Among RACs, MACs, MICs, and Z-PIC concerns, along with new survey protocols, new CY 2012 regulations, the advent of 5010, Accountable Care Organizations, and looming ICD-10 CM, what tools can a leader utilize to help mitigate risk? One such tool is the agency Performance Improvement Plan.

Some agencies treat these plans as necessary evils while others embrace the strength of the process and its ability to reduce risk. Recently, we have been asked about initiating a workable, useable, beneficial program.

The Purpose

The purpose of a Performance Improvement Program, Plan, or Process (PIP) is to outline a process that needs improvement. The team that will review the improvement process needs to baseline the present processes seeking efficiencies or other outcomes. This Performance Improvement Plan should support the organization Mission and its Corporate Plan.

Quality Concepts

·            The PIP is established to benefit the organization. It should address an issue or issues that require improvement.

·            The entire organizational team chosen for this Program should be actively included in all phases.

·            Focus on patient or operational outcomes, but try not to take on too many projects at once.

Suggested Patient Care Functions

·            Rights and Responsibilities

·            Ethics and Compliance

·            Assessment and OASIS

·            Adequate Documentation of Care

·            Patient Education and Re-Teaching

·            Continuum and Care Transitions

Agency/Organizational Operations

·            Leadership

·            Ethics and Corporate Compliance

·            HIPAA Privacy and Security

·            Management of Resources

·            Appropriate and Current Policies and Procedures

·            Infection Control

·            Supportive Environment Conducive to Optimum Employee Performance

·            Safety

·            Fiscal Soundness

Responsibility

The Board of Directors approves the Agency Administrator position and the Performance Improvement Program supports with adequate resources and financial support. The Agency Administrator oversees the program or appoints a delegate and assures the Program is continuous, is providing meaningful process monitoring and improvement. Annually, at minimum, results are reported to the BOD.

The Process and the Design

Processes should approach an issue that requires improvement. Processes are designed to be in alignment with the agency mission and strategic plan. They should also be based on evidenced based processes or best practices. They may be benchmarked against other organizations.

Measurement

There needs to be a sound way to collect data. The data will be collected, measured, and analyzed. The goal is to decide the statistical control methods, agree upon how the data will be collected, and determine how it will be measured. Is the agency seeking to evaluate a present process? Design a new process? Assess Performance? Identify areas of Improvement?

Over what period of time will you collect data? Will you evaluate your methods of collection and tools of measurement? Will you evaluate unusual occurrences? Will you keep drilling down until you locate the root cause of the issue?

Assess

The agency should be assessing for improved efficient processes. Will you analyze and discuss new processes so the best process is chosen. Who will be involved? How will they be involved? Will you reevaluate the new processes? When?

Improvement

Buy- in comes with improvement. Be certain that the new processes are truly an improvement. For each issue resolved or impacted, be certain there are clear recommended actions with a responsible party named who will monitor the new processes. Have a timeframe delineated for evaluation as well as evaluation of the “improvement.” Be certain everyone knows the expected outcome. Survey results and identify satisfaction levels.

Buy- In

Buy- in can drive motivation and success. It is important that employees see results for the extra work of the PIP. This process can be applied after Organization Risk Assessments. It teaches problem resolution and hones skill sets. It encourages team building and drives results in an organized fashion. Organizational learning is essential for success. This is one simple way of achieving positive results while reinforcing respect and value for each employee.

Recently, I was speaking with an agency leader, whose firm is known for its Performance Improvement Projects. She has two teams. The key is fun as they attack real problems. Each team identifies projects that impact improved care, outcomes, impact employee morale, or directly impact costs. They present two projects each to the BOD or the Professional Advisory Committee. This allows many to be involved,

Each team defends their chosen project as to benefits derived. They defend the value of the project. Each year the BOD presents a cash bonus and dinner to the team with the best project over the past 12 months. The Leader stated employees via to be on the committees and the PIP are becoming more creative. They are “attacking real problems and finding real solutions we all can live with.” Employees see they are impacting positively on their agency; its care and reputation. They also see the value of group dynamics, peer pressure, and improved performance.

For 2012, the employees have proposed a third team. Leadership is thrilled at that proposal and the fact that she frequently hears, “That should be referred to the PIP, because we can do better.”