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• Dashboard
• Balance scorecard
• Outcome Measures
• Benchmarking
A dashboard
is a performance
measurement system and a
performance management
tool that uses key indicators or
performance measures (e.g.,
clinical quality, patient
satisfaction, employee
productivity, financial) to
visually ascertain the status
(or "health") of the
organization.
• Dashboards display data pulled from systems and
processes within varied departments to provide a
"snapshot" of performance at given points in
time
• The balance scorecard is a system you use to
manage and measure the organization performance in
areas that are crucial to its success.
-It translate M,V and Strategies into operational
performance indicators.
-It combines financial measures with other key
performance well the organization is doing now and
how it will perform in the future.
 Measure Perspectives or Categories:
• Customer Perspective
-Satisfaction (patients, physicians, employees);
-Point of service survey results (patient services, key
suppliers/partners);
-Complaints (patients, physicians, employees, other
customers);
-Time to first appointment
 • Financial Perspective:
-Revenue and cost per unit of service; cost /adjusted
discharge; reimbursement minus cost per case;
-Operating and total margins, days accounts
receivable, days cash on hand;
-FTEs/adjusted occupied bed
(Full-time equivalent An FTE of 1.0 means that the
person is equivalent to a full-time worker, while an
FTE of 0.5 signals that the worker is only half-time).
 • Operations/Internal Perspective

- Utilization: acute/subacute inpatient length of

stay;
-Access: aggregate wait times; % patients in disease
management
-Clinical Outcomes and Health Status: prioritized by
high volume/risk/cost and links to strategic goals.
Innovation and Growth
-Market share
-% of revenue from new services
 Outcome Measures
Avedis Donabedian defines outcomes used as
indicators of quality as "states or conditions of
individuals and populations attributed to
antecedent health care. "
He includes as outcomes:
Changes in health states;
Changes in knowledge or behavior pertinent to
future health states;
Satisfaction with healthcare.
 Outcome Measures
Categories of Outcome Measures
Outcome measures should be selected to monitor
three aspects of patient/client care:
 Patient health : Clinical indicators directly linked to
treatment; Are expected clinical results achieved?
 Patient functioning : Short and longer-term
indicators of ability to perform: Are expectations met
for ability to use, to act, to execute, to operate as
normal?
 Patient satisfaction/perception : Did care meet
patient expectations for access/availability,
timeliness, caring/compassion, listening,
communication, follow-through, impact on quality of
life?
 Outcome Measures
Purpose :
 Increasingly, quality management is dependent on the development
of outcome measures to evaluate effectiveness of care and to screen
for opportunities to improve care processes and services.
 Outcomes enable us to measure and assess:

–What is the right thing to do, e.g., the right surgical procedure,
medication, diagnostic test, healthcare setting, emergency service,
appointment system, or psychotherapeutic intervention; and
–Whether what is already known to be best care is being
implemented;
–Whether what is being done is acceptable (quality of
performance).

Outcomes data are being now demanded by healthcare purchasers

and consumers as one means of differentiating among health plans.
 Outcome Measures
Donabedian's Attributes of Outcomes as
Quality Indicators
 Outcomes infer, but do not directly assess, quality of the process
and structure of care. They serve as red flags;
 The inference is based on the causal relationship between the
process and the outcome and between structure and the
process;
 The causal relationship is modified by many factors other than
healthcare, so must be corrected through risk-adjustment , to
ensure valid comparisons;
 Outcomes, if poor, indicate damage already done;
 Outcomes are integrative, including the contributions of all
involved in the care (providers and patients). Therefore, they
conceal the detail needed to isolate specific errors. We rely on
process analysis, and then structure analysis for specifics;
 Outcome Measures
A Matter of Integration: Using the Paradigm
According to Donabedian, the best strategy in quality
measurement and analysis is to adopt a mixture of indicators of
outcome and process, with consideration of structure as
indicated.

