Developing and implementing systems
management and transactional reform in
acute public hospitals in Greece
Presented by:
Dr. Gareth Goodier
Mr Peter Donnelly
Mr Takis Kotis
MB, ChB, MHA, DHSc (Hon), FAFPHM,FRACMA
B.Com, Dip. BIA, CA, MCCP (Harvard), AEP (Kellogg North Western Chicago)
M.B.A (Health Administration)
July 2010
Contents
Background
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1 Activity based funding and Funding Policy reform
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2 Management Training
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3 Accreditation of Hospitals
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Appendix
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Our Team
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Contents
Background
Greece is facing an unprecedented financial crisis. All aspects of public services are under scrutiny to ensure that monies
spent are delivering the maximum public benefit. Health spending in Greece accounts for 9.6% of GDP. A large
proportion of this is spent on services provided by acute public hospitals.
This proposal directly addresses the value for money imperative in the public hospital sector. The proposed reforms will
drive improved efficiency, effectiveness, accountability, patient safety and quality in the sector. Under the control of an
internationally recognised management team, this project will build the necessary infrastructure and human capacity to
sustainably change the Greek hospital system, in the areas addressed, to a level of one of the best in Europe.
A key element of the project will be the transfer of knowledge to Greek nationals.
The project will have three core elements. These will be:
1
The introduction of activity based funding as a transactional reform . Resources will follow the patient and hospitals
will be rewarded for the work that they do rather than being compensated for the costs they incur. This will reward the
best and most efficient providers, giving others the incentive to improve.
2
The training of hospital managers and the introduction of business intelligence systems to provide managers with the
information they need to manage. Acute hospitals are complex institutions and require specific management skills.
The current skill level in Greece is inadequate and requires the input of experienced international expertise to rapidly
upgrade and address the current problems.
3
The formal accreditation of hospitals to ensure that they have the necessary governance , processes, management
capability and clinical skills to provide safe, appropriate, quality services.
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Developing and implementing systems management and transactional reform in acute public
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1 Activity based funding and Funding
Policy reform
Activity based Funding
Overview
Case-mix funding using the Australia Diagnosis Related Groups (AR-DRG V.6) and ICD 10- AM as a basis will to be
introduced as part of transactional reform in the acute hospital inpatient sector. The overall aim is to improve technical
efficiency in providing accessible , timely and appropriate patient care while improving the quality of care to patients.
The Australian Grouper and underlying diagnoses and procedure codes has been chosen for a number of reasons. This
is the most widely distributed system internationally and has been used to introduce activity based funding by a number of
countries including Germany, Ireland, China, Singapore, Lithuania ,Romania ,Slovenia, New Zealand , Bosnia and
Turkey. There are available a wide range of well developed training materials. The World Health Organisation promotes
the use of ICD 10- AM as the basis for procedure coding for those countries that do not have their own classification of
interventions
It is essential that case-mix implementation is preceded by the solid establishment of sound building blocks which will
facilitate the engagement of clinicians and managers to drive the changes sought. Jurisdictions which have done this ,e.g.
Germany, Victoria Australia have achieved successful change on the ground in terms of improved productivity and
measureable quality of care. Jurisdictions which have rushed to implement have invariably not delivered e.g. UK ,
Ireland. Romania.
The scope of this project therefore will encompass:
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the technical implementation of GR-DRG classification system for funding purposes based on the Australian Refined
DRG’s and ICD 10-AM.
implementation of costing systems to support the establishment of prices and the benchmarking of most cost effective
practice in 30 hospitals.
targeted upgrading of medical records administration, medical transcription and clinical coding to ensure the correct
recording of actual case-mix activity in 30 hospitals
training of counterparts and provision of training material templates to enable the rollout of ICD 10 –AM to all
hospitals
advice and assistance in establishing a Directorate of Data Integrity
advice and assistance in the establishment of a ”National Centre of Excellence” for clinical coding and information
including the establishment of coding and information standards. This will build on similar work already successfully
undertaken by the European Commission in the Czech Republic.
advice and assistance in the formation of various oversight committees to ensure Greek expertise and input into
significant issues concerning case-mix funding by classification groupings and to develop on-going local expertise in
case- mix administration and supervision .
advice on funding policy options to complement activity based funding in order to meet Government’s overall strategic
goals for hospital activities.
advice and training on budget modelling of individual hospitals for option analysis based on various funding policy
scenarios.
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Project Plan
The project will consist of a number of discrete sub-projects with clearly defined deliverables. These sub-projects will
build on existing personnel, information system and IT capabilities wherever possible.
The first stage of the overall project will necessarily involve a situational analysis to obtain a thorough understanding of
the existing infrastructure and capabilities. An initial desk top questionnaire will be followed up by on the ground
validation site visits by senior project management and experts. A gap analysis will be undertaken and step by step plans
developed for each sub-project.
Until this gap analysis is undertaken there will be a level of uncertainty and assumption regarding the overall resource
requirement. Based on current knowledge, a programme that includes the following elements is envisaged to be executed
over 3 phases.
