Performance and Benchmark & KPI PDF

Performance and benchmark & KPI  Concept of Performance Measurement:  Measuring performance (data collection) is the basis of all quality improvement activities  Measurement : is the systematic collection (planed process) of quantifiable data about both processes and...

Performance and benchmark & KPI  Concept of Performance Measurement:  Measuring performance (data collection) is the basis of all quality improvement activities  Measurement : is the systematic collection (planed process) of quantifiable data about both processes and outcomes (structure) over time (dynamic) or at a single point (static) in time.  The measurement of performance was always the intent in using "indicators" of  Concept of Performance Measurement: In the now past  the focus in analysis of  Healthcare in now having those indicators was on both the information negative variance from an technology and the acceptable clinical standard understanding to use or threshold ( point of performance measures to translation ,, when u provide information about starting something new ) how well processes are working to deliver patient  clinical variance was care in the organization. assigned to the appropriate responsible direct care The provider:tools of the physician, nurse,performance-based quality management system consists physical therapist, etc. of standards and guidelines as well as performance measures, indicators, and metrics. Regulations establish requirements for healthcare organizations to follow. There must be absolute compliance with the laws and  A Standard Expect  Statement of : expectation : defining the ation What Capabil ity capability of a governance, managerial, clinical, must or support system to deliver value. Nation be al/ done Measur interna  It iswhat is expected from ed/ tional outcom performance. e  Indicate what must be done. Standards can be obtained from national, accreditation/regulatory organizations, as well as the community standards and standard developed by the organization itself. Measurement occurs to indicate if the  Benchmark ing:  Management tool that uses a formal measurement process to compare your own organizational performance against that of other organizations considered to have "best  practices as a noun ". it is "something that can be used as a way to judge the quality or level of other, similar things". ((The term is usually used as a point of reference or as a standard by which others may be measured or  judge )) as a verb, it is defined as "to study as ( a competitor's Way of product or business practices) in order to improve the judgme Compa performance of one's own company“. nt re Study Best competito practic r’s e product  Potential data source for benchmark  There must be similar data collection methods utilized and same population  The collected data should be analyzed utilizing similar risk adjustment factor for fair comparisons  Key of effective benchmark is to make sure that you are  Type of Benchmarking: : Internal benchmarking : External benchmarking identifies best practices involves utilizing comparative within an organization. It can data from other organizations be used to compare best to determine performance practices within the and identify improvements organization and to compare that have been successful in organizational practices over other organizations. time. 4 consideration must be taken when analyzing variation in outcome Variancebenchmark may be due : to: Different data collection methods. Different case-mix data is utilized, it could cause a variance in the outcome benchmarks. Simply due to chance. Clinical Practice Guidelines / Evidence Based Practice  Refers to a set of specifications for care and process that pertain to the functions of healthcare practitioners. is the integration of best research evidence with clinical expertise and patient values. Advantages : 1. Method of standardization of care 2. Decrease the variation in the care provided. 3. Facilitate cost-effective health care. 4. Utilize to improve processes and  Measurement occurs to indicate if the guidelines were followed, and if they were not, documentation is required of why the variation occurred and what  was subsequently done. There will always be variation due to: 1. the variation of different patients/clients 2. the human factors that they bring with  Determine Evidence based  practices: Clinical expertise encompasses "the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice.  EBP incorporates not only the perspective of the clinician but also the perspectives of the patient.  Benchmarking is a major factor in the establishment of evidence-based practices. COMPONENTS: 1. Clinical practice 2. Current best practice  The initial step is to clearly identify the practice problem: Identify the practice problem, issue, or clinical area of concern for which the evidence is sought. The development of a PICO or PICOT question guides the search for the research evidence. The "P" stands for population, problem, situation. The “I” stands for Intervention or issue. The “C" stands for comparison. The “O” stands for outcome. The “T” stands for time. An example of a PICO question could be: P = pneumonia patients in the ER; I = early initiation of antibiotics; C = Using the process as it is now; O = quicker recovery for the patient. Next step:  The strength of the evidence is determined by: ranking the evidence based on the type of research, the highest being systematic reviews or meta-analysis of randomized studies and the lowest being expert opinion.  This includes asking questions such as: 1. how rigorous and reliable is the evidence? 2. What is the magnitude of the effect of this evidence? 