Quality and Organizational Performance Management:

An Integrated Approach

Gregory Richards, MBA, Ph.D, FCMCProfessor of Performance Management

May 7, 2010

Agenda

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• Our research• Concept of a “performance

management framework”. Where do quality initiatives fit?

• Technical issues: data, information, analytics

• The human component

Our Research Multiple case studies (private and public sector) Large scale survey (338 private sector, 80 public

sector) Experimental: decision modelling/data modelling “Participant” observation specific to health care:

• Montfort• The Ottawa Hospital• University of Pittsburg Medical Centre

Performance Management Frameworks

“Organizational capital” created by a managerial process that:• Clarifies expected outcomes: what, who and

how• Reviews key measures on a regular basis• Focuses on process improvement,

especially in service organizations• Closes the loop between outcomes and

processes

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The PM framework is based on a “model” of success

Variations of success models:• “Theory” of the business (Drucker)• Value-based management (Porter)• Causal modelling (Ittner and Larcker)• Strategy mapping (Kaplan and Norton)

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Planning for Success: A simple logic model

Inputs activities outputs outcomes

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“Theory of Change” & Logic Models

Inputs activities outputs outcomes

Strategies Outcomes/Impact

Logic model: “service” strategy

Performance Indicators:

Targeted-improved quality of life-reduced cost of health care-healthier communities

-early intervention and education-rapid care and issue resolution-continuous learning

Theory of Change: understanding outcomes

# staff available

-# of visits-time per visit

-# issues resolved-response time

Patient satisfaction

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Example of a Logic Model from MOH-LTC

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DATA, INFORMATION, ANALYTICS

"In God we trust, all others bring data." W. Edwards Deming

Applying “Managerial” Analytics: Step 1: Modelling decisions

Patient satisfaction

Patient satisfaction

Develop service

processes and procedures

Develop service

processes and procedures Service and

AccessService and

Access

Organization’s reputation

Organization’s reputation

Patients visit the centre

Patients visit the centre

Patient well being

improves

Patient well being

improves

Presumed key success factorTranslated into a service standard

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Step 2: understand relationshipsNumber of satisfied patients

Number of dissatisfied patients

Wait time < 2 hours

220 160 380

Wait time > 2 hours

90 190 280

310 350 660

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"Without a standard there is no logical basis for making a decision or taking action."Joseph M. Juran

Outcome of the analysis

Chi-Square test of independence = 42.9, df=2; p<.0001

Conclusion: Our service standard of 2 hours does make a difference to patient satisfaction.

From analysis to action:

What is our cost for maintaining this standard?How much of a difference does it make?Is a 2-hour wait time important for all patients?How can we ensure consistency?

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WHERE QUALITY & “LEAN” FITS: IMPROVING PROCESSES

"If you can't describe what you are doing as a process, you don't know what you are doing." W. Edwards Deming

Reducing wait time is a process-level issue

Reception Assignment Treatment Discharge

-Capacity-Flow-Value added versusNon-value added time-Consistency

< 2 hours

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THE PERSONAL SIDE OF ORGANIZATIONAL PERFORMANCE

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Individual Aspects

95% of performance is related to systems and processes, not to individual effort*

“Systems and processes” are full of people

*Joel Barker16

Inverted “U”: motivation versus performance

Engagement reduces uncertainty, builds ownership, developsa sense of of control and self-efficacy. Allows a “right shift”along this graph so that higher targets can be set and met.

The use of LEAN techniques is a powerful way of engagingstaff!

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Conclusions High performance in complex environments

depends on strategic clarity which brings focus, consistency and continuous improvement.

Causal planning is one way of creating clarity: works from the patient backwards; represents hypotheses about how value is delivered.

Measures are used to test hypotheses and to point to core processes that need to be examined.

Don’t forget the human component: the organization should value excellence and accountability but also engagement and support. LEAN processes are exceptional ways of engaging staff.18

École de gestion Telfer

Université d’Ottawa

55 Laurier Avenue

Ottawa ON K1N 6N5

Tél. : (613) 562-5731

Télec. : (613) 562-5164

www.gestion.uottawa.ca

Telfer School of Management

University of Ottawa

55 Ave Laurier

Ottawa ON K1N 6N5

Tel.: (613) 562-5731

Fax: (613) 562-5164

www.management.uottawa.ca

Gregory Richards, MBA, Ph.D, FCMCProfessor of Performance Management

613-562-5800 x 2611richards@telfer.uottawa.ca