Principles of Organizational Performance Management

The purpose of this research paper is coming up with a plan to improve performance in the Intensive Care Unite department in the hospital. The ICU is a critical department as it is the house for patients who are severely ill and those who need close monitoring by doctors and nurses. According to Guo et al. (2019) , ICU is one of the most stressful and risky working environments. It is an environment that brims with different medical specialists and high-class medical equipment. Therefore, understanding the best mechanism to improve the quality, performance, and safety of the patients and staff in this department contribute to quality care improvement in the entire hospital. The aim is to come up with a performance improvement scorecard that targets the patients’ safety, quality care at the ICU, general performance improvement, and employee engagement. The aim is to define a plan that can work better at the ICU to improve quality services to reduce instances of risks to the patients. 

A1. Identify the Patient Population Being Addressed 

The article focuses on patients in the Intensive Care Unit. The ICU of a hospital is a section that houses patients who need close monitoring by a team of medical staff. These could be patients who have head injuries or those under monitoring after surgical intervention. The ICU is also a section that houses patients who have lung problems and need ventilation monitoring. These are patients who are not in a position to breathe appropriately and need ventilators to aid in breathing. Patients with cardiac issues also form part of the patients under an intensive care unit. These could be patients who have either very high or very low blood pressure ( Huijben et al., 2019). 

Additionally, the patients suffering from a heart attack or unstable heart rhythms can also get admission to the ICU. Patients with severe infections are also part of the ICU. In general, any nature of these patients is suitable for this research because the core of the study is to look at their safety and quality care they receive from this department and come up with goals and measures that can help boost the safety and quality of such care. 

Indicator		Outcome Measure/Goal		Necessary Processes		Drivers
Performance		Reduce the rate of ICU readmission by reducing the rate of infections and enhancing the rate at which the medical staff at the ICU use evidence-based practice to improve the quality of medical care at the ICU department.		Regular ongoing in-services to identify early onset of CLABSI’S, VAP & CAUTI’S  Ongoing assessment for all the medical process/protocols to ensure quality performance		Reduce the length of ICU and hospital stay for patients.  Reduce the cost incurred by the ICU patients in the hospital  Reduce the mortality rate at the ICU
Quality		Reduce the rate of medication errors by ensuring that there are two patient identifiers.  Calling a time out anytime a bedside procedure ensures that the proper procedure, to the correct side, and or the correct patient is being done.		Enhance evidence-based practice at the ICU  Implement a double-checking system of confirmation of medication administration  Sensitizing staffs on medication errors  Implementing a time out form for the nurse & physicians to sign at the time of bedside procedure to ensure they make no errors.		Reduce the rate of morbidity and mortality  Increase patients’ satisfaction at the ICU  Reduce the chance of readmission at the ICU
Patient Safety		Reduce the rate of hospital-acquired infections such as ventilator-associated pneumonia and central line-associated bloodstream infections by developing bundle procedures for medical staff to perform regularly during their shift.		Implementing regular ongoing hygiene such as oral care at least every 2 hours for vented patients to prevent the colonization of ET tubes.  Encouraging medical assessment processes  Promoting evidence-based Practice  Strong handwashing skills		Increase the emphasis of handwashing hygiene by emphasis high level of hygiene culture safety culture  Increase patient satisfaction with the provision of the services at the ICU department.  Reduce the cost of care for the patients visiting the hospital and increase the hospital reputation
Employee Engagement		Increased education and training for staff working with this population by introducing programs meant to increase the interaction between patients and medical staff, evidence-based practice training, and safety training for the staff.		Organizing monthly Meetings for performance reviews  Enhancing Benchmarking		Better patient outcomes  Decrease the risk of job-related injuries related to working with this population

A2. Identify At least One Outcome Measure Relating to the Population 

Performance 

The high rate of readmission is an outcome measure of poor performance. In research by Huijben et al. (2019) that looks into the reasons behind ICU readmission, the authors reveal that the readmission rate in most hospitals is between 7 to 9 percent. The rate of ICU admission accounts for 5% to 14% of the entire admission rate in most hospitals. The study reveals a similar data to the study by Doesburg et al. (2019) that places the rate of ICU readmission at 8%. One of the drivers is health care cost reduction. Readmission increases the hospital bills for the patients and families, thereby increasing the cost of care. Additionally, readmission increases the length of stay in the hospital. Finally, the quest to reduce the mortality rate at this department could be a driver to reduce the readmission rate. Reducing the readmission, therefore, reduces the cost of care, the length of stay for the patients as well as mortality rate. 

