1. What kind of Performance Im

1. What kind of Performance Improvement Plan would you developfor your healthcare facility and why? – Describe the function ofproject management in performance improvement programs – Identifyspecific knowledge and skills required for team leadership -Describe project life cycles and the group dynamics of team lifecycles – Identify the steps a team leader should follow tosuccessfully implement and complete a project 2. Describe the areasthat should be addressed in the development of a healthcareorganization’s performance improvement plan 3. Explain whyperformance improvement programs are evaluated – Identify theaspects of the performance improvement program that should beevaluated – Describe what organizations should do with theinformation gathered from the performance improvement programevaluation


The process involves setting goals,implementing systematic changes, measuring outcomes, and makingsubsequent appropriate improvements. Performance Improvement: Anapproach to the continuous study and improvement of the processesof providing healthcare services to meet the needs of patients andothers.

Performance Improvement hasdeveloped a language of its own. There are many terms that haveoverlapping meanings, which has given rise to confusion asimprovement activities have evolved. As you will see, the terms ofimprovement are ever evolving.


Quality is the degree to whichhealth services for individuals and populations increase thelikelihood of desired health outcomes and are consistent withcurrent professional knowledge.

Quality Assurance (QA) orQuality Management (QM):

An internal review process thataudits the quality of care delivered and implements correctiveactions to remedy any deficiencies identified in the quality ofdirect patient care, administrative services or support services.The process can employ peer review, outcomes measurement, andutilization management techniques to assess and improve the qualityof care. The level of care may be measured against pre-establishedstandards.

Quality Improvement (QI) orContinuous Quality Improvement (CQI):

A management technique to assess andimprove internal operations. QI focuses on organizational systemsrather than individual performance and seeks to improve qualityrather than correcting errors when safety thresholds are crossed.The process involves setting goals, implementing systematicchanges, measuring outcomes, and making subsequent appropriateimprovements.


An approach to the continuous studyand improvement of the processes of providing healthcare servicesto meet the needs of patients and others.

Performance improvement is measuringthe output of a particular business process or procedure, thenmodifying the process or procedure to increase the output, increaseefficiency, or increase the effectiveness of the process orprocedure.


There are several factors that aredriving performance improvement:

  • Consumers are more aware of qualityand performance issues in healthcare and they are demanding higherquality and accountability while containing costs.
  • Accrediting bodies such as theJoint Commission on Accreditation of Healthcare Organizations(JCAHO), the National Committee for Quality Assurance (NCQA), aswell as state agencies are requiring demonstrated performanceimprovement activities.
  • Those with purchasing power such asHMOs and insurance companies want to work with healthcareorganizations committed to improved outcomes.
  • Cost and reimbursement issues inhealthcare are forcing healthcare providers to look for more costeffective ways to provide care while maintaining quality.
  • Media coverage of quality issuessuch as the Institute of Medicine report on medical errors bring tolight how critical performance improvement is.

Basically, the purpose of theperformance improvement plan is to act as a tool in facilitatingimprovements by the employee. It is a fundamental part inconstructive discussions between employers or line managers andemployees about what is expected and what can be done to achievethis.


There are many barriers toperformance improvement. It is beneficial to be aware of them soyou can recognize them and find ways to overcome them.

  • Resistance to change is the mostpervasive and most common barrier to performance improvement. It ishuman nature to resist change and it is a difficult barrier toovercome.
  • Lack of commitment to performanceimprovement from leadership and/or employees. Many hospitaladministrators, managers, physicians and staff view performanceimprovement as a necessary task that they must perform in order tomeet accreditation requirements and do not really believe that theprocess of improvement works.
  • Needs for professional autonomysuch as physicians’ history of self-governance and peer review canbe a barrier. Many professionals in healthcare do not want toparticipate in ‘team’ performance improvement activities as theyfeel that others are not qualified to ‘judge’ theirperformance.
  • Healthcare organizations havelimited resources and many view performance improvement activitiesas merely a cost center and not adding value to the organization(lack of commitment).
  • There exists in healthcare aculture of shame, blame and fear associated with medical errors andundesirable performance.
  • Turf issues among professionals(such as physicians and administrators) and departments (such asadmitting and nursing) are common problems.
  • Time constraints are often cited asa reason for not being able to participate in performanceimprovement activities. Historically, administrators/managementhave not made giving staff time to participate in improvementactivities a priority.
  • Team members and others come to theproject with their own agendas and work to achieve their own goalsthat may or may not be in the best interest of the project.
  • Large improvement projects thatdrag on for long periods of time and lose focus or have littlesuccess may suffer from loss of momentum.
  • The performance improvement processis too complex and unwieldy.
  • Teams get bogged down in minutiainstead of rapid cycles of improvement that obtain results andreinforce that the process does work.

