Why Do Organizations Struggle With OPPE?

The following is an excerpt from The Complete Guide to OPPE: Strategies for Medical Staff Professionals, Physician Leaders, and Quality Directors.

For many organizations, an OPPE program is the first systematic process for broad scale practitioner performance improvement. Organizations run into common pitfalls that often hamper the progress of OPPE, particularly when selecting indicators, reviewing reports, and engaging practitioners. The following are some common mistakes that medical staffs make when implementing OPPE programs.

• Jumping to tasks (such as selecting indicators) without defining the organizational vision and quality goals for OPPE. Without a compelling reason for the OPPE program, practitioners may not be receptive to how the program will be implemented. This lack of direction leads to difficulty in selecting meaningful indicators. During the indicator selection process, ask the question, “Does this indicator measure performance that aligns with the organization’s or department’s vision and goals?”
• Holding one group accountable for creating the OPPE program. At some organizations, medical staff leaders coordinate the entire process, whereas at others, the quality and performance improvement departments or the medical staff services department are responsible for data collection and report evaluations. Rather than being a segregated effort, organizations will benefit most if medical staff leaders and the appropriate administrative department work together as they bring different skills and knowledge to the table.
• Failing to allocate appropriate resources up front. OPPE requires increased staff resources, and excluding certain stakeholders can be detrimental to the program’s success. Not involving medical staff leaders up front may result in a lack of support for the program. Not involving clinical informatics and information technology (IT) resources up front may cause the medical staff to select indicators that are not feasible to collect. Chapter 2 discusses important stakeholders to involve and how to set expectations regarding roles and responsibilities.
• Selecting indicators and thresholds in a vacuum. Although it is important for each department to determine the indicators that best evaluate practitioners’ performance, working in silos often duplicates efforts and leads to inconsistent indicator definitions and fragmented priorities. Encourage coordination across specialties to allow for collective learning and collaboration. Consider grouping related specialties, such as family practice and internal medicine, so they are selecting indicators together or sharing knowledge between groups.
• Failing to assign performance thresholds or triggers to indicators. Failing in this area impedes the ability to apply a fair and equitable performance expectation across a group of practitioners. It also prevents the medical staff from systematically acting on information received via the OPPE process and does not conform to current requirements.
• Basing indicators on low-integrity data. Whether the data are untimely, inconsistently captured, gleaned from an insufficient sample size, or simply riddled with data integrity issues, the resulting indicators will not meet accepted standards for validity. During indicator selection and report evaluations, it is crucial to scrutinize the accuracy and reliability of the data.
• Failing to identify deficiencies in the current program and addressing practitioner skepticism. Practitioners may be skeptical of the new OPPE program based on their experiences with the previous program for reappointment profiling. For example, they may feel that the data provided was not helpful in determining clinical competence relative to the privileges requested. If an OPPE program is to be credible, it is important to identify deficits in the existing program for reappointment profiling so that the medical staff does not make the same mistakes in the development of the OPPE program.
• Failing to effectively engage practitioners in OPPE. Medical staffs often make the mistake of spending a lot of time developing an OPPE process, but they fail to collaborate with practitioners to identify clinically unnecessary variation. Once the process is implemented, they are disappointed with the lack of improved clinical outcomes and view the OPPE process as not worth the time or resources spent.
• Failing to provide effective communication and education regarding OPPE. If medical staff members do not understand the intentions of OPPE, they may push back or appear disinterested or uncooperative.