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Why Performance Improvement Doesn’t Always Improve Performance

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Providers are facing increased pressure from patients and payors to demonstrate greater value by improving care quality and costs. To meet these expectations, physician groups and ambulatory care networks have sought and deployed an array of strategies and tools to improve performance. And yet, while many providers have begun this journey, few have realized the desired results.

Despite the best of intentions, why have so many organizations been unable to achieve their improvement goals?

To answer this question, we must first understand the fundamental requirements of a successful improvement strategy.

Abraham Maslow’s well-known Hierarchy of Needs[1] theory states that all individuals hold a similar set of fundamental needs; and for humans to flourish in their pursuit of more advanced motivations, they must first satisfy those needs. The same is true for healthcare organizations seeking to provide greater value through high performance. Organizations must address a basic set of needs in order for performance improvement efforts to thrive. To illustrate this point, I have adapted Maslow’s model to help us better understand these fundamental organizational needs and how addressing them can truly lead to improved performance for physician groups and ambulatory care networks.

  • Process Understanding. To improve, the organization must first become an expert in its current processes and operations. While this sounds intuitive, it requires standardization and a culture of measurement – strategies that are not well established in many healthcare organizations.
  • Willingness to Change. Both leadership and frontline staff must be prepared to adapt practices and processes based on the findings of their improvement efforts. This should include the expectation to try and learn along the way.
  • Improvement as an Expectation. All members of the organization should be included in the process improvement strategy. As involvement is effectively established, improvement becomes a core job function and the expectation of all members of the organization.
  • Process Improvement Knowledge and Skills. Once the culture is prepared, the tools and techniques will facilitate and manage the improvement tasks. An understanding of fundamental improvement principles should be developed as a basic skill among all members of the organization.
  • Continuous Improvement. Continuous improvement represents the “self-actualization” of process improvement and demonstrates the organization’s ongoing pursuit of value. At this point, improvement efforts become frontline-driven and the culture pervasive in all organizational activities.

Many organizations have jumped into improvement strategies by utilizing established tools and adopting oft-used techniques (e.g., Lean Six Sigma). These are meaningful components of a continuous improvement strategy; however, if the basic organizational needs for improvement are not satisfied, these techniques will likely be unsuccessful, and any progress short-lived. A successful approach to process improvement must begin with specific activities that initiate a transition in the organization’s strategy and culture. Once this has begun, the appropriate tools and techniques can leverage the organization’s motivation to meet and exceed performance goals.

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