Quality Improvement (QI) Qualityimprovement (QI) consists of systematic and continuous actions thatlead to measurable improvement in health care services and thehealth status of targeted patient groups.


  • A committed and involved leadershipgroup is a key ingredient to a successful performance improvementculture and initiatives.
  • The entire organization must betrained and educated about performance improvement methods andtools.
  • Teamwork is an absolute must inorder to succeed in improving performance. The teams should bemultifunctional, multidisciplinary and made up of the appropriatemembers. Team members should be knowledgeable of the process and beenthusiastic about participating.
  • Communication among leadership,team members and the organization must be effective. Communicationis vital at all steps of the improvement process.
  • Data that is measurable, meaningfuland reliable must be available to teams to facilitatedecision-making and evaluating the performance improvementproject.
  • Another key element for success is“Project Champions”. They are leadership and/or staff that arecredible and can influence participation and change.
  • Adequate and appropriate resourcesare also required for a team to be successful. These might includeadequate human resources, money, time, and materials to get the jobdone.
  • A knowledgeable and effectivefacilitator is extremely helpful in keeping the team on track,educating team members and those affected by changes. Facilitatorscan also motivate teams as well as drive and monitor theproject.
  • An organization wide culture thatcontinuously seeks opportunities for improvement and embeds this inthe mission and values of the organization.

Key things that team managers needto do if their team is to thrive and succeed. These range fromchoosing the right people and deciding who does what, tocommunicating with, developing and motivating people. It alsocovers some of the most common pitfalls to be avoided.

First ThingsFirst

But before that, some definitionsare useful. What is management, exactly? And how does it differfrom leadership?

A good starting point is “Leadersare people who do the right things; managers are people who dothings right.” Leadership involves creating a compelling vision ofthe future, communicating that vision, and helping peopleunderstand and commit to it. Managers, on the other hand, areresponsible for ensuring that the vision is implemented efficientlyand successfully.

Of course, these two roles overlap –and, to be fully effective, you need to fulfill both roles.However, the focus of this article is on the specific skills andresponsibilities of managers, and on the tools available to them.After all, there’s no point energizing people to work towards afabulous vision of the future, only to fall flat on your face whenit comes to implementation.

Importance ofDelegation

The top priority for team managersis delegation . No matter how skilled you are, there’s only so muchthat you can achieve working on your own. With a team behind you,you can achieve so much more: that’s why it’s so important that youdelegate effectively!

Successful delegation starts withmatching people and tasks, so you first need to explain what yourteam’s role and goals are. A good way of doing this is to puttogether a team charter , which sets out the purpose of the teamand how it will work. Not only does this help you get your team offto a great start, it can also be useful for bringing the team backon track if it’s veering off course.

Only then will you be in a positionto think about the skills, experience and competencies within yourteam, and start matching people to tasks. Read our article on taskallocation for more on how to do this, and to find out how to dealwith real-world challenges, such as managing the gaps between teammembers’ skill sets.

Motivating YourTeam

Another key duty you have as amanager is to motivate team members. Try different approaches youprefer to adopt, you also need to bear in mind that differentpeople have different needs when it comes to motivation. Someindividuals are highly self-motivated, while others willunder-perform without managerial input.

Developing YourTeam

Teams are made up of individuals whohave different outlooks and abilities, and are at different stagesof their careers. Some may find that the tasks you’ve allocated tothem are challenging, and they may need support. Others may be “oldhands” at what they’re doing, and may be looking for opportunitiesto stretch their skills. Either way, it’s your responsibility todevelop all of your people.

