Performance Management and Process Improvement PDF

PERFORMANCE MANAGEMENT AND PROCESS IMPROVEMENT Definitions of performance management process of ensuring process of identifying , that a set of measuring and activities and developing the performan...

PERFORMANCE MANAGEMENT AND PROCESS IMPROVEMENT Definitions of performance management process of ensuring process of identifying , that a set of measuring and activities and developing the performance of outputs meets an individual or team with organization's goals the goal of aligning in an effective and performance with the efficient manner. strategic goal of Org.  System : Roadmap of creating a high performance organization through the integration of organization vision.  Performance management and improvement process:  It shifts the primary focus from the Performanc performance of individuals to the e: what is performance of the organization's done and how systems and processes, while well it is done to provide continuing to recognize the healthcare. importance of the individual competence of medical staff members and other staff. 1. Performance improvement program structure 2. Performance improvement plan 3. Implementation of performance improvement program 4. Dissemination of performance improvement information 5. Team 6. Practitioner appraisal process 7. QM & PI orientation and training and education  1. Performance improvement program Building an Effective Quality Improvement structure 2. Performance improvement plan Program Structure: 3. Implementation of performance improvement program 4. Dissemination of performance improvement information organization structure 5. Team 6. Practitioner appraisal process must be should be 7. QM & PI orientation and training and involved in based on the NOW quality is education improving the organization' imbedded in the quality of s mission structure services and and vision products should be then develop assessed to the process determine if to engage they are the people to producing the serve the desired patient will outcomes or do lead to better they need to be out come improved. Building an Effective Quality Improvement Program Structure: 1. Definition of the term quality for the organization 2. Clarify leadership roles 3. Create an accountability structure 4. Determine what the name of your program will be (i.e., quality or performance improvement) 5. Identify the important functions of the organization 6. Identify approaches to process improvement framework 7. Develop an information flow chart 8. Establish reporting routines 9. Integrate quality principles into organization's policies and procedures 10.Identify educational needs Building an Effective Quality Improvement 1. Definition of the term quality for the organization Program Structure: 2. Clarify leadership roles 3. Create an accountability structure 4. Determine what the name of your 1-Determine the Definition of Quality for program will be (i.e., quality or the Organization: performance improvement) 5. Identify the important functions of the organization 6. Identify approaches to process Every healthcare organization must define improvement framework 7. Develop an information flow chart how they view quality for their organization. 8. Establish reporting routines  This definition will be impacted by: 9. Integrate quality principles into organization's policies and procedures 10. Identify educational needs 1. the type of organization. ( gov or non gov) 2. it is for profit or not for profit. 3. the mission, vision, and values of the organization. 4. patient population. 5. type of services offered, type of practitioners utilized. 6. geographic and environmental factors. 2-clarify 1. Definition of the term quality for the organization Leadership Roles 2. 3. Clarify leadership roles Create an accountability structure 4. Determine what the name of your The The role program will be (i.e., quality or Leaders performance improvement) program must delineat 5. Identify the important functions of and know working ed in the organization quality their together writing, 6. Identify approaches to process strategy roles and toward a perhaps improvement framework 7. Develop an information flow chart should be meet the common within 8. Establish reporting routines shared expectati quality the 9. Integrate quality principles into and on in the strategy, quality organization's policies and procedures acknowled Q.strateg plan 10. Identify educational needs ge y itself.  There should be one group held accountable for inspi the organization's quality strategy for both re clinical and nonclinical processes and outcomes; empo that group is typically called the Quality Council. wer leade 1. eliminate all redundant bodies. rs Shar 2. reduce the need for multiple meetings e and duplicative reporting. chall visio 3. ensure appropriate and timely enge n communication throughout the organization Quality 1. Definition of the term quality for the organization 2. Clarify leadership roles council 3. Create an accountability structure 4. Determine what the name of your  body of senior managers representing with in program will be (i.e., quality or performance improvement) a firm and quality specialists who meet 5. Identify the important functions of the organization periodically to identify quality problems and 6. Identify approaches to process devise appropriate solutions of these improvement framework 7. Develop an information flow chart problem. 