Framework for Improving Performance: From Principles to Practice. - book reviews

"This book, Framework for Improving Performance: From Principles to Practice, describes and exemplifies the Joint Commission's theory-based, practical methodology for continuously improving the core work and resulting outcomes of any health care organization." Thus begins the Joint Commission's most recent publication providing guidance in achieving organizational excellence.

Rather than providing a wide range of information, the Commission focuses on a narrow range of methods and tools. It points out the shortfalls of quality assurance and moves on to the implementation of newer methodologies to attain excellence. The "framework" focuses on three broad areas: the external environment; the internal environment; and a methodology for designing, measuring, assessing, and improving key functions or work processes.

The word "quality" is most noticed by its few appearances. Rather, the term "performance" is used to emphasize processes and outcomes of interest to patients and other customers. The Joint Commission is interested in what is done and how well it is done. Of interest is an emphasis on outcomes, cost, satisfaction, and information systems necessary both to monitor and judge quality and to provide data to patients, purchasers, regulators, and other stakeholders.

After an "Overview," the book is divided into chapters dealing with the Shewhart Cycle (Plan-do-study-act). However, there is a subtle change of emphasis to matters dealing with leadership, especially as it relates to quality issues, and a refreshing emphasis on patient satisfaction and "customer" interests. The external environment moves more to center stage.

The framework has these primary goals:

* To emphasize that an organization's performance of important functions significantly affects its patient outcomes, the costs to achieve these outcomes, and judgments about the quality and the value of its services.

* To illustrate how an organization can mesh the rich variety of concepts and methods developed independently over the past several decades into an operational performance system.

* To show how the effectiveness with which an organization manages its relationships with the external environment is as important to fulfillment of its mission as the effectiveness with which it manages its internal environment.

The book is intended as a practical guide. It can be used to acquire an over-view of performance improvement concepts and methods and as a reference tool to help organizations carry out their improvement activities. The book also contains three helpful appendices: the Joint Commission's "Improving Organizational Performance" standards, excerpts from the scoring guidelines that explain and interpret these standards, and indicators being developed for the Joint Commission's indicator measurement system.

The book stresses outcomes and resource use. It defines nine important dimensions by which quality can be measured and improved:

* The efficacy of a procedure or treatment for a specific condition. * The appropriateness of a specific test, procedure, treatment, or service to meet a patient's needs.

* The availability of a needed test, procedure, treatment, or service to a patient who needs it.

* The effectiveness with which tests, procedures, treatments, and services are provided.

* The timeliness with which a needed test, procedure, treatment, or service is provided to a patient.

* The safety to the patient, staff, and others in the services provided.

* The efficiency with which services are provided.

* The continuity of the services provided to a patient with respect to other services, other practitioners, and other providers.

* The respect and caring with which services are provided.

The efficacy and appropriateness parameters can be defined as doing the right thing and the seven remaining items as doing the right thing well.

The approaches to and tools of health care improvement include:

* Quality assurance.

* Practice guidelines. * Process mindedness.

* Outcomes management/comparative databases.

* Total quality management/ continuous quality improvement.

* Systems thinking.

Although the material is not new, the subtle changes in emphasis by this important certifying body and the clarity of presentation make the purchase of this book worthwhile.

COPYRIGHT 1995 American College of Physician Executives
COPYRIGHT 2004 Gale Group