AR-DRG Version 6
A temporary “testing licence” will be required from the Australian Federal Government subject to discussions on the
licence fee to be negotiated for ongoing use. Negotiations will also need to take place regarding the use of the coding e
book
In order to use the AR-DRG’s grouper it will be necessary that diagnoses and procedures align with or are mapped to
the Australian Modified version of ICD-10 ( ICD-10-AM). Current mappings can be obtained or updated from most
versions of ICD-10 and common procedure classifications to ICD-10-AM.
ICD-10- AM is based on the latest upgrade of the WHO issued ICD 10 classification plus additional diagnoses codes.
Procedure coding used is the Australian Classification of Healthcare Intervention (ACHI). The World Health Organisation
the Australian procedure structure.
An English to Greek translation of the WHO version of ICD 10 labels already exists. The translation of the approximately
4000 additional diagnoses used in ICD 10 –AM will be necessary. Translation of the procedure labels used in ACHI will
also be required. The Greek Ministry of Health will be responsible for providing the necessary translations. Once
translated, the GR-DRG’s will needed to be printed both in hard copy and in the e book format. This will be a prerequisite
to commencement of the clinical coding sub -project of the training of coders.
Initial feedback has indicated that the calibre of medical transcription, coding and costing of patient episode records may
not be of sufficient quality to underpin a successful implementation of activity based funding i.e. an implementation which
effectually drives change. Experience has shown that it would be a very illusory quick win to map poor quality data to AR
DRG V6 and in turn to use this for funding. Data which lacks credibility serves to undermine the very principle of casemix funding which is to pay a fair price for services delivered. Acceptance by management and clinical staff in particular,
is an essential precursor to change in behaviour.
In order to produce quick wins while building a suitable information infrastructure
we will place an increased focus at the beginning of the project on management
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training in the key processes and procedures that drive increased efficiency and
effectiveness.
Medical Records and Clinical coding
Recording
The medical record is at the core of health information for appropriate funding. It is also central to outcome measurement,
epidemiology, health forecasting and facility planning. It is vitally important therefore that this fundamental building block
for so may elements of the health system is not only reliable, sound and trustworthy but is seen to be so.
Accurate, comprehensive and honest coding is a prerequisite for a successful outcome of activity based funding. To
ensure that this takes place requires that the medical record be precise and complete.
This programme will prepare and execute a quality assurance programme for medical records which will result in a
certification for a hospital. Together with the endorsement of its patient level costing system, this will result in an
organisation being accredited as suitable for supplying data for the formulation of case-mix funding.
This quality assurance process will involve a planned and systemic approach to assessing the current service, identifying
and planning for improvements and providing a mechanism through which action is taken to make and maintain these
improvements. In developing this process attention will be given to those activities and functions which are common to all
medical record departments. These include:
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information systems (PAS)
admissions
discharge analysis
medical transcription
forms structure
coding
record retrieval
work box accuracy
filing and record control
tracer systems
quantitative analysis
policy and procedure manuals
initial and ongoing education
Coding
There will be a separate discrete hospital coding sub- project. The system audit above will include an intensive audit to
determine the reliability of medical transcription and the accurate coding of these.
This will involve intensive on-site examination of practices and records
The aim of the coding sub-project will be to ensure that by the end of phase 1 that coding of patient records in the 20
project hospitals will be of a sufficient standard to implement case-mix funding from those records i.e. the first 12 months
will be an intensive training and upskilling of clinicians and coders in the accurate recording and coding of medical records
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The transfer of knowledge from the project experts to Greek counterparts is a crucial aim. During the project it is intended
that 12 Greek coders will be developed to become coding “auditors.” This is recognised as being at very senior level of
the occupation with the ability to carry out professional audits as well as “train the trainers” Extending the ability to train
others will be vital to ensure the necessary coverage for all hospitals.
We anticipate that 4 expatriate experts in AR-DRG coding will be required as the nucleus of this program. A large part of
their time will be spent “in the field”. During each phase they will each have a Greek counterpart who will undergo
intensive upskilling.
Working on a hub and spoke model the experts will design and, together with their counterparts ,during Phases 1 and 2
will implement intensive training for clinicians and coders in 40 chosen hospitals. This will entail a number of seminars
and training events for both coders and the clinical staff who record the patient event on the patient notes. Follow up site
visits to assess the quality of this recording and the subsequent coding will be undertaken.
Building on their experience in the field in Phases 1 and 2 , during Phase 3 of the coding sub-project the 4 expatriate
experts along with their 8 counterparts will roll out coding training in ICD 10 - GM to the remainder of hospitals so that
they will be a position to appropriately record diagnoses and interventions and code patients records by the beginning of
Phase 4 i.e. the funding of hospitals based upon these coded records. During this period a further 4 counterparts will also
be trained as experts
Institutional Infrastructure
i) It is strongly recommended that the Ministry create the position of Director of Data Integrity to address data quality
assurance activities, oversight of audits and health data complaints. This director will co-ordinate an enhanced program of
data analysis to be undertaken by the department to improve the capacity to identify issues in data requiring audit
attention or other data quality initiatives. The project team can provide advice regarding this role and its execution.
