Analyze & critically discuss the following key points:
? The area of an organizational performance that is of concern and how it relates to the
organization’s strategic goals and objectives.
? The steps required to implement a process for improving this aspect of organizational
? The approach best suited to improving performance in this instance.
? The type of performance indicators or measures selected.
? Strategies for motivating and engaging stakeholder in ongoing performance improvement.
PERFORMANCE IMPROVEMENT 2
Performance improvement plans or action plans help give struggling employees get the
opportunity to succeed and at the same time make them accountable for their past performance.
The poor performance of clinicians is not smooth on the presence of it. Various reasons can be
brought forward on the reasons for poor performance. This can be whether the clinician received
the appropriate training and their knowledge of the expectations of the job. Any unforeseen
roadblocks for future achievements also facilitate performance improvement plans (Bonow, et
It is, therefore, critical for the departments of a healthcare practice to give room for an
open dialog and feedback directly from employees. This helps in the determination of the extent
to which employees are provided with the sufficient resources and tools necessary for their
success. Performance improvement can be used to address the failures that are arising to issues
related to performance and behavior. The outcome of the performance improvement plan can be
improved the performance of the health workers in Hong Kong. Also, training gaps and
recognition of skills of employees can be evaluated. Employment related issues that may result
can lead to the demotion of individual employees, transfer of some and demotion of
In Hong Kong health care practice, an employee who does not perform well to meet
expectations can be corrected by their supervisors. The performance improvement plan can be
used to replace the disciplinary processes. This helps correct workplace behaviors that affect
productivity given that any action taken earlier is better compared to waiting for the result. The
presence of employee relations staff help in consultation and providing any technical assistance
PERFORMANCE IMPROVEMENT 3
to health supervisors and other clinical employees and services. Training can also be supplied in
the course of the performance improvement plan (Ferrer, et al., 2014).
Area of organizational Improvement
People who practice medicine have a high potential in assisting patients to stop smoking.
Deficits have been found concerning the amount and type of training these people receive when
undertaking smoking cessation counseling whereby they little consider the training. This area
ought to be improved in health care facilities so as to improve the levels of service delivery in
health systems. Trials should be conducted to examine the relativity of effective Quality
improvement. The difference in educational programs of Departments of health care of Hong
Kong in teaching smoking cessation skills help in achieving this noble course of improving
Quality improvement works as a systems and processes. To make improvements, the
health care and clinical departments need to have a clear understanding of their systems and
delivery of services. Quality improvement takes into account the relationship between the
resources of the organization and the activities carried out will help achieve improved health care
quality. The service delivery in health is typically straightforward, and an example in a dental
clinic and on the other hand, a large managed care hospital requires complex systems (Eijkenaar,
et al., 2013).
The senior trained medical students and practitioners should demonstrate their efforts in
improving the performance through their intervention to reduce smoking. The educational
purposes of medical students should expose them to smoking cessation and the efforts to help
PERFORMANCE IMPROVEMENT 4
smoking patients. Specific training should be provided in order to increase the rate of success of
the nursing students. Traditional methods will not be effective and embracing teachings of that
are appropriate in nature in all levels of education will help the students achieve this noble
Focus on patients: This is another area of measuring quality improvement and the level
to which smoking cessation is effectively done. Patient’s needs ought to be met in health care,
and the society and beneficiaries of the clinical area can be that there should be systems that
affect the level of access by patients. Patients do not expect to queue for long due to slow
systems. Patients also expect to receive care from the clinics that are based on evidence. The
health practitioners can be trained so that they are well conversant with the type of treatment that
they provide as per the DOME clinical skills. Evidences on successful cessation can be used.
(Hamric, et al., 2013).
Patients also should expect safety at the premises and, therefore, need to assure them of
safety by ensuring that medical practitioners observe security in their areas of service. Safety can
be both physical and provision of quality medicines. Support for the engagement of patients in
the treatment process is critical because patients can be able to express their problems directly.
Care is communicated and coordinated with other parts or departments of the health care system.
Another measure could be to ensure cultural competence in the assessment of the literacy levels
of patients and to ensure that care is linguistically appropriate to ensure client satisfaction.
Focus on being part of the team: Quality improvement is a team process, and thus,
knowledge and skills are brought together. Differences in thoughts of individuals are combined
to obtain lasting solutions, and this approach is most useful when the process of quality
PERFORMANCE IMPROVEMENT 5
improvement is complicated, and not even one person has the clinical skills or issue at hand.
