Making a performance improvement plan work.
A carefully crafted organizational performance improvement (PI) plan can guide implementation and demonstrate that the organization is serious about continuously improving its processes and patient care outcomes. A good plan provides an overview of both the processes that are used to achieve PI and the expected outcomes. This article describes the process by which St John's Regional Medical Center (Joplin, Mo) developed and implemented its P1 plan. The first task is to define the desired PI program elements, such as use of teams and teamwork, measurement and monitoring systems, resource management tools, work redesign and reengineering, and customer-focused care. Then cultural changes to support the PI system need to be identified; the plan should include specific strategies to avoid or overcome any possible stumbling blocks. As an example of customer-focused improvement, intensive care unit nurses formed a team to address customer complaints about waiting room policies and physical facilities. An open visiting policy was initiated, pagers for family members of patients were provided, and the waiting room was made more comfortable. Use of resource management tools is illustrated by the development of algorithms and pathways to address variation in care provided to patients with complicated and uncomplicated acute myocardial infarction. Expectations for involvement from the top should be set, holding managers and employees accountable for participating appropriately; hospital departments and the medical staff should be integrated as soon as possible; and bureaucratic requirements should be kept to a minimum.