Experiences on Performance Management System in a Private Hospital Setting: TPORs of a Consultant-Adviser

Experiences in
Performance Management System
in a Private Hospital Setting:
TPORs of a Consultant-Adviser
Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg
Consultant-Adviser
Manila Doctors Hospital
Ciudad Medical Zamboanga

Experiences in
Define
•Context
•Limit of Scope

Experiences in
Experience
• experience of a hospital – PMS
• my personal experiences – consultant-adviser
on PMS

Experiences in
Experience
• experience of a hospital – PMS
• my personal experiences
• Thoughts, Perceptions, Opinions, and
Recommendations (TPORs)
– consultant-adviser on PMS of 2 private
hospitals

Experiences in
Private Hospital Setting
•Manila Doctors Hospital – 1999
•Ciudad Medical Zamboanga – 2009
TPORs – Thoughts, Perceptions, Opinions and Recommendations
from experience with MDH and CMZ as consultant-adviser

Experiences in
• PMS in hospital system – not part of
presentation
•PMS in a stand-alone hospital and
its units – focus of presentation
• PMS for hospital clinician-physicians and PMS
for hospital clinical and administrative staff –
not part of presentation

Experiences in
Contents:
TPOR1: Journey towards performance
excellence of MDH and CMZ
TPOR2: Tools for evaluation of performance
management system (whole hospital)
TPOR3: Starting and continuing journey
towards performance excellence for private
hospitals

Just look for and focus on
the similarities!

Just look for and focus on
the similarities!
• Strategic Planning
• Balanced Scorecard
• Baldrige / PQA Criteria for
Performance Excellence
• PhilHealth Benchbook

TPOR1.1
The journey towards performance excellence
is long and tedious.
It may take at least 10 years even with good
planning, commitment and support from top
management, and perseverance.
Recommendation: Allot 10 years!

Macro-indicators of Performance Excellence (Baldrige):
Integrated approach to organizational performance
management that results in
(1) delivery of ever-improving value to customers and
stakeholders, contributing to organizational
sustainability
(2) improvement of overall organizational effectiveness
and capabilities
(3) organizational and personal learning
GOAL
(short-/long-term)

3 Macro-indicators of Excellent Hospital (ROJoson):
• Contributing to achievement of targeted health
outcomes in its catchment community
• Providing value-based health care services
• Sustainable while providing excellent services
GOAL
(short-/long-term)

Performance Excellence
• Five performance outcomes to monitor and
evaluate:
• Product and process outcomes
• Customer-focused outcomes
• Workforce-focused outcomes
• Leadership and governance outcomes
• Financial and market outcomes

TPOR1.2
There are no absolute end-points in the
journey. It is a continuous journey.
Recommended initial end-points:
1. Being given the highest recognition from
the Philippine Quality Awards
2. With at least 25 documented best
practices

“Best Practice”
- a formally documented method or
technique that has been institutionalized
in the hospital and
- that has consistently shown performance
excellence results at least if not yet
proven superior to those achieved with
other means and
- which can be or is being used as a
benchmark by other hospitals

With at least 25 documented best practices
distributed as follows:
PQA Categories (6)
• Leadership
• Strategic Planning
• Customer Focus
• Measurement, Analysis, Knowledge
Management
• Workforce Focus
• Operations Focus

International Hospital Health Care Standards
(8):
• Access to Care and Continuity of Care
• Patient and Family Rights
• Assessment of Patients
• Care of Patients
• Anesthesia and Surgical Care
• Medication Management
• Patient and Family Education
• Hospital Infection Control

ROJ Recommended Steadfast Strategic Objectives
for Hospitals (10):
• Systems perspective in governance
• Integrated value-based health care service
• Physician engagement
• Maximal utilization of services with controlled
expenses and losses
• Customer delight
• Full compliance with the quality and performance
standards (local and international)
• Integrated IT-enabled operations system
• Staff engagement
• Learning organization
• CSR program with tangible social impact

ROJ Recommended Steadfast Strategic
Objectives for Hospitals (10):
• Systems perspective in governance
• Integrated value-based health care service
• Physician engagement
• Maximal utilization of services with
controlled expenses and losses
• Customer delight

ROJ Recommended Steadfast Strategic
Objectives for Hospitals (10):
• Full compliance with the quality and
performance standards (local and
international)
• Integrated IT-enabled operations system
• Staff engagement
• Learning organization
• CSR program with tangible social impact

ROJ Additional Recommended Must-Have
Management System or Program for
Hospitals (1):
• Communication Management System

TPOR1.3
Although helpful, one does not have to get
formal accreditation by all the available
standards-accrediting bodies.
Be COMPLIANT with the standards and
criteria without going for formal
accreditation! (through self-directed
learning and improvement!)

