Navigating Performance Improvement in the Evolving Healthcare Landscape- Insights from a Task Force Analysis

Navigating Performance Improvement in the Evolving Healthcare Landscape- Insights from a Task Force Analysis

Description of CVS Health

CVS Health Corporation is a major healthcare organization in the United States. CVS Health provides pharmaceutical services through a chain of retail pharmacies under CVS Pharmacy. It also provides pharmacy benefits management services under CVS Caremark, and insurance services are under Aetna. CVS Pharmacy is the main business focus of CVS Health. In 2022, CVS Health had a market share of 25.6%, making it the largest and leading pharmacy corporation in the U.S. (Petruzzi, 2023).

CVS Pharmacy provides mail-order pharmacy services, neighbourhood pharmacy outlets, prescription filling, refilling, delivery services, and speciality pharmacy services. CVS Pharmacy has over 10,000 stores across the United States and makes up 10 per cent of all drug refills in the U.S. (Petruzzi, 2023). Through Aetna, CVS Health provides insurance services that range from commercial health coverage to Centers for Medicare & Medicaid Services (CMS), including Medicare and Medicaid, and health insurance services for both individuals and the entire family. CVS Health’s health care and wellness services, general healthcare services, and speciality care services, including vision and dental health management, mental health and condition management, and health and wellness products to help manage various conditions. The main focus of the organization is to provide pharmaceutical services, health insurance services, and health care services and products that are affordable and accessible to all.

Figure 1

Top U.S. Pharmacies Based on Prescription Drugs Market Share in 2022

Resources and Type of Work Environment Needed for Continuous Performance Improvement in CVS Health

Performance is a process that requires the combination of both available resources and a conducive work environment. The first major resource that CVS Health will need to achieve continuous performance improvement is a well-disciplined and skilled professional healthcare workforce. Healthcare professionals, including pharmacists, nurses, and physicians, are the main driving force for organizational performance. Having the right number of staff with the right skills will ensure that the organization has the needed support for all performance improvement initiatives. Secondly, the organization will need to invest in its data and related technological technologies. The current healthcare settings is becoming more reliant on technology and data, including the use of big data and big data analytics. Technologies such as electronic health records (EHR) systems and other digital mobile health technologies, including wearables, are enabling the development, analysis, and use of big data in healthcare. Big data and big data analytics are enabling healthcare organizations to utilize big datasets to identify patterns, trends, and insights in healthcare environments that support healthcare decisions, improve patient outcomes, and reduce healthcare costs (Batko & Ślęzak, 2022). CVS Health will need to invest in health information systems that help capture, analyze, and manage patient and population data, including data on current health conditions, population income levels, and current and previous organizational performance. This will not only help the organization plan for future medication stocks but also identify previous points of failure and use such data to plan for future performance. Additionally, technologies such as Industry 4.0 technologies monitor the supply chain and provide sufficient data to timely identify possible major disruptions and help design a supply chain that responds to unexpected disruptions to restore and ensure resilience of the supply chain (Marinagi et al., 2023).

Besides the resources, continuous performance improvement is dependent on the work environment. The work environment is made of both corporate and work-specific conditions. For the corporate conditions needed for successful performance improvement, CVS Health must ensure the physical resources, organizational policies, and leadership styles employed at the organization promote open communication and employee satisfaction and support collaborative teamwork. In fact, organizational factors alongside leadership styles are major factors for work motivation and satisfaction with work, which contribute to employee performance (Pancasila et al., 2020).

Quality of Performance Metrics in CVS Health

CVS Health has set some key metrics to help measure the quality of performance in its pharmacy retail chain as well as other subsidiaries. Five major quality performance metrics that CVS Health uses across its CVS Pharmacy retail stores are sales revenue, consumer satisfaction scores, average prescriptions filled per day, average sales per transaction, and accuracy of prescription filling and dispensing. These quality performance metrics are essential in healthcare settings as they help in the evaluation, monitoring, and control of the major influencing factors of performance in healthcare organizations (Burlea-Schiopoiu & Ferhati, 2020). To begin with, the sales revenue of an organization is a key quality of performance metric as it indicates the actual market performance of the services and products the organization provides. In 2022 alone, CVS Health had a prescription revenue of over USD 140 billion in the United States alone, making it the largest pharmacy retailer by sales revenue. This performance metric complements the organization’s focus on inventory turnover as a key performance indicator (KPI) within the retail pharmacy business.

