Physicians in health care management: 2. Managing performance: who, what, how and when? (original) (raw)
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Problem Doctors: Is There a System-Level Solution?
Annals of Internal Medicine, 2006
Physician performance failures are not rare and pose substantial threats to patient welfare and safety. Few hospitals respond to such failures promptly or effectively. Failure to ensure the quality and safety of the performance of colleagues is a breach of medicine's fiduciary responsibility to the public. A major reason for this deficiency is the hospitals' lack of formal systems to monitor physician performance and to identify and correct shortcomings. To develop and implement these systems, hospitals need better performance measures and substantial expansion of external programs for assessment and remediation. This is a task well beyond the capacities of individual hospitals; a national effort is required. The authors call on the Federation of State Medical Boards, the American Board of Medical Specialties, and the Joint Commission on Accreditation of Healthcare Organizations (organizations that already bear a fiduciary responsibility for ensuring safe, competent care) to collaborate on developing better methods for measuring performance and to expand programs for helping practitioners who are deficient.
Patient management problems Issues of validity
Medical Education, 1982
Patient management problems (PMP) are being used in medical examinations with increasing frequency despite evidence which throws doubt on their validity as measures of clinical competence. This study investigated the construct validity of a PMP constructed in both written and interview formats. Each test was administered to groups of students of different seniorities and to two groups of doctors, interns and post-interns. The pattern of scores for the different groups was not that expected of a valid test of competence. The most competent groups (the postinterns) generally scored less well on the calculated indices than the senior students and interns. These findings were similar for both formats of the test so cueing was not thought to be the major factor. It appears that the scoring system is at fault. A comparison of performance on the written and interview (uncued) formats showed that many more options were chosen by all groups tested on the written PMP. It was concluded that written PMPs cannot yet be regarded as a valid simulation of clinical performance. Although content validity is high this does not appear to be so for construct validity or concurrent validity.
Focusing Measures for Performance-Based Privileging of Physicians on Improvement
The Joint Commission Journal on Quality and Patient Safety, 2008
T he Joint Commission has required that accredited hospitals perform ongoing professional practice evaluation 1-or what we at Cincinnati Children's Medical Center (CCHMC) have termed performance-based privileging (PBP)-for their medical staff reappointment and reprivileging process.* PBP is a process by which evidence regarding the acceptable performance of providers in their clinical specialty informs their reappointment. Data must be provider specific, time trended, internally aggregated for group comparison, and where possible, externally benchmarked. 1 † At the same time, professional organizations have begun to outline specific measures for assessing providers, creating a situation where health care organizations must navigate multiple, sometimes conflicting, mandates to monitor provider performance. CCHMC has previously reported on the development of tests for knowledge related to evidence-based guidelines 2 and on the development and revision of PBP measures for the radiology department. 3-5 A literature review conducted in early 2007 and updated in 2008 identified a recent article describing North Mississippi Medical Center's PBP process, 6 as well as a 10-year old description of provider assessment in military hospitals, 7 but little else was found in the literature regarding PBP per se. PBP arose against a backdrop of national efforts to collect and disseminate health care quality information, which include the Healthcare Effectiveness Data and Information Set (HEDIS), sponsored by the National Committee for Quality Assurance (NCQA) 8 ; the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey sponsored by NCQA and the Agency for Healthcare Research and Quality (AHRQ) 9 ; and several sets of quality and safety indicators also sponsored Article-at-a-Glance Background: The Joint Commission requires ongoing professional practice evaluation-or what Cincinnati Children's Medical Center (CCHMC) has termed performance-based privileging (PBP)-for the medical staff reappointment and reprivileging process. Building a System: CCHMC is a 475-bed academic medical center affiliated with the University of Cincinnati College of Medicine. Medical staff members are reappointed every two years, with divisions having staggered reappointment dates throughout the two-year cycle. In 2004, CCHMC devised a model in which the 38 divisions retained responsibility for development of measures; collection, maintenance, display, and monitoring of individual provider performance data; and sharing of data with providers, while medical staff services retained responsibility for ensuring compliance with timelines, technical assistance related to measure development, and the collection and display of data. Each clinical division developed a preliminary list of measures. The original PBP process was tested in 2005 and has been revised several times in response to division feedback. Discussion: Members of all 38 clinical divisions have now been reappointed to the medical staff at least twice using measures that have become more robust, meaningful, and outcome oriented. Many measures support organizational or divisional quality imoprovement aims, are evidence based, or build on initiatives sponsored by external bodies and specialty societies. Examples of measures are shared via the PBP intranet, personal consultations, and an annual provider performance improvement conference. Yet, challenges remain, such as the absence of real-time, providerspecific, risk-adjusted data and the difficulty of attributing provider-specific outcomes when most complex and highrisk care is managed by a team.
