High-performing provider organizations typically have at least one thing in common—clear performance goals tied to specific metrics. How an organization’s many stakeholders define what performance means, however, can vary widely.
What’s in a Word?
Definitions of “performance” often reflect an individual’s job responsibilities rather than the organization’s strategic priorities. Therefore, it is imperative for leadership to answer two key questions:
- What is our common performance language that reflects the organization’s overall strategic goals?
- How will performance be measured against these goals?
The answers to these questions are important for every provider organization, not just those undergoing large-scale change such as dramatic growth or a new affiliation.
Creating a Shared Vision of Success
Healthcare providers produce huge amounts of data that are submitted to external bodies such as Centers for Medicare and Medicaid Services (CMS), the Joint Commission, and commercial payors, to name a few. These external bodies then inform quality rankings and payment measures, such as CMS Star Ratings, Consumer Assessment of Healthcare Providers and Systems scores, and value-based payment incentives. One result of this constant data sharing and reporting is that many stakeholders have established targets for performance measures pertaining to their respective areas of interest. For example, physicians may have targeted use rates for attributed lives, case managers target reduced readmission rates of patients with heart failure, and the CFO has targeted levels of balance sheet liquidity for lenders and ratings agencies.
One of the greatest values of developing a common performance language is that this shared language will translate into a shared vision of organizational success. When all stakeholders understand the performance goals related to cost, quality, safety, patient satisfaction, and other priorities, the words “performance” and “success” share the same definition across the enterprise. Furthermore, when progress toward these goals is transparent, the result can be a shared sense of urgency and, potentially, success.
Once a common performance language has been established, leadership can use it as a tool to facilitate improvement efforts through cross-functional collaboration within the organization. Using the balance sheet liquidity example from above, let’s assume an organization’s goal is to increase days cash on hand. Initially, non–finance team members may not understand their impact on this metric. In our example, perhaps high charge-lag days are contributing to a delay in the physician billing process and creating an opportunity for cash acceleration. However, coding is not creating the backlog. The high number of unsigned patient charts is stopping medical records from getting to the coding department for charge entry in the first place. Physicians are not aware of the unsigned chart backlog because their work queues are empty—nurses have been using the wrong EHR field to complete their documentation process prior to physician review, but neither IT nor finance has provided information necessary to resolve the issue. The result is a domino effect, where one functional breakdown creates another, and another, and another. Individual stakeholders want the organization and their peers to succeed, but they need to be given the required information and education to effectively contribute. The business processes in a provider setting are extremely complex, and it should not be assumed that individuals understand all the downstream implications of their actions or inactions. It is leadership’s responsibility to help disparate teams “connect the dots’” so team members are then able to identify solutions. Identifying and resolving the root cause of the problem requires a collaborative, interdisciplinary effort—one that organizations can incentivize in a transparent way using a common performance language.
Performance Targets: An Opportunity for Collaboration
Most healthcare providers track numerous performance metrics against established targets. What is sometimes overlooked is the opportunity to share these performance targets with all stakeholders across the organization and educate on their connections. As illustrated in the example above, teams across an organization are interdependent. What they do, and how they do it, impacts other teams. That means performance targets are also interdependent. Thus, sharing performance targets and providing education on the related processes that impact the targets helps stakeholders to see how their own performance may support or inhibit another’s and that of the overall organization. This can lead to organization-wide collaboration and, more broadly, a shared understanding of what it means to succeed.