Lecture 7 - Performance Assessment PDF

Performanc e Assessmen t lecture 7 & 8 Prepared by Dr. Samraa Hussain Introduction Performance assessment is the evaluation stage of quality management. Measurement data have been gathered and now must be reported and analysed. If an organization construct measures carefully, collects a...

Performanc e Assessmen t lecture 7 & 8 Prepared by Dr. Samraa Hussain Introduction Performance assessment is the evaluation stage of quality management. Measurement data have been gathered and now must be reported and analysed. If an organization construct measures carefully, collects accurate data, and reports results in a meaningful way, it produces information useful for decision-making. So, Assessment involves judging or evaluating measurement data for the purpose of reaching a conclusion. Assessmen t and quality manageme nt  1st : The organization judges whether its performance is acceptable. The If it is acceptable, the organization continues to measure performance to ensure it does not assessme deteriorate. If its performance is not acceptable, the nt steps organization advances to the improvement step. includes: 2nd : The organization evaluates measurement results to determine whether processes are performing as expected. 3rd :. The organization assesses those results to judge the impact of improvements The The assessment phase in quality assessme management involves data analytics—the examination of raw nt data by which to draw conclusions about that information. This phase activities involves three activities: 1. Displaying measurement data 2. Comparing actual performance with expectations 3. Determining whether action is needed 1st activity - Display data The first step in analysing performance data is deciding how the information will be presented or displayed. The data should be reported in a format from which conclusions can be easily drawn. Multiple formats can be used, such as tabulations, graphs, and statistical comparisons. To display data in an understandable format, three factors must be considered: a) The type of data to be reported b) The audience c) The information's intended use CASE STUDY (For reading only) The radiology department case study Although helpful, total numbers provide analyses the performance measurement limited information over time. For results, obtained by tracking the number example, the manager cannot determine of outpatient X-ray exam reports it whether a small or large percentage of communicates to physicians within 48 reports are delayed. A more meaningful hours of exam completion, to identify any approach would be to graph the percentage trends. A line graph (also called a run of delayed reports—the number of delayed chart) of the number of X-ray reports not X-ray reports divided by the total number communicated to patients’ doctors within of X-ray reports—as shown in exhibit 4.3. 48 hours of exam completion is shown in exhibit 4.2. CHARTS AND GRAPHS Reporting performance information in the right format is critical to successful quality assessment. Charts and graphs can be effective media for conveying information quickly and clearly. Graphs create a picture of the results, sometimes referred to as data visualization. SNAPSHOT REPORT FORMATS Some performance reports provide information collected at a particular point—a snapshot of time. To create reports that represent these snapshots, data are gathered for a certain period and summarized for analysis. Common formats of snapshot reports are tabular reports, pie charts, scatter diagrams, bar graphs, histograms, Pareto charts, and radar charts. Tabular Reports Tabular reports, sometimes called data tables, are used to display numeric data gathered in one snapshot of time. Example : exhibit 4.5 is a tabular report showing the results of a two-month survey of patient experiences at a behavioural health clinic. A total of 47 patients completed the survey. Pie Charts Pie charts show the contribution of parts to a whole. For example, suppose the behavioural health clinic discussed earlier conducts a follow-up telephone survey to tally patients’ most common complaints about the clinic. The results of this onetime survey can be displayed in a pie chart, as shown in exhibit 4.6. Scatter Diagrams Scatter diagrams are tools for analysing relationships between two variables. One variable is plotted on the horizontal axis (x-axis), and the other is plotted on the vertical axis (y-axis).  Scatter diagrams usually show one of five possible correlations between the two variables: 1. Strong positive correlation. The value on the y-axis increases as the value on the x-axis increases. 2. Strong negative correlation. The value on the y-axis decreases as the value on the x-axis increases. 3. Possible positive correlation. The value on the y-axis increases slightly as the value on the x-axis increases. 4. Possible negative correlation. The value on the y-axis decreases slightly as the value on the x-axis increases. 5. No correlation. No connection is evident between the two variables. Bar Graphs With bar graphs, sometimes called bar charts, audiences can easily compare groups of data and quickly assess their implications on performance. The bar graph could present in form of vertical (see diagram 4.9) or horizontal (see diagram 4.10) Example : Exhibit 4.9 is a vertical bar graph that shows average computer response times for a six-month period at each of four hospitals in a regional health system. From the graph, the hospital with the lowest average computer response time is easy to identify, and response time performance among the four hospitals is easy to compare. Histograms Histograms, sometimes referred to as frequency distributions, are bar charts that show a distribution of values as rankings along the x-axis. Example : Exhibit 4.11 is a histogram illustrating the distribution of patient wait times in a clinic. Wait-time data were gathered for one week, and the data were grouped into three wait- time categories. The number of patients in each category is also shown. 2nd activity - COMPARE RESULTS WITH EXPECTATIONS In the second phase of performance assessment, performance measures should be tied to a predefined goal or expectation. Without performance expectations, performance results cannot be evaluated objectively. Except for healthcare services that must comply with absolute standards (such as standards found in government regulations), performance targets may be established based on: (1) opinion, (2) criteria, or (3) performance comparison. Opinion Performance targets may be derived from the opinion of those affected by the measure. A determination is made regarding the acceptable or desired level of performance, which then becomes the goal. For example : The performance data illustrated in exhibit 4.18 show that the percentage of delayed X-ray reports is gradually declining (as evidenced by the trend line). If continued improvement of this process is a departmental goal, the following year the radiology manager will set an expectation that the percentage be lower than the current year's average rate. If maintaining the status quo is the goal, the radiology manager will set the same expectation for the following year as was achieved for the current year. Criteria Performance targets should not be established on the sole basis of opinions if relevant, professionally defined criteria are available. Professionally defined criteria are found in the standards, rules, and principles that have been developed by authoritative groups, such as clinical practice guidelines , consensus statements, and position papers. For example : The American College of Radiology (2012) recommends that imaging studies not be performed for patients with an uncomplicated headache. This recommendation may prompt the medical director of radiology to set a goal of zero imaging studies performed for this condition. Performance Comparison Other organizations’ performance is the third influence on quality targets. The use of comparative information to set performance goals is a relatively new phenomenon in healthcare. The term benchmarking is typically used to describe performance comparison activity (e.g., “We are benchmarking against other hospitals”), but it involves more than simple comparison with other organizations. For example: In the 1860s, Florence Nightingale pioneered the systematic collection, analysis, and dissemination of comparative hospital outcomes data to understand and improve performance. 3rd activity - DETERMINE NEED FOR ACTION In the final phase of performance assessment, the need for further action is decided. At this point, the measurement results have been reported and performance quality is evident. Any of the following situations might signal the need to advance to the next step— performance improvement: Performance does not meet expectations; no signs of special cause variation are evident. Performance meets expectations; signs of special cause variation are evident. Performance does not meet expectations; signs of special cause variation are evident. *If none of the above situations exists, further investigation is unnecessary.  After an organization decides to advance to the performance improvement step, the people involved in the processes affecting performance investigate the performance gap—the problem causing the difference between actual and expected performance. Once the underlying causes are well understood, effective improvement interventions can be designed and implemented.