Activity Based Funding and Management
Program
Monitoring and Managing
Performance
30 June 2011
This presentation will:
1. Outline the goals and benefits of Performance Management relevant
to ABF/ABM and the use of Performance Management in other
States
2. Identify the elements of ABF/ABM Performance Management
introduced by WA Health in July 2010 as the Annual Performance
Management Framework 2010/11
3. Introduce the elements of Performance Management for 2011/12.
30 June 2011
Slide 2
Implementation of Performance Management
The implementation of ABF/ABM is supported by a comprehensive Performance
Management Framework (PMF).
The PMF is improving health system management by:
1. More clearly identifying organisational priorities and targets
2. Rewarding good performance in areas of patient access, quality &
safety, managing within budgets
3. Monitoring and management of levels of performance.
Source: Health Activity Purchasing Intentions 2010-11
Performance Management Framework 2010-2011, PAQ, May 2010
30 June 2011
Slide 3
Managing Resources to Deliver Quality
Performance management in healthcare links clinical quality, operational
effectiveness and financial outcomes.
Clinical quality
• Clinicians’
outcomes
• Patient
satisfaction
• Compliance with
clinical protocols
Operational
effectiveness
• Throughput
• Resource
utilisation
• Access targets
• Activity
30 June 2011
Slide 4
Financial
performance
•
•
•
•
•
Income
Expense
Growth
Budget
Return on
assets
Benefits of Performance Management
There are 6 key benefits of Performance Management in healthcare:
•
1. Greater
Understanding
of Performance
•
•
2. Enables
Improvement
•
•
•
3. Increases
Accountability
30 June 2011
•
•
Process encourages managers to review data to assess performance, which enables the
business to better understand major variances against plan, and uncover operational
issues.
Performance reports become the “one version of the truth” and are an historical repository
of the business’s performance.
Management can understand where actual performance sits relative to performance targets
and budget so that actions can be put in place to recover performance, if appropriate.
Monitoring actual performance provides the baseline for measuring improvements.
Allows the success of actions already in-place to be measured on a regular basis.
Tracking performance against defined metrics allows people to be held accountable for the
performance of areas under their responsibility.
Operational performance can be linked to incentives and rewards.
Individual performance reviews can be linked to operational performance indicators and
results.
Slide 5
Benefits of Performance Management
There are 6 key benefits of Performance Management in healthcare:
•
4. Instils a
Performance
Culture
•
•
•
5. Focus on
the Patient
•
•
•
6. Delivering
Quality Care
30 June 2011
•
Reviewing performance regularly instils a performance improvement culture.
Monitoring performance removes “silos” – sites and specialities are more aware of the
impact they have on overall performance.
Allows comparisons across business units, highlighting quality issues and/or inefficiencies,
or high performance which should be replicated in other areas.
The strategic intent of the organisation is the focus of the performance management
framework.
Key performance metrics are aligned with outcomes achieved for the patient.
Performance improvement initiatives are designed to improve the patient journey and the
outcomes achieved.
Safety and quality indicators are included in the performance management framework to
monitor and assess the organisation’s performance.
Safety and quality indicators are aligned and reported at all levels within the organisation.
Slide 6
Performance Management in other States
• Victoria
• Annual Performance Agreements
• 26 KPI
• Performance score with weighted domains eg
financial KPIs 30% of score
30 June 2011
Slide 7
Performance Management in other States
• NSW
• Annual Performance Agreements
• 51 KPI
• 3 Performance categories
• QLD and SA in consultation
30 June 2011
Slide 8
Performance Management in 2010/11 for WA Health
The Performance Management Framework (PMF) is designed to drive better
patient outcomes and more efficient service delivery.
