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PROF washington watson
Running head: PROCESS, OUTCOME, AND PERFORMANCE VARIATION 1
PROCESS, OUTCOME, AND PERFORMANCE VARIATION 4
Process, Outcome, and Performance Variation
Jessica Ruiz
Chamberlain University

Process, Outcome, and Performance Variation
Introduction
The nursing theory that blends effectively with the process, outcome and performance variation is the intrapersonal theory. This theory is primarily woven around the relationship between the patient and the nurse and how the bond they make results to a smooth orientation, identification, exploration, and resolution process. With such a process at hand, then it becomes easier for the healthcare personnel to work with their patients to get effective results in the end. Medicine is not random. Medicine requires that the people involved work together through a series of variation until they come up with a variant that works best for a patient. This factor means knowing exactly what the patient needs by creating a sort of bond the nurses. Regardless of the famous claim that healthcare and medicine are evidence- based, the art of healthcare and therapeutic practices remain experiential and which is dependent on various variations in process, outcome, and performance (Spath, 2013). Healthcare managers, individual patients, and clinical researchers manage difference among themselves indifferently. For instance, healthcare managers are mainly concerned with care performance, and their primary aim is to generate processes that are stable and efficient over time. On the other hand, the clinical researchers are concerned with understanding the effectiveness of care and generalizability the results, and thus they are concerned with controlling variation through their study designs and methods. Primarily, the individual patients are affected with the quality and nature of their care and clinical results.
When it comes to the attributes of determining the unique characteristics of patients and the drivers of quality in the health organizations and the whole country, the process, outcome and performance variations at times may become so illuminating. As a result, clinical researchers, individual patients, and health managers need to question how and why process, outcome, and performance vary for them to comprehend and control variation processes in various ways and in different time frames (AHA, 2008). This paper provides samples of process, outcome, and performance difference and how collecting this form of data influence decision-making within the healthcare field.
Process Variation
Process variation is one of the changes in the medical practice and it refers to the usage of different diagnostic or therapeutic procedures in an organization, geographical location or other physicians’ groups (Perlman & University of Waterloo, 2009). Apart from variation in use vs. non- use change in a given procedure, variation may arise as result of a use of multiple systems with an aim to achieve the same results as the ones obtained before. For instance, when screening for colorectal cancer, similar results may be accomplished by applying colonoscopy, fecal occult blood testing, sigmoidoscopy or the combination of the mentioned options. However, individuals and organizations should not confuse process variation with technique- multiple ways in which a single procedure can be performed within the acceptable realm of medical practices (Mottur-Pilson, Snow, and Bartlett, 2001).
Outcome Variation
This is a variation which occurs when different outcomes or results arise from a single therapeutic process (Samsa et al., 2002). When such change happens, healthcare researchers and medical practitioners tend to follow and focus on the particular factor that yields optimal results (Samsa et al. 2002). For example, when the results of treatment or research occur over a very short period or when procedural changes take place over in a timely fashion, then, it becomes easy to determine processes. However, for researchers to come up with a more outcome variation, it takes a long time- years and sometimes decades. As a result, it becomes difficult to establish whether the applied process outcome yields maximum results.
Performance Variation
Joshi et al. (2014) define performance variation as the difference in any result and the optimal results. Performance variation is among the critical category which applies to the improvement of the quality of healthcare. When it comes to quality improvement in healthcare, this kind of variation is inarguably the most significant variation. Logically, performance variation may relate to process and outcome variation which aims at obtaining optimal results in any therapeutic practice. In determining the variation in other practices, researchers and healthcare providers use the performance variation to identify and compare their variation. According to IOM (2001), the disadvantage with this standard comparison tool is that other critical analytical instruments such as analytical process (regression modeling) control do not directly address performance about a level of medical practice among providers.
Although within the realm of acceptable medical practice, performance variation may be influenced by local resources, local demands, environmental constraints and healthcare organizational constraints. With this respect, best clinical standards, guidelines, and cores guide the development of a health facility which contributes to reduction in performance variation from one institution and locality to another. However, there arises a challenge when there is a need to implement new measures or set of core measure standards (as examples) amongst providers and another healthcare workforce who have developed familiar ways of doing; this may lead to probable overstraining of healthcare providers and healthcare organizations (AHA, 2008). Therefore, organizational management needs to be most influential in advancing quality initiatives and helping in overcoming the inertia exhibited by some healthcare providers.
