Question

1. What kind of Performance Improvement Plan would you develop for your healthcare facility and why? - Describe the function of project management in performance improvement programs - Identify specific knowledge and skills required for team leadership - Describe project life cycles and the group dynamics of team life cycles - Identify the steps a team leader should follow to successfully implement and complete a project 2. Describe the areas that should be addressed in the development of a healthcare organization’s performance improvement plan 3. Explain why performance improvement programs are evaluated - Identify the aspects of the performance improvement program that should be evaluated - Describe what organizations should do with the information gathered from the performance improvement program evaluation

Answer 1

The process involves setting goals, implementing systematic changes, measuring outcomes, and making subsequent appropriate improvements. Performance Improvement: An approach to the continuous study and improvement of the processes of providing healthcare services to meet the needs of patients and others.

Performance Improvement has developed a language of its own. There are many terms that have overlapping meanings, which has given rise to confusion as improvement activities have evolved. As you will see, the terms of improvement are ever evolving.

Quality:

Quality is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

Quality Assurance (QA) or Quality Management (QM):

An internal review process that audits the quality of care delivered and implements corrective actions to remedy any deficiencies identified in the quality of direct patient care, administrative services or support services. The process can employ peer review, outcomes measurement, and utilization management techniques to assess and improve the quality of care. The level of care may be measured against pre-established standards.

Quality Improvement (QI) or Continuous Quality Improvement (CQI):

A management technique to assess and improve internal operations. QI focuses on organizational systems rather than individual performance and seeks to improve quality rather than correcting errors when safety thresholds are crossed. The process involves setting goals, implementing systematic changes, measuring outcomes, and making subsequent appropriate improvements.

Performance Improvement:

An approach to the continuous study and improvement of the processes of providing healthcare services to meet the needs of patients and others.

Performance improvement is measuring the output of a particular business process or procedure, then modifying the process or procedure to increase the output, increase efficiency, or increase the effectiveness of the process or procedure.

PERFORMANCE IMPROVEMENT

There are several factors that are driving performance improvement:

• Consumers are more aware of quality and performance issues in healthcare and they are demanding higher quality and accountability while containing costs.
• Accrediting bodies such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the National Committee for Quality Assurance (NCQA), as well as state agencies are requiring demonstrated performance improvement activities.
• Those with purchasing power such as HMOs and insurance companies want to work with healthcare organizations committed to improved outcomes.
• Cost and reimbursement issues in healthcare are forcing healthcare providers to look for more cost effective ways to provide care while maintaining quality.
• Media coverage of quality issues such as the Institute of Medicine report on medical errors bring to light how critical performance improvement is.

Basically, the purpose of the performance improvement plan is to act as a tool in facilitating improvements by the employee. It is a fundamental part in constructive discussions between employers or line managers and employees about what is expected and what can be done to achieve this.

BARRIERS FOR PERFORMANCE IMPROVEMENT

There are many barriers to performance improvement. It is beneficial to be aware of them so you can recognize them and find ways to overcome them.

• Resistance to change is the most pervasive and most common barrier to performance improvement. It is human nature to resist change and it is a difficult barrier to overcome.
• Lack of commitment to performance improvement from leadership and/or employees. Many hospital administrators, managers, physicians and staff view performance improvement as a necessary task that they must perform in order to meet accreditation requirements and do not really believe that the process of improvement works.
• Needs for professional autonomy such as physicians’ history of self-governance and peer review can be a barrier. Many professionals in healthcare do not want to participate in ‘team’ performance improvement activities as they feel that others are not qualified to ‘judge’ their performance.
• Healthcare organizations have limited resources and many view performance improvement activities as merely a cost center and not adding value to the organization (lack of commitment).
• There exists in healthcare a culture of shame, blame and fear associated with medical errors and undesirable performance.
• Turf issues among professionals (such as physicians and administrators) and departments (such as admitting and nursing) are common problems.
• Time constraints are often cited as a reason for not being able to participate in performance improvement activities. Historically, administrators/management have not made giving staff time to participate in improvement activities a priority.
• Team members and others come to the project with their own agendas and work to achieve their own goals that may or may not be in the best interest of the project.
• Large improvement projects that drag on for long periods of time and lose focus or have little success may suffer from loss of momentum.
• The performance improvement process is too complex and unwieldy.
• Teams get bogged down in minutia instead of rapid cycles of improvement that obtain results and reinforce that the process does work.

