Analyzing Principles of Organizational Performance Management

Organizational Performance Management Performance Data Scorecard: Scorecard Category Metric Employee engagement (HIV Testing and Diagnosis) % of patients diagnosed on site % of patients diagnosed in other medical facilities % of patients diagnosed via home-based test % of patients diagnosed in mobile testing unit % of couples whose partners have been HIV tested and are aware of results Performance (Linkage to Care) Median days from HIV diagnosis to referral for ART or pre-ART care % of patients ART ineligible at baseline who receive a follow-up CD4 count in 6?months Median days from clinic enrollment to ART eligibility % of patients who are enrolled in HIV clinic, received CD4 count & results within 3?months of HIV diagnosis % of patients with CD4 count? 200 cells/uL, &? 350 cells/uL at presentation Retention in Care % adults & children known to be on treatment 12 months after ART initiation % of adults & children known to be alive & on treatment 12 months after ART initiation Patient Safety (Clinical Outcomes) % of patients on ART with undetectable viral load at 12?months % of patients on ART requiring switch to second-line therapy for treatment failure at 12 and 24?months % of patients (ART-eligible on and off ART) who died 12?months after enrollment Quality (Patient Reported Outcomes) patient-reported health status 6 and 12?months after clinic enrollment 1.

The patient population The chosen group for this paper is individuals diagnosed with HIV (i.e., Human Immunodeficiency Virus) -- a relatively new infection detected about 30 years ago. The virus spread everywhere within a short period of time, and a number of nations identified it as an important public health issue. A multipronged strategy is needed to mitigate HIV's impact, since it influences various aspects of life. Research scholars from diverse disciplines including clinical, basic, and social sciences also give the virus considerable focus (Shete, 2013). 2.

Outcome measure related to the population identified for each of the following indicators: Performance Linkage to care Following diagnosis, persons infected with HIV have to be linked successfully to suitable treatment programs. Scarce data exists with regard to care linkage in nations possessing limited resources. Researches performed on South African countries indicate that between 50 and 70% of HIV-positive patients joined up clinical care between 3 and 9 months of their diagnosis; this represents the greatest lost opportunity of engaging infected individuals along continuum of HIV care.

In a systematic study of Sub-Saharan African HIV treatment interventions, an average of 59% of HIV-positive patients were found to successfully link to clinical staging or CD4 testing (Rosen & Fox, 2011). Elements like multiple care at sites (for instance, for tuberculosis treatment, HIV testing, and CD4 testing), long appointment wait times and test result receipt, as well as medication costs and transportation barriers are barriers to successful linkage.

For determining program performance in terms of HIV care linkage, 5 process measures that measure stage 1 linkage (from receiving positive testing for HIV to receiving clinical staging or CD4 count result and referring to pre-ART or ART (antiretroviral therapy) care) as well as stage 2 linkage (from referring to pre-ART patient care to eligibility for ART) are recommended. Best care linkage measurements necessitate data merging from HIV treatment and testing centers, seldom available in areas that have limited resources.

Quality Patient-reported outcomes: health-related quality of life and patient satisfaction The IOM (Institute of Medicine) provides the following definition for patient-focused care (or care that is receptive and respectful to patients): patient-focused health care is one among the six objectives for quality healthcare delivery improvement (Institute of Medicine, 2001). Self-reported patient outcomes like service satisfaction and QOL (quality of life) are two examples of outcome measures characterizing patient-focused care.

HR-QOL or health-related QOL has gained increasing recognition as a key outcome, especially in light of HIV's transformation into a long-term, chronic illness in the era of effective antiretroviral therapy. HR-QOL constitutes a multifaceted measure, which covers a number of dimensions like physical function, social role performance, symptoms, emotional status, individual feelings with regard to health, and cognitive functioning.

Numerous research works have outlined a series of challenges and barriers for underprivileged patients who seek medical attention in healthcare settings with limited resources and around the world, including difficulty getting access to care, high indirect and direct care costs, poor patient treatment by healthcare staff, and lengthy wait times. All these challenges are capable of impacting patient satisfaction, which is described as the degree to which the healthcare experiences of a patient match his/her expectations.