TPOR1.3
Going for formal accreditation - depends on
your need and situation!
Need - to participate in National Health
Insurance Program and get benefits – go for
PhilHealth Accreditation!
Need - to participate in medical tourism
program and get benefits – go for
international accreditation (JCI / ACI / NABH)

TPOR1.3
Need – to satisfy requirement of corporate
accounts – go for accreditation!
Need – to satisfy expectations of the
community – go for accreditation!

TPOR1.3
Situation – to be with the trend of having an
international accreditation (not to be left out
– strong community expectation) – go for
accreditation!

TPOR1.3
Situation – want to fast-track improvement of
quality and safety of operations and services
with accreditation – go for accreditation
(assessment, training, improvement,
evaluation)!

Integrating Hospital Quality and
Performance Standards
• Baldrige Health Care Criteria for
Performance Excellence / Philippine
Quality Award Criteria for Performance
Excellence
• ISO Quality Management System
• PhilHealth Benchbook (including PH
statutory and regulatory requirements)
• Joint International Commission,
Accreditation Canada International
• Investors in People
*Compliant but NOT necessarily going for accreditation to all standards, except
PhilHealth Benchbook and Philippine Quality Awards for Performance Excellence
Performance
Excellence
•Business
Development
•Efficiency
•Learning

Excellence
Performance
Excellence
Increase in
utilization of
services
Increase in
corporate
accounts and
patient-clients

management system
2 goals of PMS
• To promote performance excellence in the
hospital.
• To evaluate whether the hospital has
achieved performance excellence.

3 Macro-indicators of Excellent
Hospital:
• Contributing to achievement of
targeted health outcomes in its
catchment community
• Providing value-based health
care services
• Sustainable while providing
excellent services
GOAL
(short-/long-term)
Formal - Objective -
Stringent Assessment
(Internal & External)

3 Macro-indicators of Excellent
Hospital:
• Contributing to achievement of
targeted health outcomes in its
catchment community
• Providing value-based health
care services
• Sustainable while providing
excellent services
GOAL
(short-/long-term)
Internal
Auditors
with Checklists-
Rating Scales
External Auditors
PQA
PhilHealth
DOH
Others (Int’l)

Macro-indicators of Performance
Excellence:
• Integrated approach
• Delivery of ever-improving value
to customers and stakeholders,
contributing to organizational
sustainability
• improvement of overall
organizational effectiveness and
capabilities
• Organizational and personal
learning
GOAL
(short-/long-term)
Internal
Auditors
with Checklists-
Rating Scales
External Auditors
PQA
PhilHealth
DOH
Others (Int’l)

TPOR2.1 Use management reviews regularly.
TPOR2.2 Use internal and external independent audits for
evaluating PMS at planned intervals.
TPOR2.3 Use integrated evaluation checklists when using
several standards.
TPOR2.4 Make Baldrige / PQA Criteria for Performance
Excellence as the motherhood standard or framework when
using several standards.
TPOR2.5 Use a checklist, rating scale or dashboard such as a
balanced scorecard to guide, align and integrate all units,
track and assess PMS.

Excellence
Performance
Excellence
Use
integrated
checklists

A – Approach
D – Deployment
L – Learning
I – Integration
L – Level
T – Trend
C – Comparison
I – Integration

management system
TPOR2.5 Use a checklist, rating scale or
dashboard such as a balanced scorecard to
guide, align and integrate all units, track and
assess PMS.

What is a balanced scorecard?
A balanced scorecard is a scorecard, a blueprint, or
a report card
formulated by an organization to be used as a guide
and reference
for the implementation of strategies and tactical
objectives,
monitoring the implementation, and
evaluation of results of implementation.

Integration refers to the extent to
which
• your results measures (often through
segmentation) address important customer,
product and service, market, process, and action
plan performance requirements identified in your
Organizational Profile and in Process Items
• your results include valid indicators of future
performance
• your results are harmonized across processes and
work units to support organization-wide goals

BSC Framework
Translate to Function Level Scorecards (Corporate, Unit, Individual)
Corporate BSC
– formulated by the Senior Management Team and approved by
Top Management.
Unit BSC
– formulated by all medical or non-medical specialty units in the
hospital (divisions, departments, committees, offices) cascaded
from / guided by the corporate BSC.
Individual BSC
– formulated by an individual staff on how he/she will contribute
to the unit BSC.

