Performance Program Information

Performance Programs are designed for clinical teams who are interested in increasing their efficiency, eliminating frustrations in daily workflow, and improving the quality of patient care that they provide.

Performance Programs consist of a 2-day process improvement workshop and a 3-month implementation period.

What is the Performance Program?

The Performance Program supports healthcare teams to implement best practices and increase efficiency, delivering results within 3 months.

mappingParticipants (physicians, nurses, managers and other members of the healthcare team) learn how to implement the latest process management techniques. Topics include Lean Processes, Theory of Constraints, Change Management and Continuous Improvement. Emphasis is placed on implementing practical improvements that deliver rapid results.

The program helps clinical teams to:

  • Identify and eliminate barriers to patient flow (e.g. identifying process constraints and developing detailed implementation plans to increase capacity)
  • Implement best practices
  • Develop continuous process improvement plans
  • Increase access for patients to high quality care

Click this link for a chart showing the steps in the Performance Program.

What are the Results?

  • Shorten access time for initial appointments by up to 85%
  • Reduce the frequency of cancelled and missed patient appointments by 37%
  • Improve patient care and increase work satisfaction
  • Eliminate patient flow bottlenecks and streamline patient flow
  • Team building through collaborative work with all members of the multi-disciplinary care team (physicians, nurses, office staff, allied health professionals, managers and others)
  • Implement continuous improvement strategies

* Based on results published in the BMJ Quality Improvement Reports journal: Goodridge A, Woodhouse D, Barber J. “Improving patient access at a movement disorder clinic by participating in a Process Improvement Program”. BMJ Qual Improv Report 2013;2.

Required Preparation...

Attendance List for the Performance Clinic

During the 2-day Performance Clinic up to 16 people may attend. The attendance list is required at least 2 weeks prior to the Performance Clinic.

A representative from every role on the clinical team must participate, as well as a patient representative.

  • Physicians
  • Nurses
  • Allied health professionals (PT, OT, etc.)
  • Managers
  • Office assistants
  • Patient (or family member of a patient)

A attendance list must be provided, including:

  • First and last names
  • Role
  • Email address
  • Food allergies or other issues that need to be taken into account during planning


Participant Interviews

Each participant in the Performance Clinic is requested to conduct interviews with one other member of the patient care team, preferably a team member who will not be attending the Performance Clinic. Not all team members can participate directly in the Performance Clinic, however we value everyone’s opinion and would like to ensure that all views are represented.

Interviews are conducted in pairs, and both people have the opportunity to answer each question. Following discussion, the major discussion points are summarized and submitted online, ensuring that both people’s opinions are reflected in the answers. Answers may be recorded in point form. This interview process will take approximately 30 minutes.

    • Your life or the lives of your patients would be quite different if your clinic did not exist. What things are most important for you about the work that you do? What things are most important for your patients about the work that you do?
    • Think about a day when everything at work went really well. What were the things that happened to make it such a good day?
    • Describe a situation involving a patient where you feel that your team provided excellent care to a patient. What happened? (Please do not provide the patient name or any other information that could identify the patient)
    • Describe a situation involving a patient where you feel that your team could have provided better care. What happened? (Please do not provide the patient name or any other information that could identify the patient)
    • Imagine that it is a year from now, and your team is now working better than ever. Things are more relaxed than you imagined possible, yet you are treating more patients and the quality of care is higher than ever before. What things would have changed to make this possible?
    • Please describe any other important topics or ideas that you discussed:


Performance Clinic Facility Booking


  • Book a suitable location for the 2-day Performance Clinic. There must be enough room for participating teams to work without distributing one another. A room of at least 50 m2 is recommended. (See diagram)
  • Breaks and lunch are held outside of the room. A nearby area must be available for breaks and lunch (a second conference room, lobby, restaurant or cafeteria)
  • Round tables (not square tables)
  • Flipcharts x 3
  • Markers
  • Computer projector and screen
  • Name tags for all participants and facilitators
  • Tape x 2 (suitable to be used on walls)

Refreshments and Meals:

  • Reserve coffee, tea and snacks for the start of each day, and during breaks.
  • Reserve a lunch on both days for all participants and facilitators
  • Please ensure that snacks and meals are available at least 5 minutes before each break is scheduled to start
  • Optional: A team dinner with facilitators can be arranged after Day 1 of the Performance Clinic. This is a great opportunity for informal interaction.


On-site Review

It is important that the Performance Experts understand the processes at your clinic and speak with the people involved. Generally, this review takes place over a 2-day period with two Performance Experts on-site.

During the on-site review there are certain activities that must be completed. Your support and facilitation of these activities is requested. A designated support person must be available at all times during the visit (to help with answering questions, access to facilities, coordinating meetings, etc.). The goal of the process review is to:

  • Understand treatment processes and experiences of stakeholders (members of the specialty team and patients)
  • Identify best practices
  • Identify relevant issues
  • Guide project priorities

On-site Review Activities:

  • Meet with as many team members as possible, representing different functions at the clinic (including all participating physicians, secretaries, managers, nurses, patients, etc.)
  • Map the standard treatment process from referral to discharge
  • Walk the route a patient takes in the process (and possibly take pictures)
  • Review scheduling systems
  • Review data collection processes


Baseline Data Collection

Performance data from clinical practice is required to:

  • Facilitate informed discussion
  • Guide prioritization of improvement efforts
  • Serve as a baseline measurement for improvements

The following clinical performance data is required. If this data is unavailable or potentially unreliable, small surveys may be undertaken to generate reasonable estimates. Data for the previous year is ideal, but if this is not available then shorter time periods are usually sufficient.

