Performance Management and Measurement, Term Paper Example

Identifying Performance Measures

The three performance measures within health care are structure, process, and outcome. All of the above are extremely important in order to determine how patients and stakeholder groups are served by the organization. In health care, simple modifications in processes can improve patient outcomes, while structure has an impact on both outcome and processes. This means that the three performance measures are dependent on each other, therefore, they need  to be assessed based on their relationship with each other.

According to the U.S. Department of Health and Human Services (2011), performance measures are set up to assess some key areas of service and introduce quality improvement initiatives that would improve the overall performance of the unit or health care organization. Identifying the various measures for assessing performance is, therefore, extremely important. The below paper will review the methods of identifying performance measures in health care.

Structure

Nerenz & Neil (2001) defines structure as the characteristics of the health care organization, such as the care plans utilized and the capacity to serve the public. The accreditation system of health care units measures this aspect of care, considering patient safety policies, committee structures, and policies. In the case currently examined, the requirement of completing a paperwork and registering the patient electronically are a part of the system measurement element. The policy that requires an identification bracelet to be present in order to ensure patient safety and the correct administration of treatments and medication is also a part of this performance measure. A consent form is a part of the system, as well, and serves the purpose of maintaining compliance. There are several regulations that impact processes within health care, such as the registration and drug administration processes and internal policies. The qualification accreditation of health care professionals working within the unit are also strictly regulated. Jennings (2007) notes that patient participation, informed consent, and responsible care are in the main focus of regulations related to health care. The regulations, according to Jennings (2007, p. 17) are designed because with the scientific development of medicine “hospital-based, entirely new organizations became necessary to monitor quality”.

One process measure that could be used to evaluate the organization’s structure in this case could be the evaluation of safety measures, such as the accuracy of health records within the hospital’s systems.

Process

According to Nerenz & Neil (2001, p. 6), “process refers to what the organization does”. This performance measure is based on how the organization utilizes assets in order to serve the population. This refers to how professionals are assigned to various cases, how training is provided in order to improve the outcomes of treatments, and how long it takes for a patient to recover from the time they arrive at the health care facility to the time their treatment is over. Therefore, processes have an impact on the overall effectiveness of the organization. Processes are usually measured based on how many interventions are completed, or how many diagnoses are recorded. For example, the processes within the organization can impact the capacity of the health care unit to carry out screening tests or vaccination. The number of mammography examinations, for example, can be increased without increasing workload for nurses, by scheduling appointments in short blocks during a 2-hour period, instead of allowing patients to attend any time. By saving time on setting up the equipment and computer systems multiple times, the organization can improve its processes, as well as its overall performance.

In the case examined, one of the processes is registration, which is important for starting the treatment as soon as possible. The fact that family members are able to help patients feeling unwell complete the registration process has a positive impact on the overall performance of the organization, and can reduce the average time spent at the unit. The fact that the health care organization allows patients to register online before they would arrive will also reduce the time needed to admit them to the health care unit.

One process measure that could be used to evaluate the organization’s performance could be the time it takes for patients from arriving at the hospital to getting their treatment plan drawn up by the care team.

Patient Outcomes

Patient outcomes relate to the change in the health status of individuals admitted to the health care facility. There are several measures that can be used to assess this aspect of health care performance, such as mortality rates, the number of complications, and the presence of symptoms. Other, evidence-based measures are designed to assess the quality of life among patients before and after the treatment or intervention ( Nerenz & Neil, 2001, p. 6). Some measures focus on statistical records, while others are based on individual patient interviews, and the perception of individuals and families being treated at the unit.

In the case examined, examination records at admittance and after completed intervention could be compared, in order to evaluate patient outcomes. Further, the organization could record the number of early diagnoses for particular areas of diseases that are in the focus of the management team.

Quality Improvement

In order to improve the quality of care in health care organizations, it is important to assess all the above three measures, as well as their correlation with each other. There are several reasons for poor health care unit performance, according to Nerenz & Neil (2001), such as under-use, overuse, and misuse of procedures and services. Not utilizing screening facilities according to the demand of the population being served, for example, can result in late diagnosis, and increased number of complications (Lester et al. 2010). The misuse of available facilities, however, would negatively impact accuracy, and patient outcomes.

