TOOLS: Diagnosing Performance Problems: What to Look at First

PI research shows that some common problems are less expensive and less time-consuming to fix. Consider the following factors (in this order) as you diagnose performance problems or specify new performance, addressing them as you go.

Factor Questions to ask Example—Factor in Place Example—Factor not in Place
Information: Expectations
 Do people know what is expected of them? In exact, unambiguous, did-or-didn’t, cannot-argue-about-it language?
 Do they know the five W’s/two H’s (who, what, when, where, why, how, how-much) of your expectations?
 Can they tell doing it right from doing it wrong?
 Can the people repeat back to you your expectations, and have you say, “That is right!”?
Specific procedures are made known to providers: “When covering methods with clients, discuss at least four methods available at our clinic.” Providers are told to “deliver high-quality client care.”
Information: Feedback
 Do they know how well they are doing against the expectations you have set?
 Is the information accurate (and would everyone agree it is)?
 Is the feedback understandable to them?
 Is the feedback tied to something over which they have control (i.e., their own performance)?

Provider receives feedback:

 “You discussed at least four available methods with your clients 90 percent of the time.”
 “Your customer satisfaction survey ratings are at 98 percent.”

Providers are told:

 “I think you need to improve your attitude with your clients.”
 “Your clients don't seem to like coming to see you.”
Tools/ Environment
 Do people have all the items they need to do their job?
 Are there better tools available to you?
 Is the environment helping or hindering getting the performance you want?
 Is there a specific link between the performance and the items that comes to mind?
Providers have access to a private space that is equipped with samples of all six methods available at our clinic and the appropriate patient education materials. Samples are locked in the storeroom so no one will steal them (inaccessible to the providers and clients).
 If they do it right, does the job get a lot harder (disincentive)?
 If they do it right, does anything improve?
 If both are true, is the “balance” in favor of doing it right?
 If they do it right (or wrong), does anyone notice?
 Are incentives contingent on the performance?
When the supervisor observes the provider covering at least four methods with a client, the client receives feedback and the manager says, “Thank you—good job.” When the provider covers at least four methods with a client, nobody notices, and the provider has to work overtime because of taking longer with each person.
Organizational Support
 Are the organizational systems conducive to good performance?
 Does adherence to policies and procedures allow good performance?
 Do on-site supervisors support effective provider behavior (through modeling, counseling, etc.)?
 Is there an organization mission and/or clinic goal known by all?
 Do all parts of the organization work toward the same goals?
Providers are scheduled so that more are present at peak client load times. There are times when providers have no clients to see and times when the line for services becomes so long that clients leave.
Skills and Knowledge
 Could they do it right for $1m? (If so, they already have the skills and knowledge—do not train.)
 Does the exemplary performer have a “secret trick” that no one else knows?
The providers know all six methods available at our clinic. The provider only knows three of the available methods.