Chapter 18 - Performance Flashcards
performance improvement (PI)
the continuous study and adaptation of a healthcare organization’s functions and processes to increase the likelihood of achieving desired outcomes
performance measurement
the process of comparing the outcomes of an organization, work unit, or employee against pre-established performance plans and standards
performance indicators
a measure used by healthcare organizations to assess the quality, effectiveness, and efficiency of their services
financial indicators
A set of measures designed to routinely monitor the current financial status of a healthcare organization or one of its constituent parts. An example of a financial indicator would be the average cost per radiology exam compared to the average insurance reimbursement amount received.
productivity indicators
A set of measures designed to routinely monitor the output and quality of products or services provided to an individual, a healthcare organization, or one of its constituent parts. An example of a productivity indicator would be the number of patients seen per physician per day.
PDSA cycle
A cycle used to achieve the goal of constant and never-ending improvement. It is:
- Plan it
- Do it
- Study it
- Act on its results
Sometimes this is called continuous quality improvement (CQI) or total quality management (TQM).
opportunity for improvement
A healthcare structure, product, service, process, or outcome that does not meet its customers’ expectations and, therefore, could be improved.
quality indicator
A standard against which actual care may be measured to identify a level of performance for that standard.
structure indicators
Something that measures the attributes of the healthcare setting, such as number and qualifications of the staff, adequacy of equipment and facilities, and adequacy of organizational policies and procedures.
process indicators
a measure of the steps in a process and the tasks people or devices do (e.g. conducting appropriate tests, making a diagnosis, carrying out a treatment)
outcome indicators
a measure of the actual results of care for patients and populations, including patient and family satisfaction
external customers vs. internal customers
External customers are those people outside the organization for whom it provides services. For example, the external customers of a hospital would include patients, third-party payers, and the department of health. Organizations also have internal customers such as employees and shareholders.
stakeholder
- a person entrusted with the stakes of bettors
- one who is involved in or affected by a course of action
- people or groups without whose support the organization would cease to exist
systems thinking
A way of helping a person to view systems from a broad perspective that includes seeing overall structures, patterns and cycles in systems, rather than
seeing only specific events in the system. This broad view can help you to quickly identify the real causes of issues in organizations and know just where to work to address them.
common-cause variation
Variation that is inherent within the system is common-cause variation.
For example, when a nurse takes a patient’s blood pressure, she may believe she is performing the procedure in exactly the same way every time, but in practice she will get slightly different readings each time. Although the blood pressure cuff, patient, and nurse are all the same inputs into the system, variations can occur.
For example, the cuff may be applied to a different place on the patient’s arm. The patient may have a slightly different emotional or physiological status at the time of the measurement. The nurse may have a different level of focus or concentration. Any one of these (or other) factors can affect the values obtained. However, they are potentially present in every single episode of blood pressure measurement in every single patient.
It is important to recognize not every variation is a defect. The variation may just be an example of common-cause variation.
special-cause variation
An unusual source of variation that occurs outside a process but affects it.
If the special cause produces a negative effect, identify the special cause and eliminate it, if possible. If the special cause produces a positive effect, reinforce it so this positive effect will continue and perhaps be expanded into the processes of others in the organization.
An example: a patient is upset about a phone call he received just before the nurse came in to take his vitals, his blood pressure may register exceptionally high. The change in values occurred due to a special cause (phone call) and resulted in a blood pressure reading much higher than expected.