Quality Improvement (QI) Quality improvement (QI) consists of systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups.

CONTRIBUTIONS TOWARDS SUCCESSFUL PERFORMANCE IMPROVEMENT

• A committed and involved leadership group is a key ingredient to a successful performance improvement culture and initiatives.
• The entire organization must be trained and educated about performance improvement methods and tools.
• Teamwork is an absolute must in order to succeed in improving performance. The teams should be multifunctional, multidisciplinary and made up of the appropriate members. Team members should be knowledgeable of the process and be enthusiastic about participating.
• Communication among leadership, team members and the organization must be effective. Communication is vital at all steps of the improvement process.
• Data that is measurable, meaningful and reliable must be available to teams to facilitate decision-making and evaluating the performance improvement project.
• Another key element for success is “Project Champions”. They are leadership and/or staff that are credible and can influence participation and change.
• Adequate and appropriate resources are also required for a team to be successful. These might include adequate human resources, money, time, and materials to get the job done.
• A knowledgeable and effective facilitator is extremely helpful in keeping the team on track, educating team members and those affected by changes. Facilitators can also motivate teams as well as drive and monitor the project.
• An organization wide culture that continuously seeks opportunities for improvement and embeds this in the mission and values of the organization.

Key things that team managers need to do if their team is to thrive and succeed. These range from choosing the right people and deciding who does what, to communicating with, developing and motivating people. It also covers some of the most common pitfalls to be avoided.

First Things First

But before that, some definitions are useful. What is management, exactly? And how does it differ from leadership?

A good starting point is "Leaders are people who do the right things; managers are people who do things right." Leadership involves creating a compelling vision of the future, communicating that vision, and helping people understand and commit to it. Managers, on the other hand, are responsible for ensuring that the vision is implemented efficiently and successfully.

Of course, these two roles overlap – and, to be fully effective, you need to fulfill both roles. However, the focus of this article is on the specific skills and responsibilities of managers, and on the tools available to them. After all, there's no point energizing people to work towards a fabulous vision of the future, only to fall flat on your face when it comes to implementation.

Importance of Delegation

The top priority for team managers is delegation . No matter how skilled you are, there's only so much that you can achieve working on your own. With a team behind you, you can achieve so much more: that's why it's so important that you delegate effectively!

Successful delegation starts with matching people and tasks, so you first need to explain what your team's role and goals are. A good way of doing this is to put together a team charter , which sets out the purpose of the team and how it will work. Not only does this help you get your team off to a great start, it can also be useful for bringing the team back on track if it's veering off course.

Only then will you be in a position to think about the skills, experience and competencies within your team, and start matching people to tasks. Read our article on task allocation for more on how to do this, and to find out how to deal with real-world challenges, such as managing the gaps between team members' skill sets.

Motivating Your Team

Another key duty you have as a manager is to motivate team members. Try different approaches you prefer to adopt, you also need to bear in mind that different people have different needs when it comes to motivation. Some individuals are highly self-motivated, while others will under-perform without managerial input.

Developing Your Team

Teams are made up of individuals who have different outlooks and abilities, and are at different stages of their careers. Some may find that the tasks you've allocated to them are challenging, and they may need support. Others may be "old hands" at what they're doing, and may be looking for opportunities to stretch their skills. Either way, it's your responsibility to develop all of your people.

