The utilization of systematic outcome mapping to improve performance management in health care

Abstract

Performance management is an important mechanism for ensuring accountability and improving the quality of health-care services. The last decade has witnessed a proliferation in the development of performance measurement systems for assessing health-care processes and outcomes at the program, hospital, district, system and national level. This has allowed for comparison and benchmarking between similar aspects of care at each of these levels. Unfortunately, most performance systems are devoid of clear mechanisms for translating feedback from measures into strategies for action, thus leaving largely unfulfilled the quality and management aspect necessary to improve health-care services. Therefore, the thinking that goes into designing these systems must change. This article outlines a management framework called systematic outcome mapping that provides for performance management rather than just performance measurement by allowing for quality improvement to be built into performance indicator development. It utilizes evidence-based medicine and expert consensus opinion to establish linkages between processes of care and their outcomes with the clear intent that feedback from information provided by performance indicators can be used to modify health-care activities so as to improve health outcomes. This fulfils the quality improvement aspect of performance measurement and makes it an integral part of a performance management framework that reinforces organizational learning through feedback from outcomes and the assessment of organizational routines.

Making Health System Performance Measurement Useful to Policy Makers: Aligning Strategies, Measurement and Local Health System Accountability in Ontario

“…The moHLTC applied the strategy mapping approach to healthcare (Greenberg et al 2005;Persaud and Nestman 2006), in which (a) government priorities and objectives are identified, (b) these aims are grouped into a logical set of strategic goals and (c) the goals are mapped in relation to one another. The methodological steps in formulating strategy maps have been previously defined by kaplan and Norton (2004).…”

Exploring China’s western and central county systems performance measured by outcomes framework scores—A cross-sectional survey of routine healthcare data

“…In 2006, Persaud and Nestman, in their study on enhancing performance management of health services, developed a diagrammatic representation of health system outcomes in which they attempted to establish connections between outcome, process and input. From this they established an evidence-based pathway for improving performance [7] . In fact, performance is the product of multiple forces.…”

Creating a Culture of Accountability in Health Care

“…7 Furthermore, accountability encourages the assessment of evidence from process and outcome measures by using feedback from performance measurement to improve processes and outcomes of health care activities. 9 Finally, accountability is synonymous with the utilization of evidence-based practices, such as CPGs, while enhancing learning and reducing variability. 8 Intuitively, if employees and organizations are holding themselves more accountable, then the desire to learn and use evidence-based practices and performance measurement tools will be increased, thus engendering continuous assessment, learning, and change.…”

“…5,19,20 Finally, feedback from both internal and external stakeholders ought to be collected as part of a performance management program by using employee and patient surveys. 9 …”

“…12 There are 3 broad aspects to performance managementmeasuring, reporting, and management and assessment of outcomes relative to quality improvement plans. 9 Performance measurement is an important process in creating a culture of accountability because measurement informs on quality and you cannot manage what you do not measure. 7 The measurement of outcomes includes monitoring the performance of the organization against service standards and organizational goals.…”