2011 Writing Objectives and Performance Indicators Small Group Activity Objectives: Develop objectives that reflect your organization s mission and values and fit into CARF domains (Effectiveness, Efficiency, Access and Stakeholder Input/Satisfaction) Determine how objectives can be measured based on data available within your organization Develop performance indicators, appropriate for your program, that can be used to summarize data to determine whether or not an objective has been met For each performance indicator, identify a target that will help drive quality improvement efforts Identify barriers and facilitators that can impact the ability to achieve your target Participants will work in small groups organized by program area (Medical Rehabilitation, Behavioral Health, Employment and Community Service & Aging Services). Groups will develop objectives and indicators for effectiveness, efficiency, access and stakeholder input/satisfaction using the grid format presented in the course. June, 2017
Step 1: Link your organization s mission and values to your performance improvement plan. Your organization s mission and values In any field, improving performance and accountability depends on having a shared goal that unites the interests and activities of all stakeholders. In health care, however, stakeholders have myriad, often conflicting goals, including access to services, profitability, high quality, cost containment, safety, convenience, patient-centeredness, and satisfaction. Lack of clarity about goals has led to divergent approached, gaming of the system, and slow progress in performance improvement. Porter, ME, (2010) What is value in healthcare? New England Journal of Medicine 363;26, p 2477 1
Example:Bett E.R. Times Memorial Behavioral Health Center Mission: To provide mental and chemical health outpatient services, case management, and employability development services to persons with severe and persistent mental health issues, and persons with cognitive and physical challenges related to substance abuse in order to assist them in obtaining or returning to vocational independence, live as independently as possible, and improve their quality of life. Vision: All persons served will feel safe and will be able to achieve the highest level of stability and independence by working in partnership with the Bett E.R. Times Memorial Behavioral Health Center. An objective refers to a characteristic or trait that can be measured that is related to what you want to accomplish. A performance indicator includes the following components: How data will be summarized Who is assessed and included in the analyses (with attention to potential sub-groups who should be included or excluded) What is measured and how is it quantified (should reflect an important aspect of the objective that it addresses). A target is what you hope to achieve in your setting. The target should be ambitious, but attainable. You can identify a target using any of the following: benchmarks, literature, historical data, clinician and/or stakeholder input. 2
STEP 1: Determine what construct to assess. obtaining or returning to vocational independence Mission and Values Worksheet Bett E.R. Times Memorial STEP 2: Write an objective. Persons served will improve employment status Developing Objectives and Performance Indicators STEP 3: Determine how to measure. Measure baseline employment and postintervention employment. Use categories with different levels of independence. (e.g., sheltered workshop, internship, competitive employment) Step 4: Write a Performance Indicator. % of persons served, completing the program, who demonstrate an increase employment independence Step 5: Set the Target 75% live as independently as possible Persons served will achieve maximal level of independence Document living situation, at the beginning of services and at appropriate time intervals. Include categories with different levels of independence (e.g., residential facility, group home, independent) % of persons served, completing the program, who improve in their level of independence in housing 80% improve quality of life Persons served will increase their quality of life Administer a quality of life measure at the beginning and end of services (follow up if possible) % of persons served, completing the program, who demonstrate a 10-point increase in their quality of life score from admission to discharge 60% 3
Developing Performance Indicators: Components to Include Examples of the three components of a performance indicate are provided below. 1. How data are summarized 2. Who is assessed? Percent Average Persons served Persons receiving behavioral health services Persons with a diagnosis of stroke Persons referred for outpatient services Persons completing a job training program 3. How is objective quantified? change 10 points on FIM Score from admission to discharge achieve three major goals are living independently 6 months after program completion are admitted within 14 days of referral have higher functional scores than the benchmark comparison group demonstrate a 20% change in scores on our Quality of Life measure from admission to discharge 4
OK Corral Medical Rehabilitation Services Mission: To provide rehabilitation medicine services and therapy to persons with orthopedic impairments in order to assist them in improving their functional abilities so that they engage in activities that are meaningful to them. Mission/value elements Mission and Values Worksheet OK Corral Medical Rehab What could you measure? improve functional abilities engage in meaningful activities and perform desired social roles Administer a standardized functional assessment at the beginning of services and collect follow up data at appropriate time intervals. Identify meaningful activities and desired social roles as part of the objective setting process and determine if objectives were met at the end of services 5