Second, consumer satisfaction scores can help determine their experiences with the services and products provided by an organization. CVS Health focuses on consumer satisfaction scores as an indicator of the quality of the organization’s performance. Such scores are obtained from consumer surveys, feedback, recommendations, and rates of consumer references. Third, average prescriptions filled per day is a key quality performance metric that CVS Health employs. This is a key performance metric as CVS Pharmacy providing prescription medications, and refills are the main business focus and source of revenue for CVS Health. As a pharmaceutical retail chain, CVS Pharmacy, using the average prescriptions filled in a day, can track its performance within a day, a week, a week, and within a year.

Fourth, the average sale per transaction is a key performance metric in CVS Health as it presents the average revenue obtained in each transaction. CVS Health tracks the average sale per transaction to determine if its sales are dropping or rising to determine its current levels of performance. Lastly, the accuracy of prescription filling and dispensing, a key quality performance metric, is critical to CVS Health as it aligns with its mission to provide safe and affordable medications and healthcare services. The metric is aimed at ensuring the highest standards of performance are achieved and maintained to prevent medication errors that not only negatively impact patient safety but may affect the organization’s market reputation.

The Role of Performance Metrics in Developing CVS Health Improvement Capabilities

These performance metrics help develop CVS Health’s capability for improvement. For instance, the sales revenue metric can help CVS Health’s management determine whether its pharmacy retail stores are making a profit or loss based on the current revenue performance. The metric can also highlight the performance of individual outlets, identify outlets with poor performance, and, in return, implement targeted performance improvement interventions. Metrics such as consumer satisfaction scores and accuracy of prescription filling and medication dispensing are critical indicators of the quality of the organization’s performance. Consumer satisfaction scores can help CVS Health determine the quality of its services and products, including the safety of products. Both metrics can help CVS Health identify areas of poor performance that affect patient safety and consumer satisfaction and guide the design and implementation of interventions that improve consumer satisfaction.

Notably, the overall levels of patient satisfaction are an indicator of the perceived quality of services provided and largely contribute to brand image and loyalty (Vimla & Taneja, 2020). Therefore, the consumer satisfaction scores can help CVS Health design and structure its operations, outlets, products, and services in a way that presents a positive brand image to attract and retain more customers. Additionally, key performance metrics such as average prescriptions filled per day and average sales per transaction can help determine if CVS Health is meeting its sales projections and goals and its current market share and guide the organization in setting future sales and revenue targets based on current prescription filling rates.

Quality-Improvement Tools and Strategies available to CVS Health

There are multiple quality-improvement tools and strategies available that can help CVS Health further develop its improvement capability. The four major tools and strategies that are specific to CVS Pharmacy include the failure mode and effects analysis (FMEA), checklists, lean methodology, and the Plan-Do-Study-Act (PDSA) Cycle. Firstly, the FMEA is a tool that can help CVS Health improve its improvement capabilities as it helps identify ways in which a product or service can fail and the effects of such failure. As an organization that provides health products and services like vaccines, which are prone to errors and adverse outcomes, employing the FMEA tool can help CVS Health highlight and prioritize various risks associated with its products and services and prevent costly adverse outcomes.

Second, the lean methodology is another tool that can significantly improve CVS Health’s improvement capability by optimizing processes and eliminating wastage in service production and delivery. The lean methodology is associated with improved workflow efficiency, which in return reduces delays, has an impact on safety, and saves resources within healthcare settings (Ahn et al., 2021). Additionally, the PDSA is a critical tool that CVS Health can use to guide its continuous improvement efforts as it provides a rigorous systematic and cyclic approach for continuous improvement that helps test and refine changes within processes (Knudsen et al., 2019).

Figure 2

The PDSA Cycle

To improve the efficiency and effectiveness of the FMEA, PDSA, and Lean methodology, the use of checklists can ensure that all major steps within the provision of the various services, such as drug refills, are adhered to. Checklists can help CVS standardize its operations across all of its pharmacies and subsidiaries to reduce variations in procedures, which can lead to errors.

Transformational Model(s) for Organizational Performance Improvement

The transformational model that a healthcare organization like CVS Health can use to help improve its performance is the Quadruple Aim. The Quadruple Aim is a framework developed by the Institute for Healthcare Improvement (IHI) aimed at improving healthcare by focusing on patient experience, population health, cost, and clinician experience. The Quadruple Aim can guide CVS in its performance improvement efforts as it has been linked to improved interprofessional collaboration in healthcare (Bachynsky, 2020), which in return enhances the efficiency and safety of care services delivery. It also helps healthcare workers find meaning in their work and professional identity. In addition, finding meaning in work and professional identity enhances healthcare professionals’ commitment to their roles and the organization, which impacts their individual and organizational level performance.