8. Establish reporting routines 9. Integrate quality principles into  consists of the administrative, physician, and organization's policies and procedures nurse leaders and key organization staff who 10. Identify educational needs serve as an oversight committee for all quality activities (clinical and non-clinical) of the organization and including community members and/or previous patients.  ideally include members from all aspects of the organization to prove that there is cross communication throughout the organization.  All members of the Quality Council should be required to sign annual confidentiality and conflict of interest forms, which should be kept on file wherever the minutes are kept. Quality council: 1. Promote quality improvement 1. Provide technical support 2. Set goal and time frame 3. Prioritize the opportunities of improvement 4. Establish performance improvement team The Quality Council reports directly to the Governing Board through minutes, but also shares quality information with the medical staff and the administration of the organization. The frequency of the Quality Council meetings is determined by the organization, e.g. monthly or quarterly. If the Quality Council is established in the medical staff bylaws, the meeting expectations should be stated in a manner that does not violate the bylaws should a meeting not occur as stated in the bylaws. Information which presented at quality council:  is high level, aggregated, and trended data and information regarding the status of improvement efforts.  Quality Council is usually identified in the medical staff bylaws as a committee of the medical staff, which is chaired by a physician.  Quality Council is a subcommittee of the governing board, and thus has at least one governing Councils and Committees:  Other councils and committees may be needed in the organization. There are committees established by Committee is Commission is subgroup for the administration and the medical staff. The a group of people original body medical staff bylaws describe many other committees who is entrusted formed for by GB to carry that are interdisciplinary, and that relate to the out specific task. specific function and report back healthcare quality management of the organization. to the main group ( related to Q.management: the Infection Control/Prevention, Medication Use, Morbidity/Mortality (M&M) and other such committees are also mentioned in the bylaws. ) ( Departments of the organization in conjunction with the medical staff departments also have committees such as the Emergency Department, or the Critical Care committees.) Initiatives and Collaboration:  Part of the Quality Council's prioritization and development of the strategic quality plan is to determine if there are external collaborative and/or quality initiatives that the organization would benefit from participating with them.  collaborative: involves individuals working with others to do a task and to achieve shared goals  Initiative: 1- The power or opportunities to do something before others do 2- Formed when stakeholders come together to solve dilemmas. Proposing or confirming change in current status  1. Definition of the term quality for the 3-Accountability organization 2. Clarify leadership roles Structure : 3. Create an accountability structure 4. Determine what the name of your Org. should be account of their activities program will be (i.e., quality or performance improvement) 5. Identify the important functions of and responsible of them and provide many or the organization other supportive issue for its activities. 6. Identify approaches to process improvement framework Obligation to support and justify something 7. Develop an information flow chart 8. Establish reporting routines (Government answerable ha)accountability for decision and 9. Integrate quality principles into organization's policies and law which affect citizen. procedures In work place : responsibilities of employee 10. Identify educational needs Accountable Responsible to complete the tasks they are assigned to perform the task , they are assigned , to Responsible for Duty to work or perform the duties required by their job. what u do and help some one giving satisfactory who in position of reason authority Can not be Can be shared shared U r blamed for No liability mistakes  1. Definition of the term quality for the 4-Quality organization 2. Clarify leadership roles Language : 3. Create an accountability structure 4. Determine what the name of your program will be (i.e., quality or  It is important to determine the quality performance improvement) 5. Identify the important functions of language that the organization will the organization 6. Identify approaches to process utilize for their quality program. Just improvement framework 7. Develop an information flow chart as there must be an organization wide 8. Establish reporting routines 9. Integrate quality principles into commitment and strategy, there must organization's policies and procedures be a common quality language with 10. Identify educational needs well-defined terminology.  