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While focusing on the overall outcome of a performance improvement initiative is important, the involvement of individual departments is critical when it comes to how their processes contribute to achieving performance expectations, says Michelle Pelling, RN, MBA president of the Propell Group in Portland, OR. She says it is often less a linear process than it is an ongoing cycle, and leaders of the organization must begin to focus on what kind of organizational indicators they want to monitor over time and how individual departments will support those efforts.
That is one reason she advises leaders to determine the processes, outcomes, and services that are critical to the organization’s success and articulate goals relative to specific performance dimensions, such as effectiveness, efficiency, appropriateness, timeliness, and safety.
According to Pelling, that will enable leaders to track results by translating their overall goals into a small number of key performance indicators. "Focusing on a limited set of performance indicators instead of reviewing pages and pages of raw data not only minimizes information overload but helps leaders understand the interrelationships among clinical, operational, financial, and customer components and keeps their attention focused on results," she explains.
Interdisciplinary performance improvement teams typically are formed to work on processes the organization wants to improve that cut across several departments. That makes it critical that each department has "subprocess indicators," says Judy Homa-Lowry, RN, MS, CPHQ, president of Homa-Lowry Healthcare Consulting in Canton, MI.
According to Homa-Lowry, it’s important to begin by identifying patient care processes. By doing so, the entire continuum of patient care is considered. "If the process works for the patient, it will be a process that is good for the organization," she says. "Therefore, all departments can demonstrate and share the positive results of the important role they all contribute to good patient care." She adds that in order to share positive outcomes and identify further process improvements, it is important for departments to evaluate their contributions to the process. "This helps to facilitate discussions across departments."
Homa-Lowry says this also can assist departments in identifying process improvements in their own departments and staff learning needs. That way, when a process crosses several different departments in order to achieve a specific outcome, individual departments have specific indicators they can track to make sure they are in compliance.
Pelling agrees that while the focus of an improvement effort frequently is on a specific outcome, often there aren’t methods in place for departments to track their performance. Attention to "subprocess indicators," or those points in the process that are critical to the outcomes, should be tracked by the department or group responsible for the performance until the improvement has occurred and been sustained for a reasonable period of time, she says.
On the other hand, there is no need to monitor subprocess indicators indefinitely, adds Pelling. Rather, she says, they should be tracked until staff have accepted the new process steps and the process is functioning consistently at the capacity required to achieve the outcome. "When the performance expectations have been achieved and sustained, it is time for the resources to be shifted to a new improvement effort," she says.
Finally, Pelling advises leaders to continue posing two key questions relative to their performance improvement infrastructure:
1. "What are we learning from our efforts?" To answer the question, she says leaders must examine the results related to the predefined performance indicators. "Evaluating the results of performance improvement activities should lead to improved problem solving and decision making."
2. "What did we learn about how we learned?" For example, did it take a performance improvement team a year to come up with the plan on how to improve? Did the hospital have teams that faltered at first because they did not clearly understand their charge? Did the hospital falter in the implementation stage because it failed to analyze the problem adequately? How can it better support the participants in performance improvement efforts?
Pelling says performance indicators for organizational tactics will allow leaders to evaluate the effectiveness of their performance improvement infrastructure and identify necessary modifications to better support participants in performance improvement efforts. But for a performance improvement model to be effective, she emphasizes, hospitals must look for root causes instead of a quick-fix approach.
Homa-Lowry adds that it is important for individuals responsible for performance improvement to use statistical and nonstatistical methods in a manner that will lead them to the root causes. In today’s health care environment, many organizations are functioning with limited resources, she notes.
"Effective root-cause analysis requires time and resources as well as individuals that feel comfortable using the tools," she explains. "For leadership to see the benefit of the process, root-cause analyses should be directed at patient care priorities and include benefits for patients and the organization as well as the bottom line."