Nursing Organizational Performance Management: The Basics

Nursing Organizational Performance Management: The Basics
A: Introduction
Healthcare is a rapidly evolving industry where organizations face constantly changing conditions and needs of patients. The increased use of technology today has made patients more informed making competition very stiff in healthcare. To compete effectively, healthcare organizations must ensure the delivery of quality and safe patient care at all costs. As the competition in this sector grows, nurse leaders must assess their institutions and develop strategies to improve performance and productivity. The use of quality improvement tools is among the best approaches to improving productivity in healthcare. For instance, performance improvement tools like the performance data scorecards are widely used by managers to identify and correct processes to achieve organizational goals (Quesado et al., 2018). In this discussion, I envision myself as a nurse leader responsible for performance improvement in areas that are below benchmarks using the employee engagement strategy.

A1. Population

The healthcare organization served is an adult specialty facility and a teaching hospital. The institution mainly deals with patients seeking medical and surgical care including surgery and ICU care. The patient population being addressed are adults 18 years of age and older, seeking medical care in the hospital. According to the hospital community health assessment, most patients admitted have medical issues related to chronic diseases like heart disease, cancer, and diabetes. The hospital bed capacity is 187 with 98 beds allocated for the medical patients. The goal of management is to treat each patient with dignity, respect, and compassion. The organization strives to improve quality through the use of evidence-based practices, a patient-centered care approach, and performance assessment for each healthcare provider. A balanced performance scorecard focusing on areas of performance, quality, safety, and employee engagement can be used in the unit to achieve the set organizational goals.

A2. The Performance Data Scorecard

Measure	Outcome	Drivers
Performance	Reduce the patient readmission rates in the medical unit	ü Reducing readmission rates will ensure a reduction in healthcare costs for patients. ü To avoid unnecessarily expenditure related to patient readmission. ü To increase the quality of care delivered to the patient in the organization. ü To improve quality outcomes in the organization leading to more patient satisfaction.
Quality	Improve HCAHPS on the aspect of nurses’ communication	ü More financial reimbursements from the CMS as the HCAHPS scores improve. ü Improved communication will ensure patient safety and improved quality of care. ü More recognition of the organization as patient satisfaction is improved.
Patient Safety	Decrease patient falls in the medical unit through the use of evidence-based practices.	ü To reduce the healthcare costs associated with patient falls in the organization. ü Decreased fall rates will improve patient satisfaction. ü Increase awareness and response to patient falls among providers and patients/families. ü Decrease length of hospital stay for patients. ü To improve patient safety.
Employee Engagement	Ensure timely availability of employee surveys and feedback provision in the unit.	ü To reduce employee turnover rates. ü Employee engagement improves service delivery to patients. ü To improve collaborative practice while providing patient care.

Necessary Processes

Performance

Hospital readmission rate is a measure used to assess the performance of healthcare organizations and it greatly affects financial reimbursements. In 2012, through the Hospital Readmission s reduction Program (HRRP), penalties were initiated for institutions with high readmission rates (Warchol et al., 2019). The outcome measure to be addressed deals with reducing the readmission rates in the medical unit through various processes. The first approach to reduce readmissions will involve patient education to empower the individual to be champions of their health. The education program will focus on discharge information to guide the patient upon leaving the healthcare facility. Additionally, the patient’s family will be involved during the education program to help guide the patient and provide necessary assistance required at home. The second process will involve redesigning the healthcare system to ensure coordination across the care continuum. Research indicates that lack of coordination across the system leads to poor communication of outcomes including unnecessary readmission of patients (Warchol et al., 2019). The medical unit will work collaboratively with the emergency department, pharmacy, and the social services department to ensure all post-acute care services are provided effectively.

Quality

Quality is one of the most frequently emphasized principles in the healthcare system. It refers to the extent to which services provided to patients meet their expectations. To demonstrate the improvement of quality care to the identified patient population, the focus will be on the communication aspect addressed on the HCAHPS scores. The necessary processes for improving the identified HCAHPS score area will include the implementation of the SBAR (situation-background-assessment-recommendation) communication strategy and education of nurses. SBAR communication is identified by research to be a standardized method of communicating patient information during shift handoff (Shahid & Thomas, 2018). Additionally, the tool allows for the communication of patient information to physicians during an emergency or routine consultation. Education and training for nurses are recommended to ensure every aspect of communication is addressed. Another aspect that will lead to improved communication is the delivery of shift handoffs at the patient’s bedside. This practice will ensure nurses involve patients in planning their care and it will lead to more patient satisfaction.

