March 2000

Performance Management Off to a Fast Start

Catholic Health Initiatives´ performance management effort uses an eight-step prescription for achieving operating performance improvements:

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Six-month-old effort yields encouraging signs of improvement Catholic Health Initiatives’ performance management initiative began in September 1999, when the organization set operating performance improvement as its highest priority and named Ruth W. Brinkley senior vice president of performance management. The initiative has gathered momentum quickly, and three performance improvement teams now provide support to market-based organizations identified as having the greatest potential for performance improvement. "Performance management focuses on areas of needed performance improvement throughout Catholic Health Initiatives," said Brinkley. "It was the vision of Pat Cahill and Kevin Lofton to have an internal performance management function so that Catholic Health Initiatives does not have to be totally dependent on external consultants for this work." While each market-based organization stands to benefit from the performance management initiative, Brinkley works with the senior management leadership team and market-based organization chief executive officers to identify priorities. "Right now, 17 market-based organizations are on the priority list for performance management assistance," said Brinkley. "They have the greatest potential to improve performance and make a positive impact on Catholic Health Initiatives’ overall performance. We expect that, over time, market-based organizations will move on and off the priority list as their needs dictate. Our goal is to help each of them put a rigorous performance management process in place, identify and implement performance improvement objectives on an ongoing basis and then provide them with ‘tune-up’ assistance as needed." Performance improvement is a mission enabler Brinkley said that certain forces in health care, such as the Balanced Budget Act and managed care penetration, accelerated the need for the performance management initiative. "These factors have decreased reimbursement and increased the need for market-based organizations to focus on cost-effective service and the cost-to-revenue equation," she said. But for all of its focus on cost, Brinkley said the initiative is truly about enabling the mission of Catholic Health Initiatives. "The Balanced Budget Act and managed care could be perceived as threats to the mission if we do not manage their impact correctly," she said. "When there are changes on the revenue side of the equation, there have to be changes on the cost side to ensure that we have the means to carry the mission forward." Brinkley stresses that performance management is not a program that will end, but a continuing initiative. Since the initiative began in September, all of Catholic Health Initiatives’ resource groups have designated one or more members to help staff the process. "Every resource group has been cooperative and supportive," Brinkley said. Creating action plans The national performance management team, along with three external consultants, is divided into three teams assigned to specific groups of market-based organizations. "We work with the market-based organizations to identify gaps between expected and actual performance and determine the reasons why those gaps exist," said Brinkley. "Then, we work together to identify which problem areas present the best opportunities for improvement. We develop action plans that include realistic timelines and incremental targets so that the market-based organizations can realize each opportunity as fully as possible." Each market-based organization appoints a performance leader to coordinate the implementation of all of the action plans. "Members of the national performance management team partner with the performance leaders and also with clinical leaders and department directors as needed," said Brinkley. "This is very detailed work, and we support the market-based organization staff every step of the way. We work with them on how to move forward in a way that is timely, but won’t put unmanageable strain on the organization." In time, Brinkley expects the performance management success realized by individual market-based organizations to generate a set of best practices that can be shared throughout Catholic Health Initiatives. "For now, though, we’re just getting started and we’re in the process of developing the infrastructure we need," she said. "We have already seen some encouraging results, and I’m optimistic that they will be sustained. The fact that Catholic Health Initiatives made performance management a priority led to some immediate improvements, and the market-based organization chief executive officers are doing a good job of focusing on what is important. Our national performance management initiative is helping to bring additional structure and rigor to their efforts."