Why Performance Improvement Doesn’t Always Improve Performance

Providers are facing increased pressure from patients and payors to demonstrate greater value by improving care quality and costs. To meet these expectations, physician groups and ambulatory care networks have sought and deployed an array of strategies and tools to improve performance. And yet, while many providers have begun this journey, few have realized the desired results.

Despite the best of intentions, why have so many organizations been unable to achieve their improvement goals?

To answer this question, we must first understand the fundamental requirements of a successful improvement strategy.

Abraham Maslow’s well-known Hierarchy of Needs 1 theory states that all individuals hold a similar set of fundamental needs; and for humans to flourish in their pursuit of more advanced motivations, they must first satisfy those needs. The same is true for healthcare organizations seeking to provide greater value through high performance. Organizations must address a basic set of needs in order for performance improvement efforts to thrive. To illustrate this point, I have adapted Maslow’s model to help us better understand these fundamental organizational needs and how addressing them can truly lead to improved performance for physician groups and ambulatory care networks.Heirarchy_Process_Improvement_Needs_14M09D05

  • Process Understanding. To improve, the organization must first become an expert in its current processes and operations. While this sounds intuitive, it requires standardization and a culture of measurement – strategies that are not well established in many healthcare organizations.
  • Willingness to Change. Both leadership and frontline staff must be prepared to adapt practices and processes based on the findings of their improvement efforts. This should include the expectation to try and learn along the way.
  • Improvement as an Expectation. All members of the organization should be included in the process improvement strategy. As involvement is effectively established, improvement becomes a core job function and the expectation of all members of the organization.
  • Process Improvement Knowledge and Skills. Once the culture is prepared, the tools and techniques will facilitate and manage the improvement tasks. An understanding of fundamental improvement principles should be developed as a basic skill among all members of the organization.
  • Continuous Improvement. Continuous improvement represents the “self-actualization” of process improvement and demonstrates the organization’s ongoing pursuit of value. At this point, improvement efforts become frontline-driven and the culture pervasive in all organizational activities.

Many organizations have jumped into improvement strategies by utilizing established tools and adopting oft-used techniques (e.g., Lean Six Sigma). These are meaningful components of a continuous improvement strategy; however, if the basic organizational needs for improvement are not satisfied, these techniques will likely be unsuccessful, and any progress short-lived. A successful approach to process improvement must begin with specific activities that initiate a transition in the organization’s strategy and culture. Once this has begun, the appropriate tools and techniques can leverage the organization’s motivation to meet and exceed performance goals.


1 Maslow, A.H. (1943). “A Theory of Human Motivation.” Psychological Review, 50(4), 370–96. Retrieved from http://psychclassics.yorku.ca/Maslow/motivation.htm.

This entry was posted in Performance Improvement, Physician Networks and tagged , , , , , by Rick Roesemeier. Bookmark the permalink.

About Rick Roesemeier

Rick works in ECG’s Healthcare Division. His experience in healthcare operations, finance, supply chain management, and process improvement provides him with a broad foundation of skills to assist clients with complex problems and deliver innovative and actionable strategies for success. He focuses on guiding and facilitating teams toward solutions to difficult problems and provides results that are attentive to client needs and priorities. Recently, he has worked with multispecialty physician groups to develop practice strategies that align physicians with the organizational goals necessary for success in an evolving market. Prior to joining ECG, Rick served as Pharmacy Business Manager at St. Louis Children’s Hospital, a high-performing pediatric academic medical center, where he provided finance and operations leadership for multiple ancillary service lines and supported their financial and performance improvement strategies. He holds a master of health administration degree from Saint Louis University and a bachelor of science degree in public health from Truman State University.

2 thoughts on “Why Performance Improvement Doesn’t Always Improve Performance

  1. Focusing on short term activities and actions generally feels more productive and satisfying than tackling the big issues where progress is sometime challenging and slower to realize.

    • You present a good point and one that should be considered as each organization begins to initiate its performance improvement strategies. These immediate improvements or “quick wins” help to develop the willingness to change among key stakeholders in the organization and lead to a more developed culture of improvement. This being said, to achieve the long-term goal of establishing a continuous improvement culture where improvement is driven by all members of the organization, these foundational needs should be addressed. Finally, improvement should be approached incrementally and success measured through realistic process goals that are continuously monitored and adjusted as improvement occurs. Celebrating success as incremental improvement is realized should provide the momentum needed to address larger issues and reach long-term goals.

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