An outcome indicator may be the only indicator needed to

screen for effectiveness (dimension of performance) for a
function or key process of care or service, e.g., blood pressure
status of patients in a hypertension disease management
program;
If the outcome does not meet expectations or benchmarks,
processes must be analyzed. Process indicators and further
analysis should be used to determine specific causation (root
causes) for less than desirable outcomes;
If resulting process improvements are not effective, structure
analysis should occur
 Outcome Measures
• Risk Adjustment:
Risk adjustment is a technique used to take into
account or to control the fact that different
patients with the same diagnosis might, in
fact, have additional conditions or
characteristics that could affect how well they
respond to treatment. Risk-increasing
variables reflect that a patient has a high
probability of dyingor of poor prognosis
 Outcome Measures
Outcome measures examples
 Acute myocardial infarction
•Mortality rates
•Hemorrhage after thrombolytic for patients with AMI
•Intra hospital mortality for AMI
 Appendicitis
•Perforated appendix rates
•Ruptured appendix rates
 Asthma
•Asthma admission rates, ages 2-19
•Asthma admission rates, ages 20-30
•Pediatric asthma admission
Benchmarking
 Benchmarking
Benchmarking is a structured process for
comparing your organization’s work practices
to the best similar practices you can identify in
other organizations and then incorporating
this best practice into your processes.
 Benchmarking
Basic Philosophical Steps of Benchmarking :
• Know your operation: Assess the strengths and
weaknesses of internal processes;
• Know your industry leaders and competitors:
Assess the strengths and weaknesses of the
leaders and understand reasons for strength;
• Incorporate the best : Find best practices and
copy or modify to incorporate into your own
operation; emulate strengths;
• Gain superiority.
 Benchmarking
• Benchmarking Process Steps:
Planning:
•Identify what is to be benchmarked.
•Identify comparative companies or organizations.
•Determine data collection method and collect data.
Analysis:
•Determine current performance "gap."
•Project future performance levels.
Integration:
•Communicate benchmark findings and gain acceptance.
•Establish functional goals.
Action:
•Develop action plans.
•Implement specific actions and monitor progress.
•Recalibrate benchmarks.
Maturity:
•Leadership position attained;
•Practices fully integrated into processes.
 Benchmarking
Xerox Ten-step Benchmarking Model
• Step 1: Identify What is to be Benchmarked
• Step 2: Identify Comparative Companies/Providers
• Step 3: Determine Data Collection Method and Collect
Data
• Step 4: Determine Current Performance Levels and Gaps
• Step 5: Project Future Performance Levels
• Step 6: Communicate Benchmark Findings and Gain
acceptance
• Step 7: Establish Functional Goals
• Step 8: Develop Action Plans
• Step 9: Implement Specific Actions and Monitor Progress
• Step 10: Recalibrate Benchmarks
Patient Advocacy Program
 Patient Advocacy Program
Patient Advocacy Program:
• Organizations strive to meet patient needs and
improve customer satisfaction through a patient
advocacy program which includes systemic
problem solving efforts.
• If for any reason patient is unsatisfied, the entire
episode of care can be considered as
unsuccessful.
 Patient Advocacy Program
Patient Advocacy Program:
 Processing Complaints:
•Actions and resolution should be taken at the
lowest organizational level.
•Feedback regarding actions taken should be
provided in a timely manner to the patient or his or
her representative as appropriate.
 Tracking and trending:
•Tracking and trending patient inquiries, requests,
and complaints along with actions taken can provide
valuable information which should be part of any
organization’s Performance improvement process.
 MCQ1
The Balanced Scorecard answers which
questions?
a. "How are we going to get there?" "Which way
do we go?"
b. "How are we doing?" "Are we there yet?"
c. "Where are we going?" "What are we doing?"
d. "Why are we here?" "What is our purpose?"
 MCQ2
A key physician/licensed independent
practitioner OM function is:
a. researching criteria options for specialty-specific
peer review.
b. determination of what constitutes a deviation
from an accepted standard of care.
c. determination of data collection methodology for
non-physician clinical reviewers.
d. tabulation of peer review data for periodic
committee reporting.
 MCQ3
The most effective way to ensure patient safety as
a dimension of performance is to:
a. sponsor a "hotline" for reporting problems.
b. focus on processes and minimize individual
blame.
c. have leaders who commit to and foster a safe
culture.
d. encourage patients and families to identify risks.
 MCQ4
The responsibility to reduce risks of endemic and
epidemic nosocomial infection is vested in:
a. the organization.
b. an interdisciplinary committee.
c. a qualified infection control practitioner.
d. the attending physician
 MCQ5
In any quality management approach, how can you
best evaluate the effectiveness of action taken?
a. use the same performance measures to re monitor
the process.
b. formulate a new special study to monitor the action.
c. interview the staff involved in implementing the
action plan.
d. do nothing. effectiveness is expected with well-
planned action.
 MCQ6
. Based on most quality improvement
standards, those responsible to prioritize data
collection to monitor organization wide
performance are:
a. the quality council.
b. the leaders.
c. those most knowledgeable about the process.
d. those most experienced with statistical analysis
 MCQ7
The phrase "intensive analysis," as used in
quality/performance improvement :
a. applies only to peer review.
b. is an automatic indication of a problem.
c. means the trigger is never set at 0%.
d. includes all defined sentinel events.
 MCQ8
Occurrence or event reporting is an example
of :
a. peer review.
b. root cause analysis.
c. generic screening.
d. special study.
 MCQ9
Accreditation credentialing requirements
generally include :
a. appointment to the appropriate category based
on activity.
b. current adequate malpractice insurance
coverage.
c. compliance with policies and procedures.
d. history of loss of, or limitation of, privileges to
practice.
 MCQ10
 All quality improvement approaches or
models include the following mechanisms
except :
a. developing strategic goals.
b. prioritizing problems/projects.
c. collecting and analyzing data.
d. taking action to improve