Managing Quality Safety and Individual Performance in Healthcare

With the ever-changing health care sector, reimbursement has increasingly been tied to care quality and health care outcomes. The Centers for Medicare and Medicaid Services (CMS) have particularly been changing the way hospitals are reimbursed, with hospitals that deliver high quality care and report better health outcomes getting higher reimbursements than those that perform poorly. This has led to increasing prominence of the pay-for-performance approach. Under this approach, hospitals that report greater patient satisfaction, reduced error rates, lower readmission rates, and higher recovery rates for chronic illness get higher reimbursements than their poorly-performing counterparts. The implication is that health care organizations must pay greater attention to performance, especially in terms of quality, safety, and individual performance. Measurement and models used in the commercial world for these three aspects are considerably relevant to the health care sector. This paper discusses the usefulness of the total quality management (TQM) model, the Organization for Economic Cooperation and Development (OECD) Safety Performance Management Framework, and the balanced scorecard in the health care sector.

TQM is a management philosophy that advocates for organization-wide and continuous improvement of an organization's products and processes. The philosophy espouses five major principles: customer focus, management commitment, employee empowerment, continuous improvement, and evidence-based decision making (Kaynak & Rogers, 2013). The element of customer-focus means that every decision an organization makes and process it undertakes is geared towards creating value for the customer. From strategic planning and personnel management to product decisions, the organization places the customer above everything else. Management commitment is about the management of the organization mobilizing and providing the necessary resources as well as creating and maintaining a culture of quality improvement. Indeed, a culture of quality improvement is an important element of quality management. The organization continuously measures quality, builds on successes, and improves on weaknesses. Ongoing measurement of quality means that the organization makes every decision based on authentic data as opposed to intuition. Finally, the element of employee empowerment means that employees are involved in decision making and motivated properly.

With its origin in the Japanese manufacturing industry in the 1960s, TQM has over the years found relevance in other industries and sectors. Organizations, large and small, and across the public and private sectors, have increasingly embraced TQM in an attempt to improve their products, services, and/or processes. One of the contexts where TQM has become ever more relevant is healthcare. Customer focus is one of the major concepts of TQM. In the health care sector, quality care is a vital driver of patient satisfaction. This explains why the notion of patient-centered care has gained immense popularity in the health care sector. Another aspect of TQM is fact-based decision making. Evidence-based care is integral for health care effectiveness and efficiency, further substantiating the relevance of TQM to the health care sector. The usefulness of TQM in health care further stems from the concept of employee empowerment. Issues such as understaffing, job dissatisfaction, overstretched work schedules, and employee turnover remain major concerns in the health care sector, meaning deficiencies in employee empowerment. Without addressing these issues, achieving the desired health outcomes can be quite difficult.

In practice, TQM has indeed been applied in the health care sector, and the outcomes have been quite impressive. TQM has been effective in improving patient satisfaction, reducing medical errors, shortening wait times, promoting patient-centeredness, improving productivity, as well as fostering evidence-based practice, continuous quality improvement, and interdisciplinary teamwork (Balasubramanian, 2016). Nonetheless, the implementation of TQM in the health care sector has its fair share of challenges, largely due to resource constraints and lack of proper understanding of the philosophy and specifically how it applies to the sector (Balasubramanian, 2016).

Workplace safety is an important aspect of management framework. Creating and maintaining a workplace that is secure for everyone within the organization can prevent the loss of property, injuries, loss of productivity, morbidities, mortalities, legal claims, and associated costs. One widely used tool for safety performance is the OECD Safety Performance Management Framework. Business enterprises, public sector organizations, and communities can utilize the model to ensure health and safety at the workplace. The model involves specifying the acceptable level of safety performance, gathering data, evaluating performance against the specified performance level, and taking remedial action to achieve the desired performance level (Janicak, 2010).

Though the OECD framework was originally developed for business enterprises, it can be applied to the health care sector. The health care environment presents numerous risks to both patients and workers. Common patient safety concerns revolve around issues such as medical errors, slippery floors, air quality, healthcare associated infections (HAIs), food and poisoning. For workers, major safety concerns include HAIs, hazardous office equipment, exposure to chemicals, as well as injuries caused by patients, manual lifting, and medical equipment such as needles. As per the OECD framework, the first step would to be to set measurable safety performance goals and objectives (Janicak, 2010). Setting these goals and objectives requires collecting data about the current status of safety performance. The data in this case would be related to staff hygiene and the incidence of medical errors, HAIs, workplace injuries, and falls, for instance. Once data is collected, performance indicators are established and actions undertaken to improve safety performance deficiencies (Janicak, 2010). For example, actions may include introducing new staff hygiene protocols, proper walking surfaces, and procuring protective equipment.

The OECD framework can be an effective tool for improving safety performance in the health care sector. Indeed, safety issues cost health care organizations millions or billions of dollars every year in lost work days, treatment costs, compensation claims, and loss of revenue. By adopting the framework, therefore, health care organizations can benefit immensely. They would improve patient and worker safety, consequently enhancing patient satisfaction and ratings.

Individual input is critical to the achievement of quality, underscoring the need for monitoring individual performance. One tool often used to measure individual performance is the balanced scorecard (Niven, 2006). This tool is employed by managers to monitor how employees execute tasks assigned to them and the outcomes arising from the execution of those tasks. Quantitative information such as sale targets and performance standards specified for every position determine the engagement of an employee towards those targets and standards. Organizations in diverse industries and sectors have adopted the balanced scorecard approach to drive customer satisfaction, enhance internal processes, accelerate innovation, and boost financial performance.

More specifically, the balanced scorecard tool has increasingly gained popularity within the healthcare context (Inamdar, Kaplan & Bower, 2002). Delivering effective, efficient, timely, affordable, and safe care is not a straightforward undertaking. It requires a collective effort of nurses, doctors, physicians, pharmacists, and technicians with the right set of skills and abilities. In other words, the performance of healthcare workers must be outstanding if health care organizations are to provide evidence-based care, prevent or minimize medical errors, increase patient satisfaction, and thereby enhance overall organizational productivity. The balanced scorecard provides an ideal tool for measuring and monitoring employee performance. The tool can be used to define performance objectives and standards for each employee. Performance outcomes would then inform reward, compensation, and other personnel management decisions.

Tying remuneration to performance can have important implications for individual productivity. When employees understand that their compensation and promotion is subject to attaining a certain level of performance, they are likely to be more productive (Niven, 2006). Improved individual productivity would positively affect organizational productivity. The fundamental idea behind the balanced scorecard is focus on results. In other words, the organization pays attention to metrics that matter to the organization. Within the context of health care, such metrics may include patient satisfaction levels, medical error rates, costs, incidence of HAIs, waiting times, length of hospital stay, readmission rates, and emergency care effectiveness. Achieving these metrics requires the input of nurses, doctors, and other healthcare workers, underscoring the significance of exceptional employee performance. The balanced scorecard can be used to measure and monitor employees' effectiveness in achieving these outcomes. The balanced scorecard, that measures all such factors, can be an effective tool for measuring and monitoring individual performance in the health care sector.