A common quality language facilitates leaders' ability to articulate clearly the corporate passion for quality and to be consistent and organized in the development and rollout of the selected quality strategy. The language of the organization  1. Definition of the term quality for the 5-Organizational Important organization 2. Clarify leadership roles Functions : 3. Create an accountability structure 4. Determine what the name of your program will be (i.e., quality or Determination of what should be performance improvement) 5. Identify the important functions of measured and then improved if needed, the organization 6. Identify approaches to process there are many things to consider. improvement framework It is well known that the organization 7. Develop an information flow chart 8. Establish reporting routines cannot measure and improve 9. Integrate quality principles into everything at the same time due to the organization's policies and procedures lack of resources available. 10. Identify educational needs Nevertheless, the organization needs to focus their improvement efforts on the issues that provide the most value to the organization and its patients/clients. ‫ كاندى مش هرهق‬50 ‫مصنع حلويات العلبة فيها‬ ‫ بالظبط واقعد اعد ال‬50 ‫نفسى ان كل علبىه فيها‬ ‫ اتنين قشط يبقى ممكن اوزن‬-/+ (‫ممكن ابقى‬ ‫واريح دماغى‬  Hip replacement: I would assess only  1. Definition of the term quality for the 6-Approaches to Performance organization 2. Clarify leadership roles improvement : 3. Create an accountability structure 4. Determine what the name of your program will be (i.e., quality or performance improvement) Several methodologies can be 5. Identify the important functions of the organization 6. Identify approaches to process used to establish an organization improvement framework 7. Develop an information flow chart wide approach for 8. Establish reporting routines 9. Integrate quality principles into Quality/Performance Improvement organization's policies and procedures (Q/PI) activities. 10. Identify educational needs These possible approaches/models focus on process improvements and are generally designed for use by cross-functional, interdisciplinary teams. Leadership and planning are essential for integrating existing and new improvement activities and for gaining consensus across the organization or system.  Common characteristics of all approaches/models: 1. Identifying/focusing on prioritized areas in the organization 2. Developing measures and collecting data 3. Assessing performance , taking action for improvement 4. Assessing improvement 5. Effective team development and interaction 6. Use of statistical, analytical, and  consensus The key totools at all steps successful selection (meaning buy-in and adoption by the organization) is making certain that the approach( es ) make good, common sense to clinicians, quality professionals, top-level leaders and directors/managers, and teams. Shewhart Cycle - PDCA Cycle or PDSA Cycle:  Shewhart developed the Plan-Do-Check-Act (PDCA) cycle for planning and improvement in the 1920s. W. Edwards Deming adapted PDCA and called it the Plan-Do-Study-Act (PDSA) cycle. Both are conceptually the same with a slight variation as to whether you 'check' or 'study' as the third part of the cycle.   plan what needs to be done.  Take action based on what you  Recognize an opportunity and learned in the study step.  If the change did not work, go plan a change.  you need to be sure that you through the cycle again with a answered some basic different plan.  If you were successful, concerns: 1. What is the core problem incorporate what you learned we need to solve? from the test into wider changes.  Use what you learned to plan new 1. What resources do we need? improvements, 2. What resources do we have? beginning the cycle again. 3. What is the best solution Base line for fixing the problem with Decision??? data the available resources? 4. In what conditions the plan will be considered successful? What are the  Data is collected again as it was goals? before the improvement efforts  An action plan is developed began. with goals and targets that  Analyze of this data compared have been identified. to the previous data  Design New process.  The team determines if the goal /target have been reached.  the action plan is implemented,  Determine what action or usually on a small scale in a modification are necessary prior Pilot trial basis (Pilot study) to the full implementation of the study/small  This stage include education action plan ( decide u will scale repeat the cycle or not?) and training.  Benefits of PDCA: 1- It stimulates continuous improvement of people and processes. 2- It lets your team test possible solutions on a small scale and in controlled environment. 3- It prevents the work process from recurring mistakes Accelerated/Rapid Cycle Change Approach: Keep .Mergers and acquisitions continue pacin to accelerate change in healthcare g organizational structure and culture. Reengineering efforts change systems, functions, and processes radically, not incrementally, as continuous  quality improvement Healthcare theory purchasers want would "proof dictate of quality". now in order to make appropriate contract decisions about health plans and providers.  changes are made in a less disruptive environment, resistance to change is reduced, and everyone is learning from ideas that work and those that do not.  