Referrals (Demand) – By indication, by physician:

  • Number of internal referrals (from other specialists, on-call, in-patient, etc.)
  • Number of external referrals (from Family Docs or other)
  • Number of rejected referrals (referral sent back to referrer for any reason, and patient not booked for appointment)

Wait Times – By referral indication:

  • Number of patients waiting for initial appointment, by triage category
  • Average wait time, and range (min/max or statistical variability)

Cycle Time – By referral indication:

  • Average cycle time (Average of Date patient discharged – Date patient referral received)

Capacity (Supply) – By indication, by physician:

  • Number of initial patient appointments
  • Number of follow-up patient appointments
  • Number of appointment no-shows for initial appointment
  • Number of appointment no-shows for follow-up appointment
  • Number of discharged patients

If referral data is not readily available, a short survey may be completed by administrative staff over a representative two week period of all newly referred patients for all physicians (ensure that all referrals/bookings are captured, including Doc-to-doc referrals). This should include:

  • Physician identifier
  • Date of referral and date of booking
  • Indication (i.e. diagnosis)
  • Status: Accepted or rejected
  • Triage category/urgency (If this can be assessed)

Similar surveys may be undertaken for other missing data, for example a 2-week appointment log to generate baseline capacity/supply data.

Agreement and Pre-Clinic Survey

All participants are required to complete a participation agreement and a short survey prior to the Performance Clinic. This helps to identify issues that are relevant for you and to ensure that the program meets your personal goals. Please click here to complete this. A unique token is required to identify yourself, and this will be e-mailed to all participants.

A significant investment is made by all stakeholders in the Performance Program. This includes program sponsors and senior administration. It also includes members of the clinical team who will invest time in improvement activities, resulting in a temporary decrease in availability for patient care activities. A firm commitment to attaining results from all participants is required prior to the launch of the program.

  • Complete a survey (by each participating team member) to identify issues and personal goals
  • Collect baseline data
  • Dedicate time for the program (2-day Performance Clinic + minimum of 4 hours per team member per week for implementation activities over a 3-month period)
  • Report monthly on progress and results
  • Present results to senior administration at the conclusion of the program (in 3 months)
  • Continue process improvement activities after program completion

What is the Agenda for the Performance Clinic?

Participants at the Performance Clinic are requested to arrive at 8:15am both mornings. Sessions begin at 8:30am sharp.

Day 1
08:30 – 09:15 | Goal Setting and Introduction
09:15 – 10:45 | Session 1: Brainstorming and Process Mapping
10:45 – 11:00 | Break
11:00 – 12:30 | Session 2: Lean and Patient Selection
12:30 – 13:15 | Lunch
13:15 – 14:45 | Session 3: SURI and Treatment Planning
14:45 – 15:00 | Break
15:00 – 16:00 | Session 4: Treatment
16:00 – 16:30 | Review and Evaluation

Day 2
08:30 – 10:00 | Session 5: Treatment evaluation and Follow-up
10:00 – 10:15 | Break
10:15 – 12:00 | Session 6: Theory of Constraints
12:00 – 12:45 | Lunch
12:45 – 14:15 | Session 7: Change Management
14:15 – 14:30 | Session 8: Continuous Improvement
14:30 – 14:45 | Break
14:45 – 15:30 | Action Plan Presentations
15:30 – 16:00 | Course Review and Evaluation

What do Participants Say about the program?

evaluation“This workshop was remarkable in a number of ways. A particularly valuable aspect was the engagement of all the stakeholders as equal partners around the table… It was truly enlightening to learn of the perspectives of all the team members giving each of us insights of the full operations of the clinic with all of its strengths and limitations and giving a broad perspective to all of us that none of us had had before.”

“The ultimate outcome was truly remarkable. Through a variety of simple strategies that were within the control of the group itself, the efficiency of the running of the clinic greatly improved, ultimately enhancing the quality of the care given to the patients.”

“Some of the specific outcomes of this process included:

  • The wait times for patients to be seen in these multi disciplinary clinics was markedly reduced.
  • The ability to see patients in a more timely fashion for follow up visits was also greatly improved.
  • The wait list for patients getting into the multi disciplinary clinics was virtually eliminated.
  • The clinic ran more efficiently with minimal waiting by the patients or the health care providers to provide the scheduled services.”

“We are very proud of the results that we have achieved and I would highly recommend the Performance Program to other clinical teams.”

“We accomplished more in two days during the Performance Clinic than we would have in two years in our normal work environment.”

“Just wanted to say what a wonderful 2 days it was. I not only thoroughly enjoyed it but also learnt more than I have ever learnt on any course and feel 100% inspired.”

“The Performance Clinic was the best piece of my continued medical education during my entire career as a physician.”

“I just wanted to say thanks so much for organizing one of the best course I have been on. It was great from beginning to end. I haven’t stopped raving about it since I returned. It was professionally delivered and great to be part of.”

“The changes have been great for physiotherapy. We have found it more streamlined and efficient. We are able to identify clients who require further intervention and set that up seamlessly. I hope you can feel the “love” I have for this process. It has been a success for us.”