Abstract
Performance measurement is an important aspect that is of great concern to many health institutions. Health organizations are striving to improve the delivery of healthcare basing on performance measures that they have developed. Transformative developments in healthcare will require the use of performance measures and parameters in order to inform and enhance quality in the provision of services. This paper will provide a summary of how performance measures can be used to understand the levels of micro, macro, and meso in healthcare system. The information that will be obtained from this paper is intended to be used by those working in healthcare systems. They can use it to improve the provision of quality healthcare systems.
Introduction
Healthcare providers are faced with due pressure to provide quality healthcare to patients, communities, and payors. There are performance measures that have been put in place in order to enhance quality of healthcare at different levels. There are different levels that performance measures can be assessed. Each level has different ways in which performance can be implemented.
Levels of care
There are different levels of care that can be found in hospitals. The measures of performance can be derived from the different levels that are found in health systems. The first level of health system is that of the micro level. This is the level of the individual provider and the receiver of the health care. The metrics that can be used to measure performance at this level is the time that the patient waits to be served. Another example of metric that can be used at this level is the level at which diabetes is being handled in a healthcare organization. In this level, the clinical perspective in which performance can be assessed and looked is the level of care that the clinicians provide, the safety that the clinicians have in the organization and the rate at which the clinicians and staff stick to the laid guidelines and policies. From the side of the patient, some of the issues that are of concern to the patients include the timely access to healthcare, the satisfaction index of the services they are offered and the communications that they get from the providers.
The second level of care is that of meso level. At this level, the entities represented are the organizations which provide care and the given people whom they serve. In this level, the metric that can be used to measure performance is the rate of infection. Another performance metric is the level of commitment of the employees in the organization. The employees and their commitment play a critical role in measuring performance in the health setting.
The third level is that of the macro level. This is the care that provides for larger populations. The metrics that can be used to measure the performance of healthcare in this level is the rate of immunization, the re-admission rate that is being experienced. This is the performance at a larger perspective and covers a wider area. One of the entities of macro level of performance is the system itself. The healthcare system is a macro level itself because it is made up of several systems. The systems that make up health care system could be legal, physical or functional systems. The senior managers of a healthcare system will be tasked with reviewing these systems from time to time.
When performance measurement is being undertaken, there is always some entity in which the measurement is performed. The entity that the performance is measured may be small or large. This makes the understanding of the different levels of health system easier. Large organizations face some special challenges when it comes to performance systems design. This is because of the fact that they have to ensure that the performance systems they have designed can be integrated to the macro levels and at the same time at the micro levels. Performance measures make the understanding, then, of levels of health systems much simpler as the entities in which the performance systems are undertaken are clearly defined (Spath, 2011).
One of the performance measures that are found in health care system is financial measures. This is because the dollar is a common unit that is used for measurement for most health care units. The senior management and the board are required to set and review the financial systems at the systems level from time to time. It is hard and difficult to make use of the quality of healthcare, satisfaction, and cost as a measure in the system level because these measures are only applicable to specific units of the healthcare system.
Another level of performance is the hospital. The performance measures that are applicable at this level include the financial measures, satisfaction, cost/efficiency, and quality of care.
Domains of performance measures basing on different levels
Quality of care
The performance is measured at different levels of the healthcare system. One of the domains of performance in the healthcare system is quality of healthcare that is provided. This is an important domain as it determines the clinical content that has been provided for the different groups of patient in a healthcare. The domain of care can be used to get the quality measures for the different levels of healthcare. The quality of care can be measured at individual levels or can be measured at an organizational level. The performance measurement in this perspective can be undertaken at the three levels. The organizational level performance measurement can be assessed basing on, for example, the rate of nosocomial infection rate that is seen in the whole hospital. There are accepted patterns of treatment that have been defined for most quality of performance measures. In some instances, the accepted standards of treatment for some medical conditions may be got from expert knowledge or the local customs. In some other situations, there are published procedures that have been developed that act as important guide to the development of healthcare. There are some procedures that have been developed by scientific journals and have been used to measure the performance and quality of the treatment that patients receive. It is evident that the levels that are found within healthcare systems are addressed with the performance measure of quality (Finney, Humphreys, Kivlahan, & Harris, 2011).
This performance of measure can be used because the quality of the care is an important aspect and brings out the way healthcare is provided. Most of the players in the three levels use quality to measure the performance of the provision of healthcare. It is clear that the three levels of performance of measure health make use of quality. Quality is an important parameter.
The quality as a performance measure can be interpreted at different levels to mean many things. One of the interpretations that can be seen at the micro level could mean the number of patients which are being attended at a given time. Another parameter of quality measure is the outcome. This is the change that can be measured after a patient has been attended. The patient should be able to respond to the treatment that has been offered. This is an important interpretation because it shows that there is some form of quality care that is being offered by the organization. This will translate to the wait time that the patients will be subjected in the lines. At the meso level, it could be interpreted to mean the rate of infection and how it has been handled in a given healthcare facility. Another interpretation can be shown by the presence of the safety committee. There is also the measurement of quality basing on the process. This is what the organization undertakes. The process can be measured by the utilization measures that have been implemented in the organization. At the macro level, it could be interpreted to show the levels and the rate of immunization that has been rolled up (Baker et al., 2013).
Utilization/cost/efficiency
This is another performance measure that should be undertaken in a health organization. The length that an impatient takes in a hospital is no longer interpreted to show the quality of measure for a given situation. This is because of the fact that there is the use of DRG payment system. These systems have shortened the length that inpatient take in the process of seeking treatment. The duration that inpatients take today are short and any further reduction of their stays and duration would be a compromise to quality of care.
The cost and efficiency is a meso and macro performance measure. This is due to the fact that organizations are the ones who stipulate the costs of most medical processes. The cost of given medical procedure and the efficiency of that procedure can be interpreted to show the care and concern. This is a meso and macro level performance measure.
Satisfaction
This is part of the quality domain and is viewed to be am outcome measure of performance. The satisfaction of the patient is at the micro level because it entails the outcomes of the patient after they have been to the health institution. The satisfaction is categorized under the outcomes of the quality measure as the patient will either be satisfied or not satisfied after they have been treated.
This measure of quality performance can be interpreted to show the number of patients who would return to the same health institution. This would mean that they were satisfied with their initial visit.
Conclusion
The measures of performance are useful in understanding the levels of performance in health care systems. The performance levels are applicable to given areas only. This is the reason why it is important to understand the levels of performance in an entity and understand how the measure of performance and the level work together. Measures of performance are important aspects when it comes to assessing the quality that is being offered by an institution. Performance measures help in dissecting the levels of micro, meso and macro and enhance the understanding of these levels.
References
Baker, D. W., Qaseem, A., Reynolds, P. P., Gardner, L. A., Schneider, E. C., & American College of Physicians Performance Measurement Committee. (2013). Design and use of performance measures to decrease low-value services and achieve cost-conscious care. Ann Intern Med, 158(1), 55-59.
Finney, J. W., Humphreys, K., Kivlahan, D. R., & Harris, A. H. (2011). Why health care process performance measures can have different relationships to outcomes for patients and hospitals: understanding the ecological fallacy.Journal Information, 101(9).
Spath, P. L. (Ed.). (2011). Error reduction in health care: a systems approach to improving patient safety. Wiley. com.
