Home » Courses » Performance improvement program » Holistic hospital performance improvement

"Talent wins games, but teamwork and intelligence wins championships."

Michael Jordan, *1963

Photo by JESHOOTS.COM on Unsplash

What is hospital performance?

The hospitals` predicament

Hospitals are increasingly exposed to the demands of insufficient funding, increasing competition, internationalization of medicine, increase in morbidity and the age of patients, and, last but not least, a critical shortage of applicants and staff.

Hence, hospitals can only be successful in the long term if they recognize and exploit synergies in optimizing
  • the quality of medicine,
  • teaching,
  • management and organization,
  • and research.
Only by integrating all processes can these multidimensional demands be met in the long term.

In addition to the well-known pressures in the healthcare sector, such as limited time and financial resources, maximum work compression and, in some cases, inadequate training and educational opportunities for junior medical staff, it is often insufficient management and leadership structures that represent major obstacles to optimal patient care.

Target agreements, change management and strategy development as well as their implementation do not always enjoy the highest priority, professionalism or consistent implementation in the healthcare sector.

Interdependent quality dimensions form overall hospital performance

According to the traditional perspective in healthcare, medical quality is the primary focus of all efforts in the hospital. Nevertheless, non-medical quality dimensions are not less crucial for the hospital’s performance and, thus, influential on the medical results.

We advocate that
  • medical quality,
  • employer quality,
  • cooperation quality, and
  • economic outcome
be treated as equal and complementing goals in a modern clinic.

Medical excellence: primary and secondary influential factors

Medical excellence is composed of several primary and secondary parameters. The two most decisive factors are the achievement of treatment goals and patient safety. We call it medical excellence if the short-, medium- and long-term treatment goals are achieved with a low rate of adverse events.

In addition, secondary parameters also significantly impact the actual and perceived medical quality of a hospital.
These include
  • appropriate treatment length,
  • length of stay,
  • lean processes without long waiting times,
  • general patient satisfaction, and, finally,
  • the communication culture between service providers and patients and their relatives.
There are numerous interactions between the primary and secondary parameters. So, medical excellence can be sustained only by taking a comprehensive perspective on the hospital`s highly complex structure and pathways.

Economic results

Medicine and economics are guided by different reference standards in terms of good work and good decisions.

A good economic result is the basis for investments, innovative procedures, sufficient personnel resources as well as independence in treatment and, thus, an influencing factor on the medical result as well as the quality of a clinic as an employer and cooperation partner.

Employer quality

Poor employer quality leads to weaker clinic performance. High employee turnover generates high direct and indirect costs and leads to a dangerous loss of knowledge in addition to inconsistency in processes and treatment strategies.

Medical quality can be directly improved with high employee motivation and systemic discipline alone.

To optimize the overall result, it is essential to offer optimal work conditions for the caregivers. Flawless processes, a sound infrastucture, appreciative leadership, and a positive entrepreneural culture form the conditions necessary to perform optimal patient care.

Cooperation quality

Optimal patient care is only possible in cooperation with
  • interdisciplinary, internal hospital partners,
  • referring colleagues and clinics, as well as
  • partners for post-inpatient treatment.
Hence, the quality of collaborations has an indisputable impact on the quality of medical care.

Moreover, a sufficient number of well-prepared patients with valid and complete findings upon hospital admission and a rapid postoperative transfer are known influencing factors for the hospital´s economic outcome.

The hospital`s external partners, such as
  • insurance companies,
  • industry partners,
  • the government, and
  • the public,
also are essential for the overall hospital performance.

In conclusion, every doctor, nurse, or hospital manager should aim for a good relationship with those stakeholders even under the often challenging clinical workload.

How to get to peak performance in hosptials?

The positive impact of professional hospital management on hospital performance

The connection between different management styles and the outcome in the quality dimensions of medicine, employer quality, and finances of a hospital cannot always be established directly. Sometimes, measures or processes generate positive effects indirectly: Numerous studies demonstrate an impact of nurse management and leadership on medical outcomes, job satisfaction, turnover, and performance.

In total, a well-managed, comprehensive performance improvement program often is decisive for a hospital`s future.

Initiating comprehensive performance improvement programs. But how?

The initiation of a performance improvement programme in hospitals may be driven by either currently less than optimal results or by a farsighted desire to prevent poor outcomes in the future. In most cases, a performance improvement programme builds on different kinds of change in the organization.

Physicians and nurses understand the need for change and see the improvement potential in the daily clinical work abundantly clearly. Unfortunately, they are rarely educated in management methodologies or have enough time to drive the change in the hospital`s complexity systematically.

More than often, well-intentioned and relevant projects bog down because of non-sustainable project management or an overwhelming number of other (medical) tasks that need urgent attention.

Scope of the course

This course will offer you a systematic approach to initiate and set up an efficient and long-term performance improvement programme.

We extracted management tools and principles for successful process optimization from established models and transferred them to the healthcare sector.

Eventually, business principles are usable for healthcare professionals without any precedent business education.

Section 1: Performance Analysis

Relevant quality dimensions in a hospital

This section starts with identifying relevant quality dimensions. What does really matter? This discussion aims for the recognition of improvement categories like processes, infrastructure, personnel development, and cooperation with the hospital`s partners.