Evidence-Based Performance Measures

The below  part of the paper will review five evidence-based performance measures, related to assess organizations’ performance related to chronic obstructive pulmonary diseases (COPD). According to the National Quality Measures Clearinghouse (n.d.), there are several methods to assess the quality of diagnosis services. One of the measures is recording the number of patients seen in the emergency room in a period of a month. This measure would provide information on the quality of advice and care, preventive interventions provided for patients with COPD. The next measure provided by the website (National Quality Measures Clearinghouse, n.d.) is based on the number of smoking cessation interventions provided for patients visiting. Further, other measures include the number of diagnosed patients with two or more hospital admissions in a period of 12 months, the management of patients referred to appropriate therapy and their health outcomes, and the impact of pulmonary rehabilitation program referrals on overall health outcomes and the quality of life.

All the above measures are all designed to improve patient outcomes in order to choose the right intervention methods and plans. In the next part of the essay, the author would like to analyze some peer-reviewed studies measuring the effectiveness of various interventions and their impact on overall health care unit performance.

Ali (2009) reviewed the existing measures and intervention methods utilized by hospitals to improve care for COPD patients. The author classified conditions in three different levels of acuteness: mild to moderate(1), moderate to severe (2), and severe (2). The intervention methods identified for level one patients were patient education, broncholodators, corticosteroids, and antibiotics to treat related infections. For level 2 patients, supplemental oxygen therapies are utilized, while ventilatory support is needed for level 3 patients. All the above interventions were analyzed and assessed based on clinical trial resutls. Ventilatory support was found to be the most successful, with the length of hospital stay significantly reduced. However, trials and studies related to prevention focusing on smoking cessation and lifestyle changes was also found to have a positive impact on performance measures. Further, the author (Ali, 2009, p. 15)  states that “a systematic review of randomized controlled trials showed that pulmonary rehabilitation after an acute COPD exacerbation reduces the risk of hospitalization and mortality”.

Gross (2008) used a different categorization of COPD severity, creating four stages: mild, moderate, severe, and very severe. The management methods introduced and analyzed in the  study were: reduction of risk factors, broncholidators, cortisteroids, preventive influenza vaccination, rehabilitation, and long-term administration of oxygen.

Monotherapy and Combination therapy approaches were analyzed by the author, and the findings confirm that there is a need for developing an intervention framework for each stage of the condition in order to identify  the most effective intervention method or combination of methods that improve patient outcomes and utilizes the available resources  of the health care organization in the most effective way. Focusing on Tiotropium therapy, the study’s results showed that the number of exacerbations was reduced, as well as the number of days. There was a lower need for utilizing antibiotics, due to complications resulting in infections, and hospitalization days were also lower for the study group, compared with the placebo group.

In clinical practice, it is important to implement changes in processes, systems, and intervention plans based on evidence from related studies. As the above examined review of related studies has revealed, some of the current interventions are not producing measurable improvements, while the cost associated with administered with them is significantly higher than other, more effective methods. In evidence-based practice, based on the financial and resource strains health care organizations currently face, it is important to consider the cost related to the changes made in processes and systems, as well as the impact of the quality improvement project on the overall performance of the facility. It is important that hospitals and health care facilities develop a quality improvement committee to analyze evidence-based intervention alternatives and assess the needs of patients, before they would make a final decision regarding the plan.

Flottorp et al. (2010) states that health care professionals should use an audit and feedback analysis in order to develop a plan for improving the quality of care. The authors also state that those organizations that face performance issues will benefit from QI improvement interventions the most: “the benefits of audit and feedback measures are most likely to occur where existing practice is furthest away from what is desired, and when feedback is more intensive” (Flottorp et al., 2010, p. iv.). In order to assess the quality of care, both processes and outcomes need to be measures, development areas have to be identified, and a stakeholder assessment has to be completed. To evaluate processes and outcomes, professionals (QI teams) need to define the source of reliable information, and the method of interpretation. The three areas of improvement that QI teams should focus on are effectiveness, safety, and patient-centeredness ( Flottorp et al., 2010).

References

Ali, N. K. (2009). Evidence-based approach to acute exacerbations of chronic obstructive pulmonary disease. Hospital Physician, 2, 9-16.

Department of Health and Human Services (2011) Performance Management and Measurement. Retrieved from http://www.hrsa.gov/quality/toolbox/508pdfs/performancemanagementandmeasurement.pdf

Flottorp, S. A., Jamtvedt, G., Gibis, B., & McKee, M. (2010). Using audit and feedback to health professionals to improve the quality and safety of health care (p. 54). WHO.regional office for Europe.

Lester, H., Roland, M., Smith, P. C., Mossialos, E., Papanicolas, I., & Leatherman, S. (2010). Performance measurement for health system improvement.

Nerenz, D., & Neil, N. (2001). Performance measures for health care systems. Commissioned paper for the Center of Health Management  Research.