experiences on performance management system in a private hospital setting: tpors of a...

Experiences inPerformance Management System

in a Private Hospital Setting: TPORs of a Consultant-Adviser

Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg

Consultant-Adviser

Manila Doctors Hospital

Ciudad Medical Zamboanga



Define

•Context

•Limit of Scope



Experience

• experience of a hospital – PMS

• my personal experiences – consultant-adviser on PMS



Experience

• experience of a hospital – PMS

• my personal experiences • Thoughts, Perceptions, Opinions, and

Recommendations (TPORs) – consultant-adviser on PMS of 2 private hospitals



Private Hospital Setting

•Manila Doctors Hospital – 1999

•Ciudad Medical Zamboanga – 2009

TPORs – Thoughts, Perceptions, Opinions and Recommendations from experience with MDH and CMZ as consultant-adviser



Performance Management System

• PMS in hospital system – not part of presentation

•PMS in a stand-alone hospital and its units – focus of presentation• PMS for hospital clinician-physicians and PMS

for hospital clinical and administrative staff – not part of presentation



Define

•Context

•Limit of Scope



Contents:

TPOR1: Journey towards performance excellence of MDH and CMZ

TPOR2: Tools for evaluation of performance management system (whole hospital)

TPOR3: Starting and continuing journey towards performance excellence for private hospitals


Just look for and focus on the similarities!



• Strategic Planning • Balanced Scorecard• Baldrige / PQA Criteria for

Performance Excellence• PhilHealth Benchbook


TPOR1.1

The journey towards performance excellence is long and tedious.

It may take at least 10 years even with good planning, commitment and support from top management, and perseverance.

Recommendation: Allot 10 years!

Macro-indicators of Performance Excellence (Baldrige):

Integrated approach to organizational performance management that results in (1) delivery of ever-improving value to customers and

stakeholders, contributing to organizational sustainability

(2) improvement of overall organizational effectiveness and capabilities

(3) organizational and personal learning

GOAL (short-/long-term)

3 Macro-indicators of Excellent Hospital (ROJoson):

• Contributing to achievement of targeted health outcomes in its catchment community

• Providing value-based health care services

• Sustainable while providing excellent services


Performance Excellence

• Five performance outcomes to monitor and evaluate:• Product and process outcomes• Customer-focused outcomes• Workforce-focused outcomes• Leadership and governance outcomes• Financial and market outcomes


TPOR1.2

There are no absolute end-points in the journey. It is a continuous journey.

Recommended initial end-points:

1. Being given the highest recognition from the Philippine Quality Awards

2. With at least 25 documented best practices


“Best Practice”- a formally documented method or

technique that has been institutionalized in the hospital and

- that has consistently shown performance excellence results at least if not yet proven superior to those achieved with other means and

- which can be or is being used as a benchmark by other hospitals


With at least 25 documented best practices distributed as follows:

PQA Categories (6)• Leadership• Strategic Planning• Customer Focus• Measurement, Analysis, Knowledge

Management • Workforce Focus• Operations Focus



International Hospital Health Care Standards (8):• Access to Care and Continuity of Care• Patient and Family Rights• Assessment of Patients• Care of Patients• Anesthesia and Surgical Care• Medication Management • Patient and Family Education• Hospital Infection Control



ROJ Recommended Steadfast Strategic Objectives for Hospitals (10):• Systems perspective in governance • Integrated value-based health care service• Physician engagement • Maximal utilization of services with controlled

expenses and losses• Customer delight • Full compliance with the quality and performance

standards (local and international) • Integrated IT-enabled operations system • Staff engagement• Learning organization• CSR program with tangible social impact



ROJ Recommended Steadfast Strategic Objectives for Hospitals (10):

• Systems perspective in governance • Integrated value-based health care service• Physician engagement • Maximal utilization of services with

controlled expenses and losses• Customer delight



ROJ Recommended Steadfast Strategic Objectives for Hospitals (10):

• Full compliance with the quality and performance standards (local and international)

• Integrated IT-enabled operations system

• Staff engagement

• Learning organization

• CSR program with tangible social impact



ROJ Additional Recommended Must-Have Management System or Program for Hospitals (1):

• Communication Management System


TPOR1.3

Although helpful, one does not have to get formal accreditation by all the available standards-accrediting bodies.

Be COMPLIANT with the standards and criteria without going for formal accreditation! (through self-directed learning and improvement!)


