GET YOUR QUALITY PLANNING IN ORDER

A successful health care performance improvement program is one that deals with important issues. Selecting important issues requires that two questions be answered by the organization: "What is important to improve?" and "How do we improve it?" Before administrative and physician leaders can adequately answer these questions they must have fully dealt with the strategic and operational side of quality planning. Performance improvement can fail when it is managed as a series of projects that stand outside of the organization's strategic business direction. If your organization lacks a clearly defined mission, vision, and values statement there is bound to be disagreement over where improvement efforts should focus. Often, the strategic element of performance improvement is overlooked in the rush to deal with the persistent "sore thumb" problems that have long frustrated physicians and staff. During the discussions of what project to start next, ask the leaders to consider the strategic implications of each performance improvement project. If they can't determine how vital a particular project is to the organization, this is usually a symptom of strategic planning problems. Below are some diagnostic questions that can be used to uncover the problems in your strategic planning process:

Do we have a consensus on our vision?

Do medical staff and administrative leaders have a definite picture of where they want the quality process to lead? Does the vision communicate the organization's values and commitments toward customers, suppliers, and each other?

Does the organization's quality plan translate the vision into more definitive objectives and measures of success?

The quality plan should be fully integrated with the hospital's strategic plan so that it supports and complements it. For each strategic goal established by the organization the leaders should establish performance improvement objectives related to these goals.

Do we have a leadership group for prioritizing improvement needs?

The quality leadership group (often referred to as the Quality Council) of the organization should serve as a clearinghouse for inter-departmental improvement projects. They can set priorities based on the proposed project's contribution to the vision and quality plan. This group should include managers and physicians. In the absence of a multidisciplinary Quality Council, be sure that managers and physicians have adequate input into the priority-setting process.

Do we have the means of allowing our customers to tell us, through their attitudes and perceptions, where we should direct our improvement efforts?

If you are responsive to customer needs, then your improvement project selection should follow the lead provided by your customers. Of course, this presumes a clear understanding of who your customers are, which may not exist. If this is the case, then your quality leadership group should revisit this critical issue.

Effective performance improvement requires a strong strategic management effort. Strategic planning must link with the day-to-day business of patient care. Strategic goals define the changes required to move the organization toward its vision. They are long-range change targets that guide an organization=s efforts in moving toward a desired future state. The performance improvement objectives explain how the goal will be achieved. These objectives should be specific, measurable, short- to mid-term action statements that everyone agrees are important to accomplish. To illustrate this point, shown below are excerpts from two quality planning documents. One is from a hospital and the other is from a home health agency. From year-to-year the organization's strategic goals may remain the same (or similar) however the objectives (what will be done to achieve the goals) should be revisited and revised based on current organizational priorities.

Excerpt from Hospital Quality Planning Document

Strategic Goal: Increase appropriateness of services

Performance Improvement Objectives:

Reduce over-utilization of at least one diagnostic test in each clinical support department.
Reduce the number of nonacute days of inpatient care.

Strategic Goal: Improve patient satisfaction

Performance Improvement Objectives:

Ensure that all non-English speaking patients are provided a means of communicating with caregivers.
Improve involvement of patients and their families in the patient care decision-making process.

Excerpt from Home Health Agency Quality Planning Document

Strategic Goal: Improve timeliness of initial patient assessments.

Performance Improvement Objectives:

Ensure that all patients discharged from the hospital on Friday, Saturday, and Sunday are visited and assessed within 24 hours of discharge.
Ensure that all unscheduled rehabilitation assessments are completed within 48 hours of request.

Strategic Goal: Patients/families are able to demonstrate new learned behaviors.

Performance Improvement Objectives:

Ensure that at first home visit of patient who has undergone lower extremity orthopedic surgery that patient/family (or caregiver) is able to demonstrate dressing change techniques.
Ensure that at first home visit of patient who has undergone lower extremity orthopedic surgery that patient/family (or caregiver) can verbalize schedule for medications and patient can demonstrate transfer techniques and use of assistive devices.

In the book, AIMing for Quality Results: An Improvement Primer for Healthcare Organizations, you'll find a quality planning model and techniques for establishing organizationwide performance improvement goals and objectives. For ordering information visit the Brown-Spath & Associates' web site at http://www.brownspath.com or call (503) 357-9185 for a publications brochure.

To Learn More: Patrice L. Spath is available for inhouse presentations on this topic and other health care quality and resource management topics. For further details, visit the Brown-Spath & Associates' web page at http://www.brownspath.com.

Address comments or correspondence to: Brown-Spath & Associates, PO Box 721, Forest Grove, OR 97116.