Objective and Performance Indicator Examples EXAMPLE 1: Organization: Health - Bett E.R. Times Memorial Behavioral Health Center Objective: Persons served will report that they are treated with respect (what measured). Performance Indicator: Percent (how data are summarized) of persons served (who is assessed) who indicated that they were treated with respect in follow-up surveys (what measured). Target: 90% (what you want to achieve) Actual:?? (what the data show) EXAMPLE 2: OAK E. Dokey Memorial Workforce Development Center Objective: Persons served will improve their job status (what measured). Performance Indicator: Percent (how data are summarized) of persons served who complete the program (who is assessed) who move from supported employment to competitive employment (what measured). Target: 50% (what you want to achieve) Actual:?? (what the data show) EXAMPLE 3: Behavioral Health - Bett E.R. Times Memorial Behavioral Health Center Objective: Expedite access to program services (what measured). Performance Indicator: Percent (how data are summarized) of new cases (who is assessed) that are scheduled for a first appointment within 10 days of referral (what measured). Target: 75% (what you want to achieve) Actual:?? (what the data show) EXAMPLE 4: Medical Rehabilitation - OK Corral Rehab Center Objective: Maximize functional change based on utilization of services (what measured). Performance Indicator: Percent (how data are summarized)of persons served (who is assessed) who improve 5 points or more on the Functional Independence Measure (FIM) and participate in 15 hours of physical therapy or less and (what measured). 6
Example 5: Aging Services Swan Homes Objective: Minimize secondary complications (what measured) for persons served. Performance Indicator: Percent (how data are summarized) of persons served (who is assessed) who develop a pressure sore (what measured). Target: 10% (what you want to achieve) Actual: (what the data show) 7
Developing Objectives and Performance Indicators: Small Group Activity Morning Groups will review mission statements and generate potential objectives and performance indicators. Use a statement from a group member s mission statement to develop objectives and performance indicators. If you don t have your organization s mission statement, use one of the sample statements listed in Appendix A. Afternoon Groups will use the grids to develop objectives and performance indicators for each of the four CARF domains. o Effectiveness o Efficiency o Access o Stakeholder Input/Satisfaction Each group will share one objective and performance indicator for each domain with the large group. Review your objectives and performance indicators to ensure that the SMART criteria are met. 1.) Specific o Focused on actions that are important for your organization? o Applied to the most appropriate subset of persons served? 2.) Measurable o o 3.) Ambitious o 4.) Realistic o 5.) Timely o o Data elements appropriate for the characteristic or quality you want to assess? How can you manipulate or transform your data to yield an appropriate metric? Serves as a motivator setting a bar that is high enough to promote real improvement? Do you have the necessary resources to achieve the objective/performance indicator? Have you established a time frame for monitoring and reviewing outcomes? Is the time frame appropriate for the indicator? 8
Appendix A: Mission and Vision Statement Examples 1. Behavioral Health - Bett E.R. Times Memorial Behavioral Health Center Mission: To provide mental and chemical health outpatient services, case management, and employability development services to persons with severe and persistent mental health issues, and persons with cognitive and physical challenges related to substance abuse in order to assist them in obtaining or returning to vocational independence, obtain an earned income, live as independently as possible, and improve their quality of life. Vision: All persons served will feel safe and will be able to achieve the highest level of stability and independence by working in partnership with the Bett E.R. Times Memorial Behavioral Health Center. 2. Employment & Community Services OAK E. Dokey Memorial Workforce Development Center Mission: To provide employability services and personal adjustment services to persons with cognitive, mental and physical challenges in order to assist them in becoming vocationally independent, obtain an earned income, and live as independently as possible. Vision: All persons served will be able to achieve the highest level of independence by working in partnership with the OAK E. Dokey Memorial Workforce Development Center. 3. OK Corral Medical Rehabilitation Services Mission: To provide physical rehabilitation medicine services, therapies, vocational counseling, independent living skills, and job placement services to persons with orthopedic impairments in order to assist them maximize their functional status, become vocationally independent, obtain an earned income, and live and participate in the community. Vision: All persons served will be able to achieve the highest level of functional independence and participation in life activities and the community by working in partnership with the OK Corral Rehab Center. 4. Aging Services Swan Homes Mission: To provide quality care to older persons unable to care for themselves while ensuring that all persons served are respected and encouraged to engage in the highest level of functioning that they are capable of performing. Vision: All persons served will be respected and maintain their maximum functional by being cared for and working with staff at Swan Homes. 9