Also, it is useful when the process involves more than one discipline or work area and thus
leading to the creation of creativity so as to establish a lasting solution (Nicolay, et al., 2012).
Let us say an organization wishes to reduce smoking cessation by reducing the patient
wait time in the health care, the efforts presented by a team will help the health care facility
achieve a lasting solution to these problems. All individuals should contribute to the team to
ensure proper analysis as per the DOME clinical skills. Members bring in different perspectives
on an issue and on how to sustain the improvements. Quality improvement and the participation
of the teams highly depend on the availability of infrastructure. These can be team leadership and
procedures plus the policies of undertaking each activity (Hermann, et al., 2014).
Focus on use of data: The major activity in quality improvement of services in Healthcare
is data because it mainly describes how well the existing systems to reduce smoking are working.
It is also an indication of the outcomes of applying a new change and is useful when noting a
success in performance. The use of data helps in separating what is happening actually from
what people think. For example, the level of attendance of patients to the available number of
clinical officers. Data is useful in setting up a baseline whereby performance at that baseline is
acceptable and deemed fit. Scoring low at the first episode can be accepted with an anticipated
improvement in subsequent results. It also helps in the reduction of solutions not useful from
being placed be the supervisors.
Procedural changes can easily be monitored, and this helps make sure that the resulting
improvements can be sustained. The clinicians and nurse should be able to cope with the
improvements in helping smoking patients and give an indication if the changes affected have
PERFORMANCE IMPROVEMENT 6
shown any improvement in their service delivery. Performance can easily be compared to all the
departments, and, therefore, patients and staff satisfaction surveys can easily be conducted
(Witter, et al., 2012). Quality improvement will help achieve improved health of patients and
efficiency in managerial and clinical processes. It also helps avoid costs that are associated with
failure of processes and errors thus leading to a balance of quality in Hong Kong health care
services (Unützer, et al., 2012).
Steps to implement the process
The first step is to document the performance issues. The issue being a quality
improvement in health care, it is good to develop a format or use existing ones to ensure that
consistency of values is observed. This helps protect the clinical heads if any legal claims are
made in expectations. The performance plan will include information about the staff. These are
their skills and training received to handle patients. Also, the dates should be expected and any
performance gap should be indicated. Expected performance is described and compared with the
actual performance and the plan of action designed by the team stated clearly.
The second step is to develop an action plan in the process of quality improvement. The
quality of service provision is desired to be improved to match the DOME clinical skills and thus
need to create a plan that suits those standards. An action plan can be established by the
supervisors and request an expression of interests from employees to ensure that everyone agrees
to it. Collaborative engagement makes it easy to solve issues and thus, creating database requires
employee participation (Murray, et al., 2013). Some of the nursing and clinical tools can be
PERFORMANCE IMPROVEMENT 7
included while others can be excluded depending on the mutual decisions. The consequences of
not meeting the objectives are also set.
The third step is reviewing the performance plan in the organization. Quality
improvement in the clinical case engages the top management and the supervisors. The director
of a department should seek guidance from the senior manager or directors of health on matters
documentation of the performance plan. This will help ensure that all the parties to the quality
improvement project adhere to the requirements of the program and hence instill disciplinary
activities to lazy clinical workers. It should be specific, attainable and relevant (Jha, et al., 2012).
The fourth step is meeting with the employees and, if possible, the other stakeholders
including patients. A program might be in the process of its quality improvement, but the
patients feel that lack sufficient knowledge of how to use the service. Here, the action plan can
be modified to include specifications and proposals from the stakeholders. The nurses and
clinical officers can then sign the personal improvement plan forms.
The fifth stage involves making follow ups. Both the employees and the supervisors
should be holding meetings on designed basis to evaluate the level of improvement of the quality
of service. The meeting should include discussions concerning the objectives and any matters
arising are documented. The employees are expected to ask questions and go further to seek
guidance on a particular step, for example, the introduction of online medicine payment and the
establishment of booking systems. The nurses and clinicians are motivated towards producing
the best in quality improvement (Santiago, et al., 2014).
