Setting performance standards for an anesthesia department.

The Stanford University Department of Anesthesia established performance standards by identifying aspects of their service that were related to an important "customer's" perception of quality. A "quality grid" targeted service attributes that surgeons scored high for importance and low for performance. Control charts and flow charts helped establish reasonable performance levels for "timely first case starts" and "turnaround time." Control charts indicated that a reasonable performance standard for timely first case starts was "less than 20% of first case delays will be related to anesthesia activities." For turnaround time, the standard was set at "less than 10% of all turnaround times will be greater than 15 minutes, because of anesthesia-related activities." After instituting performance standards, the performance for first case start times improved from a 36% defective rate to a 9% defective rate. Anesthesia-related delays in turnaround times stabilized at a 16% defective rate. Using appropriate service standards can improve performance.