Taming the measurement monster

The healthcare performance measurement landscape continues to evolve. Despite questions about the value of performance data, healthcare organizations are being challenged to meet the data demands of a growing number of mandatory and voluntary measurement projects. Standardization of measure specifications and definitions is months (if not years) away. For healthcare organizations, the measurement "monster" may seem impossible to tame. Although the measurement capabilities of healthcare organizations are being stretched, there are some solutions. First, senior executives must be actively involved in promoting a meaningful measurement system that is compatible with the organization's quality goals and meets regulatory, purchaser, and accreditation requirements. Next, efficiency improvements in the way of systemwide collaboration and expanded information technology support can help reduce the administrative burdens. There is no denying that the focus on measurement has advanced the quality of patient care. Healthcare organizations must create the systems necessary to sustain these gains and move forward toward ever better patient care.     

Lean healthcare

As healthcare organizations look for new and improved ways to reduce costs and still offer quality healthcare, many are turning to the Toyota Production System of doing business. Rather than focusing on cutting personnel and assets, "lean healthcare" looks to improve patient satisfaction through improved actions and processes.     

基于工作分析的社区卫生服务机构岗位绩效考核构想

简述了绩效考评在卫生服务领域中的应用,分析了我国社区卫生服务机构岗位绩效考评中存在的问题,提出基于工作分析的社区卫生服务机构岗位绩效考核构想,建议采取"业绩+技能+态度+工作强度"的绩效考核模式,在工作分析的基础上,编制社区卫生服务机构中医、护、防等各类卫生服务人员的工作说明书,并制定有针对性的岗位绩效考核体系,从而真正提高社区卫生服务机构岗位绩效,使社区卫生服务能够满足社区居民不断变化的卫生需求.     

Arranged marriages, unlikely partners. How will their offspring look?

In the new era of managed care, many religious healthcare providers are making "arranged marriages"--permanent partnerships with secular organizations. As they do so, the religious partners naturally ponder how best to ensure that their values permeate the new entity and thus prevail in later organizational "offspring." The organizations most likely to perpetuate their values are those with ethical corporate cultures and climates. These include religiously based healthcare providers, but such providers seem to lack confidence today in their ability to maintain culture and climate in newly formed partnerships. That may be fortunate because it prevents them from trying to impose their values on secular partners. Nevertheless, such values are often attractive to a prospective partner. A religious healthcare provider will need market leverage, as well as attractive values, to make a good "marriage." Even so, religious providers and secular investor-owned organizations are unlikely partners, because their motives and incentives differ radically. But religious providers can form solid relationships with secular, not-for-profit healthcare organizations if they take care to negotiate a binding commitment to maintain an ethical culture and climate. However, Catholic providers are at a disadvantage in such negotiations because Catholic religious congregations are unlikely to continue as owner-sponsors much beyond another decade. It is crucial that a stable source of influence develop to ensure a religious presence in the offspring of new partnerships.     

Fast changes for tough times: employee suggestion programs

In the midst of the current marketplace's turmoil, healthcare organizations (HCOs) lack two critical commodities: time and money. Today, time and money are all that stand between many HCOs current operations and their demise at the hands of healthcare reform; therefore, healthcare administrators cannot afford to spend either frivolously. Consultants have put forth an array of employee incentive programs designed to address cost containment and market positioning goals of various institutions. Many of these programs are well packaged and can be considered "politically correct" in terms of current philosophies on employee-management relations. However, many programs focus on long-term goals and strategies and, therefore, are most appropriate for organizations not in immediate danger of demise. One long-term program espoused and implemented widely by organizations is the employee suggestion system. This article looks at employee suggestion programs.     

Reviewing lessons learnt of SARS in Singapore during planning for influenza pandemic

There were many lessons learnt in Singapore's fight against SARS, and they have proven to be all the more important in our preparations for an influenza pandemic. The following lessons are discussed in this paper including: the widespread ramifications among the various sectors in Singapore (individuals, organizations, community and economy), the first principles of outbreak response, need for enhanced infectious disease control measures, high demands on the healthcare system, the role of management policies implementation and dissemination, multidisciplinary involvement, importance of communication, and business continuity planning.     

The effect of commitment to the organization on physicians' familiarity with guidelines for diabetes in managed care organizations

Despite continuous efforts, healthcare organizations still find it difficult to influence physicians to follow clinical guidelines. Previous studies have not taken into account the organizational context of the physicians' practice. We conducted a survey of a representative sample of 743 primary care physicians employed in Israel's 2 largest managed care health plans. The findings indicated that "commitment to the health plan" and "perceived monitoring by the health plan" had an independent positive effect on familiarity with guidelines for treating diabetes. We propose that managers of healthcare organizations consider enhancing physicians' commitment to the organization as a means for increasing their adherence with clinical guidelines, thereby improving the quality of care provided to diabetic patients.     