In order to build the necessary basis for the future it will be also be imperative to establish a National Centre for
Classification and Coding. This could be based at the Ministry, the National School of Public Health, a University or a
leading hospital.
This Centre will carry out training as well as providing definitions, coding standards, documentation standards and support
for the industry. Support may include an accreditation of coders, a coding query data base, educational videos and
newsletters. It should provide a central point for commentary on related issues industry –wide. These are essential to
ensure an acceptable level of accuracy in the flow of information to Government agencies.
The Centre will incorporate help-desks for both standards and for providing advice on how coding relates to case-mix
funding. It will also ensure that data dictionaries and coding standards, data entry/extraction functions and reporting
protocols (PRS/2) relating to case-mix funding are up to date and in use by hospitals.
A project has recently been undertaken to build a similar national centre in the Czech Republic. Our team is in contact
with the personnel involved in this project and will incorporate lessons learned into the Greek project.
IT
In order for hospitals to be able to be paid on the basis of case-mix it is necessary that coded patients records be
received electronically, that each case is assigned the appropriate DRG and that the current funding policies are applied
to calculate the reimbursement for the patient episode. It is anticipated that any new IT requirements will” piggy back”
onto existing infrastructure using web based data transfer systems new data base management.
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Clinical Costing
Good costing at the patient level forms the basis for determining appropriate case-mix pricing. The granular information
used to determine the costs of a patient i.e. the costs and volumes of the interventions, events and processes within a
patient episode, also provides crucial information for the Business Intelligence necessary for improved efficiency and
quality. The same information is used to examine variation from clinical pathways and to examine the effect of specific
inputs on quality and outcomes.
The clinical costing sub project will:
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review existing cost and financial accounting mechanisms in the hospitals
draw up a set of uniform clinical costing standards to be used by hospitals providing cost information for the setting of
case-mix prices
assist and guide hospital management in explaining to key stakeholders the reason for the project and in forming the
project team within each hospital. It is essential that these teams include clinicians and that adequate and
appropriate resource is provided by the hospital to execute the task.
assist the hospitals in drawing up their own project implementation plans
assess the quality of feeder systems within each hospital. In the likely event that these will not all be fit for purpose,
draw up a plan based on our international knowledge and access to data to enable the best possible fit using cost
modelling and/or relative weights
assist in the selection of two costing system suppliers and negotiate with these suppliers on the level of support which
they will provide in implementation.
provide a regular series of workshops with key people
assist hospitals to implement recording of appropriate activity at the process ( e.g.knife to skin to incision close) or
event (e.g prescription of high cost drugs ) level.
receive and validate regular reports on progress within the hospital
monitor the activity of system suppliers to ensure that they are delivering on schedule
provide overall guidance and general assistance.
It is envisaged that the costing team in the first year will comprise 1 full time expatriate plus one qualified local accountant
and 3 full time counterparts. We foresee that software suppliers would devote a minimum of one full time person each to
support hospitals in the implementation of their products.
In years 2 and three we would supplant the expatriate with one of the initial counterparts. We will train a further 3
counterparts in each of the years 2 and 3.
The aim of the costing sub-project in Phase 1 will be to:
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ensure that patient level costing practice within each of the Wave 1 : 15 hospitals will be of a standard that future
costing will be able to:
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inform case-mix funding
and
provide useable cost report comparisons to allow clinical unit managers to benchmark their cost and utilisation
practices with best practice levels.
Developing and implementing systems management and transactional reform in acute public
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to ensure that hospital managers will understand patient level costing data and will be able to use this use data as
part of the Business Intelligence solution.
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In phase 2 of this sub-project an additional 15 hospitals will be brought on stream. Contemporaneously the stage 1
hospitals will be using their costing systems to derive costs at the patient level to inform the GR-DRG classification,
pricing levels and funding policy. During Phase 3 these costs, along with any from the Wave 2 hospitals which meet
specified standards will be used to prepare for the roll out of GR-DRG funding.
Funding policy
An essential element for the success of activity based funding is the accompanying funding policies which complement
the pay per piece payment system. An unfettered pay per piece system leads inevitably to supplier induced demand and
significant distortions in an area where many normal market mechanisms do not exist or cannot be applied. An carefully
integrated funding policy is needed to ensure that the transactional reforms also meet other health reform goals such as
those set out below.