TPOR1.3

Going for formal accreditation - depends on your need and situation!

Need - to participate in National Health Insurance Program and get benefits – go for PhilHealth Accreditation!

Need - to participate in medical tourism program and get benefits – go for international accreditation (JCI / ACI / NABH)


TPOR1.3


Need – to satisfy requirement of corporate accounts – go for accreditation!

Need – to satisfy expectations of the community – go for accreditation!


TPOR1.3


Situation – to be with the trend of having an international accreditation (not to be left out – strong community expectation) – go for accreditation!


TPOR1.3


Situation – want to fast-track improvement of quality and safety of operations and services with accreditation – go for accreditation (assessment, training, improvement, evaluation)!

Integrating Hospital Quality and Performance Standards• Baldrige Health Care Criteria for

Performance Excellence / Philippine Quality Award Criteria for Performance Excellence

• ISO Quality Management System• PhilHealth Benchbook (including PH

statutory and regulatory requirements)• Joint International Commission,

Accreditation Canada International • Investors in People

*Compliant but NOT necessarily going for accreditation to all standards, except PhilHealth Benchbook and Philippine Quality Awards for Performance Excellence


• Business Development• Efficiency• Learning








Increase in utilization of

services

Increase in corporate

accounts andpatient-clients

TPOR2: Tools for evaluation of performance management system

2 goals of PMS

• To promote performance excellence in the hospital.

• To evaluate whether the hospital has achieved performance excellence.

Macro-indicators of Performance Excellence (Baldrige):

Integrated approach to organizational performance management that results in (1) delivery of ever-improving value to customers and

stakeholders, contributing to organizational sustainability

(2) improvement of overall organizational effectiveness and capabilities

(3) organizational and personal learning


3 Macro-indicators of Excellent Hospital (ROJoson):





3 Macro-indicators of Excellent Hospital:





Formal - Objective - Stringent Assessment(Internal & External)

3 Macro-indicators of Excellent Hospital:






Internal Auditors

with Checklists-Rating Scales

External AuditorsPQA

PhilHealthDOH

Others (Int’l)

Macro-indicators of Performance Excellence:• Integrated approach• Delivery of ever-improving value

to customers and stakeholders, contributing to organizational sustainability

• improvement of overall organizational effectiveness and capabilities

• Organizational and personal learning



Internal Auditors

with Checklists-Rating Scales

External AuditorsPQA

PhilHealthDOH

Others (Int’l)


TPOR2.1 Use management reviews regularly.

TPOR2.2 Use internal and external independent audits for evaluating PMS at planned intervals.


TPOR2.3 Use integrated evaluation checklists when using several standards.

TPOR2.4 Make Baldrige / PQA Criteria for Performance Excellence as the motherhood standard or framework when using several standards.

TPOR2.5 Use a checklist, rating scale or dashboard such as a balanced scorecard to guide, align and integrate all units, track and assess PMS.








Use integrated checklists

A – ApproachD – DeploymentL – Learning I – Integration

L – LevelT – TrendC – ComparisonI – Integration

TPOR2: Tools for evaluation of performance management system

TPOR2.5 Use a checklist, rating scale or dashboard such as a balanced scorecard to guide, align and integrate all units, track and assess PMS.

What is a balanced scorecard?

A balanced scorecard is a scorecard, a blueprint, or a report card

formulated by an organization to be used as a guide and reference

for the implementation of strategies and tactical objectives,

monitoring the implementation, and

evaluation of results of implementation.

Integration refers to the extent to which

• your results measures (often through segmentation) address important customer, product and service, market, process, and action plan performance requirements identified in your Organizational Profile and in Process Items• your results include valid indicators of future

performance• your results are harmonized across processes and

work units to support organization-wide goals

BSC Framework

Translate to Function Level Scorecards (Corporate, Unit, Individual)

Corporate BSC – formulated by the Senior Management Team and approved by Top Management.

Unit BSC – formulated by all medical or non-medical specialty units in the hospital (divisions, departments, committees, offices) cascaded from / guided by the corporate BSC.

Individual BSC – formulated by an individual staff on how he/she will contribute to the unit BSC.

