| Performance Improvement Measures
History and Development
During the course of the 16-month Speaking Together learning collaborative, 10 hospitals will use rapid cycle change and other quality improvement techniques to improve the delivery of language services within their institutions. Sites will use uniform data collection and reporting mechanisms to track progress throughout the program and also to compare their programs and activities with others in the collaborative.
In order to implement these valuable learning techniques, it is essential that performance measures be available to provide reasonable and consistent information about aspects of quality associated with the delivery of services. Because the field of language services does not currently have commonly used language performance measures, the Speaking Together National Program Office (NPO) housed at The George Washington University developed a set performance measures for language services.
The NPO used a multi-stage process to develop these measures:
Stage 1: Identifying a framework for quality: The Institute of Medicine’s (IOM’s) six dimensions of quality, as articulated in Crossing the Quality Chasm, was used as a framework for developing language service performance measures. These dimensions are safety, timeliness, effectiveness, efficiency, equity, and patient-centeredness.
Stage 2: Reviewing the relevant literature: The NPO conducted extensive literature searches to support the development of evidence-based measures and identify key quality concerns related to the delivery of language services in hospitals and other health care settings.
Stage 3: Interviewing experts: Several experts in the field of language services and directors of established hospital-based interpreter services programs were interviewed in order to further identify issues related to quality of language services and potentially valuable performance measures.
Stage 4: Identifying a framework for organizational change: Nerenz and Neil’s “Performance Measures for Health Care Systems” (2001)1 was used as a guidepost to look across an organization and identify how care is organized and delivered. Using this framework, the NPO identified components of language and interpreter services, and measurable events as potentially valuable performance measures.
Stage 5: Developing the measures: Using the frameworks mentioned above, as well as information from the literature and interviews, the NPO developed a set of 10 draft measures for review and field testing.
Stage 6: Getting feedback on the draft measures: A panel of experts in language services, who have contributed greatly to the literature in the field, was assembled to review the draft performance measures and evaluate them according to uniform evaluation criteria. Comments from a group discussion with these experts were used to solidify and revise the performance measures.
Stage 7: Meeting with clinicians and interpreters services directors: The draft measures were also reviewed by the individuals who are most likely to use these performance metrics on a day-to-day basis. A working group of medical directors, physician leaders and interpreter services directors were assembled for a one-day meeting in Washington, DC to review the measures and discuss the feasibility of implementing the measures in the context of busy acute care hospitals and outpatient settings.
Stage 8: Field testing the measures: Two hospitals participated in a two-week pilot test of the performance measures, gathering information on the feasibility of data collection, usefulness of data reporting formats, and barriers and challenges associated with successful data collection and submission.
Stage 9: Going live with the measures: The 10 Speaking Together grantee hospitals will use measures throughout the learning collaborative, applying quality improvement methodologies to improve the delivery of language and interpreter services.
Speaking Together ultimately seeks to produce improvements in language services beyond the 10 hospitals that participate in the program. The program will also provide an opportunity to test the utility and adequacy of the performance measures and determine whether they are sustainable over a long period of time.
Speaking Together is committed to developing measures that provide useful information on improving language services operations. The program will disseminate lessons from the collaborative to hospitals and other health care organizations across the country to help them assess the quality of their language services operations and benefit from the experiences of the Speaking Together grantees.
1 Nerenz, D. R., and N. Neil. 2001. “Performance Measures for Health Care Systems, Commissioned Paper for the Center for Health Management Research.” Online. |
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