What is Performance Improvement?

Benefits of Performance Improvement

Performance improvement is a big boost for:

  • Your Patients: they’re healthier and happier.

  • Your Personnel: people like to work for agencies that are striving to improve.

  • Your Agency: you can do more with limited resources.

Performance Improvement Defined

Performance improvement is closing the gap between what we’re currently doing and what we know is best.

flowchart LR
  A(What We're Currently Doing) --> B(What We Know is Best)

Quality Assurance is Not Performance Improvement

  • Quality assurance is about making sure your processes and protocols are followed.

  • Performance improvement is about making your processes and protocols better.

William Edwards Deming estimated that 94% of problems are due to systems, processes, structures, and practices, and only 6% are due to individuals performing poorly. (Deming 2018)

Foundations

Performance improvement focuses on changing systems and processes. It’s not about punishing people.

Crossing the Quality Chasm (2001, 5–6) outlines six aims for healthcare. When considering a change to improve performance, run it through these filters:

  • Safe: Will it reduce the risk of patients and providers getting hurt? Or will it expose them to new risks?

  • Effective: Will it help give the right treatments when needed and avoid treatments that won’t make a difference?

  • Patient-centered: Will it help you respect each patient’s individual needs, preferences, and values?

  • Timely: Will it help patients get faster treatment? Will it speed things up for your personnel?

  • Efficient: Will it help reduce waste of equipment, supplies, ideas, and energy?

  • Equitable: Will it help people without making things worse for other people?

Performance improvement efforts are supported by data. They are measurable. You should be able to use data to objectively evaluate whether a change worked or not.

Performance improvement involves everyone in your agency: leadership, providers, and support staff.

Fitting It In

You probably don’t have all the the resources you’d like to have in your agency. You can’t hire a whole team of performance improvement specialists. It’s OK. You can infuse a culture of performance improvement in the things you already do rather than layering it on as an additional thing.

Tip

How about using performance improvement to tailor the training that you conduct in your agency? You have to do training anyway to meet licensing requirements, but when you have a performance improvement culture, you train on what will really make a difference, rather than just checking off a box.

Failure is OK

Failure is learning. If you try something and it fails to improve performance, you can move on and try something else instead.

A report from the NEMSQA Lights and Siren Collaborative said, “Only nine out of the 50 EMS systems were able to make meaningful changes to their systems.” (“Improving Safety in EMS: Reducing the Use of Lights and Siren” 2024, 4)

References

Crossing the Quality Chasm. 2001. National Academies Press. https://doi.org/10.17226/10027.
Deming, W. Edwards. 2018. Out of the Crisis. The MIT Press. https://doi.org/10.7551/mitpress/11457.001.0001.
“Improving Safety in EMS: Reducing the Use of Lights and Siren.” 2024. National EMS Quality Alliance (NEMSQA). https://nemsqa.org/assets/LSChangePackage/Improving%20Safety%20in%20EMS%20Reducing%20the%20Use%20of%20Lights%20and%20Siren.pdf.