PERFORMANCE IMPROVEMENT

1
PERFORMANCE IMPROVEMENT

• What is it and how is it done?
• 2002
• Presented by
• John F. Neale, DDS, MPH
• CAPT, USPHS (ret.)

2
Course Outline

• Introduction
• NNMC PI program
• Process/Outcomes
• Dimensions/Functions
• Identifying projects/indicators for your
  department
• Tools

3
Learning Objectives

• At the completion of this session, participants
  should be able to do the following
• Define discuss the the varying definitions of
  quality
• Define FOCUS-PDCA apply to daily tasks
  departmental PI activities
• Define process/outcome how you apply to your PI
• Define the Dimensions of Performance apply to
  PI
• Describe various PI tools and how they are used

4
What is QUALITY?

• Meeting or exceeding the customers expectations
  the first time and every time
• In Healthcare The degree to which health
  services for individuals and populations increase
  the likelihood of desired health outcomes and are
  consistent with current professional knowledge

5
What is QUALITY?

• How do you define quality?
• How do you think your departments customers
  define quality?

6
Customers

• Who are your departments customers?
• External
• Internal

7
What is Performance Improvement?

• JCAHO defines PI as The continuous study and
  adaptation of a healthcare organizations
  functions and processes to increase the
  probability of achieving desired outcomes and to
  better meet the needs of individuals and other
  users of services.

8
What Performance Improvement is NOT

• Peer Review
• Customer Satisfaction Surveys
• Quality Control Activities
• Routine Monitoring and Evaluation
• All of the above activities are ways to gather
  data to identify where performance can be
  improved

9
What is a Process?

• A goal directed, interrelated series of actions,
  events, mechanisms, or steps. An interrelated
  series of events, activities, actions,
  mechanisms, or steps that transform inputs into
  outputs.

10
What is an OUTCOME?

• The result of the performance (or
  non-performance) of a function(s) or process(es).

11
Functions
12
Dimensions of Performance
13
Performance Improvement tools

• Flow chart
• Cause effect or fishbone diagram
• Pareto chart
• Control charts
• Histograms
• Scatter diagram
• Run chart

14
Flow Chart
15
Cause and Effect Diagram
16
Pareto Chart
17
Control Chart
18
Histogram
19
Scatter Diagram
20
Run Chart
21
The PI Mindset

• Doing whatever it takes to ensure
• the best service
• the best outcome
• customer satisfaction
• employee satisfaction
• financial success

22
The PI Mindset

• Continuously examining processes and seeking
  opportunities for improvement that will
• benefit customers
• improve our results
• make us more efficient
• maximize the quality of everything we do
• It is no longer if it aint broke, dont fix
  it, it is now even if it aint broke, improve
  it.

23
If 99.9 were good enough
Every year there would be 20,000
prescription errors made 15,000 newborn
babies dropped during delivery 32,000 missed
heartbeats per person. Every month there would
be 1 hour of unsafe drinking water Every
week there would be 500 incorrect surgical
procedures performed Every day there would be
2 unsafe landing at OHare airport Every hour
there would be 22,000 checks deducted from
the wrong bank accounts. 16,000 pieces of
mail lost by the US Postal Service
24
Hospital Corporation of America Performance
Improvement Methodology

• F ind an opportunity for improvement
• O rganize a team
• C larify the process
• U nderstand variations
• S elect the improvement
  

• P lan
• D o
• C heck
• A ct

25
Find an opportunity to improve

• How or where do we find opportunities for
  improvement?
• Ongoing monitoring activities such as
  Safety/RM/IC/PI
• Customer feedback (patient or staff satisfaction
  surveys)
• Outcomes
• Strategic Planning
• New services

26
Organize a team

• Size large enough to include all disciplines or
  departments involved, but small enough to be
  workable.
• Membership include all knowledge/skills/departme
  nts needed to address the process in question
• Resources money, time, materials, training,
  etc.
• roles/responsibilities see team guidelines in
  the Service Unit PI plan

27
Clarify current knowledge of the process

• Break the process down into its component parts
  or steps in order to better understand how it
  works and to find areas where the process varies
  from its purpose.
• Flow chart
• Cause effect or fishbone diagram
• Research
• Literature
• Past experience

28
Potential Sources of Variation - Why things dont
turn out as planned

• People Not trained or oriented to a procedure
• Forget to perform a step in a complex
  process
• Machinery Machine malfunctions
• Different machines used
• Materials People use different procedures
• Methods Missing steps or unpredictable sequence
• or tasks
• Conditions Different environments such as
  changes in
• weather, shift work

29
Understand causes of process variation

• Collect and analyze data on the various steps in
  the process identified in the previous step to
  see where problems or inefficiencies occur
• Pareto diagrams the 80/20 rule
• Run charts
• Control charts
• Histograms

30
Select the step(s) in the process that will be
improved

• Use the results your C and U activities to
  identify the step or steps in the process that
  contribute the majority of the process variation.

31
Plan

• How will the improvement be done?
• Who will do it?
• What is the Timeline for implementation?
• What Outcomes are desired?
• How much will it Cost
• What Training or Education is needed?
• Is a Trial Period or Pilot Program indicated?
• What data will need to be collected to monitor
  the changes?

32
Do

• Implement the Plan
• Schedule needed training
• Collect the needed data
• Pilot Test the plan if appropriate

33
Check

• Collect and Analyze data to determine the
  following
• Did the action work?
• Did you achieve the desired outcomes?
• Is the process working as predicted, or is
  further refinement needed?

34
Act

• Change processes or further tweak the Plan if
  needed to achieve desired outcomes
• Repeat the PDCA cycle as needed to maximize
  improvement
• Finalize and implement full scale
• Develop New flow chart and/or New P/P for the
  redesigned process
• Educate/orient patients and staff
• Story board report to communicate results to
  staff and customers

35
Identifying opportunities for improvement in your
department

• Outcomes
• Process
• Strategic Planning
• Prioritizing
• Staff/Customer feedback