Rapid-cycle change models utilize the traditional quality tools, but expediting the change and the results. Instead of 3-6 months for a team to implement and measure a change, rapid cycle change occurs within several days up to 4 to 6 weeks.  This process is labor intensive and must have the support of the leadership. The leadership must commit to the staff time and the financial resources.  Rapid cycle improvements cause the team to focus on reducing failure rather than just improving performance.  Benefits of rapid cycle improvement consist of quick improvements resulting from small tests, failures are noted quickly and affect few individuals, measurement is concurrent and on small samples. Lea n:  Lean management strives towards elimination of waste and non-value added activities from the poor application of resources and the supply of equipment/supplies (too little or too much) does not meet the demand.  The goal is to match the supply Lean thin king is a transfo rmational framew with the demand exactly. that aims to provi to organize huma de a new way to ork think about how n activities to de benefits to socie liver more ty and value to in eliminating dividuals while  lean is about providing the most value for the customer while minimising resources, time, energy and effort. Eliminate waste: One of the key elements of practicing Lean is to eliminate anything that does not add value to the customer. Waste X value Waste: is defined as "any activity or resource that destroys value or consumes resources without creating value for the patient or the healthcare enterprise" It involves variation, and overburden within processes.  There are eight forms of waste: 1. Defects. 2. Oversupply. 3. Waiting. 4. not fully utilizing people's abilities. 5. Transportation. 6. Inventory motion. 5S tool: This is extremely important to the lean methodology. This tool utilizes a systematic approach that is effective and simple to use model for process design and improvement. There are five phases in this tool: (Sort, Store, Shine, Standardize, and Sustain) .The current state process map is drawn first to display how the process currently functions prior to any improvements and to determine the overall processing 5 STEPS : evaluates what is needed and what non-value added SORT items/steps can be deleted. consists of examining the effectiveness of the order of STORE steps in the process, and reorganized to increase efficiency and productivity. consists of streamlining the process to eliminate SHINE additional processing time. Standardize work phase is when the process steps are standardized Standar work phase is when the process steps are dize standardized. the process can be monitored and refined in order to SUSTAIN maintain the new processing time.. Kaizen is a compound of two Japanese words that together translate as "good change" or "improvement." However, Kaizen has come to mean "continuous improvement" through its association with lean methodology and principles. KANBAN : scheduling system for lean manufacturing  Several components are required for successful : 1. The scientific method is utilzed to solve problems. 2. There must be a manager who is a facilitator, mentor, and coach. 3. The frontline workers are the ones who identify and solve the problems. The quality manager must move the organization toward reducing the risk of adverse events and assisting staff and practitioners in the redesign of processes that improve the quality of the services provided. One of the first things that must be done is to begin to change the Six sigma: Is a disciplined approach to process improvement, used for redesigning or designing new processes. It is a concept representing the amount of common cause variation in a process relative to customer needs, expectations, requirements, and/or specifications. Variation in a process creates waste and errors. Eliminating this variation makes the process more cost-effective, more efficient, and more error-free. elimination of defects and reduce variation Six sigma:  is a business strategy, focusing on: Continuous improvement. Understanding customer needs. Analyzing business processes (evaluate process capability) Utilizing appropriate performance measures and statistical methodology.  It was developed by Motorola in the mid- 1980.  Goal: is the near elimination of defects and reduce variation [Juran's "zero defects" concept from any process, product, or service. Key Concepts for Six Sigma: Utilizes the DMAIC approach: 1- 2- 3- 4- DEFINE: Translate the "voice of MEASURE Collect : on baseline data ANALYZE: Root or potential IMPROVE Create possible: solutions for the customer" defects and possible causes of current or root causes and select (complaints, unmet causes, aggregate, anticipated defects, solutions, develop plans; pilot needs, interests, quality display, perform initial respectively; confirm each plan, then implement; perceptions). analysis them with data; and measure results. Costs and benefits to be Develop key, discover non value- Determine unit realized when the realistic input, process, added process steps, cost savings as well as all proposed change/project and output measures; translating both into other benefits to customers is complete; develop the establish specific unit cost of poor quality. 