Patient Safety:

Patient safety represents the absence of preventable harm to a patient during the care delivery process including the reduction of risks to an acceptable minimum. To ensure patient safety in the organization, the outcome measure will involve the reduction of patient falls in the medical unit. Falls that occur in hospitalized patients is a widespread and serious threat to the safety of patients. As the most frequently observed safety events in healthcare, falls cause injury, harm, and prolong hospital stays (Walsh et al., 2018). To ensure the problem is addressed, purposeful hourly rounding will be used to assess the condition of the patient and make interventions that can solve the problem. Hourly rounding is a proactive approach to falls prevention which ensures nurses get to assess the patient’s needs at a given time (Walsh et al., 2018). The nursing team will be educated on the use of 4P’s (Pain, potty, position, and placement) during the rounding to ensure patients are kept comfortable. Another strategy that will ensure the prevention of falls in the unit is the encouragement of multidisciplinary approaches to patient care. All medical teams will be involved in ensuring patients in the medical ward are safe through reporting of possible hazards that can cause falls.

Employee Engagement:

Employee engagement refers to the emotional commitment that staff has to the company and its goals which helps in maintaining good relationships in the workplace. Engaged employees feel passionate about their jobs, are committed, and put discretionary efforts into their work. To improve employee engagement in the organization, surveys will be administered to collect the healthcare worker’s views on important aspects of patient care. These surveys will help to identify areas that are performing well, the perception of the employees towards the healthcare system management, and any changes required to make the workplace better. The second process will involve the education of the managers and leaders on how to care for their employees while promoting engagement. Aspects such as treating employees fairly, providing timely feedback, and respecting the employees will be stressed to improve engagement. Lastly, employee engagement surveys will be administered to measure performance, strategic alignment, competency, and satisfaction. These surveys will be benchmarked against other organizations to effectively determine the level of employee engagement in the facility.

Additional Measure:

An additional indicator to realize better outcomes in the facility will be the improvement of nurse staffing levels. Nurses represent the largest group of healthcare workers responsible for most of the patient care activities. There is a growing body of evidence indicating that improved nurse-to-patient ratios have an impact on quality and patient safety. Studies indicate that inadequate staffing in healthcare leads to adverse events such as medication errors, patient falls, healthcare-related infections, and increased mortality rates (Haegdorens et al., 2019). In the medical unit, the majority of the patients require long-term care because they suffer from chronic conditions. Adequate nurse staffing is required to allow surveillance and more time spending with the patients. Insufficient staffing only allows minimal time for interaction between the provider and the patient leading to missed care. To ensure that outcomes such as patient falls, readmission rates, and improved patient satisfaction are realized in the unit, improving staffing ratios will be required.

Advantages of Performance Scorecards

Advantage Number One

Balanced scorecards are crucial to the successful management of organizational long-term strategies. Research establishes that performance scorecards allow for visualization of strategies through the design of the strategy maps (Quesado et al., 2018). For example, a performance scorecard deploys indicators such as goals, initiatives, and personal alignments that allow the employees to have a clear picture of what is required. The use of the scorecards does not only allow for visualization of the financial impacts to the organization, but also the customer’s, internal processes, and growth that should be measured. Performance scorecards are organized in cascades to capture the synergy and commitment of employees. Through this focus, the scorecard allows for effective decision making to realize the set goals. Healthcare management is involved in the regular assessment of objectives and making of decisions during long-term strategic management. The performance scorecards play an important role at the information level provided to managers, in particular, knowledge about the implementation level and specification of the strategy (Quesado et al., 2018). Additionally, performance scorecards allow for the top-down communication that is crucial for the long-term management of organizational goals.