Your skills in this aspect ofmanagement will define your long-term success as a manager. If youcan help team members to become better at what they do, you’ll be amanager who people aspire to work for, and you’ll make a greatcontribution to your organization, too.

The most effective way of developingyour people is to ensure that you give regular feedback to membersof your team. Many of us are nervous of giving feedback, especiallywhen it has to be negative. However, if you give and receivefeedback regularly, everyone’s performance will improve.

Communicating and WorkingWith Your Team – and With Others

Communication skills are essentialfor success in almost any role, but there are particular skills andtechniques that you’ll use more as a manager than you did as aregular worker. These fall under two headings: communicating withteam members, and communicating with people outside your team.We’ll look at each in turn.

Communicating With People inYour Team

As a team manager, you’re likely tobe chairing regular sessions as well as one-off meetings. Meetingof all kinds, and regular ones in particular, are notorious forwasting people’s time, so it’s well worth mastering the skill ofrunning effective meetings .

Many meetings include brainstormingsessions. As a team manager, you’ll often have to facilitate these,so you’ll need to be comfortable with doing this. There’s more tothis than simply coming up with creative ideas, as you do whenyou’re just a regular participant in such a session: read ourarticle to find out how to run brainstorming sessions. Make surethat you understand where they can go wrong, and what you can do toavoid this.

Active listening is anotherimportant skill for managers – and others – to master. When you’rein charge, it can be easy to think that you know what others aregoing to say, or that listening is less important, because you’vethought of a solution anyway.

Don’t fall into this trap. Most goodmanagers are active listeners: it helps them detect problems early(while they’re still easy to deal with), avoid costlymisunderstandings, and build trust within their teams.

Communicating With PeopleOutside Your Team

Your boss is probably the mostimportant person you need to communicate with. Take time tounderstand fully what your boss wants from you and your team – ifyou know exactly what she likes, and how she prefers this to bedelivered, you’ll be better able to meet with her approval.

Don’t be afraid to ask your boss tocoach or mentor you: you can usually learn a lot from him, but hemay not be proactive about offering this. If you’re approachingyour boss for advice, make sure you’ve thought things through asfar as you can. Introduce the subject with a summary of yourthinking, and then say where you need help.

Also, as a manager, part of your jobis to look after your team and protect it from unreasonablepressure. Learn skills like assertiveness and win-win negotiation ,so that you can either turn work away, or negotiate additionalresources.

Another part of your job is tomanage the way that your team interacts with other groups. Usestakeholder analysis to identify the groups that you need to dealwith. Then talk to these people to find out what they want fromyou, and what they can do to help you.


However much you hope that you won’thave to do it, there comes a time in most managers’ careers whenthey have to discipline an employee. Discipline may be subtlydifferent from basic feedback, because it doesn’t always relatespecifically to the employee’s work. You can give feedback on theirphone manner, for example, but handling problems with timekeepingor personal grooming can need a different approach.

Obvious breaches of the law or ofcompany policy are easy to identify and deal with. But what ofother situations? On one hand you don’t want to seem petty. On theother hand, you can’t let things go that should be dealt with.

Traps to Avoid

There are a number of commonmistakes that new managers tend to make. Take care to avoidthem!

These are:

  • Thinking that you can rely on yourexisting job knowledge and technical skills to succeed as amanager. It is essential that you take the time to develop goodmanagement and people skills as well – these can be more importantthan your technical skills!
  • Failing to consult regularly withyour boss, in a misguided attempt to show that you can cope on yourown.
  • Approaching your boss withouthaving thought a problem through, and without having considered howthe problem could be solved.
  • Embarrassing your boss, or lettingher get a nasty surprise. Follow the “no surprises” rule.
  • Doing anything that requires yourboss to defend you to others. This can cause your boss to “loseface” with his peers and superiors, and it makes it look as if histeam is out of control.
  • Failing to talk to your customers(whether internal or external) about what they want from yourselfand your team.
  • Using your authorityinappropriately – make sure that everything you ask people to do isin the interests of the organization.
  • Many of these points sound obvious,however it’s incredibly easy to make these mistakes in the rush ofeveryday managerial life.