Quality Improvement Initiatives: The Missed Opportunity for Health Plans

Background

The increase in healthcare cost without direct improvements in health outcomes, coupled with a desire to expand access to the large uninsured population, has underscored the importance of quality initiatives and organizations that provide more affordable healthcare by maximizing value.

Objectives

To determine the knowledge of managed care organizations about quality organizations and initiatives and to identify potential opportunities in which pharmaceutical companies could collaborate with health plans in the development and implementation of quality initiatives.

Methods

We conducted a survey of 36 pharmacy directors and 15 medical directors of different plans during a Managed Care Network meeting in 2008. The represented plans cover almost 74 million lives in commercial, Medicare, and Medicaid programs, or a combination of them.

Results

The responses show limited knowledge among pharmacy and medical directors about current quality organizations and initiatives, except for quality organizations that provide health plan quality accreditation. The results also reveal an opportunity for pharmaceutical companies to collaborate with private health plans in the development of quality initiatives, especially those related to drug utilization, such as patient adherence and education and correct drug utilization.

Conclusion

Our survey shows clearly that today''s focus for managed care organizations is mostly limited to the organizations that provide health plan quality accreditation, with less focus on other organizations.Many of today''s healthcare concerns focus on the concept of value, which can be defined as a composite of cost, quality, and access. Expanding access through affordable healthcare insurance will only be possible if healthcare costs are contained through a focus on quality.1 Poor care quality results in costly errors, complications, and re-work. Conversely, high-quality care, namely, the right treatment at the right time, results in more cost-effective care. This emphasis on value is underscored by a lack of correlation between the increase in healthcare spending in recent years and health outcomes, which is often the result of a lack of information and tracking systems to determine the value of different treatments.2Greater value, therefore, can be achieved by reducing costs, increasing the quality of care, and/or increasing access. A recent report developed as a collaborative effort between different healthcare stakeholders and quality organizations calls for the development of metric systems that allow measurement and reporting the quality, as well as the cost of care.1 A new Medicare provision will provide $10 million annually to this end for fiscal years 2009–2012.3 These quality metrics are expected to help determine the value of different approaches to treatment and the definition of guidelines that maximize value in the US healthcare system. Private payers and some employer groups are also developing their own quality improvement initiatives, or are incorporating initiatives developed by quality organizations.4The Centers for Medicare & Medicaid Services'' (CMS) Physician Quality Reporting Initiative (PQRI) represents the first step toward a value-based system. PQRI is a voluntary pay-for-reporting system, in which participating professionals can earn a bonus payment for reporting to CMS on clinical quality measures specific to their practice.5 The information collected through this program will allow CMS to measure the quality of care and, in time, could lead to the establishment of a pay-for-performance (P4P) system.Employers and private payers are also increasing their focus on value.6,7 The rise in healthcare insurance premiums has made employers consider quality measures in their insurance purchasing decisions, and in turn, more healthcare plans are seeking accreditation by national quality organizations, such as the National Committee for Quality Assurance (NCQA) and others.8     

Turning teamwork into quality care

To promote quality in the healthcare setting, many organizations are realizing that they need to consider using teams to promote quality care. From establishing "a lean production system" to eliminating "waste"--in the form of poor customer service, employee dissatisfaction, and medical errors--to lowering average lengths of stays, two medical organizations found that taking a team approach can encourage good clinical care while improving bottom lines.     

Healthcare holds on tight. As the markets roil and financial giants fall, experts say things won't be all that bad for healthcare organizations

Investor fear stirred up by the news last week about Lehman Bros. and AIG should eventually subside, leaving little long-term effect on healthcare finance, experts say. Chris Payne, left, with healthcare financial advisory firm Ponder & Co., says, "I don't see any fundamental reason why this will cause a lack of capital to healthcare organizations".     

At-risk contracting: preparing to deliver what purchasers want

Behavioral healthcare organizations wishing to enter the "brave new world" of capitated and at-risk contracting must understand the various categories of healthcare purchasers and risk contracts, as well as the perspectives and goals of those purchasers. The following article also identifies some critical elements in successful at-risk contracting and next steps for providers in such areas as quality improvement, outcomes management and accessibility.     

Understanding benchmarking

In order to meet the challenges facing health care today, organizations are turning to new approaches. Benchmarking is one such approach. Benchmarking is externally driven, encouraging organizations to look outside their own walls to learn from others and achieve exemplar performance. Organizations can benchmark within their own systems, against competitors, against "best-in-class" companies in the same general industry and against "best-in-class" companies in different industries. A four-step approach to benchmarking includes planning, collecting information, analyzing results and adapting and improving. A benchmarking study team composed of the process owner and other users of the process conducts the study. Application of benchmarking to healthcare materiel management is particularly appropriate, since many materiel management processes occur in other industries and, therefore, best practices outside the healthcare industry may be adapted. The practice, through growing in other industries, is still very new in health care.     