Quality 

The ICU environment has a lot of pressure and stress, making it vulnerable to medication errors. Pandit& Koul (2018) reveal that the rate at which medical staffs make mistakes that lea to medication errors stand at 30%. The research study also reveals that medication errors  range from 1.2 to 947  errors  per 1,000 patient  ICU  days. The implication is that the rate of medication errors is emerging as a big threat to quality in the ICU department. The rate of medication errors is, therefore, an outcome of poor quality services in the hospital. Therefore, Reduce the rate of medication errors by ensuring that there is a two-patient identifier is a critical goal. Furthermore, calling a time out anytime a bedside procedure ensures that the proper procedure, to the correct side, and or the correct patient is being done is another objective that measures quality at the department. 

Patient Safety 

The outcome measure for patient safety in the ICU is to reduce the rate of hospital-acquired infections by developing bundle procedures for medical staff to perform regularly during their shift. The hospital-acquired infections are those diseases a patient acquires while staying at the hospital. In most hospitals and the entire healthcare sector, hospital-acquired infections pose a significant threat to patients' safety. The ICU contributes most of the hospital-acquired infections. Mostly, diseases such as ventilator-associated pneumonia and bloodstream infections of central lines are common among ICU patients. Ina research study focusing on the rate of infections in the hospital, Guo et al. (2019) did a qualitative research study to assess the causes of the high rate of reinfection in the hospital. From the results, there was a high rate of pneumonia. The rate stood at 47%. Another reinfection or acquired disease was the ICU acquired bloodstream infection. It rates stood at 37%. Thedriversaretoboast hygiene level in the hospital. Such an objective is likely to build a safety culture that will reduce the rate of hospital-acquired infection. Additionally, it is likely to reduce the cost of care and also increase patients’ satisfaction with the nature of care the hospital provides to them. 

Employees’ Engagement 

The Intensive Care Unit is an environment that has a lot of stress for the workers due to a lot of emergency services and the state of patients in the department. It is also an environment where medical staff works together to achieve a common goal, which is the provision of quality medical care to patients in this environment ( Doesburg et al., 2019). Therefore, training and education for workers could be a significant factor that could have a massive impact on the output per worker in the ICU department. The core is to develop workers' skills to enable them to cope up with the stress in this department and give their best to the patients. 

B. Discuss the Necessary Processes that Drive Each Outcome Measure 

Performance 

The goal of the performance is to decrease the rate of ICU readmission by enhancing the use of evidence-based practice among nurses to reduce the rate of infections in the ICU. The first driver is to reduce the cost incurred by the ICU patients in the hospital. When patients stay for long at the ICU, they accumulate a lot of bills, and this increases the cost of care. In this sense, the ICU department needs to have strategies to reduce the length of stay at the ICU to reduce the cost of ICU care to the patients. Ongoing assessment for all the medical processes to ensure efficiency and safety to the patients is thus recommendable. The second driver is to reduce the length of hospital stay for the patients. When a patient stays at the ICU for long, it means that the performance is questionable. There is a need to place in strategies to reduce the length of stay for the patients at the ICU to increase the performance. The process of reducing the length of stay is to have a regular ongoing assessment of the in-services to identify early onset of CLABSI’S, VAP & CAUTI’S. The last driver is to reduce the mortality rate in the ICU. In most cases, the high mortality rate at the ICU is due to inadequate safety practices. There is a need to have in place a strategy to ensure that all medical activities at this department are safe for the patients. A routine assessment of different procedures at the ICU and notifying the physician at the right time could also increase the rate of communication and quality of service, reducing cases of mortality at the department. 