BMC Health Services Research, 2015
Background: Peer evaluation is increasingly used as a method to assess physicians' interpersonal and communication skills. We report on experience with soliciting registered nurses' feedback on physicians' non-clinical performance in the ED of a large academic medical center in Lebanon. Methods: We utilized a secondary analysis of a de-identified database of ED nurses' assessment of physicians' non-clinical performance coupled with an evaluation of interventions carried out as a result of this evaluation. The database was compiled as part of quality/performance improvement initiatives using a cross-sectional design to survey registered nurses working at the ED. The survey instrument included open ended and closed ended questions assessing physicians' communication, professionalism and leadership skills. Three episodes of evaluation were carried out over an 18 month period. Physicians were provided with a communication training carried out after the first cycle of evaluation and a detailed feedback on their assessment by nurses after each evaluation cycle. A paired t-test was carried out to compare mean evaluation scores between the three cycles of evaluation. Thematic analysis of nurses' qualitative comments was carried out.
Public Management Review, 2014
As part of a major health care reform starting in 2005, the Netherlands introduced a Diagnosis-Related Group (DRG) system of hospital care reimbursement and performance measurement. The DRG system was applied to all hospital care, meaning that it affected the overwhelming majority of Dutch specialist medical professionals. To better understand the consequences of this new system, and the responses of medical professionals to its implementation, we conducted and analysed an original set of sixty-six semi-structured interviews focused on medical specialists' perception and utilization of the system. Our findings indicate that these professionals' behaviours can seldom be ascribed to financial motives alone. Many responses of medical professionals to the new system were attributed to valuebased motivations, related to upholding professional ethos and accommodating the dynamics of the professional process. Even responses that might be characterized at first as financially driven could not be entirely understood as perverse effects of the performance management system, as they too usually had an ancillary aim of safeguarding the professional tenets of the medical establishment.
Qualidade em um hospital acreditado especializado na percepção de profissionais de enfermagem
Revista Brasileira De Enfermagem, 2019
Objective: To identify quality of service in an accredited specialized hospital according to nursing professionals' expectations and perceptions. Method: This is a crosssectional quantitative study with the participation of 34 employees, conducted from August to October 2017 by administration of an adapted and validated version of the SERVQUAL scale. Results: The interviewees reported as their highest expectations the transmission of confidence and provision of safe services, the latter also turning out to be the best perception of service. Promotional materials were considered as the least important expectation. The perception with the lowest scores was related to the time of service delivery at the institution, which may be associated with specific factors. Safety of service was considered as the quality dimension with greater relevance. Conclusion: It is highlighted the importance of measures for maintenance of schedules and preservation of good forms of promotion, communication and team training. Descriptors: Nursing; Quality of Health Care; Accreditation of Healthcare Organizations; Quality Control; Nurses. RESUMO Objetivo: Identificar a qualidade do serviço de um hospital especializado e acreditado segundo expectativas e percepções de profissionais de enfermagem. Método: Tratouse de um estudo quantitativo, transversal, com a participação de 34 colaboradores, realizado de agosto a outubro de 2017, com aplicação da escala SERVQUAL adaptada e validada. Resultados: Os entrevistados apresentaram como maiores expectativas a transmissão de confiança e a prestação de serviços seguros, este último também se desvelou a melhor percepção para com o serviço. Os materiais de divulgação foram julgados como a expectativa menos importante. A percepção com menor pontuação foi relacionada ao período de entrega de serviços na instituição, que pode estar associado a fatores específicos. A segurança do serviço foi considerada a dimensão da qualidade com maior relevância. Conclusão: Reforça-se a importância de medidas para a manutenção de prazos programados e preservação de boas formas de divulgação, comunicação e capacitação da equipe. Descritores: Enfermagem; Qualidade da Assistência à Saúde; Acreditação Hospitalar; Gestão da Qualidade; Equipe de Enfermagem. RESUMEN Objetivo: Identificar la cualidad del servicio de un hospital especializado y acreditado, según las expectativas y las percepciones de profesionales de enfermería. Método: Se trató de un estudio cuantitativo, transversal, con la participación de 34 colaboradores, que fue realizado de agosto a octubre de 2017, con la aplicación adaptada y validada de la escala SERVQUAL. Resultados: Los encuestados presentaron como grandes expectativas la transmisión de confiabilidad y la realización de servicios seguros, este último también se desveló la mejor percepción para con el servicio. Los materiales de divulgación fueron juzgados como la expectativa menos importante. La percepción con menor puntuación fue relacionada al período de entrega de servicios en la institución, que puede estar asociado a factores específicos. La seguridad del servicio fue considerada la dimensión de la cualidad con mayor relevancia. Conclusión: Se refuerza la importancia de medidas para el mantenimiento de plazos programados y preservación de buenas formas de divulgación, comunicación y capacitación del equipo.