THE GOAL OF THIS PERFORMANCE MANAGE- MENT CONTINUING EDUCATION PROGRAM is to inform nurses about the fundamental concepts of performance management to ensure practice areas gain the basic skills to develop a practical strategy for achieving its performance mea- surements. After studying the information presented here, you will be able to:
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Describe the fundamental concepts of performance management
Delineate the differences among performance management, performance measures, performance measurement and quality improvement
Build a performance management score card for your area of practice
By Sandra Swearingen, PhD, RN
Although this is not always true, it has techniques that help identify variables that are under control of the reviewer. “Lean” is aimed at using the minimum required for efficiency. It is based on elimination of activities that do not add to the customer experience. This process eliminates waste and aims for zero defects in processes. The choice of methodology used is based on the application. In healthcare, zero defects are important as is looking for deviations from the baseline. All of the these processes review and focus on areas that improve some part of a healthcare system.1,2
PERFORMANCE MEASURES VERSUS CLINICAL GUIDELINES
As a new staff member to acute care, you keep hearing about performance management. You know if your hospital does not meet its performance management measures, the impact could be negative for the organization, potentially harming the quality of care, the hospital’s reputation, the reputation of your practice area and the finances of the hospital. You have a sense that you are responsible for performance management but not sure how. You decide to seek more information to understand what perfor- mance management is.
D
uring recent years, the interest in performance manage- ment measures has increased throughout the health- care industry. Review of performance management in
healthcare indicates that terms need to be clarified so staff can understand what performance management is.
Definitions Performance management is a process by which goals are set for the future and methodologies’ are used to check the organization’s progress toward these goals on a routine basis. Normally a goal is set, the data are reviewed that relate to the goal and actions are taken to advance compliance to the goal.1 Performance measures tend to be evidence based, and are
developed based on clinical or practice guidelines. The object is to review the care that is delivered against establishedmeasures. By benchmarking against defined data, an organization canmeasure the quality of care it delivers.1 Performance measurement allows an organization to examine
important aspects of its programs, structures and methods. It includes an overview of the methods used in data collection.1 Quality improvement is a measured and precisemethod that
uses many procedures, such as Plan-Do-Check-Act (PDCA) or its related system of Plan-Do-Study-Act (PDSA), that add increased review of the data and charts to plot data on a graph to demonstrate deviation from the acceptable. It also includes total qualitymanagement, which demonstrates an overall orga- nizational quality improvement process with use of advanced graphing and plottingmethodologies. Six Sigma is amethodology based on the idea that all variables that underlie a process are obvious, and one can identify interaction between variables.
Performance measures are different from clinical guidelines. Clinical or practice guidelines are evidence-based protocols used by clinicians and patients to make healthcare decisions about disease states. A guideline, at minimum, must be multi- disciplinary, applicable to a specific disease state and evidence based. Performance measures monitor and explore organiza- tional or clinical performance toward a specific process. Each serves a different purpose and does not always “match up” when compared with each other.1
Performance management Organizations use performance management to set goals, monitor data and follow progress toward goals. Performance management is intended to improve patient satisfaction and patient clinical outcomes and to control the costs of providing care. Collected data are analyzed to determine how well an organization’s processes are working. Once data are analyzed, they are used to make informed decisions about a process. Performance man- agement allows an organization to determine the efficiency and effectiveness of its operations and processes. It allows operational aspects that affect organizational goals to be reviewed, including service and unit level functions, and even the performance of individual employees.1 Examples of performance measurement include: • Finance: efficiency of billing procedures, such as col- lecting accounts and filing insurance claims
• Operations: efficiency of operational functions of the hospital, such as patient satisfaction, timeliness of care delivery and other measures that are included in quality improvement measures
• Clinical care: How well does the organization deliver evidence-based care? How do you and your institution know that the hospital is improving patient outcomes?
• Government regulations: How well does the orga- nization meet the regulations governing healthcare?1 National goals include the Centers for Disease Control and Prevention’s Healthy People 2020 and The Joint Commission’s National Patient Safety Goals.3,4
Why measure performance? Performance measurement provides a way to determine what is and isn’t working in an organization. In today’s economy, consumers want to know what they are getting before they are treated. They are interested in an organization thatwill help them, not hurt them.
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