Conclusion

CVS Health is the world’s leading pharmaceutical retailer. It is highly invested in continuous performance improvement with the aim of achieving equitable access to healthcare products and services. It combines various resources and tools and monitors various performance metrics to deliver high-quality pharmaceutical products and care services to its customers. By employing the Quadruple Aim as a transformational model and monitoring the various quality of performance metrics, CVS Health can be able to design and redesign its future service delivery and operational strategies to continuously improve its performance and remain the leader in the retail pharmaceutical business.

 References

Ahn, C., Rundall, T. G., Shortell, S. M., Blodgett, J. C., & Reponen, E. (2021). Lean management and breakthrough performance improvement in health care. Quality Management in Health Care, 30(1), 6–12. https://doi.org/10.1097/QMH.0000000000000282

Bachynsky, N. (2020). Implications for policy: The Triple Aim, Quadruple Aim, and interprofessional collaboration. Nursing Forum, 55(1), 54–64. https://doi.org/10.1111/NUF.12382

Batko, K., & Ślęzak, A. (2022). The use of Big Data Analytics in healthcare. Journal of Big Data, 9(1). https://doi.org/10.1186/S40537-021-00553-4

Burlea-Schiopoiu, A., & Ferhati, K. (2020). The managerial implications of the key performance indicators in the healthcare sector: A cluster analysis. Healthcare 2021, Vol. 9, Page 19, 9(1), 19. https://doi.org/10.3390/HEALTHCARE9010019

Knudsen, S. V., Laursen, H. V. B., Johnsen, S. P., Bartels, P. D., Ehlers, L. H., & Mainz, J. (2019). Can quality improvement improve the quality of care? A systematic review of reported effects and methodological rigour in plan-do-study-act projects. BMC Health Services Research, 19(1), 1–10. https://doi.org/10.1186/S12913-019-4482-6/FIGURES/3

Marinagi, C., Reklitis, P., Trivellas, P., & Sakas, D. (2023). The impact of industry 4.0 technologies on key performance indicators for a resilient supply chain 4.0. In Sustainability (Switzerland) (Vol. 15, Issue 6). https://doi.org/10.3390/su15065185

Pancasila, I., Haryono, S., & Sulistyo, B. A. (2020). Effects of work motivation and leadership toward work satisfaction and employee performance: Evidence from Indonesia. Undefined, 7(6), 387–397. https://doi.org/10.13106/JAFEB.2020.VOL7.NO6.387

Petruzzi, D. (2023, August 30). CVS Health – Statistics & facts. Statista. https://www.statista.com/topics/1599/cvs-caremark/#topicOverview

Vimla, V., & Taneja, U. (2020). Brand image to loyalty through perceived service quality and patient satisfaction: A conceptual framework. Health Services Management Research, 34(4), 250–257. https://doi.org/10.1177/0951484820962303

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As an office manager at a healthcare facility, you are part of a performance-management task force. You will be analyzing strategies for ongoing performance-improvement in the changing health care industry to demonstrate your skill in performance improvement.

Preparation
Your performance-management task force is preparing for a task force meeting that will include a variety of departments, including a representative from risk management.

Select 1 inpatient and ambulatory or ancillary healthcare organization to research and use for your assessment deliverable. Consider facilities such as:

Hospitals
Dialysis clinics
Laser-eye clinics
Pharmacies
Assessment Deliverable

Create a 1,050- to 1,400-word evaluation report in which you evaluate your selected organization’s quality metrics and performance-improvement capability. In your evaluation:

Describe the selected healthcare organization. This can be about a healthcare organization in general (i.e., pharmacy) or about a specific organization (i.e., CVS).
Explain what resources and type of work environment are needed to continuously improve an organization’s performance. Correlate them to your selected organization.
Identify and evaluate metrics used by the organization to measure the quality of performance.
Explain how these metrics help develop the organization’s improvement capability.
Identify and discuss the quality-improvement tools and strategies available to help the organization develop improvement capability.
Identify and describe which transformational model(s) can be used to help improve an organization’s performance. Relate them to your selected organization.