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Five critical performance measurements and their improvement (Proceedings)

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Apr 01, 2010

The economic slump has caused many to realize they must focus less on gut feelings and more on measurement. Whether your hospital is doing well or has flat growth, you must measure your current and future status in order to effectively grow. Evidence-based management is the key to your success.

Many practices measure the average client transaction, income by category, or client visits per year, then strive to improve those numbers. Yet without evaluating what approach (what behavior) might work best, outcomes aren't always optimal. In this session, attendees will explore the behavior that might affect those numbers, then generate ideas and gather new information in order to improve.

When the economy is tough, beware of falling into a "reactive" mode. Instead, look at longer term trends. Measure what's going on in your own hospital, and verify your "gut feelings." Gut feeling is not a measurement.

Consider items that you can measure, and what you will do once you obtain those measurements. Basic items to measure include:
1. Income by area
2. New clients / yr
3. Client visits / yr
4. Compliance
5. Average client transaction

Once you have measured, what do you do? Most will want to "compare," but with what? You can compare your results with others, via services such as the NCVEI web site ( http://www.ncvei.org/). You can also compare your results with yourself—over time.

What numbers do you want to change, and how will you change them? Behavior drives numbers... but, how? The answer is not always as simple as it appears. Create a system to evaluate whether any of your changes in behavior actually change the numbers.

For example, the behavior that affects your average client transaction could include whether or how well you use check-off sheets for procedures; whether you have and adhere to any medical standards; the behavior and communication ability of your doctors and technicians; and many other factors.

The behavior that might affect your doctors' income by area could include the types of services each doctor provides or enjoys; the way scheduling is done; whether you have and adhere to any medical standards; and many other factors.

Likewise, client visits per year, client compliance, and new clients per year all may be affected by a variety of behaviors. Some of those might include how much your team is involved in their community; the quality of client-team communication; and the saturation of your local market (practices per capita). It is too easy to guess, and too easy to come to erroneous conclusions about these factors. One particularly human (common) trait is to blame outside forces for unsatisfactory results (e.g., "our ATC went down due to the economy,") instead of looking inward for possible influences (perhaps doctors feel nervous about the economy, and hesitate to make clear recommendations).

Before you institute changes in your hospital, "back up" a step and spend some time brainstorming all the different factors that might influence a particular measurement. Then, discuss and decide upon one or two of those items that you wish to improve upon. While you cannot control outside forces, there are plenty of internal changes you can try. Implement changes, then measure again.

The recession provides an opportunity. Many practices that never measured these items in the past are looking at their current data with a desire for improvement. Yet all data is influenced not only by the economy, but also your team's behavior and communication. Tracking data year by year can help you to separate out the different factors that impact your numbers, and to evaluate which processes have had a positive impact on your practice success.

In summary, it is important that you gather data to create goals. When changing behavior with the goal of changing numbers, start with your 'best guess,' then measure and verify. Evaluate how behavior influences data. Follow trends and outcomes, continuing through good times and bad. Using this evidence-based management approach will help your entire team become more successful.

Resources

Client Satisfaction Pays: Quality Service for Practice Success. 2nd Ed, AAHA Press 2009. Carin A. Smith, DVM

Team Satisfaction Pays: Organizational Development for Practice Success. Smith Veterinary Consulting, 2008. Carin A. Smith, DVM