BSC Framework
Contents of BSC
• Perspectives (5)
• Goals (Strategic Intent – General Objectives)
• Tactical Objectives (Specific Objectives – Key Result
Areas)
• Performance Measures: Outcome and Target (Key
Performance Indicators)
• Initiatives (Programs, Projects, Tasks, Activities)
• Action Registers / Action Plans of Initiatives
• Resources / budget
• Timetable (Timelines or Gantt charts)
• Person-in-Charge (Champeons, Task Forces)

BSC Framework
Tabular Presentation of the Main BSC
(Scorecard with identification of “Initiatives”)
Perspective Goals
(Strategic
Intent –
General
Objectives)
Tactical
Objectives
(Specific
Objectives
– Key
Result
Areas)
Performance
Measures:
Outcome /Target
(Key
Performance
Indicators)
Initiatives
(Programs,
Projects, Tasks,
Activities)

BSC Framework
Tabular Presentation of the Main BSC
(Scorecard with performance data and analysis)
Perspective Goals
(Strategic
Intent –
General
Objectives)
Tactical
Objectives
(Specific
Objectives
– Key
Result
Areas)
Performance
Measures:
Outcome
/Target
(Key
Performance
Indicators)
Status
(Q1/Q2/Q3/Q4)
Data:
Analysis: Variance
- achieved /
NOTachieved
Resolutions for
negative
variance:

What is a sample of a BSC of a hospital unit?
PERSPE
CTIVE
Key
Result
Areas/
Goals
Tactical
Objective
Measures Action Plans
Key Performance
Indicators
CUSTOM
ER
Custom
er
delight
Provide
quality
service
1. External and
internal customer
satisfaction rating
>80%
2. No. of complaints
/ incident report < 6
per year
Orient and train AU
staff on revised/
upgraded Operations
Manual

What is a sample of a BSC of a hospital unit?
PERSPECTI
VE
Key
Result
Areas/
Goals
Tactical
Objective
Measures Action Plans
Key Performance
Indicators
PEOPLE Staff
engagem
ent
Promote
aligned,
motivated,
empowered
and
contented
workforce
Absenteeism < 10%
Tardiness < 10%
Staff satisfaction rating
> 80%
1. Create a human
resource management
and development
program for the
Admitting Unit aligned
and integrated with that
of the whole hospital.
2. Maintain a conducive
and safe working place
for the AU staff.

BSC and Baldrige /PQA HCC
BSC’s perspectives
Financial
Customer
Process
Learning and Growth
Results
Baldrige / PQA HCC
Leadership
Strategic Planning
Customer-Focused
Process Management
Workforce-Focused
Measurements,
Analysis,
Knowledge
Management
Results
SET of KEY FACTORS / DRIVERS FOR ORGANIZATIONAL. PERFORMANCE

2013-2015 Strategic Objectives
STRATEGIC OBJECTIVES (2013-2015)
PERSPECTIVES OBJECTIVES
Governance, Service, and
Finance
1 Systems perspective in governance
2 Integrated value-based health care
service
3 Physician engagement (patronage and
loyalty)
4 Maximal utilization of services with
controlled expenses and losses
Customer 5 Customer delight
Process 6 Fully compliant with the quality and
performance standards (local and
international)
7 Integrated IT-enabled operations system
Learning and Growth of
People
8 Staff engagement
9 Learning organization
CSR 10 CSR program with tangible social impact

hospitals

hospitals
2 goals of PMS
• To promote performance excellence in the
hospital.
• To evaluate whether the hospital has achieved
performance excellence.

hospitals
TPOR3.1 Key drivers for successful journey
•Strategic planning
•Commitment
•Perseverance

CMZ’ Overall Direction and Goal for Next 3 Years, 6
Years and to Infinity and Beyond
Commitment, Support, Engagement, Involvement, Alignment,
Coordination, Collaboration, Integration
Top
Management
Middle
Management
Senior
Management
Personnel

Strategic Planning Conferences

hospitals
TPOR3.2 Creation of Hospital Teams and
Identification of Champions
Task Teams
MDH Quality Management Officer / QMR /
Internal Auditors
CMZ Task Team Corporate Planning / QC

hospitals
TPOR3.3 Assistance from an external
facilitator until a Learning Management
System is in place.
Facilitator:
• Familiar with and committed to help in the
journey to performance excellence
• Educator – innovator in facilitating learning
and development of best practices in
hospitals

Experiences in
Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg
Consultant-Adviser
Manila Doctors Hospital
Ciudad Medical Zamboanga
For queries and feedback:
0918-804-03-04
rjoson2001@yahoo.com

Experiences on Performance Management System in a Private Hospital Setting: TPORs of a Consultant-Adviser

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