Key performance indicators

Then, the degree of quality in the relevant categories will be analysed by employing fine-tuned key performance indicators.

Do all the routines and procedures align? Is the hospital`s, department`s, or unit`s workflow supporting the strategic goals? Are there any benchmarks available that would objectify the participants’ estimation of their situation? How do physisicans, nurses, patients, relatives, and cooperation partners perceive your performance? You will set key performance parameters that are relevant for your or your hospital`s strategic goals and select suitable tools that are eligible to reach those goals efficiently.

Challenging the accreditation myth

Nowadays, hospitals are undergoing extensive accreditation programs. We will discuss whether and how these tedious and expensive processes improve the patient experience.

Your performance assessment system

A tool to assess a hospital`s overall performance will be developed in this section based on your specific foci and needs, which outlines a specific need for optimization in relevant improvement categories.

Section 2: Holistic performance improvement

Balancing between personalized medicine and standardization

We delineate the way to peak performance by transferring process improvement principles from industry to healthcare. In a safety-oriented environment, the finetuning of key performance indicators and operating criteria needs to give careful consideration to the balancing between individualized patient care, personalized medicine, and standard operating procedures.

Interprofessional collaboration is key to long-term peak performance

Since successful change and consequently high performance in hospitals significantly relies on a clockwork-like intertwining of different professions, this chapter lays a special focus on measures to improve interprofessional cooperation between physicians and nurses, e.g..

Corporate culture

How do successful organizations reach and sustain excellent performance? We showcase examples from industry firms and hospitals worldwide that display some of the most relevant techniques needed for effective performance improvement in hospitals. A transparent process organization has a high impact on the hospital`s culture in this regard.

Patient engagement

An often neglected factor in performance improvement campaigns is the patient as an active contributor to better outcomes. Albeit, creative patient engagement initiatives have shown to be very supportive of achieving better medical and economic outcomes. Examples and impulses for patient engagement measures will inspire you to involve your patients into the clinical pathway.

Real-life case studies illustrate a step by step technique of creating change in performance and output. One example is the reduction of the postoperative length of stay in the ICU after a CABG procedure integrating physicians, nurses, and patients.

Personnel development

Performance improvement often goes hand in hand with improving the employees’ skills and knowledge.

Thus, we advocate a seamless integration of performance improvement measures with a systematic personnel development programme and give examples for a successful marriage of those two management areas.

Topics of this section

The topics of this section span the following areas:
  • Hospital safety
  • Routines and process organization
  • Balancing between individualized patient care, personalized medicine, and standard operating procedures
  • Infrastructure and information technology
  • Interprofessional collaboration: How to create a clockwork-like intertwining of different professions in a hospital
  • Customer relationship management in hospitals
  • Personnel development
  • Entrepreneurial culture
  • Continuous improvement systems
  • Creative patient engagement

Section 3: Execution of performance improvement measurements

Change management

Creating new processes or improving long-established routines demand effective change management. Change management principles that have proven to be applicable in the complex healthcare environment, like the traditional models of John P. Kotter (Harvard) or Kurt Lewin (Berlin) and modern approaches like change agents and participative ideas will be introduced.

Project management “light”

Professional project management tools, principles, or standards like the International Project Management Association (IPMA) guidelines are certainly very beneficial for multi-million dollar projects led by a dedicated project management team. Performance improvement measures in a hospital, a hospital`s department, or a single functional unit like the intensive care unit or the catheter laboratory have a much smaller volume. Additionally, they need to be managed in parallel to the daily clinical routine. A project manager who can spend his entire work time managing or controlling the project will be available only in the rarest cases.

In contrast to such highly complex project management systems, we experienced the Project Management methodology (PM2) developed by the European Commission (EU) to be lean yet effective enough to be applied to hospital projects run by healthcare professionals. Thus, we introduce you to the EU PM2-System with a particular focus on improvement projects in the clinical arena in this section.

Eventually, you will hold a detailed project plan for your performance improvement program that will increase the likelihood of success of your projects.


Last but not least, communication with stakeholders is a crucial factor in the success or failure of all your hospital management activities. For the important interaction with patients, colleagues, partners, politics, and the public the Hannover-Medical.Management Manual provides helpful support, too.

You will define a pratical communication campaign to capitalize on your performance improvement initiative significantly.

This section creates an opportunity for you to develop your personal 360-day-performance-improvement-progam.

Section 4: Evaluation

Continuous evaluation

We recommend evaluating all measurements right from the beginning. Continuous, self-critical monitoring of all activities and results enables timely adjustments, prevents misguided decisions, and ensures the sustainable success of your improvement project.

Data analysis for a goal-oriented project controlling

First, we put together a robust system of relevant key indicators that allow sound evaluation of the measurements. Evidence-based determination of the status quo, the progress, and the results is crucial to make your improvement program a long-term success. This system aligns closely with the performance assessment tool that you configured in section 1 of this course.

Again, we would like to assist you with the Hannover-Medical.Management Manual, in which you find useful tools for a systematic and effective evaluation.

Involving people

Internal and external surveys and interviews are suitable tools to first, get to know what physicians, nurses, patients, and partners think about the performance, the improvement measures, and their results. Second, those surveys can serve as a tool to communicate the progress of the performance improvement programme.