5- cost measures for each purpose, scope, charter; critical step in the flow- CONTROL Standardize : map the process. charted process ; the work flowchart process in processes; detail to understand the develop the current process. monitoring system. COST UNIT: cost of unit production included storage till selling. UNIT COST: cost include fixing and all variable costs involved in the There are five levels of expertise in Six Sigma methodology, designated by a color-belt system: Work on local problem- Participate as project solving teams but not part of team member Reviews Six Sigma teams Have an process improvements that awareness of Six Sigma support the project aspects Leads Green belt projects and Leads problem-solving teams Assist with the data projects Trains & coaches collection and analysis for Black project teams Dedicate all Belt projects Integrate Six Sigma implementation into their their professional efforts to primary jobs Six Sigma Concentrates on Six Sigma implementation Trains and coaches Black and Green Belts Functions at the Six Sigma program level Develops key metrics and strategic direction Assures that Six Sigma processes are applied correctly throughout the organization  There are two additional positions that provide organizational support to the team: Champions: are upper management who are concerned about the overall Six Sigma implementation and work with mentoring lower-level Six Sigma practitioners, identifying resources and removing road blocks. They translate the company's mission, vision, goals and measures that will identify individual projects and determine a project deployment plan. Executive leadership: is the highest level and includes the CEO and senior managers. The executives determine the overall strategy for Six Sigma implementation, and establish the strategic focus for the program  Remove waste Increase speed Reduce variation Better deliver Remove non Improve Quality Better added value Optimized Quality steps remaining Employee Fix connection process steps satisfaction between process Focus on Customer steps customer satisfaction Speed Accuracy  1. Definition of the term quality for the Develop an Information organization 2. Clarify leadership roles Flow Chart : 3. Create an accountability structure 4. Determine what the name of your program will be (i.e., quality or  There must be some form of information performance improvement) 5. Identify the important functions of flow that is developed for all kinds of the organization 6. Identify approaches to process information if communication is to be improvement framework effective. 7. Develop an information flow chart 8. Establish reporting routines  As previously discussed, the Quality 9. Integrate quality principles into organization's policies and Council has a flow of information of how procedures quality information flows to and from 10. Identify educational needs that council  The committees and departmental meeting minutes also need to have an information flow designated for them.  This information flow information can be documented in policies and procedures, as part of the performance improvement plan, and other such locations. It may also be useful to develop timeframes and expectations of the flow of information Establish Reporting 1. Definition of the term quality for the organization Routines : 2. Clarify leadership roles 3. Create an accountability structure 4. Determine what the name of your All quality, risk, and utilization management program will be (i.e., quality or performance improvement) activities should be reported periodically in 5. Identify the important functions of the organization summary form to the Quality Council. 6. Identify approaches to process improvement framework 7. Develop an information flow chart Certain information, should be identified 8. Establish reporting routines 9. Integrate quality principles into and documented in the Plan or in policy and organization's policies and procedures should be reported to the various medical 10. Identify educational needs staff departments and committees or other physician groups, as applicable, and to the governing body. Teams and departments/services are calendared to present the current status of quality or performance improvement activities, with a written (ideally one-page) "Outcome Summary" for distribution. All directors and/or managers are then responsible for dissemination of the information to all staff at department  1. Definition of the term quality for the Integrate Quality Principles into the Organization's organization 2. Clarify leadership roles Policies and Procedures : 3. Create an accountability structure 4. Determine what the name of your program will be (i.e., quality or Quality principles and performance improvement) 5. Identify the important functions of the organization processes that are utilized in 6. Identify approaches to process improvement framework an organization should be 7. Develop an information flow chart 8. Establish reporting routines integrated into the policies 9. Integrate quality principles into organization's policies and and procedures of the procedures 10. Identify educational needs organization. Develop, clarify, confirm or revise, and integrate all organization policies and guiding statements concerning patient safety, quality of care and service, and performance improvement efforts. If a process is improved, the  1. Definition of the term quality for the Identify Educational organization 2. Clarify leadership roles Needs: 3. Create an accountability structure 4. Determine what the name of your program will be (i.e., quality or  The educational needs in regard to performance improvement) 5. Identify the important functions of quality/performance improvement , the organization 6. Identify approaches to process risk management and utilization improvement framework management will vary in each type 7. Develop an information flow chart 8. Establish reporting routines of healthcare organization. 