Download - Performance Management in Healthcare Dr. Mohammed Alahmed [email protected] Dr. Mohammed Alahmed 1
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Performance Management in Healthcare
Dr. Mohammed Alahmedhttp://fac.ksu.edu.sa/[email protected]
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Introduction
• Performance management (PM) includes activities which ensure that goals are consistently being met in an effective and efficient manner. • Performance management can focus on the
performance of an organization, a department, employee, or even the processes to build a product or service, as well as many other areas.
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Introduction
• The fundamental goal of performance management is to promote and improve employee effectiveness. • It is a continuous process where managers and
employees work together to plan, monitor and review an employee's work objectives or goals and his or her overall contribution to the organization. • Performance management in health care is not only
aiming at the systematic generation and control of an organization’s economic value but also at the optimization of the efficiency and effectiveness of service delivery.
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Introduction
• Performance management supports better patient outcomes, and provides the knowledge to run more effective organizations.
• For example, integrating your overall healthcare strategy through scorecards or strategy maps with the appropriate underlying reports lets clinicians understand what drives better care, and helps administrators see what drives the bottom line..
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The use of performance measurement information to effect positive change in organizational culture, systems and processes, by helping to set agreed-uponperformance goals, allocating and prioritizing resources, informing managers to either confirm or change current policy or program directions to meet those goals, and sharing results of performance in pursuing those goals.
Performance management
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Performance Management System Goals
• Translate organization vision into clear measurable outcomes that define success, and that are shared throughout the organization and with customers and stakeholders;
• Provide a tool for assessing, managing, and improving the overall health and success of business systems;
• Continue to shift from prescriptive, audit- and compliance-based oversight to an ongoing, forward-looking strategic partnership involving agency headquarters and field components;
• Include measures of quality, cost, speed, customer service, and employee alignment, motivation, and skills to provide an in-depth, predictive performance management system; and
• Replace existing assessment models with a consistent approach to performance management.
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Performance Management Tools
• When you are developing a performance measurement system, you should consider a conceptual reference model:1. The Balanced Scorecard in Healthcare
Organizations2. Logic Models in Public Health Program
Management.
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THE BALANCED SCORECARD IN
HEALTHCARE ORGANIZATIONS
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Introduction
• The Balanced Scorecard (BSC) is a strategic planning and management tool that is used extensively in business and industry, government, and nonprofit organizations worldwide to align business activities to the vision and strategy of the organization, improve internal and external communications, and monitor organization performance against strategic goals.
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Introduction• The BSC was developed in the early 1990s by two guys at the
Harvard Business School: Robert Kaplan and David Norton.
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A Measurement System?
A Management System?
A Management Philosophy?
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Balanced Scorecard – Original Definition
“A multi-dimensional framework for describing, implementing and managing strategy at all levels of an enterprise by linking objectives, initiatives, and measures to an organization’s strategy.”
Kaplan & Norton, 1996 10
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Which
dimensions should we measure?
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The Four Perspectives of the Balanced Scorecard
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• Education of personal, growth strategies
• Optimizing internal process and improving performance
• Improving relations with customers, improving organization image
• All indicators related to financial goals
Financial Customer
Learning/Growth
Internal Process
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Why have a Balanced Scorecard?
• Health sector is complex, has many components• Need an efficient way to assess multiple
objectives• Overloaded with different types of reports• Stakeholders demand vigilance• Poor measurement can lead to crisis
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Balanced Scorecard in Healthcare
• In 1999, Wachtel, Hartford, and Hughes (1999) examined whether BSC method is suitable for the management of medical organizations.• Application of BSC method in healthcare organizations is
also described by:• Stevard and Bestor (2000, s. 75 – 82) - Applying a Balanced
Scorecard to Health Care Organizations,• Bisbe a Barrubés (2012, s. 919-927) – The Balanced
Scorecard as a Management Tool for Assessing and Monitoring Strategy Implementation in Health Care Organizations,
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Balanced Scorecard in Healthcare
• Chow, Gaunulin, Haddad a Williamson (1998) - The Balanced Scorecard: A Potent Tool for Energizing and Focusing Healthcare Organization Management,
• Swayne, Duncan a Ginter (2008, s. 378-379) - Strategic management of health care organizations,
• Fortenberry (2010, s. 248-259) in monography Health care marketing: tools and techniques,
• Lin et al. (2013, s. 1917-1924), in article: Integrating hierarchical balanced scorecard with fuzzy linguistic for evaluating operating room performance in hospitals, apply BSC into specific environment such as hospitals are.
