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,...

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…