Cultural contexts of Ebola in northern Uganda

Technical guidelines for the control of Ebola hemorrhagic fever (EHF) indicate that understanding local views and responses to an outbreak is essential. However, few studies with such information exist. Thus, we used qualitative and quantitative methods to determine how local residents of Gulu, Uganda, viewed and responded to the 2000–2001 outbreak of EHF. Results indicated that Acholi people used at least three explanatory models to explain and respond to the outbreak; indigenous epidemic control measures were often implemented and consistent with those being promoted by healthcare workers; and some cultural practices amplified the outbreak (e.g., burial practices). However, most persons were willing to modify and work with national and international healthcare workers.Many emerging disease specialists are sensitive to and acknowledge the potential importance of social science in disease control, but seldom is this perspective considered when organizing response efforts. In part, this situation exists because so little research in this area has been conducted. The special issue on Ebola in The Journal of Infectious Diseases (1) does not include any articles on the behavioral aspects of the disease. However, World Health Organization (WHO) technical guidelines for responding to Ebola hemorrhagic fever (EHF) state that, in conducting epidemiologic surveillance, “Special attention must be given to the actual perception of the outbreak by the community. In particular, specific cultural elements and local beliefs must be taken into account to ensure proper messages, confidence, and close cooperation of the community” (2).We describe the first systematic sociocultural study of an outbreak of EHF. The outbreak occurred in several locations in northern Uganda in 2000 to 2001. We conducted this research in villages and neighborhoods in and around Gulu during the last month of the outbreak. The field study aimed to: 1) describe local explanatory models of EHF; 2) provide understanding of topics of concern to WHO (i.e., burial practices, patients’ fear of going to the hospital, the role of traditional healers in disease transmission); and 3) identify local and international beliefs and practices that enhanced or were detrimental to the control of EHF. An “explanatory model” refers to a person’s or culture’s explanations and predictions regarding a particular illness. Some of the questions asked when trying to understand an explanatory model include: How do persons refer to the illness? How do they explain it (i.e., cause)? What do they see as appropriate treatments? What do they do to prevent the illness? Patients, physicians, healthcare workers, and local residents in different parts of the world each have explanatory models for different illnesses. Providing care and treatment for a particular disease is often based on negotiating these different models.     

Getting accredited for population health

The inclusion of population health in the accreditation process is an important new direction in the Canadian healthcare system. While quality improvement is a concept familiar to most clinicians and administrators, the inclusion of population health may raise some questions: What is "population health?"; Should healthcare organizations be responsible for population health?; If so, what could they and should they be doing about it?; How would a healthcare organization achieve accreditation in population health?     

Administrative simplification: healthcare reform and TQM

Administrative simplification is a key element of the Clinton healthcare reform proposal. Healthcare leaders, however, "cannot lay the entire burden of administrative simplification on outsiders," says Ellen J. Gaucher, Senior Associate Director of The University of Michigan Hospitals. There are numerous opportunities to use the principles of total quality management to improve operational and financial performance in healthcare organizations.     

Advancing the state of the art in healthcare strategic planning

A recent survey of the state of strategic planning among healthcare organizations indicates that planners and executives believe that healthcare strategic planning practices are effective and provide the appropriate focus and direction for their organizations. When compared to strategic planning practices employed outside of the healthcare field, however, most healthcare strategic planning processes have not evolved to the more advanced, state-of-the-art levels of planning being used successfully outside of healthcare. While organizations that operate in stable markets may be able to survive using basic strategic planning practices, the volatile healthcare market demands that providers be nimble competitors with advanced, ongoing planning processes that drive growth and organizational effectiveness. What should healthcare organizations do to increase the rigor and sophistication of their strategic planning practices? This article identifies ten current healthcare strategic planning best practices and recommends five additional innovative approaches from pathbreaking companies outside of healthcare that have used advanced strategic planning practices to attain high levels of organizational success.     

Application of environmental sampling to flexible endoscope reprocessing: the importance of monitoring the rinse water.

