Evaluating Performance Management Within Your Organization

www.TheNationalCouncil.org

July 29, 2008Evaluating Performance

Management WithinYour Organization

Paul M. Lefkovitz, PhDPresident, Behavioral Pathway Systems


Objectives

You will learn> A six point model for assessing your

organization’s performancemanagement system

> How to integrate performance data> The value of benchmarking


What is a PerformanceMeasurement System?

> All organizations measure performance> Includes clinical, operational, and

financial indices of performance> May not be integrated as a “system”> Data may not all be in one place> May consist of reports developed by

different parts of the organization> May be high tech, low tech, or no tech


Hi-Tech Data Sources

> Information system> Decision support technology> Marketing tools for measurement of

patient satisfaction> Human resources tools for the

measurement of organizational climate> Pharmacy department systems> ORYX Data


Low/No Tech Data Sources

> Home grown measurement tools> Internal and external focus groups> Community needs studies> Staff or patient surveys> FOCUS-PDCA and other performance

improvement methodologies


Importance ofData Integration

> Organizational leaders should be aware of allrelevant organizational data

> Domains of performance are inter-dependent(e.g. Balanced Scorecard)

> Clinical, Financial, Operational,Organizational Climate

> Integration supports a more cohesive pictureof the organization

> A system for organizing and prioritizingavailable data is necessary-Dashboard

Does Not Meet Goal

Close to Goal or Changing

Meets or Exceeds Goal

Goal to be Determined

GOALS MEASURES Target Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Financial

Reduce operating exp enses Cost per Unit of Service $165 $184 $192 $177 $167 $160 $158

Maintain viability Net Operating Margin 4.0% 4.2% 3.9% 3.9% 3.1% 1.8% 1.2%

Control overtime % Overtime Hours 1.5% .9 1.2 .8 1.6 .9 1.2

Clinical/Quality

Increase client role in decisions Client Satisfaction Rating 3.5 3.7 4.1 4.4 4.3 4.1 4.2

Address safety concerns % of indicators meeting target 95% 87% 84% 78% 74% 77% 79%

Facilitate positive outcomes Average change score 25 15 18 21 24 26 31

Operati onal

Secondary market penetration Admissions/1,000 population 3.75 3.65 3,8 3.9 4.2 4.2 4.6

Documentation compliance Chart deficiency % 5.0% 3.2% 3.3 3.1 2.7 3.8 4.2

Raise community awareness Increase in intakes over ‘05 10.0% 2.4 2.6 5.4 6.3 8.9 11.5

Organizational Climate

Enhance staffing stability Staff Turnover 32% 28% 27% 31% 29% 34% 31%

Enhance staff commitment Staff Satisfaction 85.0 89 95 92 94 86 91

Maximize staff competencies Percent completing training 98% 98 97 99 100 100 100

SamplePerformance Dashboard


Clinical Performance

> Patient satisfaction> Safety, e.g., medication errors,

seclusion and restraint, injuries> Re-admission rate> No-show rate> GAF> Standardized measures (OQ-45,

CAFAS, BASIS-32, BSI, SCL-90)


Operational Performance

> Staff-to-Patient Ratios> Staff Turnover> Length of Stay> Staff Productivity> Service Mix> Access to Services


Financial Performance

> Revenues> Expenses> Net Margin> Debt Ratio> Bad Debt Percentage> Cost-Per-Unit of Service> Days in Accounts Receivable


Assessing Your PerformanceManagement System

> Is your system asking the right questions?> Is your system using the right tools?> Is your system supported by the right

analyses?> Is your system generating the right

reports?> Is your system involving the right people?> Is your system leading to the right

changes?


Is Your System Askingthe Right Questions?

> All organizations establish priorities--noteverything can receive equal attention

> Is the organization measuringperformance in the most vital areas?

> Alignment between stated priorities andmeasurement efforts is important-itensures that the organization knowswhat it needs to know.


Is Your System Askingthe Right Questions?

> System must produce information thatis responsive to such issues as:>Board mandates>Strategic plan directives>Regulatory compliance requirements>Response to patient complaints>Financial concerns

> Strategy-driven measurement

1. Is your system asking the right questions?

Is your system gathering information that is driven by the strategy and vision of the

organization? Please enter the ten most important organizational priorities in Column A. In

Column B, check those areas in which relevant performance data is available.

A. Key Organizational Priorities B. Availability

of Data

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Item 1 Score:

Interpretive Notes: This score is based on the number of

key organizational priorities for which data is available . A

high score (above 7) suggests a significant degree of

harmony between the organization’s priorities and the data

generated by the performance measurement system.


Is Your SystemUsing the Right Tools?

> Effort on the part ofclients

> Effort on the part of staff> Helpful information

provided> Materials easy to

handle/manage/store> Modest costs> Acceptance by staff

> Acceptance by clients> Validated tools> Prompt availability of

data> Philosophical alignment

2. Is your system using the right tools?

Please evaluate your performance management system tools (surveys, forms, inventories,

tests, etc.) by checking all of the following applicable items:

Tools involve acceptable effort on the par t of clients

Tools involve acceptable effort on the part of staff

Information provided is helpful

Materials are easy to handle/store/manage

Inventory, survey, instrument costs are modest

Tools are accepted by staff

Tools are accepted by clients

Tools have been validated

Data is available quickly —no great delays for scoring

Tools r eflect the clinical philosophies of the staff

Item 2 Score:

Interpretive Notes: This item score is the number of items

checked. A high score reflects good selection of

measur ement instruments. A score of 5 or lower would

suggest that the benefits of the tools may be outweighed by

the effort involved or ot her factors.