The last step is concluding the process whereby non-performing employees who do not
follow the quality improvement plan will experience poor performance. This is because the new
PERFORMANCE IMPROVEMENT 8
system is taking over slowly. This can be a high time for him or her to request for reassignment
to other departments of the clinic such as social work or can choose to be transferred. When the
goals have been reached, the quality improvement plan can be done periodic reviews to ensure
its flexibility in service provision and health care practices.
Approaches to Performance Improvement
Not all quality improvement strategies are successful although health care facilities seek
to improve performance. The first approach is through the system view. The best acceptable
approach in quality improvement should be taken using Systems Thinking techniques that help
in the identification of activities that are reducing the ability of the clinical skills from being
achieved. Operations analysis can be used to ensure the maximum improvement of quality all
through the performance improvement phases. This will enable focus on development that brings
change to the health care departments (Toussaint, et al., 2013, January).
People involvement is an approach because any quality improvement’s success depends
on the efforts of people at all the improvement levels. All the employees including the social
workers and nurses plus clinical officers should be at the front line and involved in the decision-
making process. Most of the failed quality improvements as per DOME clinical skills is as a
result of ignorance. The lead supervisors should include other employees in the decisions to
undertake quality improvement. This results in failed efforts of the management. Engaged
PERFORMANCE IMPROVEMENT 9
workers will feel the ownership of the quality improvement process and thus enabling them to
become owners of the project (Haas, et al., 2013).
Another approach to ensuring quality in health care is improved is to focus on the process
involved. Focusing on the process is the best approach compared to building up blames due to
lapses. Maybe some of the health workers and clinicians do not come to their jobs on a daily
basis which is an indicator of failed implementations. The new process will help promote the
operations and patient attendance and achieving the quality improvement goals. The
improvements in quality require that people within the health care change their behavior and
focus on the process to suit the new quality improvement plans for the clinics.
The purpose of the quality improvement should be evaluated and defined. Here, it is to
improve service delivery to the patients while reducing the queuing of these patients. The
process involves all the levels of management in Hong Kong health care, and thus, definition of
the existing system and the available staff plus patients is important. The value of service offered
by the clinic is critical and customer satisfaction should be measured. In a clinical case, the
primary customers are patients and therefore there is a need to ensure that the level of services
offered to them is satisfactory (DeRenzi, et al., 2012, March).
The value stream is important in the determination of the entity’s value creation to the
patients through the existing Value Stream Analysis set aside by the quality improvement team.
At a strategic level, the firm is analyzed and compared to the tactical level of individual
departments in the clinical case. People performing value stream such as nurses should be
included, and this carries a short period.
PERFORMANCE IMPROVEMENT 10
An improvement plan will be produced by the value stream whereby actions are
categorized according to the ability of undertaking. Others can just be done while others will
follow the rapid improvement events. The achievement of these goals should include
involvement in the process of implementing the quality improvement to people. It values the
current ways of job performance while reducing the discrepancies in the process of improving
the quality of health care services. The last approach base is to sustain the improvements in the
quality of services. Key metrics plus the loops for controlling quality improvement are planned
with an aim of ensuring that health workers adapt to the new changes in the system (Källander, et
Monitoring the quality improvement is facilitated by the indicators, and they help to
create the basis for improving the quality of health care practice and the modified system. The
indicators need to be designed and defined so as to enable its implementation in agreement with
medical practices. A rate based index will use the data concerning the events unfolding and their
occurrence at the same frequency. These are the rates and proportions with which the quality
improvement project has satisfied the patients in the hospital. The trends over the years will
indicate the speed with which the performance improvement has been active (Kern, et al., 2014).
The sentinel indicators will help in identifying the individual events such as patient
waiting time and its improvements. This helps in triggering further alterations to the performance
improvement plan of quality. It will show the poor performance as a comparison to the past
clinical skills performance. Process indicators will show the actual performances and what has
been done while giving and receiving care by patients and clinicians. It helps indicate what the
PERFORMANCE IMPROVEMENT 11
clinicians attended to the patients and the quality it was done. The care that health care provider’s
accord to patients and the limits of the stipulated period all through the process according to
dome clinical skills are included (Unützer, et al., 2014).
