Performance Improvement Methodology Research Articles

Patient satisfaction in the Emergency Department: a review of the literature and implications for practice

This article reviews the empirical literature on patient satisfaction in the Emergency Department (ED). It explores the implications for clinical practice, discusses limitations and weaknesses of the literature, and provides direction for future research. Articles resulting from a comprehensive electronic search were obtained, their references examined, and all other relevant articles not already discovered via the electronic search were acquired and reviewed. Articles were included if: 1) the stated goal of the study was to investigate satisfaction with at least one aspect of ED care, 2) the study was conducted in the United States, 3) it provided enough information on the study methods, design, and statistical analyses to conduct a critical review, and 4) it used quantitative methods. Fifty studies met the above criteria. Based on the multivariate predictive studies, the most robust predictor of global satisfaction is the quality of interpersonal interactions with the ED provider. Perceived waiting times are more closely associated with satisfaction than actual waiting times. Several methods for improving satisfaction have shown promise, but none has garnered sufficient support to recommend unequivocally. Promising interventions include: providing information on how the ED functions through visual media, improving ED processes through performance improvement methodologies, and improving the interpersonal skills of providers. Interventions designed to reduce actual waiting times have not been sufficiently studied, but results from several well-designed studies suggest that such a strategy is unlikely to have as great an impact as those targeting perceived waiting times. To advance this area of research, investigators must use: 1) larger, more representative samples; 2) reliable and valid assessment instruments; 3) theory-driven hypothesis testing; and 4) randomized, controlled trials.

Quality improvement processes in growing a service line. The myriad of opportunities.

The authors describe the evolution of a pediatric quality management program in a large community hospital that has rapidly grown in size and complexity to be a tertiary care center. Positive changes in senior leadership expectations, physician involvement, and training in performance improvement methodologies contributed to the development of a more comprehensive program. The authors from several specialty areas of the pediatric service illustrate three quality and performance improvement projects that they used in coping with the challenges of fast growth and higher acuity.

Refining performance improvement tools and methods: Lessons and challenges

Performance improvement methods and tools have proven effective and are now widely used throughout the Americas Europe and parts of Asia. In the last five years there has been increased interest and experience in applying these same approaches to health services work in low-resource settings around the globe. Recognizing that successful performance improvement processes require adaptation and tailoring in any given situation interesting patterns of challenges and opportunities particular to health service delivery in low-resource settings are beginning to emerge. This article captures some of the knowledge gained through a growing body of field experience; in particular it highlights a handful of tools and discusses existing challenges and opportunities for applying performance improvement methodologies in low-resource settings. (excerpt)

The birth of PRIDE

New York Presbyterian Hospital created a performance improvement methodology to facilitate the redesign of its maternal-child health services.

Continuous improvement improved

There is no one performance improvement methodology or technique which is universally applicable. Analyses the various approaches to performance improvement that have been used over the last decade within manufacturing industry. Uses the lessons to identify the key components of an approach to continuous improvement that can be tailored to a particular organisation.

Application of data envelopment analysis for cell performance evaluation and process improvement in cellular manufacturing

This paper proposes a methodology for cell performance evaluation and improvement which considers multiple cell inputs and outputs. A specific technique in data envelopment analysis called 'window analysis', which captures the cell efficiency changes over time, is modified and utilized in the methodology. The evaluation is performed by considering the local part families (manufactured in single cells) and the infrequent parts (manufactured in multiple cells) processed by a cell. A major contribution of this research is in proposing a new 'modified window analysis' technique for cell performance evaluation, and in demonstrating its effectiveness over the 'traditional window analysis'. Another contribution is in using the cross efficiency matrix to identify periods of best cell operating practices which aid management in cell process improvement.

Quality engineering for continuous performance improvement in products and processes: A review and reflections

In the face of stiff and demanding competition internationally, there is a growing resolve in the industrial community to provide the customers and the market in general products and services of superior quality. Quality engineering has been established as an important continuous performance improvement methodology during the last decade. Consequently, numerous developments and innovative methods have been reported in the literature by researchers and practitioners alike. In this paper, a critical appraisal of recent developments, improvisations, and innovations in the field of quality engineering has been made. It is observed that there exists an immense body of knowledge in terms of better approaches, techniques, methodologies, aids, analysis tools, etc. However, most of these are oriented toward product improvement or process improvement in a localized manner, and a systematic approach for the application of quality engineering encompassing all the importnat functions in an organization is lacking. In view of this a comprehensive quality engineering methodology is also proposed in this paper so that the implementation of quality engineering in an organization will be more effective, and the benefits to be achieved will be substantial in real-life situations.

Performance measurement in prostate cancer care: Beyond report cards

Objectives Review and analyze various approaches to performance measurement in health care, demonstrating the value of provider-initiated performance measurement in which ongoing monitoring of both processes and outcomes of care coupled with the use of clinical guidelines enhances performance improvement efforts. Describe some of the issues and findings associated with the use of such a methodology in prostate cancer care. Methods Literature review and case study. Results There are a number of significant limitations in the use of a “report card” methodology to improve quality and efficiency in health care. The complementary approach of combining “instrument panels” and clinical guidelines within an overall continuous quality improvement framework appears to have resulted in improved clinical outomes and reduced costs in a six-physician urology group located in a heavily managed-care penetrated market. Conclusions Performance measurement tools are integral to efforts to improve outcomes and efficiency in health care. Providers of care might consider adapting the kind of performance improvement methodology described in this article. Practice benefits including improved clinical and economic outcomes are likely to follow. UROLOGY ® 47: 356–365, 1996.

Managing computer performance with control limits

Dr. Bell received his doctorate in Operations Management from the University of California at Los Angeles in 1968. He immediately joined the Rand Corporation as a Member of the Technical Staff in its Computer Science Department and undertook research in the simulation and perfomance improvement of computing systems. During this research he participated in the definition of the Extendable Computer System Simulator, the development of a methodology for computer performance improvement, and analysis of large, multi-machine computer installations. He also analyzed requirements for future command-and-control systems and for logistic systems, in order to determine required system functions and hardware size. He left Rand in early 1974 to join the Software Research and Technology Staff of TRW Systems Group where he is currently developing improved techniques to specify the requirements of computer software systems.