---
title: "What is Performance Improvement?"
---

## Benefits of Performance Improvement

Performance improvement is a big boost for:

<ul>

<li class="icon patients">

**Your Patients:** they're healthier and happier.

</li>

<li class="icon personnel">

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

</li>

<li class="icon agency">

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

</li>

</ul>

## Performance Improvement Defined

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

```{mermaid}
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. [@deming2018]

## Foundations

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

@crossing2001 [pp. 5-6] outlines six aims for healthcare. When considering a change to improve performance, run it through these filters:

<ul>

<li class="icon safe">

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

</li>

<li class="icon effective">

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

</li>

<li class="icon patient-centered">

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

</li>

<li class="icon timely">

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

</li>

<li class="icon efficient">

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

</li>

<li class="icon equitable">

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

</li>

</ul>

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.

::: callout-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.

::: {.callout-note appearance="minimal"}
A report from the <abbrev title="National EMS Quality Alliance">NEMSQA</abbrev> Lights and Siren Collaborative said, “Only nine out of the 50 EMS systems were able to make meaningful changes to their systems.” [@lights2024, p. 4]
:::
