Dr. Mohammed Alahmed fac.ksu.sa/alahmed [email protected] Dr. Mohammed

Dr. Mohammed Alahmed http://fac.ksu.edu.sa/alahmed [email protected] Dr. Mohammed Alahmed Performance Management in Healthcare 1

Performance management (PM) includes activities which ensure that goals are consistently being met in an effective and efficient manner. Performance management can focus on the performance of an organization, a department, employee, or even the processes to build a product or service, as well as many other areas. Dr. Mohammed Alahmed Introduction 2

The fundamental goal of performance management is to promote and improve employee effectiveness. It is a continuous process where managers and employees work together to plan, monitor and review an employee's work objectives or goals and his or her overall contribution to the organization. Performance management in health care is not only aiming at the systematic generation and control of an organization’s economic value but also at the optimization of the efficiency and effectiveness of service delivery. Dr. Mohammed Alahmed Introduction 3

Introduction The use of performance measurement information to effect positive change in organizational culture, systems and processes, by helping to set agreed-upon performance goals, allocating and prioritizing resources, informing managers to either confirm or change current policy or program directions to meet those goals, and sharing results of performance in pursuing those goals. Dr. Mohammed Alahmed Performance management supports better patient outcomes, and provides the knowledge to run more effective organizations. For example, integrating your overall healthcare strategy through scorecards or strategy maps with the appropriate underlying reports lets clinicians understand what drives better care, and helps administrators see what drives the bottom line. Performance management 4

Translate organization vision into clear measurable outcomes that define success, and that are shared throughout the organization and with customers and stakeholders; Provide a tool for assessing, managing, and improving the overall health and success of business systems; Continue to shift from prescriptive, audit- and compliance-based oversight to an ongoing, forward-looking strategic partnership involving agency headquarters and field components; Include measures of quality, cost, speed, customer service, and employee alignment, motivation, and skills to provide an indepth, predictive performance management system; and Replace existing assessment models with a consistent approach to performance management. Dr. Mohammed Alahmed Performance Management System Goals 5

When you are developing a performance measurement system, you should consider a conceptual reference model: 1. The Balanced Scorecard in Healthcare Organizations 2. Logic Models in Public Health Program Management. Dr. Mohammed Alahmed Performance Management Tools 6

Dr. Mohammed Alahmed THE BALANCED SCORECARD IN HEALTHCARE ORGANIZATIONS 7

The Balanced Scorecard (BSC) is a strategic planning and management tool that is used extensively in business and industry, government, and nonprofit organizations worldwide to align business activities to the vision and strategy of the organization, improve internal and external communications, and monitor organization performance against strategic goals. Dr. Mohammed Alahmed Introduction 8

Introduction The BSC was developed in the early 1990s by two guys at the Harvard Business School: Robert Kaplan and David Norton. Dr. Mohammed Alahmed A Measurement System? A Management System? A Management Philosophy? 9

“A multi-dimensional framework for describing, implementing and managing strategy at all levels of an enterprise by linking objectives, initiatives, and measures to an organization’s strategy.” Kaplan & Norton, 1996 Dr. Mohammed Alahmed Balanced Scorecard – Original Definition 10

Dr. Mohammed Alahmed Which Which dimensions dimensionsshould should we wemeasure? measure? 11

The Four Perspectives of the Balanced Scorecard Optimizing Optimizing internal internal process process and and improving improving performance performance Improving Improving relations relations with with customers, customers, improving improving organization organization image image Financial Customer Internal Process Learning/ Growth Dr. Mohammed Alahmed All All indicators indicators related related to to financial financial goals goals Education Education of of personal, personal, growth growth strategies strategies 12

Health sector is complex, has many components Need an efficient way to assess multiple objectives Overloaded with different types of reports Stakeholders demand vigilance Poor measurement can lead to crisis Dr. Mohammed Alahmed Why have a Balanced Scorecard? 13

In 1999, Wachtel, Hartford, and Hughes (1999) examined whether BSC method is suitable for the management of medical organizations. Application of BSC method in healthcare organizations is also described by: Stevard and Bestor (2000, s. 75 – 82) - Applying a Balanced Scorecard to Health Care Organizations, Bisbe a Barrubés (2012, s. 919-927) – The Balanced Scorecard as a Management Tool for Assessing and Monitoring Strategy Implementation in Health Care Organizations, Dr. Mohammed Alahmed Balanced Scorecard in Healthcare 14

