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Don’t underestimate performance measures’ power
By Patrice Spath, ART
Brown-Spath & Associates
Forest Grove, OR
"How’s it going?" How many times have you been asked that question about case management at your facility? Many of us answer the question in terms of what’s happening with patients today. But can you answer that question for your overall program?
The case management department must have a performance measurement system that gives managers and staff the feedback they need to guide program decisions and future patient care activities. Without it, the facility and its staff are flying blind. Just knowing how you are doing today is important, but even more important is knowing what needs to be done to improve case management services in the future.
A performance measure is nothing more than a tool you can use to assess your performance in a particular area. Measurement is at the heart of a good, customer-focused case management system. Clearly, case managers need to measure the effect of their efforts on the facility’s financial performance. However, most case management departments today find that they also need to assess several aspects of the process itself. The case management measurement system should cover at least the following areas:
• Customers. Measure case management performance against customer requirements. This requires that you ask internal and external customers what they want from the case managers. Once the customers’ expectations are clear, measures can be developed to evaluate how well case managers are meeting these requirements. Measures of customer satisfaction are an important element of the case management measurement system.
• Performance of work processes. Case managers have specific tasks that must be performed in the course of doing their jobs. Performance measures can be used to evaluate timely completion of these tasks. Service quality can also be measured: Are case managers’ notes sufficiently detailed to ensure effective communication with other caregivers? Cost performance, such as productivity and budget vs. expenditures, also can be measured.
• Employee satisfaction. Measures of staff morale, satisfaction with working conditions, and staff turnover can provide important information about the case management department.
Once you’ve chosen a comprehensive set of measures that relate to each of these aspects of the case management department, ask yourself, "Will these measures inspire case managers to do the right things?" In other words, will the measures help the case management department achieve the best results, both for today and for tomorrow?
Do not underestimate the power of your performance measures. Staff will take action to achieve what you, by the measure, have told them is important. In some cases, the action they take may surprise you. It may not be at all what you had intended. For example, by measuring the completeness of patient transfer forms, you are telling staff to be sure all required areas are filled in. The case manager’s attention may be inadvertently diverted to ensuring all boxes are checked off rather than ensuring that the most pertinent information is recorded on the form.
Developing case management performance measures may seem easy at first, but many departments have fallen into common traps that can be avoided. Following are two of the most common:
— Using so many different performance measures that staff are overwhelmed with data collection and the department experiences excessive overhead costs. Be sure to only collect data about relevant case management activities. This simply means don’t measure things that are not important.
— Developing performance measures that are complex and difficult to explain to others. If your performance measures require a lot of explanation and definition, then collecting data and translating those data into actions becomes more difficult. When measures are easy to understand, it is clear when you chart your performance over time which direction is "good" and which direction is "bad." Also, simple measures have a stronger impact on the process and the people who are involved.
The best performance measures are those that are specific and targeted to the topic you want to know more about. For example, if you want to know how satisfied your customers are with case management services, a good measure would be direct feedback from customers. A poorer measure would be the number of customer complaints. While complaints may be something you can count, they are an indirect measure of customer satisfaction. As such, the results can be misleading.
Steps for selecting measures
To select performance measures for your case management department, start by identifying your customers and the outputs of your processes. Customers may include end-users of case management services (patients, other providers, payers) and process users (physicians, staff nurses, therapists). It may help to draw a flow chart to identify all the customers of case management.
Next, determine what each of the customer groups needs from case management. It is useful to meet with important customers, such as physicians, to discuss what they hope to gain from case management services and what their requirements are as customers of case management. Not only do these meetings provide you with valuable information for your performance measurement efforts; the discussions also can help in gaining customer buy-in.
You’ll also begin to understand which of the many case management tasks are most important to customers. These key activities should be the focus of your process measures. For example, if patient families tell you that early involvement in discharge decisions is important to them, then develop a performance measure that can be used to evaluate how quickly families are contacted to discuss discharge plans. Your customers also may make good suggestions about how to measure how well you are meeting their needs.
Next, determine what you’ll measure. Remem ber to focus case management performance measures on at least three areas: customers, work processes, and employee satisfaction. During this step, you may find that brainstorming is a particularly effective tool for identifying measures. Then, develop a data collection strategy by answer ing the following questions for each measure:
- What data elements are needed to create this measure?
- Are the data elements currently available? Where? Does a new data collection instrument need to be developed?
- Who is responsible for gathering the data and creating periodic reports of the results?
- What individual or group is responsible for evaluating the performance data and selecting appropriate actions?
When you have completed determining what to measure in the case management department, ask yourself:
- Do the performance measures make sense?
- Will the data provide a comprehensive picture of the department’s performance? For example, have you adequately covered the needs of customers, important work processes and employees’ attitudes?
- Do the measures reinforce desired behaviors? Will staff be working toward the right goals?
Once you are satisfied with the performance measures you’ve selected for the case management department, have them in place, and are gathering data, you can begin tracking your progress. Ideally, you’ll use run charts to show how you’re doing. A run chart is a graph with time along the "x" axis and your performance measurement data on the "y" axis. As you gather data over time and add it to the charts, you will begin to see a trend over time. The data will allow case managers and the facility’s leaders to see how well the case management department is meeting the needs and requirements of its customers. Armed with this type of data, the next time someone asks, "How’s it going?" you’ll have some very powerful and meaningful results to share with them.