Relatively little emphasis has been given to HIV patient satisfaction within resource-limited HIV care settings (Ahonkhai, Bassett, Ferris, & Freedberg, 2012). Patient safety Clinical outcomes Ideally, HIV-positive individuals will continue to be in care, on ART, with controlled illness. However, patients in medical settings that have scant resources and initiated on ART are three-and-a-half times more prone to succumb to the disease than patients getting treated in nations that re rich in resources.

This mortality risk is greatest in the initial months following ART initiation; the increased risk has been ascribed to patients' presentation to medical care with progressive illness. In spite of increased risks of death early on into treatment, patients from resource-rich and resource-limited settings seem to achieve similar virologic and immunologic benefit from ART. Roughly 70% of patients on therapy attain virologic suppression six-months into treatment.

The World Health Organization has offered guidelines for failure of treatment on the basis of CD4 count patient response; however, discordant immunologic and virologic responses to ART can ensue in as many as 20 to 30% of patients; also, viral load testing/monitoring isn't available extensively in a number of resource-limited places. Patients who fail therapy might need rigorous adherence programs, or might need to switch to costlier 2nd and 3rd line treatment programs (Ahonkhai, Bassett, Ferris, & Freedberg, 2012).

An HIV program indicator scorecard must eventually incorporate metrics that reflect patient-reported and clinical outcomes. These have to be key measures in themselves, or possess known links to clinical outcomes, like retention in clinical care, treatment failure, mortality (prior as well as subsequent to ART initiation), and switch to 2nd-line therapy.

Employee engagement Involvement and motivations Considering the potential importance of involvement of healthcare personnel in retention and performance, as well as the lack of research works for HRH (Human Resource for Health) crisis nations, additional research is necessary for examining the link between performance, engagement, and retention, building on the preliminary evaluations of healthcare worker engagement in the endeavor to improve healthcare, and identifying how this information can apply to the area of HRH planning, management, and development.

If, as established by research on high-income nations, increased engagement, indeed improves healthcare personnel retention and performance, the existence of tools for enabling evaluation of healthcare worker involvement, which adequately take into account appropriate engagement characteristics and factors impacting engagement, is vital. Employee involvement and motivation will be employed as a measure for gauging outcomes (Kundy & Wuliji, 2012). B.

Processes that drive each outcome measure Linkage to care Median number of days from diagnosis of HIV infection in patients to their referral for pre-ART or ART care Percentage of ART-ineligible patients at baseline receiving follow-up testing of CD4 count within a period of six months Median number of days from patients' enrollment in care to eligibility for ART Percentage of patients enrolled in clinics for HIV care, who have been tested for CD4 count and received test results within a period of three-months of being diagnosed with HIV.

Patient-reported outcomes: patient satisfaction and health-related QOL Patients' self-reported health status at 6 months and 1 year after enrollment in clinics Clinical outcomes Percentage of patients receiving ART, showing undetectable testing for viral load after 12 months Percentage of patients being administered ART, who need to move over to 2nd-line HIV therapy for ARV treatment failure at twelve and twenty-four months Percentage of patients (i.e., ART-eligible patients off and on ART) who succumbed to HIV 12 months into enrollment in clinical care (Ahonkhai, Bassett, Ferris, & Freedberg, 2012).

Employee engagement Percentage of employees showing performance and engagement Additional indicator that would be important for a nurse leader to monitor on a regular basis to drive outcomes as part of the performance data scorecard Greater percentage of individuals remaining on ART after a period of 6 months, 1 year, and 2 years With expansion and maturity of large-scale ART programs for HIV / AIDS patients, focus has moved from a resolute concentration on access to and initiation of treatment, to the wider group of long-run challenges associated with sustaining a complex and extensive public health effort.

One concern among these is: patient retention in care settings. ART represents a lifetime commitment, which necessitates that patients conform diligently to the everyday medicine dosing schedules, whilst frequently visiting the clinic for care. Individuals who discontinue their treatment face high illness and mortality risks, owing to AIDS-related health conditions.

