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

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

3. 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

4. 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

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

6. Customers
Who are your department’s customers?
External
Internal

7. 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.”

8. 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

9. 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.”

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

11. Functions

12. Dimensions of Performance

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

14. Flow Chart

15. Cause and Effect Diagram

16. Pareto Chart

17. Control Chart

18. Histogram

19. Scatter Diagram

20. Run Chart

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

22. 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.”

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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.

31. 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?

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

33. 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?

34. 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

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