Teams in the workplace have “lifecycles,” different stages of evolution during which members exhibitdifferent patterns of behaviour and productivity. Being promotedfrom team member to team leader is rife with challenges. In thatsituation, it’s critical to understand what stage of its life cycleyour team is currently in, in order to understand the teamdynamic.

This life cycle is based the theorythat group dynamics go through distinct phases of development,including:

Forming: The firststage of the team process realizes the transition from a group ofindividuals to a functioning team. In this stage members developconfidence in each other and in their leaders.

Storming: Adifficult, but natural, stage known for its negativity. During“storming,” team members often lash out at each other when theyrealize the amount of responsibility and amount of work that liesahead.

Norming: Therainbow after the storm, norming is the sweet phase when membersbecome accustomed to working with each other co-operatively.

Performing: Thisinvolves group maturation, and is characterized by extremeproductivity.

Practical and effective projectmanagement has its roots in simplicity. Keeping a thing simplemakes it easier to understand for most stakeholders e.g. projectstakeholders can provide requirements in simple terms – teamsunambiguously, they can set clear expectations. Projectstakeholders can measure project success in terms of benefits itdelivers.

These days all of us are expected tobe efficient. Always! So, if efficiency is expected from everyone,how can we make the difference? By being effective. Here is a 6steps approach to do effective project management for yourorganization and drive better results.

1. The Groundwork – First DoYour Homework

Before project manager or portfoliomanager (PM) can jump on to project planning, you as PM should bedoing certain ground work. As mentioned earlier you shouldidentify

  • Who are project stakeholders, whowill be beneficiaries?
  • What are expected benefits?
  • Based on these benefits, how youcan garner buy-in from senior management or customers?
  • High level of deliverable, skillset required to deliver those
  • Identify metrics: projectmanagement KPI to define project success
  • How project artifacts, progress,issues, deliverable will be communication i.e. communicationplan

Let’s look at these six basic stepsfor effective project management: project planning and projectexecution that a project manager can follow in almost every projectto ensure project is delivered successfully.

2. Clarity of projectrequirements, project scope

In most cases, unclear projectrequirement definitely results in project failure. Right at thebeginning ensure all relevant stakeholders understand projectrequirements clearly and the importance of having unambiguousproject scope. It is pretty common these days to see that salesteam, project managers working with clients and help him articulateclient’s requirements. Based on very high level projectrequirement, you can chalk out project charter, project scope.

If you would like to avoid projectscope creep, you will have to make stakeholders understand thatproject scope is sacrosanct. Having said that total inflexibilitycan also kill project outcome (i.e. project outcome will not beuseful or beneficial to customer as expected). You can accommodatechange request after reviewing its value to project outcome.

It is crucial for effective projectmanagement to be able to have complete and clear projectrequirement, right at the beginning and avoid project scope creepduring project execution. You can use right project managementtools to draft, articulate project requirements, review and seekapprovals, so that transparency and accountability for projectrequirement is ensured.

3. Planning schedule, risks,resources

Team Selection

Once a project charter and projectscope is defined and articulated, you will have to identify projectmanager and project planners. Having project manager, projectplanner and team members who are subject matter expert for aproject in consideration wins half-battle. As project manager &project planners define work-breakdown-structure (wbs) and identifyhigh level deliverable, identifying right skillset to work on thosedeliverable is equally important. So based on these identifiedskillset, project manager has to select resources who will beallocated to project and will be assigned work.


The planning phase of projectrequires well defined project charter and project scope. Based onthis project manager can work on project schedule identifyingimportant deliverable, WBS, milestones. As he gets betterunderstanding of project scope, available resources, he can createdetailed project schedule identifying minute level details ofproject schedule : i.e. tasks, milestones, subtasks, allocating andassigning resources to each of these tasks. As we know, detailingleads to questions, questions brings clarity, and clarity drivespredictability.

This phase marks a clear assignment,responsibility for project team members. Again it is important tohave detailed project schedule for effective project management.And equally important it is, to be able track project tasksseamlessly

Planning for ProjectRisks

Managing project risks is integralpart of project management. If your projects are not trivial,whether you like it or not -risk will be inevitable part of yourprojects. If it is not done as an academic exercise of managingproject risks, project risk management saves you greatly fromsurprises. It is important for effective project management to planfor project risks right at the beginning. You need to make teammembers aware of project risks also provide a platform like onlinerisk register where team members and other stakeholders can quicklyrecord & highlight project risks.

