1. Performance Management in Healthcare
Dr. Mohammed Alahmed
Dr. Mohammed Alahmed

2. 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.
Dr. Mohammed Alahmed

3. 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.
Dr. Mohammed Alahmed

4. Introduction
Performance management
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..
The use of performance measurement information to effect positive change in organizational culture, systems and processes, by helping to set agreed-upon
performance 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.
Dr. Mohammed Alahmed

5. 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.
Dr. Mohammed Alahmed

6. Performance Management Tools
When you are developing a performance measurement system, you should consider a conceptual reference model:
The Balanced Scorecard in Healthcare Organizations
Logic Models in Public Health Program Management.
Dr. Mohammed Alahmed

7. The Balanced Scorecard in Healthcare Organizations
Dr. Mohammed Alahmed

8. 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.
Dr. Mohammed Alahmed

9. A Management Philosophy?
Introduction
The BSC was developed in the early 1990s by two guys at the Harvard Business School: Robert Kaplan and David Norton.
A Measurement System?
A Management System?
Dr. Mohammed Alahmed
A Management Philosophy?

10. 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
Dr. Mohammed Alahmed

11. dimensions should we measure?
Which
dimensions should we measure?
Dr. Mohammed Alahmed

12. The Four Perspectives of the Balanced Scorecard
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
Dr. Mohammed Alahmed

13. 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
Dr. Mohammed Alahmed

14. 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 ) – The Balanced Scorecard as a Management Tool for Assessing and Monitoring Strategy Implementation in Health Care Organizations,
Dr. Mohammed Alahmed

15. 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 ) - Strategic management of health care organizations,
Fortenberry (2010, s ) in monography Health care marketing: tools and techniques,
Lin et al. (2013, s ), 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.
Dr. Mohammed Alahmed

16. 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)
Dr. Mohammed Alahmed

17. 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 provider of health care services in our region/market
Dr. Mohammed Alahmed

18. 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 changes
Dr. Mohammed Alahmed

19. Implementing a Balanced Scorecard
Collaborative Efforts - Implementing the BSC agency-wide will provide:
a common methodology and coordinated framework for all agency performance measurement efforts;
a common “language” for agency managers;
a common basis for understanding measurement results; and
an integrated picture of the agency overall.
Dr. Mohammed Alahmed

20. Implementing a Balanced Scorecard
Pathway to Success
Make a commitment at all levels — especially at the top level
Develop organizational goals
Offer training in improvement techniques
Establish a reward and recognition system to foster performance improvements
Break down organizational barriers.
Coordinate Headquarters and Field Office Responsibilities
Dr. Mohammed Alahmed

21. Implementation steps of BSC
Dr. Mohammed Alahmed

22. 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
Dr. Mohammed Alahmed

23. Example: Brigham and Women’s / Faulkner Hospital Strategy Map (2009)
Dr. Mohammed Alahmed

24. 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
Dr. Mohammed Alahmed

25. Dr. Mohammed Alahmed

26. 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.
Dr. Mohammed Alahmed

27. 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
Dr. Mohammed Alahmed

28. 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 stakeholders
Dr. Mohammed Alahmed

29. 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 measures of progress for the most important outcomes
Dr. Mohammed Alahmed

30. 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.
Dr. Mohammed Alahmed

31. 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.
Dr. Mohammed Alahmed

32. 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.
Dr. Mohammed Alahmed

33. Logic Model Components
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?
Dr. Mohammed Alahmed

34. 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.
Dr. Mohammed Alahmed

35. Example Logic Model Resources Activities Outputs Outcomes
Dental Clinic Coordinator
Community Health Director
Staff dentist
Staff pediatrician
Medical providers
Money for supplies
Activities
Training
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
# of two-hour trainings held
# of one-on-one trainings held
# of medical providers trained
# 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
Dr. Mohammed Alahmed

36. Benefits of Logic Models
Integrates planning, implementation, performance measurement and evaluation
Prevents mismatches between activities and effects
Builds program clarity from the process
Keeps staff, managers, and partners focused on outcomes
Helps planners prioritize most effective activities for directing resources
Uses evidence-based models and practice wisdom to design and refine a program
Reveals data needs and framework for analyzing data
Dr. Mohammed Alahmed

37. Limitations and Pitfalls of Logic Models
Logic models make the program theory clear not true
They take time to complete
Without data collection, their utility is limited
They strike fear in the hearts of many
Pursuit of perfection can impede utility
The notion that “evaluation is being done to me, rather than with me”
Dr. Mohammed Alahmed

38. 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
If you can demonstrate results, you can win public support
Dr. Mohammed Alahmed

39. Creating a Logic Model How? Who? When? 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
Dr. Mohammed Alahmed

40. Dr. Mohammed Alahmed

41. Example of logic models
Dr. Mohammed Alahmed

42. Smoke-free environments
Dr. Mohammed Alahmed