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.
conflate
- to bring together: BLEND
- to confuse
- to combine (things, such as two versions of a text) into a composite whole
A checksheet is a data collection tool that records and compiles observations or occurrences. The checksheet consists of a simple list of categories, issues, or observations on the left side of the health record and a place on the right to record incidences by placing a checkmark. When the data collection is finished, the checkmarks are counted to reveal any patterns or trends. A checksheet is a simple way to obtain a clear picture of the basic facts.
data abstracts
A defined and standardized set of data points or elements common to a patient population that can be regularly identified in the health records of the population and coded for use and analysis in a database management system.
Not to be confused with data abstraction, which is the reduction of a particular body of data to a simplified representation of the whole.
Time ladders support the collection of data that must be oriented by time; they specify intervals of time necessary to address the problem under consideration listed down the right side of one, two, or three columns. Then, as the data collector observes, he or she records events next to the time of occurrence.
For example, a receptionist could record on a time ladder when a patient arrives at his or her workstation and then record again on the same time ladder when the patient goes to an exam room. To visualize how the receptionist’s other duties have an impact on his or her interactions with patients, he or she could also be asked to record timing of phone calls, provider requests for assistance, and other competing tasks.
Collecting time ladder data over an appropriate period develops a detailed, clear picture of the workflow or process. Another example is a time ladder created from computer-based data. For example, the EHR could be used to generate a report documenting the time of arrival for patients without appointments. Using this data from a substantial period of a month or more, clinic management could anticipate the need to keep a specific number of appointment slots available for walk-ins.
A run chart displays data points for a specific time frame to provide information about performance. In a run chart, the measured points of a process are plotted on a graph at regular time intervals to help team members identify whether there are substantial changes in the numbers over time.
A statistical process control chart looks like a run chart except that it has reference lines indicating the upper control limit (UCL) and lower control limit (LCL) drawn horizontally at the top and bottom of the chart. The upper line represents the UCL, and the lower line represents the LCL.
The middle line represents the mean and the line above represents two standard deviations above the mean. The line below the mean represents two standard deviations below the mean. Remember, two standard deviations from the mean statistically include 95 percent of the observations of a process and three standard deviations include 99 percent. Like the run chart, the statistical process control chart plots points to show how a process is performing over time. However, the two control limit lines permit the evaluator to use the rules of probability to interpret whether the process is stable (in other words, predictable and within the bounds of probability) or out of control (many points of data outside the second or third standard deviations).
The statistical process control chart makes it possible to see whether the variation within a process is the result of a common cause or a special cause. It lets the PI team know whether the team needs to try to reduce the ordinary variation occurring through common cause or to seek out a special cause of the variation and try to eliminate it. Removing the variation will bring the upper and lower control limit lines closer together. Common-cause variation would produce patterns that would stay within the two or three standard deviations of the mean, whereas a special-cause variation is more likely to produce patterns that will exceed the limits of chance of the two or three standard deviations.
A flow chart is a graphic tool that uses standard symbols to visually display detailed information, including time and distance of the sequential flow of work of an individual or a product as it progresses through a process. A flow chart should be created to illustrate the current process used because the team must first examine and understand the current process before making improvements.
There are different types of flowcharts: each type has its own set of boxes and notations. The four most common types of boxes/symbols in a flowchart are:
A start or end point, represented by an oval.
A processing step, usually called activity, and denoted as a rectangular box.
A decision, usually denoted as a diamond.
A line is a connector that shows the relationship between different shapes.
nominal group technique
A process used to reach consensus about an issue or an idea that the team considers most important. Each team member ranks each idea according to importance.
For example, if there were six ideas, the most important idea is ranked with the number six (giving it six points); the second most important idea is ranked the number five, and so on. After each individual team member has had a chance to rank the list of ideas, the scores for each idea are totaled. The nominal group technique demonstrates where the team’s priorities lie.