Part 2: It's All About Quality

Avoid 10 Common Mistakes in Performance Improvement
Part 2. It’s All About Quality

In the last installment, we explored the tendency to create an inventory of experts right away. Training an army of people in methods and tools for performance improvement may not have the outcome you expect if the right pieces of the puzzle aren’t in place. It’s better to start small and explore how to best implement these methods in your particular organization first, and then roll out the training after fine-tuning your approach. One of the things that often requires fine-tuning is project selection. We all know how limited our time and resources are to accomplish the myriad performance improvement objectives that exist in our hospitals, medical centers, large physician networks and practices, nursing homes and rehabilitation centers, but which ones will get us the results we really need now?

As leaders and managers in a healthcare organization, our days are filled with a multitude of decisions that force us to prioritize. Sometimes we get it right and other times we just don’t. When it comes to making decisions about which initiatives are most important for our performance improvement program, we risk doing too little and falling behind or trying to do too much and not being able to execute well. So how do we select projects that are important to the organization–as an enterprise made up of interdependent functions?

With all the data and reports required to maintain compliance and accreditation, it is easy to see why resources are caught up in that daily routine with precious little time left over to do the real value-added work – improving healthcare. To set the gears in motion for performance improvement we must know:

• what is important for the organization as a whole (the strategy);
• what is the current performance;
• where the gaps exist;
• which of the opportunities are most important to tackle first;
• who will champion each effort;
• what resources are needed to support the priorities.

Most improvement initiatives require cross-functional teams. So, with a finite and number of staff members that can participate, the efforts cannot be completely decentralized. Remember, at risk is the trying to do too much and executing poorly or not having enough going on and falling behind!

As part of the leadership team’s management system, an opportunity prioritization matrix should be used to quickly rack and stack the opportunities at regular intervals. This prioritization matrix is made up of weighted criteria that are based on business strategy. It allows the team to decide in a structured and analytical way which things are most important to work on right now. Through this form of decision-making, the leadership team achieves a level of engagement in the performance improvement program that will help it to thrive. We’ll explore more about leadership engagement in a future edition of this series, but the takeaway here is that performance improvement must be championed by leaders who are engaged – not just supportive. There is a difference and this is one way to get there.

When sorting through the opportunities, it’s time to think big – think enterprise. If the decision-making occurs on only one axis, then a big piece of what makes performance improvement successful is missing. How is improvement measured?

Because enterprise is a set of interdependent processes, having an understanding of how an improvement in quality or safety also impacts the organization in terms of things like capacity, utilization, length of stay, satisfaction, throughput, cost, and so on is vital. It is certain that our primary goal is to increase patient quality and safety, but the changes that are made need to also take into account these secondary measures.

For example, once an organization begins to understand how to measure and document the cost reductions associated with a specific quality improvement effort, new levels of involvement can be realized from the finance department. The chasm between the clinical and financial functions in a hospital doesn’t need to be so large, and working together to achieve cost reductions and quality improvements simultaneously is a good start.

Further, by establishing standards for documenting cost reductions or revenue increases as a result of performance improvement, it is much easier to justify new expenditures such as adding FTEs to the program, sending staff for more training, or purchasing technology. In today’s highly cost-conscious healthcare environment, with battle-lines drawn between providers, payors and the government, there is no more important to begin linking performance improvement with finance to play a part in making ends meet.

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