HLTH 6882 Week 2 Performance Definition Post Example

Week 2 Discussion: Initial Post and Replies

Defining Performance for a Visiting Specialist Clinic: Kept Specialist Time, Not Margin

For Prairie Bend's visiting specialist clinic, performance is the share of booked specialist time that becomes a completed visit for a local resident. That figure is recorded already: the scheduling system marks every booked slot as arrived, no-show or canceled, and in the past 12 months, on illustrative figures, about three slots in four ended in a visit.

I chose this definition because of what the clinic exists to do. J. Gregory Dees described social entrepreneurs as people who create social value by pursuing opportunities without being limited by the resources they currently hold (Dees, 2007). A small hospital does not usually look like a social venture, but the idea fits here in a specific way. The hospital has already paid for the specialist's day under a fixed session fee, so an empty slot is an opportunity already purchased and not used. Visiting clinics exist to bring specialist care into patients' home counties (Gruca et al., 2016), so every empty slot means a neighbor went without that care. Treating those slots as the clinic's main product, rather than treating the session as a cost to be minimized, changes what managers look at. Margin would push the hospital to cut session days; kept specialist time pushes it to fill the ones it has.

The definition leaves things out. It ignores patient satisfaction, which matters but which the clinic does not measure reliably and which would not tell us whether residents got care. It ignores cost per visit, which falls automatically when more slots are kept, so it would add little. And it does not judge the quality of the specialist care itself, which belongs to the visiting group's own review. I rank all three below kept time because none of them tells us whether a resident who needed a specialist saw one.

Reply to Keisha

Keisha, I like your definition for the infusion center, completed infusions as a share of scheduled ones, but I am not sure how it would be counted when an infusion is started and stopped partway because of a reaction. Would that count as completed, as a no-show or as something else? If the rule is not written down, two people pulling the same month's report could reach different figures. Could you add a sentence saying which way partial infusions fall?

Reply to Ben

Ben, your definition for the rural health clinic, visits per provider hour, is easy to count, which is a strength. My worry is that it rewards short visits, so a clinic could raise it by rushing patients without anyone being better served. A counterweight might help: for example, tracking the share of patients who return within seven days for the same problem alongside visits per hour, so a rise in volume that comes with a rise in returns would show up. Missed appointments are also costly in their own right; one long study in a large medical center put the average cost of a no-show at $196 per patient in 2008 (Kheirkhah et al., 2016), which suggests that volume measures should account for slots lost as well as visits delivered.

References

Dees, J. G. (2007). Taking social entrepreneurship seriously. Society, 44(3), 24-31. https://doi.org/10.1007/BF02819936

Gruca, T. S., Pyo, T.-H., & Nelson, G. C. (2016). Providing cardiology care in rural areas through visiting consultant clinics. Journal of the American Heart Association, 5(7), Article e002909. https://doi.org/10.1161/JAHA.115.002909

Kheirkhah, P., Feng, Q., Travis, L. M., Tavakoli-Tabasi, S., & Sharafkhaneh, A. (2016). Prevalence, predictors and economic consequences of no-shows. BMC Health Services Research, 16, Article 13. https://doi.org/10.1186/s12913-015-1243-z