the final question thatmust be asked and addressed is “Why not?” “Why not proceedwith the action?” Fear of change or comfort with the status quo can be reasons that the changes are not instituted readily. For any performance management activity to be successful, the“Why not?” question must be asked, answered and addressed.10 Performancemanagement is about learningwhat the issues are and


howto fix them. It informs staffwhat needs to be done to identify and fix problemsina structured, safe environment. It teaches staff toidentify obstacles, how to tolerate failure and how to collaborate with others. Performance management encourages active inquiry and reflection on what is learned, which leads to increases in critical thinking skills for the staff. Through performance management, employees learn to determine howto decidewhat is right to do,howto do the right things, and, finally, are things being done right?11


prevention of skin breakdown. If a unit or service line has an increase in skin breakdown, the first thing staff needs to do is decide what is right to do.Next, they have to figure out how to do the right things: • Are they turning patients, using pressure-relieving devices, such as specialty beds and mattresses, to reduce the potential for skin breakdown?


• What does the evidence say is the best way to pre- vent breakdown?


• Is staff following recommendations? • Are things being done right? Are patients being repositioned, and is it done correctly?


• Are patients eating the food they are served and drinking fluids given to them?


CE736


1. During recent years, the healthcare industry’s interest in performance measure has:


a. Decreased b. Stayed the same c. Disappeared d. Increased


2. Common terms used in quality are performance management, quality improvement, performance mea- sures and:


a. System analysis b. Performance measurement c. Organizational analysis d. Management systems


3. Clinical or practice guidelines:


a. Provide an indication of the organi- zation’s performance in relation to a specific process


b. Are identical to performance measures


c. Are evidence-based protocols clinicians and patients use to make healthcare decisions about a disease state


d. Serve the same purpose as perfor- mance measures


4. How efficiently billing processes are working is an example of:


a. Collections ratios b. Payments from Medicare c. Fiduciary regulations d. Finance measures


5. An example of a performance measurement that looks at patient satisfaction is:


a. Finance measures b. Clinical care measures c. Operations measures d. Process measures


6. Performance measurement provides a consistent, reliable process:


a. That punishes people for their errors


b. That determines what is and isn’t working in an organization


c. That is only good for measuring change in one point of time and not for measuring sustainability of changes


d. That is not good at ensuring transpar- ency of data


7. The percent of patients with conges- tive heart failure on an established protocol is an example of what domain of measurement?


a. Clinical quality measures b. Clinical efficiency measures c. Related healthcare delivery measures d. Structure


8. The prevalence of COPD among health plan enrollees is an example of what domain of measurement?


a. User-enrollee health state b. Outcome measures


c. Process measures d. Cost measures


9. Goal setting in healthcare:


a. Is important because accountability for performance has become increasingly important


b. Is not important in healthcare since no one outside of the organization sees the data


c. Drives workers to do better d. Is not related to outcomes


10. What healthcare payer system withholds payment for poor quality of care?


a. Blue Cross Blue Shield b. Aetna c. Medicaid


d. Medicare


11. Organizations typically set goals based on: a. Competitor’s goals b. Areas in which they will be accountable c. Community goals d. Physician-driven goals


12.A scorecard allows:


a. An organization to set its own bench- marks regardless of the presence of established benchmarks


b. The organization to disseminate perfor- mance management information


c. The staff to monitor the performance data without the support of senior leadership


d. Decentralization of management of the data


2016 • NURSE.com/Careers 47


• Are the specialty beds/mattresses being used incorrectly (excessive use of linen can negate the effects of specialty beds and mattresses)?


• Is staff interpreting evidence-based guidelines correctly? All these areas must be addressed to ensure that the organiza-


tion meets its goals of preventing skin breakdowns. One of the important issues thatmust be considered in relation to


performancemanagement is to stay engaged.Many times organizations think of performance management as a series of projects that have a beginning,middle andan end.12


Inactuality,performancemanagement An example of this relates to


is a continuous,never-ending processdirected atmeeting or exceeding the goals of theorganization.Poorly executedperformancemanagement programs can be expensive and not yield maintainable results, so it pays to take the time and effort to execute a consistent programthat is aimed atmeeting the goals and the objectives of the organization.13 The more you know and understand about performance man-


agement, the easier it will be to ensure that your facility is meeting goals. If the staff has access to and understands quality improvement data, it will help themunderstand theirown personal impact on the performance measures of an organization. The only way an orga- nization or unit can change and improve is through measurement of important data to determine what is working and what is not.9


Sandra Swearingen, PhD, RN, is a consultant and contributing partner with Courageous Healthcare, an organization that assists organizational leaders in making human factor improvements.


EDITOR’S NOTE: References available at CE.Nurse.com/Course/CE736.


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