Chow, Gaunulin, Haddad a Williamson (1998) - The Balanced Scorecard: A Potent Tool for Energizing and Focusing Healthcare Organization Management, Swayne, Duncan a Ginter (2008, s. 378-379) - Strategic management of health care organizations, Fortenberry (2010, s. 248-259) in monography Health care marketing: tools and techniques, Lin et al. (2013, s. 1917-1924), in article: Integrating hierarchical balanced scorecard with fuzzy linguistic for evaluating operating room performance in hospitals, apply BSC into specific environment such as hospitals are. Dr. Mohammed Alahmed Balanced Scorecard in Healthcare 15

BSC application into management of healthcare organizations can be defined as follow: How patients perceive an organization? (Customer perspective). What is financial situations? (Financial Perspectives) What can we do to improve level of services? (Perspective of learning and growth) What do we want to be the best in? (Perspective of internal business processes) Dr. Mohammed Alahmed Balanced Scorecard in Healthcare 16

Duke University Hospital explained these four perspectives in healthcare organizations as follow (Jones and Filip, 2000): Customer perspective: Deliver high quality innovative care while respecting needs of the patient. Financial perspective: Deliver strong and consistent financial performance in the eyes of payers and the board of trustees. Learning perspective: To be recognized as a leader in developing skills and performance of employees. Business perspective: To be recognized as the premier provider of health care services in our region/market Dr. Mohammed Alahmed Balanced Scorecard in Healthcare 17

Balanced Scorecard in Healthcare It aligns the organization trend a more market oriented, customer-focused strategy, It facilitates, monitors, and assesses the implementation of the strategy, It provides a communication and collaboration mechanism, It assigns accountability for performance at all levels of the organization, It provides continual feedback on the strategy and promotes adjustments to marketplace and regulatory changes Dr. Mohammed Alahmed Potential benefits for the successful implementation of the BSC in the healthcare organizations: 18

Collaborative Efforts - Implementing the BSC agency-wide will provide: 1. a common methodology and coordinated framework for all agency performance measurement efforts; 2. a common “language” for agency managers; 3. a common basis for understanding measurement results; and 4. an integrated picture of the agency overall. Dr. Mohammed Alahmed Implementing a Balanced Scorecard 19

Implementing a Balanced Scorecard 1. Make a commitment at all levels — especially at the top level 2. Develop organizational goals 3. Offer training in improvement techniques 4. Establish a reward and recognition system to foster performance improvements 5. Break down organizational barriers. 6. Coordinate Headquarters and Field Office Responsibilities Dr. Mohammed Alahmed Pathway to Success 20

Dr. Mohammed Alahmed Implementation steps of BSC 21

Elements of the Balanced Scorecard Financial Customer Internal business process Learning and growing Linking measures to strategy Structure and strategy Strategic alignment—top to bottom Targets, resources, initiatives, and budgets Feedback and the strategic learning process Dr. Mohammed Alahmed Mission and vision Perspectives 22

Dr. Mohammed Alahmed Example: Brigham and Women’s / Faulkner Hospital Strategy Map (2009) 23

Some key learnings: Having automated performance reporting software facilitates monitoring and analysis of results at all levels of the system as well as more rapid rollout of the Balanced Scorecard. Real time reporting, particularly for operational measures, is seen as an important goal for more rapid and timely decision-making. This is a good example of where a Balanced Scorecard in the health sector has been cascaded to individuals – it shows it can be done for medical staff as well as management, something that some organizations see as too hard Dr. Mohammed Alahmed Brigham and Women’s / Faulkner Hospitals 24

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Whether your agency’s programs or initiatives are large or small, simple or complex, short-term or long-term, they probably share some common elements. A logic model simply depicts the relationships among all these different elements in some logical order—in a way that can be readily understood by someone who was not involved in the program planning or design. Dr. Mohammed Alahmed What is a logic model ? 26

A logic model visually links program inputs and activities to program outputs and outcomes, and shows the basic (logic) for these expectations. A graphic depiction of the relationship between the key elements of a program or initiative Dr. Mohammed Alahmed What is a logic model ? 27

How are logic models used? For program design/planning For strategic planning To test initial assumptions For ongoing monitoring of program implementation To evaluate long-term results To communicate with and establish buy-in from stakeholders To negotiate with partners, funders, and other stakeholders Dr. Mohammed Alahmed Logic models can be used in many ways, including: 28