Advantage Number Two

Performance scorecards are tools that can be used to link the mission and strategy to performance measures and strategically aligned initiatives. The scorecard enables the availability of a tangible link to the mission and the organizational strategy to increase the workforce morale (Quesado et al., 2018). During the process of performance improvement, communication is crucial to ensure employees understand what is expected. The scorecard system is observed to involve all levels of the organization and boosts communication between senior executives and lower-level employees. Different scholars have addressed the issue of strategic alignment in relation to the use of performance scorecards. One of the crucial findings is that scorecards present a set of innovations in relation to other strategic management models, in particular, how the indicators are organized and aligned (Quesado et al., 2018). Balanced scorecards allow for a joint design of key business areas and identify sequences of actions that lead to the realization of set goals.

Advantage Number Three

Balanced scorecards boost the process of change management in organizations through streamlining of activities. For instance, a performance scorecard is used to convert strategy into action during quality improvement activities. It enables the employees to know the required actions that can lead to a successful change process. Secondly, the scorecard provides a systematized vision of operational performance (Quesado et al., 2018). Through this vision, the managers can adjust processes and update strategies that can be used to effectively manage change. Another aspect is the ability to communicate effectively using the balanced scorecard system. Change management requires routine communication of the mission and strategies that are well-outlined in performance scorecards. The scorecards allow for the motivation and education of employees through the communicated strategies and actions for process improvement. Lastly, performance scorecards can be used to predict change using the outlined performance indicators. Managers can use this prediction to design more strategies that can improve change management.

Current Trends

Current Trend Number One

The first trend that affects employee engagement in healthcare is the availability of employee assistance wellness programs. These wellness programs are provided by the provider to improve employee health and also to help individuals with particular health problems to cope with work. An example of such wellness programs is the Workplace Health Promotion (WHP) in long-term care facilities. This program intends to modify employee health behavior to reduce the risk of chronic health conditions (Kernan et al., 2020). Most of the programs have focused on aspects such as exercise, healthy eating, and mental health to ensure the aging population of healthcare workers reduces healthcare spending. For the nurses, workplace health promotion has focused on mental health due to the perceived challenges of burnout and work-related stress. The use of wellness programs is observed to improve employee morale as they appreciate their value in the workplace. These programs ensure employees get to make informed choices and become more engaged as their health improves.

Current Trend Number Two

Transparency of pricing or hospital price transparency is a new strategy by the CMS that can help in improving employee engagement. This strategy aims at ensuring healthcare organizations provide clear, accessible pricing information about services provided. Through the new strategy, employees will get to understand how their services translate to the financial stability of the organization. Additionally, the organization can perform a cost-analysis to help in formulating new strategies that can improve healthcare service delivery. Using this platform, the employees will be able to track organizational performance and recommend ways to improve quality.

D1. Employee Engagement and Healthcare Quality

Employee engagement is a strategy that healthcare organizations should adopt to improve quality care. To ensure success, and employee satisfaction, employee engagement has been proposed as the best strategy alongside good organizational leadership. Engaged employees can produce consistently because they become part of the organizational success team. The employees are more likely to invest their time and effort in the work they do when they are engaged. According to studies, employees who are engaged work harder and are likely to double the rate of organizational success compared to less engaged employees (Motyka, 2018). Another crucial aspect of engagement is the ability to communicate care between employees and managers. Good communication ensures that employees work as teams and it reduces errors during patient care. All facilities seeking Magnet Recognition in the United States must demonstrate a high degree of employee engagement because of its positive influence on quality care. The quality of services delivered is in healthcare is assessed by metrics such as mortality rates, hospital readmission, patient falls, and cost reduction (George & Massey, 2020). Engaged employees tend to work better by observing their patients, using evidence-based practices to inform their care, and effectively utilize healthcare resources to minimize costs (Motyka, 2018). When employees are engaged, the services delivered to patients are accurate, timely, and centered on the patient’s needs rather than the employee’s preferences.

D2. Current Tools

Almost more than half of healthcare providers today measure employee satisfaction as part of their effort to provide quality care. Employee engagement is valued in my healthcare organization and the employee engagement survey is the tool used to measure this aspect. This tool measures how healthcare professionals passionately work to improve quality care delivery. The primary goal of using this tool is to assess and measure how motivated and engaged employees are in delivering quality care to patients. The employee engagement survey used addresses the areas of communication, understanding roles, planning, and healthcare leadership. The questions asked to help the nurse leaders to identify areas that are performing well and those that require improvement. For instance, data from the communication aspect helps the managers to identify broken channels of communication and formulate new strategies to improve communication during patent care.

