Posted: March 12th, 2023

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Quality and Performance Improvement in Healthcare: Theory, Practice, and Management
Seventh Edition

Chapter 3

Identifying Improvement Opportunities Based on Performance Measure

ahima.org

Objectives

Demonstrate how the principal aspects of healthcare are targeted for performance measurement

Assess the significance of outcomes and proactive risk reduction in performance improvement methodology

Apply brainstorming and the nominal group technique to performance improvement activities

Focus of Healthcare QI Philosophies
Systems: The foundations of care giving
Buildings
Equipment
Professional staff
Appropriate policies

Focus of Healthcare QI Philosophies
Processes: Interrelated activities in healthcare organizations, which promote effective and safe patient outcomes across services and disciplines within an integrated environment
Outcomes: The final results of care, treatment, and services in terms of the patient’s expectations, needs, and quality of life, which may be positive and appropriate or negative and diminishing

Continuous Improvement Monitoring: Steps to Success
Step 1—Identify performance measures
Step 2—Identify the customers for each monitored process
Step 3—Identify customers’ actual requirements with respect to the outcomes
Step 4—The organization asks whether the outcomes of the current process actually meet the customers’ requirements

The Organization Identifies Its Performance Measures
Process measure: Focuses on a process that leads to a certain outcome
Outcome measure: Indicates the result of the performance of a function or process
Benchmarking: Systematic comparison of the products, services, and outcomes of one organization with those of a similar organization
Sentinel events: Significant injury to or the death of a patient or employee through avoidable causes

The Organization Identifies the Customers for Each Monitored Process
Who is the receiver of the organization’s outcome or end product
Internal customers: Individuals within the organization or department who receive products or services from an organizational unit or department
External customers: Individuals from outside the organization or department who receive products or services from within the organization

Customers’ Actual Requirements Are Identified
Factors most valued by the customer
Examples:
Good-tasting food at the right temperature
Charts available for physician completion
Qualified clinical staff

Are Our End Products Actually Meeting Customer Requirements?
If yes, then no PI activities need to be performed
If no, then a PI team may be formed to examine the process in greater detail, or
An educational program may be developed to fine-tune organization members

QI Toolbox Techniques
Brainstorming
Affinity diagrams
Nominal group technique

Registration for Day Surgery
Step 1: Performance measure
Registration information provided and surgery scheduled by physician’s office
Preoperative workup completed
Step 2: Customers for monitored process
Patient and patient’s family
Physician and office staff
Surgery staff
Registration staff

Registration for Day Surgery (continued)
Step 3: Customers’ actual requirements
One-time communication of registration information
Preoperative workup completed before surgery and coordinated in one visit

Registration for Day Surgery (continued)
Step 4: Customers’ requirements met
Patient satisfaction surveys showed only 76% satisfaction with same-day surgery registration and preoperative workup processes
Registration staff and physician office staff were hearing complaints from patients that registration process was cumbersome and not user-friendly
Duplicate data collection occurred between physician’s office registration and same-day surgery registration

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Quality and Performance Improvement in Healthcare: Theory, Practice, and Management
Seventh Edition

Chapter 4

Using Teamwork in Performance Improvement

ahima.org

9 AHIMA
ahima.org

Objectives

Demonstrate the effective use of teams in performance improvement activities

Compare and contrast the differences between the roles of the leader and the members in performance improvement teams

Illustrate the contributions that team charters, team roles, ground rules, listening, and questioning can make to improve the effectiveness of performance improvement teams

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Three Approaches to Performance Improvement
Rapid improvement team
Disseminate information or develop an educational training program
Develop a functional or cross-functional PI team

PI Team Composition
Composition
Which departments are involved in the process?
Who are the customers of the process? Or, who will receive the product or service that the process produces?
Who supplies the process? Or, who provides materials or services for use in the process under investigation?