Your skills in this aspect of management will define your long-term success as a manager. If you can help team members to become better at what they do, you'll be a manager who people aspire to work for, and you'll make a great contribution to your organization, too.

The most effective way of developing your people is to ensure that you give regular feedback to members of your team. Many of us are nervous of giving feedback, especially when it has to be negative. However, if you give and receive feedback regularly, everyone's performance will improve.

Communicating and Working With Your Team – and With Others

Communication skills are essential for success in almost any role, but there are particular skills and techniques that you'll use more as a manager than you did as a regular worker. These fall under two headings: communicating with team members, and communicating with people outside your team. We'll look at each in turn.

Communicating With People in Your Team

As a team manager, you're likely to be chairing regular sessions as well as one-off meetings. Meeting of all kinds, and regular ones in particular, are notorious for wasting people's time, so it's well worth mastering the skill of running effective meetings .

Many meetings include brainstorming sessions. As a team manager, you'll often have to facilitate these, so you'll need to be comfortable with doing this. There's more to this than simply coming up with creative ideas, as you do when you're just a regular participant in such a session: read our article to find out how to run brainstorming sessions. Make sure that you understand where they can go wrong, and what you can do to avoid this.

Active listening is another important skill for managers – and others – to master. When you're in charge, it can be easy to think that you know what others are going to say, or that listening is less important, because you've thought of a solution anyway.

Don't fall into this trap. Most good managers are active listeners: it helps them detect problems early (while they're still easy to deal with), avoid costly misunderstandings, and build trust within their teams.

Communicating With People Outside Your Team

Your boss is probably the most important person you need to communicate with. Take time to understand fully what your boss wants from you and your team – if you know exactly what she likes, and how she prefers this to be delivered, you'll be better able to meet with her approval.

Don't be afraid to ask your boss to coach or mentor you: you can usually learn a lot from him, but he may not be proactive about offering this. If you're approaching your boss for advice, make sure you've thought things through as far as you can. Introduce the subject with a summary of your thinking, and then say where you need help.

Also, as a manager, part of your job is to look after your team and protect it from unreasonable pressure. Learn skills like assertiveness and win-win negotiation , so that you can either turn work away, or negotiate additional resources.

Another part of your job is to manage the way that your team interacts with other groups. Use stakeholder analysis to identify the groups that you need to deal with. Then talk to these people to find out what they want from you, and what they can do to help you.

Managing Discipline

However much you hope that you won't have to do it, there comes a time in most managers' careers when they have to discipline an employee. Discipline may be subtly different from basic feedback, because it doesn't always relate specifically to the employee's work. You can give feedback on their phone manner, for example, but handling problems with timekeeping or personal grooming can need a different approach.

Obvious breaches of the law or of company policy are easy to identify and deal with. But what of other situations? On one hand you don't want to seem petty. On the other hand, you can't let things go that should be dealt with.

Traps to Avoid

There are a number of common mistakes that new managers tend to make. Take care to avoid them!

These are:

• Thinking that you can rely on your existing job knowledge and technical skills to succeed as a manager. It is essential that you take the time to develop good management and people skills as well – these can be more important than your technical skills!
• Failing to consult regularly with your boss, in a misguided attempt to show that you can cope on your own.
• Approaching your boss without having thought a problem through, and without having considered how the problem could be solved.
• Embarrassing your boss, or letting her get a nasty surprise. Follow the "no surprises" rule.
• Doing anything that requires your boss to defend you to others. This can cause your boss to "lose face" with his peers and superiors, and it makes it look as if his team is out of control.
• Failing to talk to your customers (whether internal or external) about what they want from yourself and your team.
• Using your authority inappropriately – make sure that everything you ask people to do is in the interests of the organization.
• Many of these points sound obvious, however it's incredibly easy to make these mistakes in the rush of everyday managerial life.

Teams in the workplace have “life cycles,” different stages of evolution during which members exhibit different patterns of behaviour and productivity. Being promoted from team member to team leader is rife with challenges. In that situation, it’s critical to understand what stage of its life cycle your team is currently in, in order to understand the team dynamic.