3. How precise is the evidence of effects? 4. What evidence is there of side benefits or side effects? 5. What is the financial cost of applying or not applying the evidence? 6. is the evidence relevant to the particular situation that it is Clinical Pathway  A clinical pathway is a PROSPECTIVE patient management strategy and tool describing the timing of key events in the process of care for a given diagnosis or condition that the healthcare team determines are most likely to result in positive outcomes.  Clinical pathway serve as a patient management plan NOT a standard of care  Select patient Group Select interdisciplinary pathway Clinical development team Review literature & best practice and pathway identify the appropriate developm Identify the needed category of care ent (Nutrition/pharmacy/physiotherapy…..et c) Reach consensus Education plan Implemen tation Pilot test Monitoring and track variance  Clinical practice guidelines and pathway Specifications Clinical / Healthcare of care/ processes Complexity to decrease the Critical variations Pathways based on the best scientific evidence of effectiveness combined with expert opinion They describe "typical" treatment for "typical" patients and provide  Clinical pathway Clinical guideline Structure multidisciplinary plan Make specific recommendation of care designed to support on healthcare and link these to implementation of guideline and research evidence. protocols , based on Q/cost (total cost of care). Prospective management plan Consensus statement developed provide sequence timing of action to help practitioner to take decision related to specific clinical circumstances Decrease variation Come from many sources (Evidence based practices) A Performance Database:  Standardized data elements and definitions and validated data accuracy and completeness, provides the capability for statistical analysis, aggregation, display, and trending of measures/indicators over time.  The data required to success in specific business area  The data required to get the job done  This data base should be where individual go first to determine if there is predetermined indicators and other information that can be utilized rather than creating new indicators Performance Measures/Indicators/Metrics :  Points of reference for evaluating the organization's actual performance and comparing that performance with a targeted objective or a standard.  Well-defined and constructed performance measures are predictors of the organization's ability to achieve strategic goals.  They are measurement tools to assess the degree to which the appropriate and expected course of action (process) is being followed, and the degree to which the expected DONABEDIAN PARADIGM  It is causal relationship between structure, process and outcome. Structure Process Outcome Is the arrangement of parts or elements of the Care system that Refer to the procedure , facilitate care. It is the methods , means , or The results of care evidence of sequences of steps of whether adverse or organization’s capacity providing or delivering beneficial, or it is the to provide care to care and producing product of the process. patients. e.g. outcomes. resources, staff number, staff refer to activities that qualifications, act on an “input” from medical record, “suppliers” to produce settings of care, an output for a 1- Proces Types of process: sClinical processes Care delivery processes Administrative processes what The support The activities practitioners activities utilized performed in the 1. Patient flow do for patients by practitioners governance and 2. Information flow and what and all suppliers management 3. Material flow patients do in of care and care systems of the response products to get organization Factors affect the degree to (sequence of the product to the which healthcare services diagnostic and patient. achieve desired outcome: therapeutic interventions). 1. Disease process & severity. 2. Care process. 3. Patient compliance. 4. Random & unidentified variables.  “Process variation” Any change or deviation in form, condition, appearance, extent, etc., from the usual state or assumed standard either in the whole process Common or in a step of the process. Special cause )random & intrinsic( cause )assignable & extrinsic( variation variation Intrinsic (predictable)to the process Extrinsic of the usual process. itself. Related to Identifiable factors can be Related to situations within process, tracked to root cause. chronic, noise & inliers. Refer to sentinel event, unique, one- More time consuming, more difficult. time occurrences, out of the ordinary circumstances, outliers & tails. More easy to identified & resolved. Response: no focus, monitoring, May be positive or negative. process redesign & improvement (aim to reduce variation). Process Reliability DEF.: probability that each step of the process will occur when, where, and how it needs to occur. failure-free operation over time. Reliability Rate (PR): the probability of success in HC (delivering desired outcome) by measuring compliance with performance measures (KPIs). Example: medication administration process consisted from 4 steps ((( Step1 (99%) step 2  The indicator must be feasible and have reliability, validity and relevant.  The same definition must be utilized by everyone who is measuring the process or outcome.  Reliability: is the degree to which the measure accurately and repeatedly identifies the event or fact from among all cases in the group or cohort.  Validity: is the degree to which the measure identifies all appropriate events or facts.  How to improve process reliability? 