PERFORMANCE IMPROVEMENT “What is it and how is it done? “ 2002 Presented by: John F. Neale, DDS, MPH CAPT, USPHS (ret.)

Course Outline Introduction NNMC PI program Process/Outcomes Dimensions/Functions Identifying projects/indicators for your department Tools

Learning Objectives At the completion of this session, participants should be able to do the following: Define & discuss the the varying definitions of quality Define FOCUS-PDCA & apply to daily tasks & departmental PI activities Define process/outcome & how you apply to your PI Define the Dimensions of Performance & apply to PI Describe various PI tools and how they are used

What is QUALITY? Meeting or exceeding the customer’s expectations the first time and every time In Healthcare: The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge

What is QUALITY? How do you define quality? How do you think your department’s customers define quality?

Customers Who are your department’s customers? External Internal

What is Performance Improvement? JCAHO defines PI as: “The continuous study and adaptation of a healthcare organization’s functions and processes to increase the probability of achieving desired outcomes and to better meet the needs of individuals and other users of services.”

What Performance Improvement is NOT Peer Review Customer Satisfaction Surveys Quality Control Activities Routine Monitoring and Evaluation All of the above activities are ways to gather data to identify where performance can be improved

What is a Process? “A goal directed, interrelated series of actions, events, mechanisms, or steps. An interrelated series of events, activities, actions, mechanisms, or steps that transform inputs into outputs.”

What is an OUTCOME? “The result of the performance (or non-performance) of a function(s) or process(es).”

Functions

Dimensions of Performance

Performance Improvement tools Flow chart Cause & effect or fishbone diagram Pareto chart Control charts Histograms Scatter diagram Run chart

Flow Chart

Cause and Effect Diagram

Pareto Chart

Control Chart

Histogram

Scatter Diagram

Run Chart

The PI Mindset Doing whatever it takes to ensure the best service the best outcome customer satisfaction employee satisfaction financial success

The PI Mindset Continuously examining processes and seeking opportunities for improvement that will: benefit customers improve our results make us more efficient maximize the quality of everything we do It is no longer “if it ain’t broke, don’t fix it,” it is now “even if it ain’t broke, improve it.”

If 99.9% were good enough Every year there would be: 20,000 prescription errors made 15,000 newborn babies dropped during delivery 32,000 missed heartbeats per person. Every month there would be: 1 hour of unsafe drinking water Every week there would be: 500 incorrect surgical procedures performed Every day there would be: 2 unsafe landing at O’Hare airport Every hour there would be: 22,000 checks deducted from the wrong bank accounts. 16,000 pieces of mail lost by the US Postal Service

Hospital Corporation of America Performance Improvement Methodology F ind an opportunity for improvement O rganize a team C larify the process U nderstand variations S elect the improvement P lan D o C heck A ct

Find an opportunity to improve How or where do we find opportunities for improvement? Ongoing monitoring activities such as: Safety/RM/IC/PI Customer feedback (patient or staff satisfaction surveys) Outcomes Strategic Planning New services

Organize a team Size – large enough to include all disciplines or departments involved, but small enough to be workable. Membership – include all knowledge/skills/departments needed to address the process in question Resources – money, time, materials, training, etc. roles/responsibilities – see team guidelines in the Service Unit PI plan

Clarify current knowledge of the process Break the process down into its component parts or steps in order to better understand how it works and to find areas where the process varies from its purpose. Flow chart Cause & effect or fishbone diagram Research Literature Past experience

Potential Sources of Variation - Why things don’t turn out as planned People *Not trained or oriented to a procedure *Forget to perform a step in a complex process Machinery *Machine malfunctions *Different machines used Materials *People use different procedures Methods *Missing steps or unpredictable sequence or tasks Conditions *Different environments such as changes in weather, shift work

Understand causes of process variation Collect and analyze data on the various steps in the process identified in the previous step to see where problems or inefficiencies occur Pareto diagrams – the 80/20 rule Run charts Control charts Histograms

Select the step(s) in the process that will be improved Use the results your “C” and “U” activities to identify the step or steps in the process that contribute the majority of the process variation.

Plan How will the improvement be done? Who will do it? What is the Timeline for implementation? What Outcomes are desired? How much will it Cost What Training or Education is needed? Is a Trial Period or Pilot Program indicated? What data will need to be collected to monitor the changes?

Do Implement the Plan Schedule needed training Collect the needed data Pilot Test the plan if appropriate

Check Collect and Analyze data to determine the following: Did the action work? Did you achieve the desired outcomes? Is the process working as predicted, or is further refinement needed?

Act Change processes or further tweak the Plan if needed to achieve desired outcomes Repeat the PDCA cycle as needed to maximize improvement Finalize and implement full scale Develop New flow chart and/or New P/P for the redesigned process Educate/orient patients and staff Story board & report to communicate results to staff and customers

Identifying opportunities for improvement in your department Outcomes Process Strategic Planning Prioritizing Staff/Customer feedback