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constraints within the overall budget
distribution according to health needs
appropriateness of services ,both efficacy and equity
audit processes
access criteria
timeliness criteria
incentives for quality
specialised services
small hospitals with community service obligations
incentives for achieving strategically important objectives
Drawing on their direct ,practical experience in a number of countries, the project team will be available to provide
options to the Ministry on the above issues. The project team can also assist the Ministry with the collection of data;
modelling of individual hospital incomes under varying scenarios; the issuance of policy and funding guidelines and
payment methodologies. It is important to understand at an early stage what information flows might be necessary to
underpin various funding policy options so that these can be put in place early on. This will enable time for these systems
to bed in before they are required for the actual distribution of funds.
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Developing and implementing systems management and transactional reform in acute public
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2 Management Training
To achieve overall improvements in efficiency and quality requires that hospitals change the way in which they deliver
patient care. This in turn requires that hospital managers are provided with appropriate information and are trained to
understand and measure the factors that drive efficiency, quality and safe patient care.
A number of activity based funding systems have failed to deliver improvements because hospital management have not
been given the support and guidance required to know how to make the necessary changes. This results in hospital
managers and clinicians becoming increasingly defensive and concentrating on proving “the system wrong” rather than
focusing their efforts on upgrading the performance of their own facilities.
The efficient operation of major acute hospitals is complex and methodologies are continuously improving. There are
some constant features of all acute hospitals however which are at the core of good hospital management .
Our programme addresses this issue by giving attention to management training contemporaneously with the
development and strengthening of coding, costing and business intelligence information.
This training will enable quick wins to be made on the ground and delivered early
within the project prior to the more measured introduction of activity based
funding.
The management training will include the following:
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leadership
patient safety
clinical governance
corporate governance
risk management
doctor and nurse productivity
improving the performance of operating theatres
reducing length of stay without compromising quality
converting multi day cases to same day cases
problem solving through root cause analysis and action
supply chain management
HR recruitment
HR performance management
change management
Training will take part in 4 distinct phases:
1
A series of seminars and workshops in Greece to introduce and explain management concepts and constructs. At the
end of this series each manager will be expected to draw up a 1 year deliverable action plan, with actions and
milestones, which will be implemented in their organisation. It is anticipated that the managers will be held
accountable by the Ministry for the execution of these plans. These plans will drive early wins.
2
Visits in groups of 20 to Cambridge University Hospitals Trust to see the management techniques and business
intelligence tools in action. ( Note: The agreement for these visits will be made directly with Cambridge University
Hospitals Trust and no costs involved with these visits will form part of this proposal).
3
At the completion of each visit the group will be required to submit a report on their learning and make amendments
to their action plans where appropriate.
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4
Following the installation of Business Intelligence systems and the collection of appropriate data, each of the 30
hospitals involved in the initial wave of coding/costing/BI will be individually reviewed on the basis of these actual
data. Opportunities for improvements will be identified and the required actions incorporated into a new plan.
It is anticipated that around 240 senior managers, involving all CEO’s, will complete this entire programme. We would
seek to explore with the National School of Public Health, the possibility of an examination at the completion of this
management training with a view to the award of a Diploma.
Business Intelligence
A driving purpose of the health reforms is to ensure that hospitals efficiently provide appropriate ,accessible, timely, safe
and high quality care . Business intelligence provides the information to measure hospital activities to ensure that these
goals are being met. Without measurement; feedback; analysis and comparison with best practice international norms it
is impossible to know whether, or by how much, these aims are being achieved.
Business Intelligence will therefore include a series of operating metrics to ensure that resources are being used
efficiently. These measurements take place on an organisational, divisional and individual clinician basis. This enables
areas of underperformance to be highlighted and root cause analysis to be under taken to appropriately rectify shortfalls
in achievement. In addition to operating efficiency metrics, the Business Intelligence module will also have a core focus
on quality and its core drivers. This will include timeliness of care, particularly when this is clinically critical, infection
control, treatment protocols and clinical outcome measurement by patient on a consultant and organisational basis.
We have a developed suite of informatics across the spectrum of operational efficiency, HR, clinical process, patient
safety, patient satisfaction and outcome of patient care received.
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3 Accreditation of Hospitals
The provision of safe, quality care adjusted to patients’ individual requirements is a hall mark of a good public health
system. OECD Governments are increasingly recognising the indispensible need to ensure that care is safe and patient
focused rather than provider focused to meet the expectations and demands of the 21st Century.
The first requirement for this body is to develop an appropriate set of National Safety, Quality and Performance
Standards for Greek public acute hospitals.
These Standards will focus on areas that are essential to improving the safety and quality of care for patients and the
proper running of an efficient and effective hospital. The Standards will include an explicit statement of the expected level
of safety and quality of care to be provided to patients by health services organisations and provide a means for
assessing an organisations performance in both clinical and management areas. We will provide a dedicated team of 6
people under the leadership of Dr Goodier ,to draw up these standards. These Standards will be developed in extensive
collaboration with clinicians, consumers, experts and key stakeholders and will draw where appropriate on work
undertaken in other jurisdictions.