1) Reduce the number of steps (lean): Medication administration process in 3 steps PR= 0.99*0.95*0.95= 90% (10% probability of failure) 2) Improve the reliability of individual steps (redesign process): Compliance of staff in Medication administration process increase PR= 0.99*0.95*0.95*0.95= 85% (15% probability of failure) 3) Process Breakthrough 2- outcome Clinical outcome Function perceived outcome outcome Short term results of process ( control Long term health Pt & family blood sugar level ) status satisfaction and Activities of daily knowledge living status (ADL) Peer accountability Pt progress to meet ( pt. satisfied with objectives new life style) ( pt. back to normal activities , diet , sport ) Key Points in Indicator Selection/Development:  The detemination of specific indicators to utilize is often driven by many different needs of the organization.  What needs to be measured?  What indicators to utilize? Can derive from regulations, accreditation standards, governing boards and other leader determinations, the organizational strategic plan, current data or by identification of weak areas within the organization. The process or outcomes to be measured has been defined as to specifically what is to be examined. 1. Choose the indicator 2. Define the indicator clearly 3. Identify who is responsible and to whom the  Patient/client care outcomes should be selected to monitor three aspects of care:  Patient/client health  Patient/client functioning  Patient/client satisfaction and Perception of care.  Increasingly , quality management is dependent on the development of outcomes, in order to screen for opportunities to improve care processes  and when the organization cannot determine an services. indicator from a measure set that meets the needs of the organization. In these cases, they can be developed by the organization themselves.  The indicators are often used to improve quality, for accountability, or for research.  Accountability: these indicators require higher validity and reliability since they are often used by purchasers, consumers, accreditation entities, and other external quality oversight groups, as well as the organization itself. Research: indicators are used to develop or produce new knowledge about the healthcare system Developing indicators:  The developer must be able to identify and understand the organization functions and key processes that are involved in meeting the stated objectives and strategic goals.  In the first step of developing an indicator, the developer must consider the intent of each quality initiative, objective, or process of care or service.  The indicator should focus on the expectations for that care or service.  POSSIBLE AREA FOR INDICATORS: 1. Accessibility, appropriateness, timeliness, efficiency, and continuity of delivery 2. Safety and acceptability of care and service 3. Patient outcomes (clinical) 4. Service outcomes (Non-Clinical) The indicator should focus on the expectations for that care or service (scope,.objective).determine if the indicator is to be rate-based or a sentinel event indicator (type)  The rate-based indicator: consists of a numerator and a denominator. A rate-based indicator assesses either for  An event for which a certain proportion (subset of the population) of the events that occur in a specified time period represent expected care, or service.  Assesses for the degree to which an event/outcome occurs with a different denominator.  Sentinel event indicators: ( 100% analysis or 0% acceptability ) assess serious or significant events that require further investigation for each occurrence. This type of indicator does not have both a Trigg er:  Defined as a stimulus that sparks or activates an action.  Performance analysis should include comparison of actual performance data with a benchmark, previous validated data, an aggregated rate over time, or another equally significant "signal."  A trigger is not an expected level of compliance or a "minimum standard."  A trigger should be set at a level that requires a "must" response, whether the decision is to validate the accuracy of the data, resolve an identified Characteristics of Triggers: 1. Stated as incidence rates (numerator over denominator ( 2. >0 for sentinel event indicators. 3. Upper and/or lower control limits. Investment of organization resources for in-depth analysis must be weighed against potential for quality improvement and improved patient satisfaction.  Three questions should be answered before intensive, in-depth analysis is begun: 1) Is there or is there not a problem? 2) Should action be taken now to prevent a problem later? 3) Is there still an opportunity to improve care or  In performance improvement, dipping above or below outcome control limits can serve as triggers that alert the observer that something intentional needs to be done quickly to get the process back into control or stable.  Triggers can also be derived from authoritative sources supported by expert clinical and quality management literature or the organization's own policies, procedures, A performance data, trigger should beorset clinical at aexperience and level that expertise. requires a "must" response, whether the decision is to validate the accuracy of the data, resolve an identified problem, gather more specific information, or simply respond to an opportunity to improve.  Creativity Innovation Act of creating new idea - imagination Process of transform the creative idea into a new product or service in the market Can not measure(not quantified) Can measure(quantified) Not money consumption Money consumption Imaginative Productive (implementation  Mohamed Eldeeb CPHQ,CPHRM,LSSBB,TQM,SCRUM Master ,TOT , Team STEPPS master training