Managing Performance

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Managing Performance
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Performance

• . . .measured against predetermined standards
  and action is taken to correct discrepancies
  between these standards and actual performance.
  MH, p. 441

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• What is Quality?
• How do you know when quality is achieved?

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Quality Control

• Activities which
• Evaluate
• Monitor
• Regulate
• Goal in Nursing quality care while meeting
  intended goals

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Criteria for Effectiveness of Quality Control

• Support of top-level administration
• Institutional commitment to quality
• Fiscal and human resource support

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Quality Control as a Process

• IOM definition of healthcare quality
• the degree to which services for individuals and
  populations increase the likelihood of desired
  health outcomes and are consistent with current
  professional knowledge.

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Implications of IOM Definition

• Quality continuum
• Focus on services provided by healthcare system
• Evaluation perspectives individual, populations,
  communities
• Emphasis on desired health outcomes
• Research evidence defines what improves health
  outcome (MH, 443)

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Measuring Healthcare Quality

• The criterion or standard in determined.
• Information is collected to determine if the
  standard has been met.
• Educational or corrective action is taken if the
  criterion has not been met. (MH, p. 445)

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Standards

• Predetermined level of excellence
• Guide for practice
• Established by authority
• Professional
• Organizational
• Communicated to and accepted by those affected by
  them
• Measurement tools
• Must be objective, measurable, and achievable

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Audits

• Measurement tools
• Systematic and official examination to evaluate
  performance
• Timing
• Retrospective
• Concurrent
• Prospective
• Most common types
• Outcome
• Process
• Structure

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Total Quality Management/Continuous Quality
Improvement (TQM/CQI)

• Philosophy (Deming)
• Premises
• individual is the focal element on which
  production and service depend
• quest for quality in an ongoing process
• Never-ending process
• Everything and everyone in organization is
  subject to continuous improvement efforts
• Always room for improvement
• Continuous evaluation of customer needs and
  experiences
• Empowers employees (MH, p. 453)

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Who Should be Involved in Quality Control?

• Everyone in the organization
• Multidisciplinary Team
• Consumers

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Why did healthcare get involved in Quality
Control?

• External impacts (not voluntary)
• Professional Standards Review Board legislation
  (PL 92-603), 1972
• Diagnosis-related groups (DRGs) early 1980s
• Prospective payment system

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JCAHOs Impact on Quality Control

• Early 19802
• Mandated quality assurance programs
• Required quarterly evaluations of standards
  measured against written criteria
• Late 1990s
• Shifting focus from organizational structure to
  organizational performance or outcomes
• Required development of clinical indicators to
  measure quality of care provided.

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