9. Integrate quality principles into organization's policies and  It is up to the quality management procedures leaders to determine who? requires 10. Identify educational needs what? education and to determine the best methodology to deliver that education.  Specific educational goals should be developed along with ways to measure the effectiveness of the teaching.  The effectiveness should be measured at the conclusion of the educational event, but also later in time to assure that information The structure and processes are determined by: 1. Organizational culture (degree of leadership commitment to mission, vision, values, people, and the community served ) 2. Ability to trust and empower individuals and groups (with information, to make decisions, to change and make change) 3. Ability to relinquish and/or share power and control (information, delegation, resources, influence) 4. Degree to which willingness to change accompanies the "buy-in" to quality (changes in policies, procedures, budgets, schedules, organizational charts, roles and responsibilities, reporting relationships, etc) 5. Depth of understanding of the practical implications of QM: - Relationships between board, administration, and physicians (committee structure, flow of Organizational Influences for Program Effectiveness :  There are many organizational influences impacting program effectiveness, and these must be considered throughout the development. 1. Organizational culture 2. Governing body support and involvement 3. Administrative and management leadership support and involvement 4. Medical/professional staff or medical group/IPA support and involvement, as applicable 5. Organizational, team, and committee structures 6. Scope of services and programs 7. Important organization wide functions 8. Strategic quality initiatives. 9. Care and service delivery functions, systems, and processes 10.Information system resources 11. Financial budget and resources Quality/Performance 1. Performance improvement program structure 2. Performance improvement plan Improvement Plan : 3. Implementation of performance improvement program 4. Dissemination of performance improvement information  The Quality/Performance Improvement (Pl) Plan 5. Team 6. Practitioner appraisal process should be developed by the executive and clinical 7. QM & PI orientation and training and education leadership and must be approved by the organization's governing body.  The plan is the road map for all quality related activities, clinical and service related, for the organization.  The Quality/Performance Improvement plan, generally outlines, the quality performance improvement focus areas for the current and future years.  The prioritization of improvement opportunities should include appropriate strategic initiatives of the organization.   five characteristics of a Quality/Performance Improvement Plan: 1. A systematic process that includes leadership, accountability, and dedicated resources. 2. Use of data and measurable outcomes in the progress towards evidence-based benchmarks. 3. Focuses on linkages, efficiencies, and provider and client expectations when improving outcomes. 4. Continuous process that adapts to change within the organization's quality Improvement arena. 5. Data collected is utilized to assure that the goals of the program are accomplished and they are concurrent with the improved outcomes.  Balance score card 1. It Organize the data with key performance measures (indicators). 2. Performance measurement system based on and organized around the strategic plan. 3. It is a translation of mission, vision, and strategic plan into actions. 4. It gives an overall snapshot of the organization's status. 5. It answers “ How are we doing?" and "Are we there yet?“. 6. Reflect the priorities of both the organization and its customers & Vision Innovation. 7. It’s better than looking for financial issues only. It’s balanced.  The importance of BSC 1. The main goal to link organisation mission and vision with the strategic plan. 2. Align day to day work which every one is doing with strategy. 3. Prioritise the projects, products and services. 4. Measure the progress toward strategic target. Dashboard Balance score card Support Operational decision Support strategic plan Monitor in real time (Performance Performance management(Progress monitoring)(snapshot of business toward target) performance) Real time feed Monthly snapshot (retrospective) Display performance (KPI) Display Progress (metric against target) Visualise performance to understand Align KPI, Objective and action to see the current status (NOW) the connection between them Than ks