Experiences on Performance Management System in a Private Hospital Setting: TPORs of a Consultant-Adviser

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Lecture given on April 2, 2014 - PSQUA - Performance Management System in the Hospital

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Experiences on Performance Management System in a Private Hospital Setting: TPORs of a Consultant-Adviser

  1. 1. Experiences in Performance 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
  2. 2. Experiences in Performance Management System in a Private Hospital Setting: TPORs of a Consultant-Adviser Define •Context •Limit of Scope
  3. 3. Experiences in Performance Management System in a Private Hospital Setting: TPORs of a Consultant-Adviser Experience • experience of a hospital – PMS • my personal experiences – consultant-adviser on PMS
  4. 4. Experiences in Performance Management System in a Private Hospital Setting: TPORs of a Consultant-Adviser Experience • experience of a hospital – PMS • my personal experiences • Thoughts, Perceptions, Opinions, and Recommendations (TPORs) – consultant-adviser on PMS of 2 private hospitals
  5. 5. Experiences in Performance Management System in a Private Hospital Setting: TPORs of a Consultant-Adviser 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
  6. 6. Experiences in Performance Management System in a Private Hospital Setting: TPORs of a 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
  7. 7. Experiences in Performance Management System in a Private Hospital Setting: TPORs of a Consultant-Adviser Define •Context •Limit of Scope
  8. 8. Experiences in Performance Management System in a Private Hospital Setting: TPORs of a Consultant-Adviser 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
  9. 9. TPOR1: Journey towards performance excellence of MDH and CMZ
  10. 10. TPOR1: Journey towards performance excellence of MDH and CMZ
  11. 11. TPOR1: Journey towards performance excellence of MDH and CMZ
  12. 12. TPOR1: Journey towards performance excellence of MDH and CMZ Just look for and focus on the similarities!
  13. 13. TPOR1: Journey towards performance excellence of MDH and CMZ Just look for and focus on the similarities! • Strategic Planning • Balanced Scorecard • Baldrige / PQA Criteria for Performance Excellence • PhilHealth Benchbook
  14. 14. TPOR1: Journey towards performance excellence of MDH and CMZ
  15. 15. TPOR1: Journey towards performance excellence of MDH and CMZ 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!
  16. 16. 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)
  17. 17. 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 GOAL (short-/long-term)
  18. 18. 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
  19. 19. TPOR1: Journey towards performance excellence of MDH and CMZ 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
  20. 20. TPOR1: Journey towards performance excellence of MDH and CMZ “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
  21. 21. TPOR1: Journey towards performance excellence of MDH and CMZ 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
  22. 22. TPOR1: Journey towards performance excellence of MDH and CMZ With at least 25 documented best practices distributed as follows: 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
  23. 23. TPOR1: Journey towards performance excellence of MDH and CMZ With at least 25 documented best practices distributed as follows: 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
  24. 24. TPOR1: Journey towards performance excellence of MDH and CMZ With at least 25 documented best practices distributed as follows: 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
  25. 25. TPOR1: Journey towards performance excellence of MDH and CMZ With at least 25 documented best practices distributed as follows: 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
  26. 26. TPOR1: Journey towards performance excellence of MDH and CMZ With at least 25 documented best practices distributed as follows: ROJ Additional Recommended Must-Have Management System or Program for Hospitals (1): • Communication Management System
  27. 27. TPOR1: Journey towards performance excellence of MDH and CMZ 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!)
  28. 28. TPOR1: Journey towards performance excellence of MDH and CMZ
  29. 29. TPOR1: Journey towards performance excellence of MDH and CMZ 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)
  30. 30. TPOR1: Journey towards performance excellence of MDH and CMZ TPOR1.3 Going for formal accreditation - depends on your need and situation! Need – to satisfy requirement of corporate accounts – go for accreditation! Need – to satisfy expectations of the community – go for accreditation!
  31. 31. TPOR1: Journey towards performance excellence of MDH and CMZ TPOR1.3 Going for formal accreditation - depends on your need and situation! Situation – to be with the trend of having an international accreditation (not to be left out – strong community expectation) – go for accreditation!
  32. 32. TPOR1: Journey towards performance excellence of MDH and CMZ TPOR1.3 Going for formal accreditation - depends on your need and situation! Situation – want to fast-track improvement of quality and safety of operations and services with accreditation – go for accreditation (assessment, training, improvement, evaluation)!
  33. 33. 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 Performance Excellence •Business Development •Efficiency •Learning
  34. 34. 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 Performance Excellence Increase in utilization of services Increase in corporate accounts and patient-clients