Quality 

The rate of medication errors at the ICU is the outcome measure of the level of quality at the ICU department. Furthermore, calling a time out anytime a bedside procedure is made to ensure that the proper procedure, to the correct side, and or a correct patient is being done could also be a good objective to assess the quality at the ICU. The drivers, in this case, are the patients’ satisfaction with the services provision at the hospital, reduction of mortality and morbidity, as well as reduction of the rate of readmission. Education and training of medical staff to be aware of medical errors and means of avoiding them could be a process to drive the change. The training should cover an overview of the medical errors and means of avoiding them. It should also touch on the use of EBP and how it is important in enhancing safety in the department. 

Furthermore, enhancing evidence-based practice could also help with the situation. Incorporating technology such to help the nurses seek knowledge from online journals of nursing and other materials could be a good process for enhancing EBP. The incorporation of Evidence-Based Practice (EBP) is the outcome measure of the level quality at the ICU. When the staff in this unit give more weight to evidence and have the determination to prove their decisions before implementing them, it could be a sign of quality care. The drivers to achieving quality through the use of evidence-based practices are many. For instance, reducing the errors during the process of monitoring the patients or treatment at the ICU could be a driver to use EBP to improve on the quality of the care at the department. 

Besides, the urge to reduce readmission and also to reduce the high rate of acquired diseases at the ICU could also be a driver to use EBP to improve the process of providing care and increase quality in general. Enhancing team spirit and teamwork at the unit that allows a suitable environment for consultation between the nurses and staff could be a good driving process to achieve quality through the use of EPB ( Doesburg et al., 2019). Moreover, the implementation of different forms of communication technology such as smartphones and separate smartphone applications such as medical dictionaries could also be a process that could drive the use of EBP to improve quality in the ICU unit. Such technologies allow the workers to easily access the internet and journals while dealing with a particular condition at the ICU. Lastly, implementing a time out form for the nurse & physicians to sign at the time of bedside procedure to ensure there are no errors is another process that can ensure quality at the ICU. 

Patient Safety 

The rate of hospital-acquired infection could be an outcome measure to understand the level of patient safety in the ICU department in the hospital in general. The driver could be to improve the patients' satisfaction. Furthermore, the urge to improve on the safety culture and the level of hygiene at the ICU could also be a driver for reducing the acquired infections. Lastly, the quest to reduce the cost of care to the patients could also be a drive to reducing hospital-acquired infections. There are different process measures for such level safety in the ICU. The first is to enhance a high level of hygiene in the ICU. Implementing regular ongoing hygiene such as oral care at least every two hours for vented patients to prevent the colonization of ET tubes could be an important process. Hygiene is critical in reducing the chances of infection in the ICU ( Teijeiro & Wilcox, 2019). Encouraging strong handwashing skills could also be important in enhancing hygiene. It could be a process that could drive the change and adoption of strategies that could increase patients’ safety. Another safety process could be monitoring and assessment of all the ICU equipment to ensure that they are safe for patients. Such a process could reduce any error that could stem from different ICU machines such as patients monitors and Ventilator-Associated Pneumonia (VAP). Lastly, enhancing evidence-based practice is also a critical process that can lead to cost reduction and increase patients’ satisfaction and safety. 

Employees’ Engagemen t 

The level of employee training and education is a measure to determine the employees' participation. The first driver is an increase in the use of EBP while delivering care at the ICU to reduce medical errors. Another driver is to increase better treatment outcomes from the ICU unit. Organizing benchmarking for the ICU staff is an excellent process to meet such outcomes. It entails benchmarking in hospitals and ICU departments that have better facilities and are doing better with regards to employees' engagements. Furthermore, holding a meeting with staff and briefing them on the needs to integrate technology and evidence-based practice in their practice at the ICU could also be helpful (Huijben et al., 2019). Additionally, onboarding, coming up with a list of mentors at the ICU that could act as drivers of change, could also be essential processes. Lastly, encourage staff at this unit to attain a high level of education could be a process that could lead to a better outcome in this case . 