Thus, numerous studies have aimed at quantifying and ascertaining status of those patients who don't show up for follow-up, many of whom are from South Africa, for gaining a better understanding of the reasons for patients defaulting from treatment interventions, and for suggesting actionable interventions for retention improvement (Miller, Ketlhapile, Rybasack-Smith, & Rosen, 2010). C. Advantages of the performance data scorecard Overcoming Challenges Balanced scorecards aid organizations in overcoming three main challenges, namely, performance measurement, strategy implementation, and growth in intangible assets.

The conventional financial performance measures fail to reflect the present-day healthcare business environment, as well as fail to inspire long-term thinking. Further, intangible assets generate roughly three-quarters of organizational value. A balanced scorecard will offer metrics to ensure effective utilization of the aforementioned assets. Effective strategy implementation constitutes a key challenge for every organization. Vision, management, people, and resource barriers are capable of thwarting strategy. Components A balanced scorecard for the healthcare organization will measure organizational performance from 4 interrelated angles: financial, growth and learning, customer, and internal business processes.

With advances in personnel learning, an organization's internal business processes also improve. This gives rise to better services and products. Hence, increased market share and customer satisfaction are attained, which get reflected in the financial measures of the organization. New Management Processes The healthcare balanced scorecard aids in initiating 4 management processes which link long-term goals to short-term programs. The foremost process translates organizational strategy and vision into operational stages. The next step communicates these operational stages' terms to different departments.

Business planning constitutes the third management process; it assists managers in selecting the best options to realize organizational objectives. Lastly, learning and feedback aid in adapting to evolving circumstances. This helps ensure the organization's long-term survival (Sarkissian, n.d.). Constant feedback as well as learning must be espoused, as these facilitate quick adjustments to changes in regulation and in the marketplace (Inamdar, 2002). D.

Current trends in healthcare that are related specifically to employee engagement Using CSR (Corporate Social Responsibility) for personnel engagement In the present day, CSR is employed in the form of a "tool" for recruiting, engaging, and retaining personnel (in addition to the social responsibility concerns it addresses mandatorily), as a growing number of youth in America (and all over the world) aspire to gain "something more" out of their jobs.

Research proves that about 75% of Millennials (born from 1978 to 1998) wish to be employed in an organization that takes an interest in, or feels concerned about, its contributions to and impact on society. Healthcare institutions attempt several different things for engaging personnel through CSR.

For instance, a growth has been witnessed in traditional corporate volunteerism (e.g., supporting personnel mentoring schoolchildren; caring for the disadvantaged, homeless, or elderly; taking part in emergency management/disaster relief efforts; building habitat-for-humanity houses and community playgrounds, etc.) and other engagement efforts that are more "skills-based" and require employees to apply their commercial and technical know-how for addressing societal concerns (Mirvis, 2012).

Engagement of Workforce continues to be a Major Ingredient in Quality Achievement The move towards value-based patient care increases emphasis on personnel engagement and patient satisfaction at all organizational levels. Yet, the attainment of such engagement remains a challenge. In view of the attention this topic has received over time, one would have expected it to progress further towards positive employee engagement, indicating that further prioritization is required. B. E.

Smith often provides the following recommendation to organizations, for improving workforce engagement: Cultivate a sincerely collaborative culture that perceives employees as partners, all of whom are capable of generating fresh ideas. Promote an appropriate competitive atmosphere that does not stifle, instead motivates change. Acquire leadership exposure outside of the healthcare arena to achieve fresh perspectives. Work hard and be attentive, for overcoming social and cultural norms that hinder engagement.

For instance, women account for 80% of the workforce in the healthcare sector, but just 18% of them are in leadership roles (Smith & Ricci, 2015). 1. Relationship between employee engagement and healthcare quality Hospitals that cultivate a high-performance-focused and engaging work experience improve both patient satisfaction and care quality outcomes. At a number of healthcare organizations, rife with pressure, stress, and angst linked to delivering contemporary healthcare, this number may probably be even lower. This definitely matters, as healthcare organizations' mission is serving patients, usually at rather vulnerable moments of their lives.