Appendix B: Definitions Objective: A general category of issues/value statements that are values of interest to stakeholders. Objectives may encompass several indicators. Performance indicator: A quantifiable statement that can be used to evaluate key performance areas or quality over time often expressed as a rate or ratio. Target: Objective or benchmark that can be adjusted as performance changes over time to reflect changes and improvement in the organization and/or environment. Effectiveness: Results achieved and outcomes observed for persons served. Can apply to different points in time (during, at the end of, or at points in time following services). Can apply to different domains (e.g., change in disability or impairment, function, participation in life s activities, work, and many other domains relevant to the organization). Efficiency: Relationship between resources used and results or outcomes obtained. Resources can include, for example, time, money, or staff/ftes. Can apply at the level of the person served, program, or groups of persons served, or at the level of the organization as a whole. Access: Barriers or lack thereof for persons in obtaining services. May apply at the level of the individual persons served (timeliness or other barriers) or the target population for the organization. Stakeholders: Individuals or groups who have an interest in the activities and outcomes of an organization and its programs and services. They include, but are not limited to, the persons served, families, governance or designated authority, purchasers, regulators, referral sources, personnel, employers, advocacy groups, contributors, supporters, landlords, business interests, and the community. 10
Appendix C: Objective and Performance Indicator Examples Effectiveness Domain 1. Behavioral Health - Bett E.R. Times Memorial Behavioral Health Center Objective: Persons served will obtain or maintain appropriate community housing. Performance Indicator: Percent of persons served who are able to obtain or maintain community housing. Target: 50% (based on past performance) 2. Employment and Community Services OAK E. Dokey Memorial Workforce Development Center Objective: Persons served will improve their job status. Performance Indicator: Percent of persons served who move from supported employment to competitive employment. Target: 50% (based on past performance) 3. Medical Rehabilitation OK Corral Rehab Center Objective: Persons served will show improved function on discharge. Performance Indicator: Percent of persons served who improve 5 points or more on the Functional Independence Measure (FIM) from admission to discharge. Target: 75% (based on past performance) 4. Aging Services Swan Homes Objective: Minimize acute care needs of persons served. Performance Indicator: Percent of persons served who develop a pressure sore. Target: 10% (based on past performance) 11
Efficiency Domain 1. Behavioral Health - Bett E.R. Times Memorial Behavioral Health Center Objective: Minimize no-show rate for outpatient services. Performance Indicator: Percent of persons served who have more than one missed appointment in a 4-month period. Target: 40% (based on past performance) 2. Employment and Community Services OAK E. Dokey Memorial Workforce Development Center Objective: Optimize customer service hours to allow for transition to competitive employment. Performance Indicator: Percent of persons who receive 20 customer service hours or less and transition from supported employment to competitive employment within 6 months. Target: 50% (based on past performance) 3. Medical Rehabilitation OK Corral Rehab Center Objective: Maximize functional change based on utilization of services. Performance Indicator: Percent of persons served who participate in 15 hours of physical therapy or less and improve 5 points or more on the Functional Independence Measure (FIM). Target: 75% (based on past performance) 4. Aging Services Swan Homes Objective: Reduce time to complete admission assessment. Performance Indicator: Percent of new admissions for whom the initial assessment is completed in 3 days. Target: 70% (based on past performance) Service Access Domain 1. Behavioral Health - Bett E.R. Times Memorial Behavioral Health Center Objective: Expedite access to program services. Performance Indicator: Percent of new cases scheduled for a first appointment within 10 days of referral. Target: 75% (based on past performance) 2. Employment and Community Services OAK E. Dokey Memorial Workforce Development Center Objective: Expedite referral to vocational training for appropriate candidates. Performance Indicator: Percent of persons served, identified as benefiting from vocational training, who are referred for training within 7 days. Target: 80% (based on past performance) 12
3. Medical Rehabilitation OK Corral Rehab Center Objective: Services will be provided in a barrier-free environment. Performance Indicator: Percent of persons served who report ease of physical access to the building, treatment rooms and rest rooms. Target: 90% (based on past performance) 4. Aging Services Swan Homes Objective: Persons served will receive rehabilitation services, as appropriate. Performance Indicator: Percent of persons identified as benefitting from occupational therapy services who are seen by OT within 3 days. Target: 80% (based on past performance) Stakeholder Input/Satisfaction Domain 1. Employment and Community Services OAK E. Dokey Memorial Workforce Development Center Objective: On completion of services, persons served will be satisfied with their employment status. Performance Indicator: Percent of persons served who report that they are satisfied with their employment status in follow-up surveys. Target: 50% (based on past performance) 2. Medical Rehabilitation OK Corral Rehab Center Objective: Persons served perceive value in the services received. Performance Indicator: Percent of persons served who report that they would refer a friend or family member to our facility. Target: 75% (based on past performance) 3. Aging Services Swan Homes Objective: Address the needs of persons served. Performance Indicator: Percent of persons served who agree with the statement: My needs were met. Target: 75% (based on past performance) 13