B1. Discuss One Additional Indicator 

Patient Indicator; improving documentation could be an excellent way to measure the quality of outcome at the ICU. A better documentation system in the hospital is critical because it enhances safety, effective patient care, and also ethical care practice. Documentation records, communicate data, describes, and also increase knowledge and timely reminder for nurses mostly in the ICU environment where stress can escalate. The driver for the documentation is diverse and may include the urge to get better care at the ICU. Furthermore, the call to facilitate a timely care plan could also be a driver to get a better system of documentation at the ICU. Documentation serves as a legal document so, and it should be clear and concise following the organization's policies and procedures. 

The process that can drive this outcome lies with the nurses and other staff at the ICU. They should monitor patients and record their data regularly. Such action is critical in planning for the entire treatment for the patients at the department. Furthermore, such a process can also engage feedback provision mostly from the patients and their relatives and even staffs concerning the conditions of the patients. Improved documentation results in painting a real picture of a situation or patient experience, and allows for the interdisciplinary team to read the documentation and make changes to the plan of care and treatment regimen based on the documentation. 

C. Advantages of the Balanced Scorecard Created in A1 

A balanced scoreboard is a tool that is vital for an organization that needs to improve its performance. The first advantage of a balanced scorecard is its flexibility. The flexibility of a balanced scorecard is a good trait that makes it unique since its applicability is possible in a diverse environment. For the ICU patient and department in general, a scoreboard is a tool that puts together the department's mission, desires, vision, and objectives and underlines the strategies the department can implement to achieve them ( Hameduddin & Fernandez, 2019). For instance, by pinpointing quality as an indicator of improvement in a department and outlining the drivers and process of achieving quality, the scorecard provides a template the ICU department can follow to improve on its quality services provision to its patients . 

The second advantage of a balanced scorecard is that it highlights areas where the improvements are necessary, and also showcase areas where the department is placing more emphasis than others. A balanced scorecard aims to highlight the position of an organization at its current status and the position it ought to be in the future. In this sense, the balanced scorecard provides a template for strategic planning for all the departments or areas where the organization needs necessary improvements (Doesburg et al., 2019). With such nature of strategy planning, the organization can distribute its resources in specific areas where improvements are necessary to achieve a balance in all areas . 

The third advantage of the scorecard is a better process alignment. In the scorecard chart, it is easy to pinpoint the indicators of performance in the ICU department, the outcome, and the drivers of the outcome measures. The implication is that the ICU department can come up with a narration from the chart on areas where there improve are necessary and the strategies they need to achieve such improvement in the department. Therefore, they can come up with processes that could drive the outcome measures and achieve them. With a presentable scorecard, the department can understand how to align such operations with the measure, the outcome, and the drivers. With such alignment, it could be easy to achieve such goals in the department (Huijben et al., 2019 ). 

D. Analysis of Two Current Trends Related to Employee Engagement 

Facilitating an open communication and transparency culture is an excellent example of current trends that most hospital management uses to improves on employees' engagement. The current healthcare system serves a dual purpose. It helps the community where there is an expectation to deliver quality care to the clients. It also serves a business purpose where there is a need to increase profitability. In this sense, motivating employees and engaging them in every operation in the hospital is becoming a vital strategy to be successful in both roles. A culture of transparent and open communication is becoming a successful trend for many hospitals because it enhances employees' trust in the administration. When employees can communicate with any person regardless of the rank and get feedback, they feel a sense of importance, and this increases their level of motivation ( Hameduddin & Fernandez, 2019). Currently, most employees complain that employers ignore them when creating organization policies or making any change in the company. Most of them feel tired with a robotic system of management where employees come to work, do according to instructions, and go home. Most of them are fed up with a culture where the organization expects them to implement new policies and changes in their work that they had no chance to participate in the process of creating. In this sense, motivating employees, informing them, and letting them have positive participation in every change and strategy is becoming an excellent strategy to engage workers . 