Structural indicators such as health system characteristics and quality improved will
affect the quality of the improved system to meet the needs of healthcare of patients. It will help
in describing the amount of resources used by the quality improvement system of the
organization in delivering the services and programs. These systems are directly related to the
health care performance improvement system and are affected by the number of the staff
dispatched to the new system. Resources concerning money, the beds in the health care and the
supplies plus the wards or buildings for in-patients are analyzed (Jha, et al., 2012). This will help
in judging the quality of care provision under conducive to the quality of health provision in
Outcome indicators assist in showing the health states and events that follow the quality
improvement program in the health care system. This includes the possible effects of the new
system on both patients and the health workers. It captures the potential impact of the policy on
the health improvement and performance of patients. The worst outcome of the quality
improvement is death. This results from untimely or naive implementation. Another outcome is
the possibility of disease outbreak and its symptoms and abnormalities. Discomfort can result
from the quality improvement process, and these may include nausea and dyspnea. Disability is
another possible outcome, and it can present itself in the form of impaired recreation. The
patients can also be dissatisfied with the quality of service and can lead to persistent complaints.
PERFORMANCE IMPROVEMENT 12
Adjusting to these indicators can involve the factors that are contributing to the survival
of patients in the clinical process and the outcomes of the health quality improvement. The
results of the quality improvement can be adjusted in comparison to other factors not within the
health care system through quality assessment and other factors or components that are about
quality health care. Demographic factors of the patients such as age and sex are considered. The
lifestyle of the patients and psychosocial factors plus compliance to the prescribed medication
can affect the quality of outcome. The severity of the illness and its comorbidity should be
considered in the outcome evaluation (Groves, et al., 2013). The quality of treatment and the
competence plus technical equipment available and the evidence-based treatment can affect
quality. Adherence to using the clinical guidance available and cooperation from the top medical
stakeholders is essential.
Strategies for Motivating and Engaging Stakeholders
Despite the advances in the quality improvement through healthcare in performance
improvement, there is a failure in reliability from the customers as a result of health care. The
systematic increase in health workers’ complexity and hard work does not guarantee efficiency in
health care provision. Fixing these problems require transformations in systems to a team-based
services aimed at satisfying the customers.
Engagement in the shared purpose of the quality improvement in clinical skills involves
leaders’ shift of conversation to achieving the articulated visions and improved patient care. The
need for sacrifice should be embraced because the performance improvement process can reduce
autonomy and income levels of physicians. Leaders should encourage health workers to change
PERFORMANCE IMPROVEMENT 13
the mentality of maintaining the status quo to advanced medical services (Friedberg, et al.,2014).
The needs of the patients need to be prioritized, and doctors cannot be shielded from this.
Consensus needs to be built to allow the views that are varied to be articulated. An appeal
to self-interest is essential given that physicians need to be motivated through financial
incentives. The measures of performance should be realistic and non-biased o reinforce
engagement of the health workers. The compensation can be pledged depending on the quality of
improvements per individual. The successful health workers can be communicated to through
earning them respect from their duties. Role play is appreciated through the positive feedback
from the top management as no employee yearns to lose respect from colleagues.
The tradition of the health care and clinical practice of the physicians should be valued as
a member of the health care system. They are given motivation so that they can adhere to the
standards and traditions of the organization. Dome clinical skills tradition has been followed by
doctors, and they are required to wear hosiery for female physicians and neckties for male
medical practitioners (Reeves, et al., 2013). The patients can be engaged by the provision of
training on the ease of access to certain technological improvements. Mass education can be
carried out and the patients given sessions to express their levels of satisfaction. With this, the
entire process of quality improvement in performance improvement of health care can be
PERFORMANCE IMPROVEMENT 14
Bonow, R. O., Ganiats, T. G., Beam, C. T., Blake, K., Casey, D. E., Goodlin, S. J., … &
Masoudi, F. A. (2012). ACCF/AHA/AMA-PCPI 2011 Performance Measures for Adults
With Heart Failure: A Report of the American College of Cardiology
Foundation/American Heart Association Task Force on Performance Measures and the
American Medical Association–Physician Consortium for Performance
Improvement. Journal of the American College of Cardiology, 59(20), 1812-1832.
Ferrer, R., Martin-Loeches, I., Phillips, G., Osborn, T. M., Townsend, S., Dellinger, R. P., … &
Levy, M. M. (2014). Empiric Antibiotic Treatment Reduces Mortality in Severe Sepsis
and Septic Shock From the First Hour: Results From a Guideline-Based Performance
Improvement Program*. Critical care medicine, 42(8), 1749-1755.