4. Communication Plan -Clarity & Frequency

At every phase and step of managingproject, project manager has to communicate. Communication strategyand plan is crucial for greater project visibility and ultimatelyfor project success. Project communication is required for

  • Informing stakeholder about projectplan, scope; review and approvals thereof
  • Keeping team members informed aboutchange in project schedule
  • Being able to highlight issues andrisks in project
  • Being able to provide clear &real better visibility to sponsors, portfolio/executive managerswith project portfolio KPIs
  • To get buy-in or support fromsenior management if anything is going wrong

Get Organized & StartUsing Project Management Tool

Nobody likes bad surprises, clearand frequent project communication will save you from surprisingyour customer or senior project management.

Even today most people rely onemails for day to day communication. But if you are sending emailsto stakeholders by yourself, then you are certainly not doing it inthe best way, you are spending time on things which are besthandled and automated by project management tool. A projectmanagement software is indispensable to automate projectcommunication. Any change in project schedule, issue assignment,new risk in register, comments to tasks, issues, risks, projectmeetings, task due date reminder, project status changenotification, etc. will be automatically communicated by a projectmanagement system and thereby leaving no manual error forcommunication gap or manual error in informing project teammembers, project sponsors or senior management or evencustomer.


Now almost everything looks ready ona paper, it is a time for a project team to jump-in and startworking on minute level tasks. As mentioned earlier, every teammember, vendor, customer should be informed and made aware of clearexpectations from them i.e.

  • When a specific task is supposed tostart,
  • Who will do it,
  • When it should be completed
  • What information should be updated(timesheet, expenses, document, and deliverable)?

It is then become the work to bedone on the ground. As team members start working on it, projectmanager and project leaders can play a role of facilitator,guide/coach so that there is a productive and positive environmentfor project team.

5. Monitor &Control

As the project is kicked-off andproject team has started working on project deliverable, as projectmanager you need to track project progress, communicate it tosenior project managers, customers as appropriate. In order tomonitor and control project

  • You will have to collect progressupdates, and check project is not going off-the-track
  • Adhere to the project schedule,cost and keep watching project baseline
  • Follow the mantra Get Things done,no matter what are obstacles
  • Check project deliverable forquality
  • Involve project sponsors, customersand end-users informed
  • Take a regular feedback from team,customers and end users
  • Manage change requests, issues andrisks judiciously; as these are inevitable but if not managed wellcan take project off the track

6. Deliver, close andReview

When you will deliver projectartifacts, meet milestone ; you would like your project customersto see the benefits. You would like customer to actually make useof it. Hence you will have to see

  • Project deliverable are working forcustomer
  • Address any issue, gaps
  • Work with customer to identifytrainer or champion
  • Train the trainer
  • Run a pilot, make it successful andenable customer to market it inside and outside customer’sorganization

To get customer confirm successfulproject deliverable, you can schedule a pre-planned review meetingto get a formal agreement, seek feedback, identify positives andnegatives of the whole exercise of delivering projects – projectreview. Thereafter, you should also conduct an internal review ofthe project to identify mistakes made, learning thereof and bestway to move forward.

Successful project delivery is not arocket science. But it is perceived to be complicated and demandingprocess and if these perceptions are not clarified, it induceserrors, risks and makes project go off-track, overrun cost, deliversub-standard outcome. Though it can be complicated and demandingprocesses, it is not conquerable. As per industry reports, there isstill large percentage of project which are delivered successfully(on time, within budget, of desired quality). Following closingpoints will help you in succeeding project delivery.

  • Get clear project requirement, haveclear understanding of project requirements
  • Have an eye for detailing : be itrequirements, tasks, issues, risks or communications
  • Ensure team members have enoughinformation to perform tasks, make them accountable
  • Stick to project schedule, yetthings can go wrong with project so deliberately have buffer whilecreating project schedule
  • Review project progress, initiatecorrective actions quickly: stop project from failing
  • Keep key stakeholders informed,seek buy-in wherever, whenever necessary
  • Articulate key learning beforeclosing project and utilize these learning aptly for futureprojects.

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