The Greek National Accreditation Standards will include amongst others the following areas:
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Governance
Healthcare Associated Infection
Medication Safety
Patient Identification and Procedure Matching
Clinical Handover
Recognising and Responding to Clinical Deterioration
Falls Prevention
Emergency room services
Quality systems
Anaesthetics
as well as guidelines for the proper management of all major hospital areas such as:
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Biomedical department
Engineering and maintenance
Human resources department
Central Sterile Supply department
Imaging department
Pathology department
Laboratory
Pharmacy
Radiology
We envisage that the task of devising the Standards will take between 6 - 9 months.
Contemporaneously with the latter part of this exercise and immediately following the publication of the standards, we will
employ 4 teams of 3 persons to visit each hospital to educate hospital managers in the processes, requirements and
expectations of accreditation. This will inform managers of what is necessary and enable them to engage in face to face
questioning on practical issues during the seminars and workshops which will be held.
Formal surveys will commence at the beginning of year 2 of this project. We will employ 4 teams of 3 persons each. At
least 1 trainee will accompany each survey team at all times as part of their training.
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Each hospital will be formally surveyed twice over a 24 month period. At the completion of a survey the survey team will
provide a written report to the hospital and the Ministry outlining the findings of the survey and with proposals for action. It
is recommended that after the second survey or at the end of the 24 month period, that the survey results be made public
To give sustainable effect to the accreditation programme necessitates the development of appropriately qualified and
trained Greek survey teams. Instigating and building up this skill will be a core part of our delivery.
Surveyor selection criteria will include basic core competencies and levels of professional experience required. Common
profiles of surveyors include:
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professional experience at senior level
experience in senior management
good interpersonal skills
specific education certification
good physical and mental health
current or recent working experience
There is increasing recognition of the role of consumers in health care accreditation – from involvement in the
development of standards and governance to participation in survey teams. The engagement of consumers and members
of the broader community in developing and implementing public policies and programs is considered a best practice .
Inclusion of trained consumer surveyors in survey teams can contribute to the accountability as well as the expertise of
the survey team.
Our role will encompass:
1
Initial training and certification
Suitable candidates will be required to take part in an approved surveyor training course. Training and orientation as a
surveyor of includes learning about the standards and how to interpret them, the role of the surveyor, assessing
compliance, surveying techniques and reporting methodologies. A range of methods such as on site visits with our
surveyors, workshops, teleconferences, self-study assignments and mock surveys will be used in this initial training.
Successful completion of training will lead to time-limited certification as a surveyor.
2
Supervision, continuing education and professional development
Following certification as a surveyor, the (early-career) surveyor will be provided with support and supervision from a
senior or more experienced surveyor in his or her initial surveys. Surveyors will be required to participate in continuing
education and professional development activities.
3
Performance assessment and continuing appointment
Continuing appointment or re-certification as a surveyor will be generally contingent on the surveyor meeting his or her
role requirements (which may include satisfactory completion of a specified number of surveys and participation in
professional development activities) and may include (formal or informal) performance reviews. From years 3-5 we see
this function being increasingly carried out by a national body.
In order to consolidate the work done in the first 3 years we would strongly recommend the establishment of a national
body to provide consistency and oversight across the hospital sector . It is recommended that a body known as the
Greek Council on Healthcare Standards (GCHS) be formed to carry out this role following the first 3 years of this project.
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The ongoing coordination functions for this national body would include:
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Maintaining and regularly reviewing the National Safety and Quality Healthcare Standards
Regularly reviewing the eligibility criteria for surveyors or accreditation agencies to assess against the National Safety
and Quality Healthcare Standards.
Supporting surveyor participation in accreditation
Receiving and analysing accreditation data
Reporting accreditation results
Appeal Processes
This body could be possibly located with the National School of Public Health.
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Appendix
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Our Team
Our team brings together a unique blend of skills and
experience. A deep knowledge of the subject areas has
been built up over a number of years in a wide range of
countries. This extensive hands on accountable, practical
experience combined with the technical knowledge of the
highest level, will enable this team to deliver sustainable
long term results.
The team has substantial experience in dealing with large,
complex challenges and a considerable background in
dealing with all levels of Government.
The team realises the fundamental necessity of building
localised capacity and capability. The project is designed
to deliver this. Wherever possible we will use bi-lingual
staff, including our expatriate staff where that is possible.
The profiles of senior members of our team follow.
