring staff, customer satisfaction

Then committee members survey the staff about the PI plan and the tools they’ve been using and ask for feedback on how they might improve.

At quarterly meetings, committee members discuss how their PI program is doing and any problems or trends they’ve discovered.

3. Keep customer satisfaction in mind at all times. Committee members continually are reminded that everything they do, including each PI project, must maintain high customer satisfaction.

"So we specifically monitor patient satisfaction or the satisfaction of the parents of the children we care for," Paige says, "and we monitor referral source satisfaction and field staff nurse satisfaction."

Easing nurses’ time constraints

Since the nursing shortage began within the past year, the agency has focused a great deal on nursing satisfaction, which is the reason the agency added a PI project for recruitment and retention, Paige adds.

The revamped PI program has definitely served its purpose of cutting down on staff time, she says.

"It gives us a little more focus. Before, when we had so many people involved, while it was great to get that input, everybody had their own way of doing things, which caused us to get a little out of control. So the new committee has helped in that regard."


Shari Paige, RN, Director, MCH Services/Pediatric Nursing Specialists, 3500 DePauw Blvd., Suite 1041, Indianapolis, IN 46268. Telephone: (317) 875-6825. E-mail: