Quality Improvement and Risk Management

Discussion 03.2: Performance Factors

Discussion Topic

 

Task: Reply to this topic

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 and measure development tutorial, then complete the worksheet.

Read the case scenario and complete the performance measure development worksheet. Initial post due Thursday.

Case Scenario

Having just moved to Metro City, you are a NEW patient at Metro-Health Family Practice Clinic. Because it is in the center of the city, off the main transit routes, Metro-Health is hard to find and identified only by a small sign in front of the building. Once inside the door, you become faint and need a wheelchair. There is no staff available and no wheelchairs in sight. After a few minutes you are able to walk with the help of your family member and find the desk marked “check-in.” After waiting in line for 20 minutes, you are directed to the “registration desk” because you are a new patient.

The registration clerk is very kind and considerate of your needs and provides you a chair. The clerk has numerous questions but is taking time to explain the process and allows you to ask for clarification. This process takes another 20 minutes; however, you can review the information thoroughly and ensure its accuracy.

You are immediately placed in a comfortable room and asked if you want your family member in the room with you. The assistant closes the door and takes your blood pressure, temperature, and respirations. Assuring your privacy, she tells you the results and explains what she is doing. She leaves the room and almost immediately the physician enters.

The physician greets you warmly and asks about your history of high blood pressure, why you are here today and that you to tell her about the dizzy spells you are having. She carefully goes over your medications, the dose, timing, and any side effects. During this process, the doctor discovers you are taking two highly potent and expensive medications to lower your blood pressure. She discontinues one and prescribes a far less expensive generic brand of the other drug.

You get your prescription filled, and after a week you are feeling less tired, have experienced no dizziness, and your family member who takes your blood pressure reports it as within the acceptable limits. You then receive a phone call with a survey asking about your clinic visit.

Directions

This case study provides several opportunities to measure performance in the four categories–structure, process, outcome, or patient experience.

Because a percentage clearly communicates the prevalence, or “how often it happens” based on a population (also known as rate), we will need to determine a numerator (the top part of a fraction) and a denominator (the bottom part of a fraction).

As the manager at Metro-Health Family Practice Clinic you assure the organizational goals are met. 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 perception

Keep these goals in mind to set up performance measures for Metro-Family Practice Clinic. Post an initial copy of your worksheet with performance measure by Thursday. By Sunday, respond to at least two (2) other students in at least 100-150 words with suggestions on how to improve performance.

Setting up Performance Measures

When setting up a performance measure, we 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 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. As well, by writing the performance measure this way, we know what data to use to answer our question.

Let’s use the first example on the work sheet: “What is our rate of falls.” Here are the steps we will use.

Define the population: total number of patients we see in the clinic.

What are we measuring: falls.

Over what time frame: we will use a month.

Remember, we are setting up a performance measure so there are no “numbers” yet, that will come later based on our data.

We go about figuring out the monthly fall rate by comparing the number of falls to our total number of patients. Like this:

Number of falls in 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 percentage of falls when entering your facility in the past month.

Numerator = number of reported falls

Denominator = total number of patients

When multiplied by 100 = % (percentage or rate) of falls

In a word document, complete the following and submit to the discussion (you may copy and paste into the discussion):

Community Visibility Measure: Percentage of patient complaints “not able to easily find the facility.”

Numerator =

Denominator =

Name one thing that might be done to improve visibility:

Registration Process Measure: Percentage of patients waiting longer than 20 minutes to be registered.

Numerator =

Denominator =

Name one thing that might be done to improve patient wait time.

Physician Timeliness Measure: Percentage of patients waiting to be seen in the exam room more than 10 minutes.

Numerator =

Denominator =

Name one thing that might be done to improve physician timeliness.

 

Scoring Guide

Criteria

1.

Work addresses each measure.

2.

Numerators and denominators have been identified for each measure.

3.

Initial post includes suggested improvement response.

4.

Initial post is submitted by Thursday at 11:59MT.

5.

Reply to at least two other students by Sunday.

Rating Scale: 25 Points Total

5

Work meets or exceeds criterion at a high level of competence.

 

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