Is Your System Supported bythe Right Analyses?

> Data must be aggregated> Manual aggregation may be sufficient

for simple applications> Computerized analysis

>Faster and easier>Can provide many more possibilities

for “slicing and dicing” the data> Ad hoc analysis and decision support


What is YourData Telling You?

> A thermometerreading would be ofno value as ameasure of yourhealth…

> If you didn't knowthat 98.6 is the“average”temperature!


Is Your System Supported bythe Right Analyses?

> Importance of Benchmarking> Data in the absence of a context is often

just a bunch of numbers> Benchmarking helps establish priorities> Benchmarking prompts action> Benchmarking can help track progress> Benchmarking can lead to the

identification of best practicesBPS Web Site: www.bpsys.org

3. Is your system supported by the right analyses?

Which statement most accurately describes your performance measurement system? Enter

the most appropriate rating from 0 to 10 in the space provided below.

Description Scale

Computerized data analysis is conducted that routinely provides detailed

reports with external comparative benchmarks as well as customized

supplemental analyses upon request

10

Computerized data analysis is conducted that routinely provides detailed

reports with external comparative benchmarks 8

Computerized data analysis is conducted that provides basic reports with

external benchmarks or more detailed reports without external benchmarks 5

Manual data analysis is conducted that provides basic summary information

2

No data analysi s is conducted

0

Item 3 Score:

Interpretive Notes: Performance measurement is a highly

technical process that requires the proper expertise and

support. A score below 5 is likely to leave many questions

unanswered.


Is Your System Generating theRight Reports?

> Professionalappearance

> Well-organized> Clearly written> Limited use of jargon> Good balance of

narrative text andtables

> Relevant information

> Comfortable—notoverwhelming

> Not too lengthy> Not too sparse> Easy to understand

4. Is your system generating the right r eports?

Describe the reports generated by your performance measurement system. From the list

that appears below, please check all that apply.

Professional appearance

Well -organized

Clearly presented

Limited use of jargon/technical language

Good balance of n arrative text and tables

Relevant information

Comfortable —not overwhelming

Not too lengthy

Not too sparse

Drives decisions

Item 4 Score:

Interpretive Notes: This item score is the number of items

checked. Performance measurement reports must be “user -

friendly” to have value. If less than 6 items from the list are

checked, the value of your performance measurement

system may be compromised. Reports may be going righ t

into the file (or the trash ) rather than being utilized.


Is Your System Involvingthe Right People?

> Performance measurement is anorganization-wide activity

> Proper involvement of staff at all levelsin selecting indices and reviewing datais critical>Senior leadership>Middle management>Line staff

5. Is your system involving the right people?

Are you getting the full use of the data that is gathered? Please use the following scale to

describe how performance measures are selected and how the findings are disseminated

and employed within the organ ization. Enter your rating in the space provided below.

Description Scale

Complete, detailed reports go to senior leadership; applicable sections go to

middle management and line staff. Selection of measures includes all staff. 10

Complete, detailed r eports go to senior leadership, applicable sections go to

middle management, and verbal reports go to line staff. Selection of

measures is limited to senior and middle management at organization level

but incorporates staff input at program level.

8

Comp lete, detailed reports go to senior leadership, applicable sections go to

middle management, and no reports go to line staff. Selection of measures is

limited to senior and middle management.

5

Complete, detailed reports go to senior leadership, summary or verbal reports

go to middle management, and no reports go to line staff. Selection of

performance measures limited to senior and middle management.

2

Complete, detailed reports go to senior leaders: no reports go to middle

management or line staff. S election of measures limited to senior leadership. 0

Item 5 Score:

Interpretive Notes: Performance measurement data can

provide the rationale and direction for helpful organizational

change. The more outcomes data are shared among leaders

and non -leaders, the more effective it can be in guiding the

change process .


Is Your System Leadingto the Right Changes?

> The ultimate litmus test of a performancemeasurement system is whether it leadsto organizational improvement

> System should stimulate the ongoingimplementation of improvement initiatives

> Does your organization endorse aperformance improvement model?

> Is Performance Improvement built intothe leadership/committee infrastructure?

6. Is your system leading to the right changes?

In the past year, how many organizational improvement initiatives originated directly from

the data derived from your performance measurement system? The score is the number of

concrete initiatives that were i mplemented, up to a maximum of 10.

Item 6 Score:

Interpretive Notes: If the answer to this question is “none”,

your performance measurement system may not be adding

value to th e organization. A system ’s contributions are

largely measured by the concrete ideas for improvement

that emanate from th e resultant data.


Closing Thoughts

> Ongoing performance improvement isthe most vivid expression of anorganization’s commitment to those itserves


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Evaluating Performance Management Within Your Organization

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