The routine sampling of environmental surfaces within a healthcare facility is generally not recommended by the Centers for Disease Control and Prevention (CDC), the Association for the Advancement of Medical Instrumentation (AAMI), and several other healthcare organizations. There are a few circumstances, however, for which some organizations do recommend this practice. For instance, the CDC and the Association for Professionals in Infection Control and Epidemiology (APIC) recommend environmental sampling as clinically required during an outbreak investigation. The CDC and AAMI also recommend routine sampling of the rinse water used during hemodialyzer (but not endoscope) reprocessing. The rationale for this recommendation is based in part on reports of pyrogenic responses, patient infections, and bacteremia due to waterborne, gram-negative bacteria during hemodialysis. To determine whether the basis for this rationale might similarly apply to the rinse water used during endoscope reprocessing, the Food and Drug Administration's medical device reporting database, the endoscope reprocessing literature, and other sources were reviewed. The results of this review indicate that nosocomial outbreaks linked to endoscopes contaminated with gram-negative bacteria have been frequently reported. As a result, for several reasons, including to minimize the risk of patient infection due to gram-negative bacteria following endoscopy, this article recommends routine microbiologic sampling of the rinse water used during endoscope reprocessing.     

Weaving spirituality into organizational life. Suggestions for processes and programs

Recent research has demonstrated a clear link between spirituality and health, but it remains a challenge for many organizations to weave spirituality into organizational life and make it an integral component of clinical care. Three dimensions of spirituality work together in healthcare: spiritual well-being of patients and families, spiritual well-being of workers, and spiritual well-being of the organization. To cultivate these dimensions in the life of healthcare organizations, several strategies may be employed. First, the definition of "spirituality" must be clear. Consider spirituality at the core of providing healthcare, instead of parallel to or part of clinical approaches. Separate spirituality from chaplaincy, since nurturing spiritual values is the responsibility of everyone in the organization. It is important to affirm what people already do spiritually, focus on what they have to offer instead of on deficiencies, and cultivate spirituality individual by individual. Organizational leaders must demonstrate spirituality in their personal and professional lives, and keep the organizational mission to the fore. When working to enhance organizational spirituality, create a vision within the organization of its spirituality and emphasize peer support and collaboration. Programs to help organizations inculcate spirituality include retreats or renewal programs for employees, forums to explore employees' spirituality, inclusion of spiritual issues in training and orientation programs, educational and development programs for working groups, regular review of spiritual well-being, training selected employees as spiritual facilitators, and supporting research on spirituality, health, and healthcare.     

Strategic cycling: shaking complacency in healthcare strategic planning

As the conditions affecting business and healthcare organizations in the United States have become more turbulent and uncertain, strategic planning has decreased in popularity. Strategic planning is criticized for stiffling creative responses to the new marketplace and for fostering compartmentalized organizations, adherence to outmoded strategies, tunnel vision in strategy formulation, and overemphasis on planning to the detriment of implementation. However, effective strategic planning can be a force for mobilizing all the constituents of an organization, creating discipline in pursuit of a goal, broadening an organization's perspective, improving communication among disciplines, and motivating the organization's workforce. It is worthwhile for healthcare organizations to preserve these benefits of strategic planning at the same time recognizing the many sources of turbulence and uncertainty in the healthcare environment. A model of "strategic cycling" is presented to address the perceived shortcomings of traditional strategic planning in a dynamic environment. The cycling model facilitates continuous assessment of the organization's mission/values/vision and primary strategies based on feedback from benchmark analysis, shareholder impact, and progress in strategy implementation. Multiple scenarios and contingency plans are developed in recognition of the uncertain future. The model represents a compromise between abandoning strategic planning and the traditional, linear model of planning based on progress through predetermined stages to a masterpiece plan.     

Management of research in healthcare centers. An exploration through nominal group dynamics]

OBJECTIVES: To determine the opinions of hospital and other research organizations managers concerning three questions: 1) the desirability of healthcare centers' managing biomedical research as a specific product; 2) the characteristics that define a "research management" culture as opposed to the current "administration of research" culture and 3) the management instruments needed to implement a "research management" culture. MATERIALS AND METHODS: A meeting was held with 14 experts from healthcare centers or research organizations from Barcelona, Madrid and Valencia to discuss the three questions and evaluate the relative importance of items comprising the last two with a score system from 1 (little relevance) to 9 (extremely relevant). RESULTS: The group was in favor of healthcare centers' managing research as a specific and differentiated product. Keys to achieving a management culture (items scoring higher than 7 with the above system) included the development of a culture to evaluate work and external auditing, transversal support and sharing infrastructures and intellectual capital, specific accounting, unified management, prioritization of research lines and capacity for cooperation, and strategic alliances between centers. Management instruments deemed essential (items scoring 7 or higher with the above system) were: support to research foundations or other organizational formulae to ensure autonomy, specific budgetary control, development of support structures and contractual formulae to support autonomy, creativity and researchers' accountability. CONCLUSIONS: Research conducted in healthcare centers should be managed just as any other product derived from the center's activities. Key points to success are prioritization, evaluation and clear assignation of responsibilities, which requires organizational structures with greater flexibility and specific information systems.