Improving Employee Engagement

The identified outcome measure for employee engagement in the performance scorecard is the timely administration of employee satisfaction surveys and feedback. The main goal of this exercise is to identify problem areas that managers may not be aware of, especially on the communication and leadership aspects. Secondly, the new strategy aims at delivering timely feedback to the employees including solutions to the problems identified in the satisfaction surveys. To ensure full engagement of the employees, a new strategy that will involve the administration of questionnaires will be used. Previously, the organization has provided engagement surveys using the interview approach. The new plan to use questionnaires will ensure that all employees get to participate and answer anonymously the questions presented. The first approach to this exercise will involve the identification of stakeholders that will monitor the administration of the surveys. Week one of the project will involve designing employee satisfaction questionnaires focusing on the aspects of communication, planning, leadership, and the nurses’ roles. Week two will involve the education of employees on the importance of filing the surveys and the expected response. The clinical nurse educator will coordinate the education sessions for the nursing team. Week three will involve the administration of the employee satisfaction questionnaires and the collection of results. The project management team will analyze the questionnaires, identify perceived challenges and provide feedback to the nursing team by the end of week five.

E1. Leadership Practices

Leaders are in a better position to promote employee engagement through the incorporation of best practices and good governance. To promote employee engagement, the first strategy is the use of formal rewards and recognition programs for employees (George & Massey, 2020). Healthcare organizations with a highly engaged workforce hold managers at different levels of accountability including performance assessment and motivation of workers. Providing rewards for employees according to performance improves morale among workers and helps to create a team spirit that leads to more engagement. While providing rewards to top performers, leaders should mentor other employees and give direction to becoming the best in the future. Mentorship ensures that employees get to share their thoughts freely and they believe in their leaders which promote engagement.

The second approach that can promote employee engagement is the maximization of feedback. Feedback should be given throughout the framework of enhancing behavior or changing processes to ensure employees feel empowered (George & Massey, 2020). Leaders can directly provide feedback to individuals regarding their performance or the entire organization, especially during project implementation. Feedback provision gives the employee a chance to understand their roles in quality improvement and they become free to air their suggestions during change management.

References

George, V., & Massey, L. (2020). Proactive strategy to improve staff engagement. Nurse Leader, 18(6), 532–535. https://doi.org/10.1016/j.mnl.2020.08.008

Haegdorens, F., Van Bogaert, P., De Meester, K., & Monsieurs, K. G. (2019). The impact of nurse staffing levels and nurse’s education on patient mortality in medical and surgical wards: An observational multicentre study. BMC Health Services Research, 19(1), 1-9. https://doi.org/10.1186/s12913-019-4688-7

Kernan, G., Cifuentes, M., Gore, R., Kriebel, D., & Punnett, L. (2020). A corporate wellness program and nursing home employees’ health. Frontiers in Public Health, 8, 646. https://doi.org/10.3389/fpubh.2020.531116

Motyka, B. (2018). Employee engagement and performance: A systematic literature review. International Journal of Management and Economics, 54(3), 227-244. https://doi.org/10.2478/ijme-2018-0018

Quesado, P. R., Aibar Guzmán, B., & Lima Rodrigues, L. (2018). Advantages and contributions in the balanced scorecard implementation. Intangible Capital, 14(1), 186-201. https://www.raco.cat/index.php/Intangible/article/view/336833

Shahid, S., & Thomas, S. (2018). Situation, background, assessment, recommendation (SBAR) communication tool for handoff in health care–A narrative review. Safety in Health, 4(1), 1-9. https://doi.org/10.1186/s40886-018-0073-1

Walsh, C. M., Liang, L. J., Grogan, T., Coles, C., McNair, N., & Nuckols, T. K. (2018). Temporal trends in fall rates with the implementation of a multifaceted fall prevention program: Persistence pays off. Joint Commission Journal on Quality and Patient Safety, 44(2), 75–83. https://doi.org/10.1016/j.jcjq.2017.08.009

Warchol, S. J., Monestime, J. P., Mayer, R. W., & Chien, W. W. (2019). Strategies to reduce hospital readmission rates in a non-medicaid-expansion state. Perspectives in Health Information Management, 16(Summer), 1a. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6669363/

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