This life cycle is based the theory that group dynamics go through distinct phases of development, including:

Forming: The first stage of the team process realizes the transition from a group of individuals to a functioning team. In this stage members develop confidence in each other and in their leaders.

Storming: A difficult, but natural, stage known for its negativity. During “storming,” team members often lash out at each other when they realize the amount of responsibility and amount of work that lies ahead.

Norming: The rainbow after the storm, norming is the sweet phase when members become accustomed to working with each other co-operatively.

Performing: This involves group maturation, and is characterized by extreme productivity.

Practical and effective project management has its roots in simplicity. Keeping a thing simple makes it easier to understand for most stakeholders e.g. project stakeholders can provide requirements in simple terms - teams unambiguously, they can set clear expectations. Project stakeholders can measure project success in terms of benefits it delivers.

These days all of us are expected to be efficient. Always! So, if efficiency is expected from everyone, how can we make the difference? By being effective. Here is a 6 steps approach to do effective project management for your organization and drive better results.

1. The Groundwork - First Do Your Homework

Before project manager or portfolio manager (PM) can jump on to project planning, you as PM should be doing certain ground work. As mentioned earlier you should identify

• Who are project stakeholders, who will be beneficiaries?
• What are expected benefits?
• Based on these benefits, how you can garner buy-in from senior management or customers?
• High level of deliverable, skill set required to deliver those
• Identify metrics: project management KPI to define project success
• How project artifacts, progress, issues, deliverable will be communication i.e. communication plan

Let’s look at these six basic steps for effective project management: project planning and project execution that a project manager can follow in almost every project to ensure project is delivered successfully.

2. Clarity of project requirements, project scope

In most cases, unclear project requirement definitely results in project failure. Right at the beginning ensure all relevant stakeholders understand project requirements clearly and the importance of having unambiguous project scope. It is pretty common these days to see that sales team, project managers working with clients and help him articulate client's requirements. Based on very high level project requirement, you can chalk out project charter, project scope.

If you would like to avoid project scope creep, you will have to make stakeholders understand that project scope is sacrosanct. Having said that total inflexibility can also kill project outcome (i.e. project outcome will not be useful or beneficial to customer as expected). You can accommodate change request after reviewing its value to project outcome.

It is crucial for effective project management to be able to have complete and clear project requirement, right at the beginning and avoid project scope creep during project execution. You can use right project management tools to draft, articulate project requirements, review and seek approvals, so that transparency and accountability for project requirement is ensured.

3. Planning schedule, risks, resources

Team Selection

Once a project charter and project scope is defined and articulated, you will have to identify project manager and project planners. Having project manager, project planner and team members who are subject matter expert for a project in consideration wins half-battle. As project manager & project planners define work-breakdown-structure (wbs) and identify high level deliverable, identifying right skillset to work on those deliverable is equally important. So based on these identified skillset, project manager has to select resources who will be allocated to project and will be assigned work.

Project Schedule

The planning phase of project requires well defined project charter and project scope. Based on this project manager can work on project schedule identifying important deliverable, WBS, milestones. As he gets better understanding of project scope, available resources, he can create detailed project schedule identifying minute level details of project schedule : i.e. tasks, milestones, subtasks, allocating and assigning resources to each of these tasks. As we know, detailing leads to questions, questions brings clarity, and clarity drives predictability.

This phase marks a clear assignment, responsibility for project team members. Again it is important to have detailed project schedule for effective project management. And equally important it is, to be able track project tasks seamlessly

Planning for Project Risks

Managing project risks is integral part of project management. If your projects are not trivial, whether you like it or not -risk will be inevitable part of your projects. If it is not done as an academic exercise of managing project risks, project risk management saves you greatly from surprises. It is important for effective project management to plan for project risks right at the beginning. You need to make team members aware of project risks also provide a platform like online risk register where team members and other stakeholders can quickly record & highlight project risks.