  35. 35. TPOR2: Tools for evaluation of performance management system (whole hospital)
  36. 36. 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.
  37. 37. 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)
  38. 38. 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 GOAL (short-/long-term)
  39. 39. 3 Macro-indicators of Excellent Hospital: • Contributing to achievement of targeted health outcomes in its catchment community • Providing value-based health care services • Sustainable while providing excellent services GOAL (short-/long-term) Formal - Objective - Stringent Assessment (Internal & External)
  40. 40. 3 Macro-indicators of Excellent Hospital: • Contributing to achievement of targeted health outcomes in its catchment community • Providing value-based health care services • Sustainable while providing excellent services GOAL (short-/long-term) Formal - Objective - Stringent Assessment (Internal & External) Internal Auditors with Checklists- Rating Scales External Auditors PQA PhilHealth DOH Others (Int’l)
  41. 41. 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 GOAL (short-/long-term) Formal - Objective - Stringent Assessment (Internal & External) Internal Auditors with Checklists- Rating Scales External Auditors PQA PhilHealth DOH Others (Int’l)
  42. 42. TPOR2: Tools for evaluation of performance management system (whole hospital) 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.
  43. 43. 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 Performance Excellence Use integrated checklists
  44. 44. A – Approach D – Deployment L – Learning I – Integration L – Level T – Trend C – Comparison I – Integration
  45. 45. 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.
  46. 46. 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.
  47. 47. 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
  48. 48. 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.
  49. 49. BSC Framework Translate to Function Level Scorecards (Corporate, Unit, Individual) 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)
  50. 50. BSC Framework Translate to Function Level Scorecards (Corporate, Unit, Individual) Tabular Presentation of the Main BSC (Scorecard with identification of “Initiatives”) Perspective Goals (Strategic Intent – General Objectives) Tactical Objectives (Specific Objectives – Key Result Areas) Performance Measures: Outcome /Target (Key Performance Indicators) Initiatives (Programs, Projects, Tasks, Activities)
  51. 51. BSC Framework Translate to Function Level Scorecards (Corporate, Unit, Individual) 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) Performance Measures: Outcome /Target (Key Performance Indicators) Status (Q1/Q2/Q3/Q4) Data: Analysis: Variance - achieved / NOTachieved Resolutions for negative variance:
  52. 52. What is a sample of a BSC of a hospital unit? PERSPE CTIVE Key Result Areas/ Goals Tactical Objective Measures Action Plans Key Performance Indicators CUSTOM ER Custom er 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
  53. 53. 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 engagem ent 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.
  54. 54. BSC and Baldrige /PQA HCC BSC’s perspectives Financial Customer Process Learning and Growth Results Baldrige / PQA HCC Leadership Strategic Planning Customer-Focused Process Management Workforce-Focused Measurements, Analysis, Knowledge Management Results SET of KEY FACTORS / DRIVERS FOR ORGANIZATIONAL. PERFORMANCE
  55. 55. 2013-2015 Strategic Objectives STRATEGIC OBJECTIVES (2013-2015) PERSPECTIVES OBJECTIVES Governance, 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 delight Process 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 organization CSR 10 CSR program with tangible social impact
  56. 56. TPOR3: Starting and continuing journey towards performance excellence for private hospitals
  57. 57. TPOR3: Starting and continuing journey towards performance excellence for private hospitals 2 goals of PMS • To promote performance excellence in the hospital. • To evaluate whether the hospital has achieved performance excellence.
  58. 58. TPOR3: Starting and continuing journey towards performance excellence for private hospitals TPOR3.1 Key drivers for successful journey •Strategic planning •Commitment •Perseverance
  59. 59. TPOR3: Starting and continuing journey towards performance excellence for private hospitals
  60. 60. 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 Senior Management Personnel
  61. 61. TPOR1: Journey towards performance excellence of MDH and CMZ
  62. 62. TPOR1: Journey towards performance excellence of MDH and CMZ Just look for and focus on the similarities! • Strategic Planning • Balanced Scorecard • Baldrige / PQA Criteria for Performance Excellence • PhilHealth Benchbook
  63. 63. Strategic Planning Conferences
  64. 64. Strategic Planning Conferences
  65. 65. Strategic Planning Conferences
  66. 66. Strategic Planning Conferences
  67. 67. Strategic Planning Conferences
  68. 68. Strategic Planning Conferences
  69. 69. TPOR3: Starting and continuing journey towards performance excellence for private 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
  70. 70. TPOR3: Starting and continuing journey towards performance excellence for private 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
  71. 71. TPOR1: Journey towards performance excellence of MDH and CMZ
  72. 72. Experiences in Performance 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 For queries and feedback: 0918-804-03-04 rjoson2001@yahoo.com

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