The best benchmark data suitable for supporting the improvement of healthcare administrator include the embedded key performance indicator which allows the monitoring of the daily workflow within the healthcare institution. The data can be collected from the patient’s feedback on their satisfaction with the services offered by the institution. Data on the patient’s level of satisfaction provides information on the performance of the institution and the willingness of the healthcare consumers to visit the institution (Doran, et al 2014). The model allows administrators to understand and manage the outcomes of pay-for-performance results. The publicly available data is used in providing information for analyzing the internal performance against the performance of other institutions in the same industry. The chosen data, in this case, supports healthcare service by recognizing the values in the essence of care benchmarking considering that this is a continuous quality improvement approach (Eijkenaar, et al. 2013).
Hospitals are adopting the pay for performance compensation plan for the purpose of improving the quality standards of care delivery within healthcare institutions. The plan requires eminent public scrutiny and the revelation of both clinical quality and the safety of patients in terms of performance. According to Ettorchi-Tardy, Levif & Michel (2012), comparison of data within the healthcare system depends on the data that could be extracted from multiple levels in the healthcare system. Benchmarking tools are useful when monitoring and evaluation of the benefits of the type of governance, current management, clinical and the support functions (Lovaglio, 2012). The process of benchmarking aims at improving the performance of the healthcare institutions. On the other hand, the success of an organization may be determined by the revenue it generates and the profits recorded. However, the main question in regard to benchmarking data is why is the information on accounts receivable not suitable as a data to use in the benchmarking process?
Currently, the personnel who fail to showcase high quality and cost-effective performance are penalized with the use of a payment modifier that is value-based. The change means that hospitals with increased rates of conditions that are acquired in the facility and high readmission rates for certain conditions face the same payment fines. Since the end of 2010, the President and Congress banned a 25 percent discount in the reimbursement rates of physicians(Moses et al, 2013). The same ban was applied to the sustainable growth rate and the reductions have grown steadily due to delays by Congress. Consequently, out-of-network profits have steadily decreased for hospitals across the United States. This has facilitated a move from the past benefit of utilizing out-of-profit networks to enhance profits and improve a facility’s negotiation position.
Conclusion
In brief, there is a need to manage variation among various outcomes, processes, and medical performance practices. In this case, clinical researchers, individual patients, and health managers need to question how and why process, outcome, and performance vary for them to understand and manage variation processes in different ways and different time frames. The data obtained from this questioning is valuable in that it offers the healthcare managers, researchers, and individuals with information on how the variation affects them either singly or as a whole which can cause misunderstanding among all of the concerned stakeholders. Also, the solution to reducing the variation in the findings from one treatment as a result of local demands, organizational constraints, and local resources can be minimized in subsequent medical practices. The hospital’s business model is meant to cover all fixed costs along with ensuring heightened rates of occupations and using any new facilities developed (Rajpal, Peruchi & Sawhney, 2013). A hospital with a new ambulatory surgical facility has high chances of lowering costs since it has minimum overhead. As a measure to end this problem, all hospitals have adopted new methods that will enable them to develop new emergency wings by partnering with interested organizations or through a joint venture (Rajpal, Peruchiv & Sawhney, 2013). The differences experienced between rates and reimbursement encourages hospitals to hold onto costs, and as a result, it will favor transparency. Through these measures, hospitals can do away with wastes on their activities and processes that are not of an advantage to patients, staff and the ones that do not promote quality.

References
American Hospital Association (AHA). (2008). Redundant, inconsistent and excessive: Administrative demands overburden hospitals. Trend Watch. Retrieved from http://www.aha.org/research/reports/tw/twjuly2008admburden.pdf
Institute of Medicine (IOM). (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academies Press.
Joshi, M., Ransom, E., Nash, D., & Ransom, S. (Eds.). (2014). The healthcare quality handbook: Vision, strategy, and tools (3rd Ed.). Chicago, IL: Health Administration Press.
Mottur-Pilson, C., Snow, V., & Bartlett, K. (January 01, 2001). Physician explanations for failing to comply with “best practices.” Effective Clinical Practice: ECP, 4, 5.
Perlman, C. M., & the University of Waterloo. (2009). Development of quality indicators for inpatient mental health care: Strategy for risk adjustment. Waterloo, Ont: University of Waterloo.
Spath, P. (2013). Introduction to healthcare quality management (2nd Ed.). Chicago, IL: Health Administration Press.

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