BSC Framework


Contents of BSC

• Perspectives (5) • Goals (Strategic Intent – General Objectives)• Tactical Objectives (Specific Objectives – Key Result Areas) • Performance Measures: Outcome and Target (Key Performance Indicators) • Initiatives (Programs, Projects, Tasks, Activities) • Action Registers / Action Plans of Initiatives • Resources / budget• Timetable (Timelines or Gantt charts)• Person-in-Charge (Champeons, Task Forces)

BSC Framework


Tabular Presentation of the Main BSC(Scorecard with identification of “Initiatives”)

Perspective Goals

(Strategic Intent – General Objectives)

Tactical Objectives

(Specific Objectives – Key Result Areas)

PerformanceMeasures: Outcome /Target

(KeyPerformance Indicators)

Initiatives

(Programs, Projects, Tasks, Activities)

BSC Framework


Tabular Presentation of the Main BSC(Scorecard with performance data and analysis)

Perspective Goals

(Strategic Intent – General Objectives)

Tactical Objectives

(Specific Objectives – Key Result Areas)

PerformanceMeasures: Outcome /Target

(KeyPerformance Indicators)

Status (Q1/Q2/Q3/Q4)

Data:Analysis: Variance - achieved / NOTachievedResolutions for negative variance:

What is a sample of a BSC of a hospital unit?

PERSPECTIVE

Key Result

Areas/ Goals

Tactical

Objective

Measures Action Plans

Key Performance Indicators

CUSTOMER

Customer delight

Provide quality service

1. External and internal customer satisfaction rating >80% 2. No. of complaints / incident report < 6 per year

Orient and train AU staff on revised/ upgraded Operations Manual

What is a sample of a BSC of a hospital unit?PERSPECTI

VE

Key Result

Areas/ Goals

Tactical

Objective

Measures Action Plans

Key Performance Indicators

PEOPLE Staff engagement

Promote aligned, motivated, empowered and contented workforce

Absenteeism < 10%Tardiness < 10%Staff satisfaction rating > 80%

1. Create a human resource management and development program for the Admitting Unit aligned and integrated with that of the whole hospital. 2. Maintain a conducive and safe working place for the AU staff.

BSC and Baldrige /PQA HCC BSC’s perspectivesFinancial

CustomerProcessLearning and Growth

Results

Baldrige / PQA HCCLeadershipStrategic PlanningCustomer-FocusedProcess ManagementWorkforce-FocusedMeasurements,

Analysis, Knowledge Management

Results

SET of KEY FACTORS / DRIVERS FOR ORGANIZATIONAL. PERFORMANCE

2013-2015 Strategic Objectives

STRATEGIC OBJECTIVES (2013-2015)

PERSPECTIVES OBJECTIVESGovernance, Service, and Finance

1 Systems perspective in governance

2 Integrated value-based health care service

3 Physician engagement (patronage and loyalty)

4 Maximal utilization of services with controlled expenses and losses

Customer 5 Customer delightProcess 6 Fully compliant with the quality and

performance standards (local and international)

7 Integrated IT-enabled operations system

Learning and Growth of People

8 Staff engagement

9 Learning organizationCSR 10 CSR program with tangible social impact

TPOR3: Starting and continuing journey towards performance excellence for private

hospitals


hospitals

2 goals of PMS

• To promote performance excellence in the hospital.

• To evaluate whether the hospital has achieved performance excellence.


hospitals

TPOR3.1 Key drivers for successful journey

•Strategic planning•Commitment •Perseverance


hospitals

CMZ’ Overall Direction and Goal for Next 3 Years, 6 Years and to Infinity and Beyond

Commitment, Support, Engagement, Involvement, Alignment, Coordination, Collaboration, Integration

Top Management

Middle Management

SeniorManagement Personnel



• Strategic Planning • Balanced Scorecard• Baldrige / PQA Criteria for

Performance Excellence• PhilHealth Benchbook

Strategic Planning Conferences


hospitals

TPOR3.2 Creation of Hospital Teams and Identification of Champions

Task Teams

MDH Quality Management Officer / QMR / Internal Auditors

CMZ Task Team Corporate Planning / QC


hospitals

TPOR3.3 Assistance from an external facilitator until a Learning Management System is in place.

Facilitator:• Familiar with and committed to help in the

journey to performance excellence• Educator – innovator in facilitating learning

and development of best practices in hospitals



Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg

Consultant-Adviser

Manila Doctors Hospital

Ciudad Medical Zamboanga

For queries and feedback:0918-804-03-04

[email protected]

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