Providing employees with a flexible work schedule is a simple way of engaging them and motivating them to perform better. Employees in the current world face a lot of challenges in their lives that build a lot of pressure and stress. The high economy in the contemporary world and the high standard of living is a massive problem for the employees. Furthermore, issues such as domestic problems and huge expectations at the workplace are additional stressors that employees in this century have to battle. In this sense, it is becoming critical for most institutions to understand that employees need work-life balance for better health. Providing flexible schedules for employees allows them time with their families at home, and this prevents burnouts ( Hameduddin & Fernandez, 2019). Furthermore, employees become flexible and can plan for their extra activities when they have a flexible schedule. In this sense, they reduce issues such as absenteeism and also sick leaves . 

D1. The Relationship Between Employee Engagement and Healthcare Quality 

Engaging employees with the hospital is the best way to improve the quality of care. An employee who gets a chance to contribute to different processes of decision making understands better the vision of the hospital. In this sense, they act as process improvement promoters rather than turning their back and quitting when a process fails ( Robertson, 2019).  They also have an opportunity to understand the strategies the organization has in place to achieve its goals. In this manner, they strive to adapt to the strategy in place to meet the objectives and the vision of the organization. On the other hand, disengaged employees lead to increased turnover and lower quality work because they do not feel like part of the organization. 

Furthermore, engaging employees motivate them and give them a reason other than financial benefits, to wake up early in the morning to go to work. In this manner, they feel like part of the organization and identify themselves with every positive and negative outcome of the organization. In this sense, they find a reason to work hard so that they work in an organization that is reputable in the market. Lastly, engaging employees bring about a shared responsibility between the management and the employees. The administration feels the freedom to delegate some duties to the employees and hold them accountable and responsible for carrying out such tasks ( Robertson, 2019).  With a sense of ownership and belonging that comes with engagement, it becomes easy for employees to strive to achieve the objectives. Overall, the leadership of an organization is at the bottom line of enhancing a positive engagement with employees. The leader must strive to create a culture of transparency and openness to creating a conducive environment for employees’ engagement. 

D2. Discuss Whether Current Tools in Your Organization Adequately Provide Data Regarding Employee Engagement 

Currently, some tools are working well at the ICU department and the entire hospital to provide data regarding employees’ engagement. The first tool is a performance survey. The performance survey provides the hospital leadership with information on the employees' rate of performance in comparison to the standard set for them in the organization (Teijeiro& Wilcox, 2019). The review of such results provides a glimpse of how people perform and areas where they need to do better. There is a monthly review of performance surveys feedbacks where the staffs get feedback on areas they are doing better and areas they need to improve. The tool is working well by providing vital information on the level of employees’ engagement . Another tool is a great place to work survey. Every two months, the organization facilitates a study that takes place in each department. The leaders in each department have the authority to come up with survey questions targeting the employees’ feelings about working in the hospital. The survey questions touch different areas such as the level of satisfaction, the relationship with the leaders, and the level of engagement (Robertson, 2019).  The data from these surveys are critical because they communicate the feelings of the employees. In this sense, they provide the organization leadership with vital information on the employees’ feelings, and how well they feel part of the organization . 

E. Create a Plan to Improve Employee Engagement Based on the Performance Data Scorecard 

The core of this is to enhance engagement by training staff to reduce safety; the objective is training for proper evidence-based practice to enhance safe medical practice in the ICU by 10%. The aim is to decrease job-related injuries and inures to the patients. The PDCA model is used to plan, do, check, and act to ensure that the plan implementation is successful. 