Eijkenaar, F., Emmert, M., Scheppach, M., & Schöffski, O. (2013). Effects of pay for
performance in health care: a systematic review of systematic reviews. Health
policy, 110(2), 115-130.
Hamric, A. B., Hanson, C. M., Tracy, M. F., & O’Grady, E. T. (2013).Advanced practice
nursing: An integrative approach. Elsevier Health Sciences.
Nicolay, C. R., Purkayastha, S., Greenhalgh, A., Benn, J., Chaturvedi, S., Phillips, N., & Darzi,
A. (2012). Systematic review of the application of quality improvement methodologies
from the manufacturing industry to surgical healthcare. British Journal of Surgery, 99(3),
PERFORMANCE IMPROVEMENT 15
Hermann, R. C., & Palmer, R. H. (2014). Common ground: a framework for selecting core
quality measures for mental health and substance abuse care.Psychiatric Services.
Witter, S., Fretheim, A., Kessy, F. L., & Lindahl, A. K. (2012). Paying for performance to
improve the delivery of health interventions in low-and middle-income
countries. Cochrane Database Syst Rev, 2(2), CD007899.
Unützer, J., Chan, Y. F., Hafer, E., Knaster, J., Shields, A., Powers, D., & Veith, R. C. (2012).
Quality improvement with pay-for-performance incentives in integrated behavioral health
care. American Journal of Public Health,102(6), e41-e45.
Murray, C. J., Richards, M. A., Newton, J. N., Fenton, K. A., Anderson, H. R., Atkinson, C., …
& Braithwaite, T. (2013). UK health performance: findings of the Global Burden of
Disease Study 2010. The lancet, 381(9871), 997-1020.
Jha, A. K., Joynt, K. E., Orav, E. J., & Epstein, A. M. (2012). The long-term effect of premier
pay for performance on patient outcomes. New England Journal of Medicine, 366(17),
Santiago, J. M. (2014). Use of the balanced scorecard to improve the quality of behavioral health
care. Psychiatric Services.
Toussaint, J. S., & Berry, L. L. (2013, January). The promise of Lean in health care. In Mayo
Clinic Proceedings (Vol. 88, No. 1, pp. 74-82). Elsevier.
Haas, L., Maryniuk, M., Beck, J., Cox, C. E., Duker, P., Edwards, L., … & McLaughlin, S.
(2013). National standards for diabetes self-management education and support. Diabetes
care, 36(Supplement 1), S100-S108.
PERFORMANCE IMPROVEMENT 16
DeRenzi, B., Findlater, L., Payne, J., Birnbaum, B., Mangilima, J., Parikh, T., … & Lesh, N.
(2012, March). Improving community health worker performance through automated
SMS. In Proceedings of the Fifth International Conference on Information and
Communication Technologies and Development (pp. 25-34). ACM.
Källander, K., Tibenderana, J. K., Akpogheneta, O. J., Strachan, D. L., Hill, Z., ten Asbroek, A.
H., … & Meek, S. R. (2013). Mobile health (mHealth) approaches and lessons for
increased performance and retention of community health workers in low-and middle-
income countries: a review.Journal of medical Internet research, 15(1).
Kern, R. S., Liberman, R. P., Kopelowicz, A., Mintz, J., & Green, M. F. (2014). Applications of
errorless learning for improving work performance in persons with
schizophrenia. American Journal of Psychiatry.
Unützer, J., Schoenbaum, M., Druss, B. G., & Katon, W. J. (2014). Transforming mental health
care at the interface with general medicine: report for the presidents
commission. Psychiatric Services.
Groves, P., Kayyali, B., Knott, D., & Van Kuiken, S. (2013). The ‘big data’revolution in
healthcare. McKinsey Quarterly.
Friedberg, M. W., Schneider, E. C., Rosenthal, M. B., Volpp, K. G., & Werner, R. M. (2014).
Association between participation in a multipayer medical home intervention and
changes in quality, utilization, and costs of care. Jama, 311(8), 815-825.
PERFORMANCE IMPROVEMENT 17
Reeves, S., Perrier, L., Goldman, J., Freeth, D., & Zwarenstein, M. (2013). Interprofessional
education: effects on professional practice and healthcare outcomes (update). Cochrane
Database Syst Rev, 3.