Dr Gareth Goodier
MB ChB MHA DHSc FRACMA FAFPHM
Career Summary
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Twelve years as the Chief Executive of major
academic hospitals in Australia and the UK
Seven years as the Regional Director/CEO of Regional
Health Authorities in Australia and the UK
Project Leader of a World Bank project to design, pilot,
evaluate and implement a hospital accreditation
system into Lebanon
Public Health physician
Health Care Management Consultant for the World
Bank and Arthur Andersen
Medical Practitioner in UK, Australia and Saudi Arabia
University course author and coordinator (Quality in
Health Care); university lecturer on the subjects of
contemporary management and leadership at Masters
level
Summary of qualifications
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Fellow of the Royal Australasian College of Medical
Administrators
Fellow of the Australian Faculty of Public Health
Medicine
Doctor of Health Science, Anglia Ruskin University,
Cambridge
Masters in Health Administration, University of New
South Wales
Bachelor of Medicine, Bachelor of Surgery, University
of Sheffield
Awards received
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Bernard Nicholson Prize for the ‘most outstanding
candidate’ at the Royal Australasian College of
Medical Administrators examination 1995
Honorary Doctor of Health Science, Anglia Ruskin
University, Cambridge, 2009 for ‘continuing efforts to
raise standards and improve performance within the
global health arena’
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Professional experience
CEO, Cambridge University Hospitals NHS
Foundation Trust (CUH)
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September 2006 to present
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With an operating budget in excess of £550 million and
staff of 7000 WTE’s (Nov 2009) this Foundation Trust
is the main teaching hospital for Cambridge University
and a leading centre for academic medicine and
clinical research. The hospitals trade with an EBITDA
of 6.5%. The Medical Research Council’s Laboratory
of Molecular Biology on the CUH campus has won 14
Nobel prizes. Also on campus are research facilities for
Cancer Research UK, GlaxoSmithKline and the
Wellcome Trust.
Top hospital, 2nd in NHS, 26th in Public Sector in the
Sunday Times ‘Best Places to Work in the Public
Sector’, March 2010
Awarded second highest score in country with
99.3/100 for Patient Safety, by Dr Foster (Imperial
College), December 2009
Standardised Mortality for 2009 was 65 (national
average 100) – best teaching hospital in the country
Maternity unit chosen as the ‘best place for choice of
birth’ by the National Childbirth Trust November 2009
Awarded Academic Health Science Centre status
March 2009, one of only five centres in the UK, as
judged by international experts
Awarded ‘Hospital of the Year’, December 2008 in the
HSJ Awards
Emergency and Urgent Care rated as ‘best performing’
by Care Quality Commission, September 2008
Awarded inaugural CHKS ‘Quality of Care’ Award,
June 2008
Awarded ‘Best Performing’ maternity services, January
2008
Awarded Comprehensive Biomedical Research Centre
status, one of only five in the UK in April 2007, as
judged by an international panel of experts
CEO, North West London Strategic Health
Authority (NWLSHA)
September 2004 to August 2006
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Responsible for the primary, secondary and tertiary
health care for a population of 1.8 million; a budget of
£2.4 billion (A$5.28 billion in 2005) recurrent funding;
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approximately 40,000 staff; the SHA included
responsibility for the mental health services and
Broadmoor Hospital
The largest and most complex SHA in London and
arguably the most difficult to manage within the NHS.
The most challenged SHA at the time of appointment.
The NWLSHA serves a very diverse population in
terms of wealth, ethnicity and health outcomes
Teaching hospitals within this SHA include:
Hammersmith, St Mary’s, Charing Cross, Royal
Brompton and Harefield, Chelsea Westminster, The
Royal Marsden, West Middlesex, Central Middlesex,
Northwick Park. The R & D budget for this SHA was
23% of the total NHS R & D budget (2005)
Significantly improved the performance of the SHA’s
trusts; six extra stars on annual review in 2005; moved
within the National league table of SHA’s from 27/28
nationally to 14/28 over eight months on major targets
and KPI’s, including waiting list reductions and access
to Accident and Emergency improvements
Introduced a new system of metrics for health
management (Measures of Success) and patient level
costing systems into the NHS
Introduced a new methodology for strategic planning to
the SHA. Responsible for the strategic management of
capital schemes/Private Finance Initiatives worth
approximately £1.6 billion (A$3.52 billion)
CEO, Royal Brompton and Harefield NHS Trust
(RBH)
March 2003 to August 2004
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RBH is a specialist, academic hospital providing
quaternary heart and lung services for paediatric and
adult patients within the NHS. Recurrent budget of
£160 million; 2000 staff. Contracts with virtually all 305
of the Primary Care Trusts within the NHS.
RBH is closely aligned to the National Heart and Lung
Institute of Imperial College and achieves the highest
levels of academic endeavour, patient care and clinical
innovation.
Achieved 3 star status (out of a maximum of 3 stars)
under the Health Care Commission quality assessment
scheme, a balanced budget, one of the lowest MRSA
rates in the NHS, very high patient satisfaction ratings
Minor internal restructures to give greater emphasis to
quality systems in general and clinical governance in
particular, business systems (including casemix
analysis), marketing/PR and fundraising.
Developing and implementing systems management and transactional reform in acute public
hospitals in Greece
23
Health Care consultant including a World Bank
project to review the Kuwait health system
January 2003 to April 2003
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One of a group of five consultants chosen from across
the world to review the Kuwait health care system. My
responsibility was to review the system from a ‘quality’
perspective. This included a review of the strategic and
capital intent of the Ministry of Health, a review of
information systems and information technology, a
review of clinical governance issues and the
opportunities for introducing a hospital accreditation
system.