Therefore, the ability of delivering superior-quality, empathetic patient care is, and has always been, extremely crucial. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) and CAHPS Hospital Survey (HCAHPS) bring the subject of patient/consumer satisfaction to a position of prominence. Even the hopefully few hospitals that did not consider patient satisfaction to be an issue of high priority earlier have been doing so, of late. The reason underlying this is: engaged personnel drive patient experiences (Baird, 2014).

The healthcare sector has always prioritized improvement of patient care; however, in the present era, outcomes are directly linked to the organizational bottom line. CMS (Center for Medicare and Medicaid Services) considers patient satisfaction and quality care measures when determining how much reimbursement is to be provided to eligible healthcare providers. Patient interactions with healthcare employees can typically determine patient satisfaction measure influencing reimbursement. Additionally, these interactions may be able to convert one appointment into a steady and loyal consumer relationship with the hospital, or guarantee another one-time patient.

In other words, healthcare provider-patient relationships now determine a vast portion of healthcare organizations' financial viability. Hospitals need to find ways for improving patient care quality through patient and employee interactions; employee engagement might just represent the best means for making these improvements. A case study by HR Solutions which employed almost 29,000 healthcare worker opinion surveys showed convincing evidence that personnel engagement is directly linked to satisfaction of patients.

It was established through the survey that: 82% of engaged personnel would wish to utilize the facility they work at as healthcare professional, as opposed to merely 22% of disengaged personnel 85% of engaged personnel exhibited a sincerely caring attitude towards patients, as against only 38% of disengaged personnel. 91% of engaged personnel recognized their place of work (i.e. organization) as committed to care of patient, as opposed to just 42% of disengaged personnel (Healthcare Source, 2014). 2. Current tools in organization that adequately provide nurse leadership with data regarding employee engagement.

The application of multi-item scale balanced score may simplify survey follow-up as well as support an exhaustive statistical result analysis, particularly testing predictive theories that prove certain drivers' "net" effect on engagement. Customary social scientific practices to follow while constructing the Employee Engagement Survey scale include the following. 1) Routinely performing environment scans; 2) Incorporating engagement measurement into regular direct meetings; 3) Integrating engagement into routine staff rounding; and, 4) Employing team meetings as the venue to check in, may offer nurse leaders data pertaining to personnel engagement. E.

Plan to improve employee engagement based on the performance data scorecard Goals Increased customer satisfaction Increased productivity, service, and quality Increased sales (i.e., referrals and repeat business) Increased shareholder returns Increased profit levels Strategies Make healthcare work meaningful for employees The foremost and, possibly, most critical element in personnel engagement is individual job fit. Healthcare employers must ensure roles are meaningful, employees possess the autonomy and tools needed for success, and choose the right candidate for the right post.

Cultivate great management Management is one strategy business and human resource leaders dwell on the most. This daily, weekly, as well as monthly, activity is utilized by managers for guiding, supporting, and aligning employees. Institute an inclusive, flexible, and humane workplace Building an inclusive, flexible, and humane workplace is imperative. Create sufficient growth opportunities When a company's top performers quit, the most common remark they leave is that they saw no proper opportunity in the organization.

Establish purpose, transparency, and vision in leadership The key strategy for a healthcare organization is effective leadership. Research indicates that four leadership practices that most directly affect personnel engagement are: 1) Development and communication of a powerful sense of purpose. An organization that defines its success through stakeholders', customers', or society's viewpoint witnesses its employees coming alive (i.e. getting engaged). 2) Transparency in leadership is the second crucial aspect of leadership. 3) Leaders ought to regularly invest in employees.

Executives of high-engagement organizations allocate funds to learning, care genuinely about every employee, and regularly meet work teams and offer them feedback. 4) Research works indicate that senior executives need to concentrate constantly on inspiration (Bersin, 2015).

Evaluation The healthcare organization computes an EEI (employee engagement index), on the basis of an employee survey item subset that measures respondent engagement: Satisfaction: Personnel are posed a question along the following lines: "Considering all aspects of work, rate your current overall satisfaction with your organization." " Advocacy: Staff is posed a question with regard to whether they consider, and would recommend, their organization as a good workplace. Retention: Personnel are asked how often they consider seeking a new job (i.e. quitting their current healthcare organization.

Pride: Personnel are asked whether or not they are proud to be.