The 2010/11 Performance Management
process established:
• Area Health Service (AHS) reporting
obligations for 2010/11
• Key Performance Indicators (KPIs),
targets and thresholds
• Performance monitoring and evaluation
Service
Agreements
Service
Providers
Performance
Reporting
(Activity & Budget)
(Undertake routine
activity within the
parameters of the
Service Agreements)
(KPI reported to DOH)
Performance
Management
(Incentives, remediation,
penalties)
Initially the PMF will included:
•
10 KPIs reported by facility (where applicable)
•
Monitoring at the facility and AHS level
•
Performance evaluation only at the AHS level
30 June 2011
Slide 9
Performance
Agreements
(CEs )
Performance
Monitoring
& Evaluation
(Performance
evaluated against
targets and
thresholds)
Performance Management
WA Health implemented a Performance Management process to facilitate
service improvement. This is jointly managed by the Director General and the
Area Chief Executives.
This involves:
•
On-going review of the performance of Service Providers
•
Identifying a performance issue and determining the appropriate response
•
Determining when a performance recovery plan is required and the level of
intervention required
•
Determining when the performance intervention needs to be escalated / de-escalated
•
Determining when a Service Provider is no longer on performance watch.
Source: Health Activity Purchasing Intentions 2010/11
Performance Management Framework 2010-2011, PAQ, May 2010
30 June 2011
Slide 10
Service Agreements in 2010/11
Service Agreements have five
components…
1. ABF for inpatients and ED
2. ABF for Ambulatory Surgery
Initiative.
3. Remainder of services provided by
AHS.
4. Mental health services which will be
clearly identified in reporting and
funds quarantined.
5. Funding of special purpose
programs.
Source: Health Activity Purchasing Intentions 2010-11
Performance Management Framework 2010-2011, PAQ, May 2010
30 June 2011
Slide 11
Service Agreements
Service Providers
Performance
Reporting
Performance
Management
Performance
Monitoring
& Evaluation
Performance
Agreements
Performance Management Framework
Key Performance Indicators
• 5 Domains
•
•
•
•
•
Effectiveness
Efficiency
Equity
Sustainability
Processes
30 June 2011
Slide 12
• Based on structure of
the Report of
Government Services
(ROGS)
• Establishes a balanced
scorecard for WA Health
Key Performance Indicators
The PMF for 2010-11 includes five domains and ten KPIs.
1. EFFECTIVENESS
Access
1.
3.
4.
The proportion of emergency department patients seen within recommended
times.
“4-Hour Rule” Program – Percentage admitted, transferred or discharged
within 4 hours.
Median wait time over boundary by category.
Elective surgery patients seen within boundary times.
5.
6.
7.
NET Expenditure to date – distance to Budget.
Volume of activity to date – proportion to target.
Elective surgery day of surgery admission rates.
8.
Staff turnover
2.
Appropriateness
Quality
2. EFFICIENCY
Inputs per output
unit
3. EQUITY
Access
4. SUSTAINABILITY
Workforce
Facilities &
Equipment
5. PROCESSES
Coding
9. Percentage of cases coded by end of month closing date.
10. Percentage of cases coded within boundary – 80% in 2 weeks, remaining
within 4 weeks.
Finance
Source: Performance Management Framework 2010-2011, PAQ, May 2010
30 June 2011
Slide 13
Performance Management in 2010/11
The Performance Management Framework (PMF) is designed to drive better
patient outcomes and more efficient service delivery.
3 elements of Performance Management
• AHS Service Agreements
• SHEF Operational Plan action items
• CE Personal Performance Agreements
The Performance Management Report (PMR) will
report monthly on:
•
10 PMF KPIs from Service Agreements
•
Performance against targets and thresholds
Service
Agreements
Service
Providers
Performance
Reporting
(Activity & Budget)
(Undertake routine
activity within the
parameters of the
Service Agreements)
(KPI reported to DOH)
Performance
Management
(Incentives, remediation,
penalties)
Performance
Agreements
(CEs )
•
The PMR commenced July 2010
•
Centrally prepared for AHS comment
30 June 2011
Slide 14
Performance
Monitoring
& Evaluation
(Performance
evaluated against
targets and
thresholds)
Performance Management in 2010/11
Performance Reporting
•Each KPI has been assessed against the thresholds at 4 levels of performance:
•
•
•
•
No
Highly Performing- exceeding target
Performing- meeting target
Under-Performing- under target
Not Performing- considerably under target
Indicator
Strategic
Pillar
Target
Thresholds
Not Performing
4
Elective surgery
patients seen within
boundary times
(a) Cat 1 < 30days
(b) Cat 2 < 90 days
(c) Cat 3 < 365 days
Underperforming
Highly Performing
Pillar 1
Cat 1: 100%
Cat 2: 100%
Cat 3: 100%
Cat 1 <70%
Cat 2:< 70%
Cat 3:< 70%
Cat 1: >70% < 95%
Cat 2: >70% < 95%
Cat 3: >70% < 95%
*In some instances these will be targets established by the Commonwealth Government's Department of Health and Ageing.