Step	Activity	Time frame	Outcome
Planning	Assessment on the use of EBP at the ICU  Assessment of safety training at the ICU  Analysis and documentation of results and recommendations on the EBP and safety training on staffs	1-2 weeks  One week  One week	EBP is at 47%  Staffs training on safety measures last done five years ago  Safety measures and the Review of EBP is done after a year  A possible solution is regular training and monthly review of the use of EBP among the staffs
Do	Hold a meeting with the ICU staffs and explain the need for change  Have a pilot study by training three staffs  Take the three staffs on a benchmark	I week  I month	Most staffs understand the need to incorporate EBP as a safety measure, but only a few of them do implement it
Check	Hold meetings with the staffs and brief them on the results of the pilot study  Compare their outcome against three untrained staffs	One week	The pilot study is successful? if yes, Proceed to the next stage  If no recheck and find the missing link before preceding to the next stage
Act	Organize resources for training the department staffs  Install technology in the ICU department  organize with the department to have reports from a different department to be complied and punched into the computers at the ICU department  Divide the staffs into groups for training  Organize a brief benchmarking for each group  Hold an internal meeting with all the staff at the ICU department to monitor the progress  Evaluate for success	One week  One week  One week  A day for each group (approximately one month  Ongoing after each month	Likely outcome:  Change resistance  A successful change

E1. Discuss Leadership Best Practices That Improve Employee Engagement 

A leader who builds a culture of transparency in communication enhances a culture of engagement in the company. Employees see their leaders as role models. In this sense, they do not expect their leaders to betray them. A form of betrayal that can come from a leader is concealing important information from specific employees. In this sense, a leader who is transparent by creating a communication system that does not alienate any person in the company can improve employees’ engagement. Transparency is critical for a leader as it is the foundation of equity, integrity, and honesty. A leader has to possess such traits to be transparent and work with people humanely. 

A leader must also find ways to inspire the workers. A leader who inspires the employees to achieve a significant milestone by motivating, encouraging, and recognizing their hard work also creates a healthy environment for the employees' engagement. Regarding the definition of leadership, a leader works through people to achieve the objective. It implies that a leader needs to have a vision, define the path to achieve the vision, and inspire employees to work together and achieve a common goal. 

References 

Doesburg, F., Smit, J. M., Paans, W., Onrust, M., Nijsten, M. W., & Dieperink, W. (2019). Use of infrared thermography in the detection of superficial phlebitis in adult intensive care unit patients: A prospective single-center observational study.  PloS one ,  14 (3), e0213754. https://doi.org/10.1371/journal.pone.0213754 

Guo, T., van Hest, R. M., Roggeveen, L. F., Fleuren, L. M., Thoral, P. J., Bosman, R. J., & Elbers, P. W. (2019). External evaluation of population pharmacokinetic models of vancomycin in large cohorts of intensive care unit patients.  Antimicrobial agents and chemotherapy ,  63 (5), e02543-18. doi: 10.1128/AAC.02543-18 

Hameduddin, T., & Fernandez, S. (2019). Employee engagement as administrative reform: testing the efficacy of the OPM's employee engagement initiative.  Public Administration Review ,  79 (3), 355-369. https://doi.org/10.1111/puar.13033 

Huijben, J. A., Wiegers, E. J., de Keizer, N. F., Maas, A. I., Menon, D., Ercole, A., & Polinder, S. (2019). Development of a quality indicator set to measure and improve the quality of ICU care for patients with traumatic brain injury — critical Care ,  23 (1), 95. Online at https://ccforum.biomedcentral.com/articles/10.1186/s13054-019-2377-x 

Pandit, A., & Koul, M. (2018). Medication errors in critical care units in a tertiary hospital.  Indian journal of public health research & development ,  9 (7), 8-12. 

Robertson, M. B. (2019).  Employee engagement in the goal setting process: can employee engagement theory improve the goal-setting process?  (Doctoral dissertation, University of Liverpool). Online at https://livrepository.liverpool.ac.uk/3031646/ 

Teijeiro, R., & Wilcox, M. E. (2019). Does ICU telemedicine improve outcomes? Current state of the evidence. In  telemedicine in the ICU  (pp. 155-175). Springer, Cham. Online at https://link.springer.com/chapter/10.1007/978-3-030-11569-2_9