Performance factors can be measured for any healthcare activity: structure, process, outcome and patient experience.
Measuring Performance
Four performance factors can be measured for any healthcare activity: structure, process, outcome and patient experience. Imagine you are a leader at the fictional Metro Health Clinic and have been assigned to determine what data will be used to measure the rate of issues identified in the case study. Carefully read the case study.
Case Scenario
Metro-Health Family Practice Clinic is in the center of the city, off the main transit routes, difficult to find and identified by a small sign in front of the building. Once inside the door, 81-year-old Mr. Smith becomes dizzy and needs a wheelchair. There is no staff and no wheelchairs in sight. After a few minutes, he is able to walk with the help of a family member and goes to the desk marked “check-in.” After waiting in line for 20 minutes, being a new patient, he is directed to the “registration desk.”
The registration clerk smiles, maintains good eye contact, greets him kindly, introduces herself, and provides a chair. The clerk has numerous questions but is takes time to explain the process and allows him to ask for clarification. This process takes 15 minutes, and he is asked to review the information thoroughly and ensure its accuracy.
He is immediately placed in a comfortable room and asked if he wants a family member in the room. Assuring his privacy, the assistant closes the door and takes his blood pressure, temperature, and respirations and tells him the results. With each procedure she explains to the level of his ability what she is doing. She leaves the room and immediately the physician enters.
The physician greets Mr. Smith warmly and asks about his history of high blood pressure, why he is here today, and the dizzy spells he is having. She carefully goes over medications, the dose, timing, and any side effects (referred to as medication reconciliation). The doctor discovers he is taking two highly potent and expensive medications to lower blood pressure. She discontinues one and prescribes a far less expensive generic brand of the other drug.
The patient gets his prescription filled, and after a week is feeling less tired, has experienced no dizziness, and a family member who takes his blood pressure reports it being within normal limits. As with all patients, Mr. Smith receives a survey asking about his clinic experience.
Directions
This case study provides several opportunities to measure performance in the four categories–structure, process, outcome, or patient experience.
A percentage is frequently used to communicate the prevalence or “how often it happens” based on a population (also known as a rate). This, we need to determine a numerator (the top part of a fraction) and a denominator (the bottom part of a fraction).
As the assistant manager at Metro-Health Family Practice Clinic, your job is to meet organizational goals. They include the following.
Safety – falls
Being visible in the community – finding the facility, advertising
Ease of registration process – patient perception
Physician timeliness – patients wait no longer than 10 minutes
Providing efficient, cost-effective care – patient experience
identify the topic of interest, for example, falls; b) develop performance measures that will identify what data to use for monitoring.
Setting up Performance Measures
When setting up a performance measure, rewrite the measure in terms of the data that will be used to calculate the measure.
The basic elements of a performance (quality) measure include:
The population or group being measured (all patients that are seen in our clinic)
What is being measured (falls).
Over what time frame (days, weeks, months, years).
With this information, clinical quality measures can be developed for virtually any aspect of healthcare. Writing the performance measure this way, we know what data to use to answer our question.
We will use falls as an example: “What is our rate of falls.” Here are the steps we use.
What we are measuring: the rate of falls that occur at our clinic.
Define the population: total number of patients seen in the clinic.
Over what time frame: we will use a month.
Remember, we are setting up a performance measure so there are no “numbers” yet, because we need to first determine what data to use. Why would we look at readmission data when it is falls in which we are interested?
By comparing the number of falls to our total number of patients we obtain the fall rate. Like this:
Number of falls in a month = Numerator
Total number of patients (in the month) = Denominator
When multiplied by 100 = % (percentage or rate) of falls
Again, we are setting up performance measures, not the actual rate in numbers because we do not have the data (numbers) yet.
EXAMPLE
Safety Measure: You want to know the rate (in a percentage) of falls in your facility throughout the past month.
Numerator = number of reported falls
Denominator = total number of patients
When multiplied by 100 = % (percentage or rate) of falls
Determine the numerator and denominator?
Community Visibility Measure: Percentage of patient complaints “not able to easily find the facility.”
Numerator =
Denominator =
Registration Process Measure: Percentage of patients waiting longer than 20 minutes to be registered.
Numerator =
Denominator =
Physician Timeliness Measure: Percentage of patients waiting to be seen in the exam room more than 10 minutes.
Numerator =
Denominator =
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