Source: Health Activity Purchasing Intentions 2010-11
30 June 2011
Performing
Slide 15
Cat 1: >95% <98%
Cat 2: >95% <98%
Cat 3: >95% <98%
Cat 1: >98%
Cat 2: >98%
Cat 3: >98%
Performance Reporting 2010/11
Example of Scorecard Report
Effectiveness
KPI 2
KPI 1
(a-e)
Proportion of Emergency patients seen
within recommended times
a
b
c
d
e
%
% Triage
% Triage % Triage % Triage
Triage
Cat 1 Cat 3 - Cat 4 - Cat 5 Cat 2 2 mins
30 min 60 min 2 hours
10min
FACILITY
AHS 1
Hospital 1
Hospital 2
Hospital 3
AHS 2
Hospital 4
Hospital 5
AHS 3
Hospital 6
Hospital 7
Hospital 8
Hospital 9
COLOUR KEY:
30 June 2011
n/a
n/a
n/a
0
n/a
0
0
n/a
0
n/a
0
n/a
n/a
n/a
n/a
-3
n/a
0
0
n/a
-2
n/a
-1
n/a
n/a
n/a
n/a
0
n/a
-3
-3
n/a
0
n/a
0
n/a
Not Performing
n/a
n/a
n/a
1
n/a
-1
-1
n/a
0
n/a
1
n/a
n/a
n/a
n/a
0
n/a
0
0
n/a
0
n/a
0
n/a
Under Performing
Slide 16
Four
Hour
Rule
n/a
n/a
n/a
-1
n/a
-1
-1
n/a
-1
n/a
0
n/a
KPI 4
(a-c)
Elective surgery
number of cases
over boundary
(a-c)
Elective surgery %
patients seen within
boundary times
a
b
c
a
b
c
% Cat
% Cat % Cat
3
Cat 1 Cat 2 Cat 3
1
2
<=
> 30 > 90 > 365
< = 30 < = 90
365
days days days
days days
days
0
n/a
n/a
n/a
n/a
n/a
n/a
0
n/a
n/a
n/a
n/a
0
n/a
n/a
n/a
0
n/a
n/a
0
n/a
n/a
n/a
n/a
Performing
0
n/a
n/a
n/a
n/a
n/a
n/a
0
n/a
n/a
n/a
n/a
n/a
n/a
n/a
0
n/a
0
0
n/a
-2
3
1
1
n/a
n/a
n/a
0
n/a
0
0
n/a
0
0
0
0
Efficiency
KPI 6
KPI 5
KPI 3
KPI 7
(a-b)
Volume of Activity to
date - Proportion of
target
Expenditure
to date
n/a
n/a
n/a
0
n/a
0
0
n/a
0
0
0
0
Highly Performing
a
b
ED
Separations
Attendances
0
n/a
n/a
n/a
0
n/a
n/a
-1
n/a
n/a
n/a
n/a
n/a
n/a
0
0
n/a
0
0
n/a
0
0
0
0
n/a Not Applicable
n/a
n/a
n/a
0
n/a
0
0
n/a
0
n/a
0
n/a
Sustainability
KPI 8
KPI 9
Elective
% cases
Surgery day of
coded by
surgery
Staff turnover
end of
admission
month
(DOSA) rates
n/a
n/a
n/a
0
n/a
0
0
n/a
1
0
0
0
n/a
0
-2
0
n/a
0
0
n/a
0
0
0
-2
n/a
0
0
0
n/a
0
0
n/a
0
0
0
0
Processes
KPI 10
(a-b)
% cases coded in
boundary times
a
b
Remaining
80% in 2 cases within
4 weeks of
weeks
discharge
n/a
0
0
0
n/a
0
0
n/a
0
0
0
0
n/a
0
0
0
n/a
0
0
n/a
0
1
0
0
Future Directions
The Performance Management Strategic Directions 2011/12 to 2013/14 Consultation
Framework will collaborate with stakeholders on the shape of the PMF.