PI Team Roles
Leader
Facilitator
Member
Recorder
Timekeeper

PI Team Leader Activities
Preparing for and scheduling meetings
Sending out announcements of meetings and other necessary materials
Conducting meetings
Focusing the group’s attention on the task at hand
Ensuring group participation and asking for facts, opinions, and suggestions
Providing expertise in the organization’s PI methodology and PI tools and techniques
Coordinating data collection

PI Team Leader Activities (continued)
Assigning tasks
Facilitating implementation of action plan items
Critiquing the meetings
Serving as the primary spokesperson and presenter for the team
Keeping attendance records
Contacting absent members personally to review the results of the meeting and provide any materials that were distributed during the meeting

PI Team Facilitator Activities
Serving as advisor and consultant to team
Acting as a neutral, nonvoting member
Suggesting alternative PI methods or procedures to keep the team on target
Managing group dynamics, resolving conflicts, modeling compromise
Acting as coach and motivator for the team
Assisting in consensus building when necessary
Recognizing team and individual achievements

PI Team Member Activities
Participating in decision making and plan development for the team
Identifying opportunities for improvement
Gathering, prioritizing, and analyzing data
Sharing knowledge, information, and data that pertain to the process being investigated

PI Team Recorder Activities
Recording information for the group
Creating appropriate charts and diagrams
Assisting with notices and supplies for meetings
Distributing notices and other documentation to team members
Developing meeting minutes
Producing an agenda for new meetings with assignments for team members from the previous meeting

PI Team Timekeeper Activities
Helps the team manage its time
Notifies team during meetings of time remaining on each agenda item

Team Charters

Explain what issues the team was implemented to address
Describe the goal or vision
List the initial members of the team and their respective departments
Helpful to keep the team’s objective in focus

Mission Statements
Organization-wide or team-based
Should answer the following questions:
What process is to be improved?
For whom is the process performed?
What products does the process produce?
What is not working with the current process?
How well must the process function?

Sample Mission Statement

Evaluate hospital laboratory services for patients with regard to safety issues, error-reduction processes, and delivery of services while maintaining 94 percent compliance with these services.

Vision Statements
A description of the ideal end-state
A description of the way the process should function

Sample Vision Statement
Safe and timely laboratory services are provided 98 percent of the time.

Ground Rules
Ground rules are basic expectations for team members and include a discussion of:
Attendance
Time management
Participation
Communication
Decision-making
Documentation
Room arrangements
Clean up

Problem-Solving Techniques
Inclusive: Gather all viewpoints and consider each
Exclusive: Get a result as quickly as possible

Effective Team Objectives
Establish goals cooperatively with all members participating
Communicate in a two-way mode
Value open expression of both ideas and feelings as important perspectives on organizational issues
Distribute leadership and responsibility among all team members
Distribute power among all team members
Match decision-making techniques to the type of decision-making situations
View periodic controversy and conflict among team members as a positive aspect of team growth
Focus on the issues for which they have been organized to address
Be cost-conscious in their PI efforts

QI Toolbox Technique: Agenda
Lists the tasks to be accomplished during a meeting
Ensures that every team member knows what items will be discussed or worked on
Should be sent to all team members before the meeting
This allows them to prepare ahead of time to discuss specific agenda items
Should include an indication of how long the team will spend on each item
Setting time frames for agenda items helps the team leader to keep the group focused on the process and moving forward

Continuum of Care Team Example
Team leader: Emergency department intake coordinator
Team members: Representatives from the business office, health information services, administration, utilization review, and finance
Ad hoc members: Representatives from regulatory affairs, reception, nursing, case management, and an emergency department physician

Continuum of Care Team Example (continued)
Mission Statement:
Evaluate the emergency department’s clinical assessment process in regard to patient privacy, data collection, and staff communication while maintaining 95 percent patient and employee satisfaction with this process.

Vision Statement:
Design a centralized clinical assessment center to facilitate patient privacy, data collection, and staff communication

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