A logic model’s visual depiction of how a program is expected to unfold and/or how an organization is expected to reach its goals offers several benefits. It allows for quick and efficient testing of assumptions, providing opportunities for feedback. It yields insights into potential indicators and measures of progress for the most important outcomes Dr. Mohammed Alahmed What are the benefits of using a logic model approach? 29

Logic Model Components Inputs — any resources needed in order to implement the activities (e.g., funding, staff time, community partnerships, technology, data, etc.) Outputs — what you will do, and whom you intend to reach. Our approach further divides outputs into: Activities — the specific steps, work plans, or program areas you (and any partners) expect to undertake with the resources listed above; and Participation — the intended audience you are trying to reach with your activities. Dr. Mohammed Alahmed Although there are many different logic model templates and formats available, most cover the following components: 30

Outcomes — the results you expect to achieve because of your inputs and outputs. Outcomes can be subdivided into time frames, depending on how long they may take to achieve and how long the project is expected to last overall (i.e., the intensity and duration of the project). For example, short-term outcomes are generally those expected to be achieved in the first year; intermediate outcomes may take up to 2 to 5 years; and long-term outcomes may take longer than 5 years. Dr. Mohammed Alahmed Logic Model Components 31

Impact — a vision for the ultimate effect that all the inputs, outputs, and outcomes, taken together, could achieve in an ideal future. Generally, impact isn’t as measurable and concrete as the other components; it might include statements such as “Improved health outcomes for Georgians” or “Equitable access to health care for all residents.” Like a vision statement, impact is intended to be aspirational —and inspirational. Dr. Mohammed Alahmed Logic Model Components 32

Resources Activities Outputs Outcomes The inputs dedicated to or consumed by the program The actions that the program takes to achieve desired outcomes The measurable products of a program’s activities The benefits to clients, communities, systems, or organizations Dr. Mohammed Alahmed Logic Model Components 33 How? Why? So what?

Logic Models in Public Health Program Management Quality improvement in public health is the use of a process, such as Plan-Do-Study-Act, which is focused on activities that are responsive to community needs and improving population health. Refers to a continuous and ongoing effort to achieve measureable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality service. Dr. Mohammed Alahmed Context for Logic Models: 34

Example Logic Model Dental Clinic Coordinator Community Health Director Staff dentist Staff pediatrician Medical providers Activities Training Develop curriculum Two one-hour didactic trainings to medical providers in oral health assessment One-on-one training to medical providers on oral health Outputs Training # of two-hour trainings held # of one-on-one trainings held # of medical providers trained Money for supplies Outreach Order dental supplies for packets Make up packets Distribute to parents at end of each visit Outreach # of parents/children receiving packets Outcomes Medical providers demonstrate accurate oral health assessment, education and prevention activities More children receive high-quality oral health assessment, education and prevention activities during well-child visits Parents/children are more knowledgeable about oral health and caring for children’s teeth Dr. Mohammed Alahmed Resources Reduced incidence of caries in children at the community health center 35

1. Integrates planning, implementation, performance measurement and evaluation 2. Prevents mismatches between activities and effects 3. Builds program clarity from the process 4. Keeps staff, managers, and partners focused on outcomes 5. Helps planners prioritize most effective activities for directing resources 6. Uses evidence-based models and practice wisdom to design and refine a program 7. Reveals data needs and framework for analyzing data Dr. Mohammed Alahmed Benefits of Logic Models 36

1. Logic models make the program theory clear not true 2. They take time to complete 3. Without data collection, their utility is limited 4. They strike fear in the hearts of many 5. Pursuit of perfection can impede utility 6. The notion that “evaluation is being done to me, rather than with me” Dr. Mohammed Alahmed Limitations and Pitfalls of Logic Models 37

The Value of Logic Models What gets measured gets done If you can’t see success, you can’t reward it If you can’t reward success, you’re probably rewarding failure If you can’t see success, you can’t learn from it Dr. Mohammed Alahmed If you don’t measure results, you can’t tell success from failure If you can’t recognize failure, you can’t correct it If you can demonstrate results, you can win public support 38

Creating a Logic Model No single way, flexible Forward logic driven by “But Why?” or “IfThen” thinking Starting from the condition or problem end Reverse logic driven by “But How?” Starting from the vision end Who? Dr. Mohammed Alahmed How? Depends When? Varies 39

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Dr. Mohammed Alahmed Example of logic models 41

Dr. Mohammed Alahmed Smoke-free environments 42