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Balanced Scorecard in Healthcare
• BSC application into management of healthcare organizations can be defined as follow:• How patients perceive an organization? (Customer
perspective).• What is financial situations? (Financial Perspectives)• What can we do to improve level of services?
(Perspective of learning and growth)• What do we want to be the best in? (Perspective of
internal business processes)
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Balanced Scorecard in Healthcare
• Duke University Hospital explained these four perspectives in healthcare organizations as follow (Jones and Filip, 2000):• Customer perspective: Deliver high quality innovative
care while respecting needs of the patient.• Financial perspective: Deliver strong and consistent
financial performance in the eyes of payers and the board of trustees.• Learning perspective: To be recognized as a leader in
developing skills and performance of employees.• Business perspective: To be recognized as the premier
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Balanced Scorecard in Healthcare
• Potential benefits for the successful implementation of the BSC in the healthcare organizations:• It aligns the organization trend a more market oriented,
customer-focused strategy,• It facilitates, monitors, and assesses the implementation of
the strategy,• It provides a communication and collaboration mechanism,• It assigns accountability for performance at all levels of the
organization,• It provides continual feedback on the strategy and promotes
adjustments to marketplace and regulatory changes18
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Implementing a Balanced Scorecard
• Collaborative Efforts - Implementing the BSC agency-wide will provide: 1. a common methodology and coordinated
framework for all agency performance measurement efforts;
2. a common “language” for agency managers; 3. a common basis for understanding
measurement results; and 4. an integrated picture of the agency overall.
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Implementing a Balanced Scorecard
• Pathway to Success1. Make a commitment at all levels — especially at the
top level2. Develop organizational goals3. Offer training in improvement techniques4. Establish a reward and recognition system to foster
performance improvements5. Break down organizational barriers.6. Coordinate Headquarters and Field Office
Responsibilities20
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Implementation steps of BSC
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Elements of the Balanced Scorecard
• Mission and vision• Perspectives• Financial• Customer• Internal business process• Learning and growing
• Linking measures to strategy• Structure and strategy• Strategic alignment—top to bottom• Targets, resources, initiatives, and budgets• Feedback and the strategic learning process 22
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Example: Brigham and Women’s / Faulkner Hospital Strategy Map (2009)
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Brigham and Women’s / Faulkner Hospitals
• Some key learnings:• Having automated performance reporting software
facilitates monitoring and analysis of results at all levels of the system as well as more rapid rollout of the Balanced Scorecard.
• Real time reporting, particularly for operational measures, is seen as an important goal for more rapid and timely decision-making.
• This is a good example of where a Balanced Scorecard in the health sector has been cascaded to individuals – it shows it can be done for medical staff as well as management, something that some organizations see as too hard
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What is a logic model ?
• Whether your agency’s programs or initiatives are large or small, simple or complex, short-term or long-term, they probably share some common elements.• A logic model simply depicts the relationships
among all these different elements in some logical order—in a way that can be readily understood by someone who was not involved in the program planning or design.
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What is a logic model ?
• A logic model visually links program inputs and activities to program outputs and outcomes, and shows the basic (logic) for these expectations.• A graphic depiction of the relationship between the key
elements of a program or initiative
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How are logic models used?
Logic models can be used in many ways, including:• For program design/planning• For strategic planning• To test initial assumptions• For ongoing monitoring of program implementation• To evaluate long-term results• To communicate with and establish buy-in from
stakeholders• To negotiate with partners, funders, and other
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What are the benefits of using a logic model approach?