•
Consultation on Triennial Strategic Directions and Draft Annual PMF 2011/12 commenced 24
September 2010 and is now at a conclusion
•
The 2011/12 PMF consultation was limited to the components of the PMF and their design
including:
•
•
•
•
•
Reporting obligations for 2011/12
KPIs, targets and thresholds
Performance monitoring and evaluation
Management interventions
Governance.
Source: Performance Management Strategic Directions 2011-12 to 2013-14, PAQ, July 2010.
30 June 2011
Slide 17
Performance Management in 2011/12
The Performance Management Framework (PMF) is designed to drive better
patient outcomes and more efficient service delivery.
The 2011/12 Performance Management
process establishes:
• Area Health Service (AHS) reporting
obligations for 2011/12
• Key Performance Indicators (KPIs),
targets and thresholds
• Performance monitoring and evaluation
The proposed PMF will include:
•
Service
Agreements
Service
Providers
Performance
Reporting
(Activity & Budget)
(Undertake routine
activity within the
parameters of the
Service Agreements)
(KPI reported to DOH)
Performance
Management
(Incentives, remediation,
penalties)
Additional KPI to complete the dimensions
•
Monitoring at the Agency, facility and AHS level
•
Performance evaluation only at the AHS level
•
Rewards and penalties may apply
30 June 2011
Slide 18
Performance
Agreements
(CEs )
Performance
Monitoring
& Evaluation
(Performance
evaluated against
targets and
thresholds)
Aligned to National Reporting Requirements
Readiness for National Reform is critical to WA Health
• National Health Care Agreement
• National Partnership Agreements: For example,
Closing the Gap in Indigenous Health Outcomes
• Australian Commission on Safety & Quality in Health
Care
• COAG Agreement National Health and Hospitals
Network Agreement
30 June 2011
Slide 19
Key Performance Indicators – Safety and Quality
Clinical outcomes and current indicators will continue to be monitored by the
OSQH. In addition the indicators endorsed in November 2009 by the Australian
Health Ministers are listed below.
The set of six national core hospital-level outcome indicators are:
1. Hospital standardised mortality ratio (HSMR);
2. Death in low-mortality Diagnosis Related Groups (DRGs);
3. In-hospital mortality rates for: acute myocardial infarction; heart failure;
stroke; fractured neck of femur; and pneumonia;
4. Unplanned hospital re-admissions of patients discharged following
management of: acute myocardial infarction; heart failure; knee and hip
replacements; depression; schizophrenia; and paediatric tonsillectomy and
adenoidectomy;
5. Healthcare associated Staphylococcus aureus bacteraemia infections,
including Methicillin resistant Staphylococcus aureus (MRSA); and
6. Clostridium difficile (C.Diff) infections;
Source: Health Activity Purchasing Intentions 2010-11
30 June 2011
Slide 20
Performance Management in 2011/12
The Performance Management Framework (PMF) is designed to drive better
patient outcomes and more efficient service delivery.
The proposed 2011/12 Performance
Management process establishes:
• Incentives- policy in drafting stage
• A process to address performance
concerns
• 3 levels of Intervention
Service
Agreements
Service
Providers
Performance
Reporting
(Activity & Budget)
(Undertake routine
activity within the
parameters of the
Service Agreements)
(KPI reported to DOH)
Performance
Management
(Incentives, remediation,
penalties)
Performance
Agreements
(CEs )
30 June 2011
Slide 21
Performance
Monitoring
& Evaluation
(Performance
evaluated against
targets and
thresholds)