Concern ~ Focus ~ Purpose
Performance Improvement: To Track or Not to Track?

Geoffrey Krueger, BA, RRT, RCP
Proactive Solutions HME Consulting LLC 

If there is one particular question I am asked by DMEPOS organizations on a consistent basis about Performance Improvement, it's this:

"What should we track as a care or service-related PI indicator?"

The answer may not be as difficult as it sometimes seems.

ACHC Standard DRX6-3B requires that Performance Improvement (PI) activities include ongoing monitoring of at least one important aspect related to the care/services that are being provided.  

General Guidelines

In addition to tracking and documenting activities (sometimes referred to as indicators) that may be specifically required by an accrediting body or other regulatory agency (e.g., incidents, infections, complaints, customer satisfaction, client record audits, billing errors, etc.), it is important to have an understanding of how to find areas of interest in an organization's operational activities that may warrant focused monitoring and tracking.  One relatively simple way to begin approaching this is by looking at activities that are:

  • "High-Volume"  -  Activities that occur frequently or consistently over time
Example 1: In the case that revenue is generated primarily from the sale/rental of respiratory products -  this would naturally be an area to concentrate on.
Example 2:  In the case that the dispensing of products and services is accomplished predominantly through home deliveries to the client as opposed to pick-up at the office, delivery processes might become an area of focus.  Timeliness and accuracy issues are usually of primary concern.

  • "High-Risk"  -  Activities that pose a risk of material adverse effect on customers, staff, and/or the organization if they are not performed correctly.

Example 1:  Proper client/family/caregiver instruction regarding the safe use of durable medical equipment.  This involves two general areas: 1) personnel training and competency, and 2) documentation of receipt and understanding of the instruction by the client/family/caregiver.

Example 2:  Proper use of infection control procedures and personal protective equipment by staff members. 


  • "Problem-Prone"   -  Activities that tend to involve recurring complaints, delays, incidents, inefficiencies, or other problems. 
Example 1:  Several customers file grievances about deliveries not occuring within the expected timeframes.

Example 2:  Periodic reviews of billing records begin to show consistent errors in a particular item or process point.

The examples offered above are by no means the only situations that apply; theoretically, the possibilities are essentially endless.  In general, the key point here is to think in terms of processes, breaking each general activity down into its component activities.  Let's use product delivery as an example:


This is, of course, only one way of looking at one general activity process, but it illustrates the point that process-oriented thinking promotes the identification of specific areas for further tracking and study.   If necessary, each of the components depicted in the above-illustrated delivery process could be broken-down further into even more components or steps.  Any one of the component steps (activities) is a potential source of PI tracking activities. 

Involve Everyone

The involvement of all ownership, leadership, and staff members is essential to provide the best opportunity for identifying activities to be monitored.  Each individual in the organization not only represents a job title, but also brings a potentially unique perspective to what goes on from day-to-day in the office and in the field.  Here are some suggestions that may help to involve everyone in this process:

  • Hold regularly scheduled staff meetings that include Performance Improvement program activities.  Encourage open discussion and suggestions from all present - emphasize the value that is placed on each individual's participation and that ALL suggestions are appreciated.  Document the agenda/minutes of these meetings and make them available to all personnel.

  • Implement the use of a suggestion process that affords everyone the opportunity to contribute their ideas for PI activities outside of scheduled meetings.

  • Incentivize employees to make suggestions by offering tangible rewards to them for suggestions that are implemented as PI activities and that result in positive outcomes in a previously unidentified activity.  The rewards do not necessarily need to be financial in nature or costly to be effective.

Solicit comments and suggestions from clients and referral sources through the use of satisfaction assessment tools such as written or telephone surveys.  Analyze the results not only in terms of raw numbers and statistical data to plug-in to periodic PI reports, but also as a possible source for the identification of situations and issues that may be appropriate areas for tracking.        

Don't Rest on Your Laurels

Even though you may have identified and implemented the tracking of a single care/service-related activity as a PI indicator, don't become too comfortable in thinking it's OK to just put that on "cruise control" and on go as usual from that point.  The continuing search for other appropriate activities to track is paramount to developing a robust Performance Improvement program that produces positive outcomes over time.  Although the accreditation standard technically requires the tracking of only one ("at least one") care/service-related activity,  the point is to track as many as possible/necessary to achieve optimal results.        
Contact Us