Project leader, World Bank funded project to
design, pilot, evaluate and implement a hospital
accreditation system into Lebanon
October 2001 to October 2002
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Project leader of the second phase of a two year
project to design, pilot, evaluate and implement a
hospital accreditation system
Successfully delivered all objectives
Rated as x1.5 Harvard Business Professor by the
World Bank
Comment on the period November 1998 to
March 2003
Six months after my appointment as Chief Executive,
Royal Perth Hospital (November 1998) the West Australian
government announced the decision to create one board of
management across metropolitan Perth – the Metropolitan
Health Service Board. A new CEO position was created
and I was asked to take a second tier role within the
MHSB. I chose the role of Executive Director, Clinical
Services. Initially the role was part-time. From April 2000
to October 2000 it was full time.
In October 2000 I chose to return to RPH as the full time
CEO. The MHSB was disbanded soon afterwards and
three health regions were created. The role of CE, East
Metropolitan Health Service was additional to my role as
CEO RPH. In July 2001 I resigned from my position as CE
RPH.
24
Chief Executive Royal Perth Hospital
November 1998 to July 2001
Royal Perth Hospital is Western Australia's premier
teaching hospital, providing a full range of emergency
services for adults (except obstetrics) and serving as the
State Referral Centre for many sub-specialty services.
Areas of excellence include interventional neuro-radiology,
cardiac and lung transplant, burns management, bone
marrow transplantation, rehabilitation medicine and trauma
services.
Royal Perth Hospital has always been a world-leader in
medical technology and research and is the home of
respected health care professionals including the 2005
Australian of the Year, Clinical Professor Fiona Wood.
The Hospital has been home to many significant
breakthroughs in medical research - significantly, research
into the bacterium Helicobactor pylori, which was found to
cause stomach ulcers. This research work won the 2005
Nobel Prize for medicine for Dr Robin Warren and
Professor Barry Marshall.
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A$323 million recurrent; 3907 FTE staff, 770 average
daily bed occupancy
Completed a review and restructure of the clinical and
business divisions of the organization
Significant improvements in productivity
Vastly improved information systems
Maintained excellence in clinical departments
Inaugural, acting Chief Executive, East
Metropolitan Health Service
November 2000 to July 2001
The key objective of this position was to establish a
regional structure of management and improve the
integration of secondary and tertiary services.
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A$448 million recurrent; 5581 FTE staff
This regional health service included Royal Perth
Hospital and four district hospitals, mental health
services and public health.
Commenced the establishment of the regional health
authority
Developing and implementing systems management and transactional reform in acute public
hospitals in Greece
Inaugural, acting Executive Director of Clinical
Services, Metropolitan Health Service. Part time
in January and March. Full time from April to
October 2000.
January 2000 to October 2000
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A$800 million recurrent; approximately 20,000 FTE
staff
Responsible for developing a strategic plan to 2010 for
Metropolitan Perth health services. This plan built
upon the State-wide strategic plan developed by the
Health Department of Western Australia.
Responsible for all clinical services in Perth, including
dental health and mental health services.
Inaugural joint Chief Executive of the Women’s
and Children’s health service (including Princess
Margaret Hospital for Children and King Edward
Memorial Hospital for Women)
Inaugural Regional Director, Peninsula and
Torres Strait Regional Health Authority,
Queensland Health
1991 to 1993
The key objective of this position was to establish a
regional management structure for Far North Queensland
health services. The region included Cape York and the
Torres Strait Islands. Approximately 15% of the population
was either Aboriginal or Torres Stait Islander and their
health issues formed a very significant part of the agenda.
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A$106 million recurrent; 2172 FTE staff; average daily
bed occupancy 715
14 hospitals and 58 community health clinics
Established the first Public Health Unit in Queensland
health. This unit was tailored to focus upon Aboriginal
and Islander health issues.
Planned for the rebuild or rebuilt every clinic, hospital
and staff quarters north of Cooktown
Introduced a Continuous Improvement management
philosophy; Cairns Base hospital became the second
hospital in Queensland Health to achieve accreditation
status
December 1993 to November 1998

The key objective of this position was to integrate two
previously autonomous and fiercely independent, specialist
teaching hospitals. This objective was largely achieved
within eighteen months, with a recurrent saving of
approximately 3% of total expenditure.
Inaugural Regional Director; Kimberley Health
Region of Western Australia
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A$156 million recurrent; 2281 FTE staff; 510 beds
Integrated both hospitals and a number of community
based health services E.G. paediatric mental health
services and the Child Development Centre
Achieved financial balance in each financial year
Significant savings and improvements in productivity
(20% improvement in hotel services over 2 years)
ACHS accreditation in 1994 and 1997 for 3 years
Achievement in Business Excellence within the
Australian Quality Awards 1997
Significant improvements in fundraising (improved by
700% and won a national prize from the Fundraising
Institute on three consecutive years), marketing and
public relations
1989 to 1991
The key objective of this position was to establish a
regional management structure and to improve the
unacceptable health status of Aboriginal people within the
region (40% of population).