• A logic model’s visual depiction of how a program is expected to unfold and/or how an organization is expected to reach its goals offers several benefits.• It allows for quick and efficient testing of
assumptions, providing opportunities for feedback.• It yields insights into potential indicators and
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Logic Model Components
Although there are many different logic model templates and formats available, most cover the following components:• Inputs — any resources needed in order to implement the
activities (e.g., funding, staff time, community partnerships, technology, data, etc.)
• Outputs — what you will do, and whom you intend to reach. Our approach further divides outputs into:• Activities — the specific steps, work plans, or program areas you
(and any partners) expect to undertake with the resources listed above; and
• • Participation — the intended audience you are trying to reach with your activities.
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Logic Model Components
• Outcomes — the results you expect to achieve because of your inputs and outputs. Outcomes can be subdivided into time frames, depending on how long they may take to achieve and how long the project is expected to last overall (i.e., the intensity and duration of the project). For example, short-term outcomes are generally those expected to be achieved in the first year; intermediate outcomes may take up to 2 to 5 years; and long-term outcomes may take longer than 5 years.
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Logic Model Components
• Impact — a vision for the ultimate effect that all the inputs, outputs, and outcomes, taken together, could achieve in an ideal future. Generally, impact isn’t as measurable and concrete as the other components; it might include statements such as “Improved health outcomes for Georgians” or “Equitable access to health care for all residents.” Like a vision statement, impact is intended to be aspirational—and inspirational. 32
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Logic Model Components
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Resources
The inputs dedicated to or consumed by the program
Activities
The actions that the program takes to achieve desired outcomes
Outputs
The measurable products of a program’s activities
Outcomes
The benefits to clients, communities, systems, or organizations
How? Why? So what?
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Logic Models in Public Health Program Management
Context for Logic Models:• Quality improvement in public health is the use of a
process, such as Plan-Do-Study-Act, which is focused on activities that are responsive to community needs and improving population health. • Refers to a continuous and ongoing effort to achieve
measureable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality service.
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Example Logic Model
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ResourcesDental Clinic Coordinator
Community Health Director
Staff dentist
Staff pediatrician
Medical providers
Money for supplies
ActivitiesTraining•Develop curriculum•Two one-hour didactic trainings to medical providers in oral health assessment•One-on-one training to medical providers on oral health
Outreach•Order dental supplies for packets•Make up packets•Distribute to parents at end of each visit
Outputs
Training# of two-hour trainings held# of one-on-one trainings held# of medical providers trained
Outreach# of parents/children receiving packets
Outcomes
Medical providers demonstrate accurate oral health assessment, education and prevention activities
More children receive high-quality oral health assessment, education and prevention activities during well-child visits
Parents/children are more knowledgeable about oral health and caring for children’s teeth
Reduced incidence of caries in children at the community health center
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Benefits of Logic Models
1. Integrates planning, implementation, performance measurement and evaluation
2. Prevents mismatches between activities and effects3. Builds program clarity from the process4. Keeps staff, managers, and partners focused on
outcomes5. Helps planners prioritize most effective activities for
directing resources6. Uses evidence-based models and practice wisdom to
design and refine a program7. Reveals data needs and framework for analyzing data 36
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Limitations and Pitfalls of Logic Models
1. Logic models make the program theory clear not true
2. They take time to complete3. Without data collection, their utility is limited4. They strike fear in the hearts of many5. Pursuit of perfection can impede utility6. The notion that “evaluation is being done to
me, rather than with me”
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The Value of Logic Models
What gets measured gets done
If you don’t measure results, you can’t tell success from failure
If you can’t see success, you can’t reward it
If you can’t reward success, you’re probably rewarding failure
If you can’t see success, you can’t learn from it
If you can’t recognize failure, you can’t correct it
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Creating a Logic Model
• How? • No single way, flexible • Forward logic driven by “But Why?” or “If-
Then” thinking • Starting from the condition or problem end
• Reverse logic driven by “But How?” • Starting from the vision end
• Who? • Depends
• When? • Varies 39
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Smoke-free environments
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