4. Communication Plan - Clarity & Frequency

At every phase and step of managing project, project manager has to communicate. Communication strategy and plan is crucial for greater project visibility and ultimately for project success. Project communication is required for

• Informing stakeholder about project plan, scope; review and approvals thereof
• Keeping team members informed about change in project schedule
• Being able to highlight issues and risks in project
• Being able to provide clear & real better visibility to sponsors, portfolio/executive managers with project portfolio KPIs
• To get buy-in or support from senior management if anything is going wrong

Get Organized & Start Using Project Management Tool

Nobody likes bad surprises, clear and frequent project communication will save you from surprising your customer or senior project management.

Even today most people rely on emails for day to day communication. But if you are sending emails to stakeholders by yourself, then you are certainly not doing it in the best way, you are spending time on things which are best handled and automated by project management tool. A project management software is indispensable to automate project communication. Any change in project schedule, issue assignment, new risk in register, comments to tasks, issues, risks, project meetings, task due date reminder, project status change notification, etc. will be automatically communicated by a project management system and thereby leaving no manual error for communication gap or manual error in informing project team members, project sponsors or senior management or even customer.

Kick-off project

Now almost everything looks ready on a paper, it is a time for a project team to jump-in and start working on minute level tasks. As mentioned earlier, every team member, vendor, customer should be informed and made aware of clear expectations from them i.e.

• When a specific task is supposed to start,
• Who will do it,
• When it should be completed
• What information should be updated (timesheet, expenses, document, and deliverable)?

It is then become the work to be done on the ground. As team members start working on it, project manager and project leaders can play a role of facilitator, guide/coach so that there is a productive and positive environment for project team.

5. Monitor & Control

As the project is kicked-off and project team has started working on project deliverable, as project manager you need to track project progress, communicate it to senior project managers, customers as appropriate. In order to monitor and control project

• You will have to collect progress updates, and check project is not going off-the-track
• Adhere to the project schedule, cost and keep watching project baseline
• Follow the mantra Get Things done, no matter what are obstacles
• Check project deliverable for quality
• Involve project sponsors, customers and end-users informed
• Take a regular feedback from team, customers and end users
• Manage change requests, issues and risks judiciously; as these are inevitable but if not managed well can take project off the track

6. Deliver, close and Review

When you will deliver project artifacts, meet milestone ; you would like your project customers to see the benefits. You would like customer to actually make use of it. Hence you will have to see

• Project deliverable are working for customer
• Address any issue, gaps
• Work with customer to identify trainer or champion
• Train the trainer
• Run a pilot, make it successful and enable customer to market it inside and outside customer’s organization

To get customer confirm successful project deliverable, you can schedule a pre-planned review meeting to get a formal agreement, seek feedback, identify positives and negatives of the whole exercise of delivering projects - project review. Thereafter, you should also conduct an internal review of the project to identify mistakes made, learning thereof and best way to move forward.

Successful project delivery is not a rocket science. But it is perceived to be complicated and demanding process and if these perceptions are not clarified, it induces errors, risks and makes project go off-track, overrun cost, deliver sub-standard outcome. Though it can be complicated and demanding processes, it is not conquerable. As per industry reports, there is still large percentage of project which are delivered successfully (on time, within budget, of desired quality). Following closing points will help you in succeeding project delivery.

• Get clear project requirement, have clear understanding of project requirements
• Have an eye for detailing : be it requirements, tasks, issues, risks or communications
• Ensure team members have enough information to perform tasks, make them accountable
• Stick to project schedule, yet things can go wrong with project so deliberately have buffer while creating project schedule
• Review project progress, initiate corrective actions quickly: stop project from failing
• Keep key stakeholders informed, seek buy-in wherever, whenever necessary
• Articulate key learning before closing project and utilize these learning aptly for future projects.