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A$34 million recurrent; 665 FTE staff; 6 hospitals, 1
nursing home, 32 community health clinics
Rationalised health services within the East Kimberley
Rationalised the Royal Flying Doctor Service for the
Kimberley
Established Heath Action Groups (consumer
representation and advocacy) in all communities
Developed and implemented a new award for Remote
Area Nurses
Closed the Leprosarium at Derby
Developing and implementing systems management and transactional reform in acute public
hospitals in Greece
25
1974 to 1989
Various clinical positions in the UK and Australia. These
positions included several SHO roles in paediatrics in
Sheffield, UK, an SHO role in obstetrics in Perth, a
paediatric registrar position in Princess Margaret Hospital
for Children in Perth, Casualty Registrar at Fremantle
Hospital in WA and 8 years as a Senior Medical Officer in
the Kimberley region of WA. This included work as a
Royal Flying Doctor, public health responsibilities, general
practitioner work and in-patient care at Derby and
Kununurra Hospitals.
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Clinical Governance (chair)
Electronic health records (chair)
Key performance indicator development (chair)
Workforce planning and workplace reform (chair)
Quality in health care management (chair)
Health Export (chair)
West Australian Medical Research Board (member)
Additional professional activities
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President, Women’s Hospitals Australasia
President, Australasian Association of Paediatric
Teaching Centers
National Councilor and State Chairperson, Royal
Australasian College of Medical Administrators
National Councilor and State Chairperson, Australian
Quality Council
Leadership role in NHS for:
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NHS Top Team – meets monthly. Top 50 senior NHS
staff.
Fellow, NHS Leadership Council
Chair, National Institute of Health Research’s External
Reference Group
Member, NHS/Bio-Pharmaceutical Leadership Forum
Productive Time Delivery Board (national)
National Practitioner Programme Implementation
Group (Chair)
Case mix Service Programme Board (national)
Dept of Health Sexual Health Programme Board
(national)
National Specialist Commissioning Advisory Group
(NSCAG)
London Cabinet – meets every 2 weeks. The five
London SHA CEO’s
Specialised Commissioning Group for London (chair),
budget £409 m
Research and Development for London (chair)
Sexual Health Steering Group for London (chair)
Principal’s Advisory Group (Imperial College)
London Deans and Regional Officers (LONDRO)
Leadership role in the Western Australian health
system for:
26
Developing and implementing systems management and transactional reform in acute public
hospitals in Greece
Peter Patrick Donnelly
Profile
Work history health
PricewaterhouseCoopers, England
November 2009 – current
A highly qualified professional with experience at senior
level in both the public and private sectors. Early career
was spent with large multi-national companies as Chief
Financial Officer/Business Controller for New Zealand
operations. Interspersed with 4 years in Cook Islands
resulting in appointment as senior financial aide to Prime
Minister.
Entered the health sector in 1990 . Senior business and
financial General Manager roles within public hospitals in
New Zealand .
As Director of Funding and Financial Policy was
operationally responsible over 10 years for activity based
funding of all public hospitals (approximately 100 hospitals
) in Victoria , Australia. Victoria was recognised as an
international leader in this field.
Executive Director of Finance for England’s’ most
financially challenged Strategic Health Authority until
national re-organisation in mid 2006. Invited by DirectorGeneral to join as a Director in the activity based funding
sectorate of Policy and Strategy Division of Department of
Health.
Internationally recognised as expert in hospital funding and
operations. Formally spoken at conferences or to
Governments in Germany, Spain, Ireland, Denmark,
Belgium, Poland, Czech Republic, Bulgaria, Hungary, the
Netherlands, Malaysia , Mauritius ,Turkey ,
Romania,United Kingdom. Australia.
Director Health Advisory reporting to Partner
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Participation in variety of projects and activities
regarding the operation of the NHS in general and
NHS agencies individually. Includes provision of
advice to Department of Health on current pricing;
advice to Government regulator on future pricing and
funding options; advice on operating turnaround of
major teaching hospital; advice to HMDepartment of
Treasury on funding policy and hospital efficiency.
Advice to PwC Canada and discussions with President
Alberta Health Services regarding acute hospital
funding
Discussions and planning with Minister of Health
Bulgaria regarding joint venture to introduce case-mix
funding, hospital management training and Business
Intelligence systems.
Head of Classification and Costing reporting to
NHS Director of Finance, Department Of Health,
England
August 2006-August 2009
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Graduate and post-graduate qualifications in finance and
management.
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Review of existing classifications ,recommendations as
to their fitness for purpose
for output based funding and recommendations for
alternatives.
Review of existing costing systems and
recommendations for alternatives.
Advising hospital managers and clinicians throughout
England of patient level information and costing
systems as the future basis of informing output based
funding; involving clinicians in understanding
unnecessary variation in clinical decision making ;
apprising clinicians of resource consequences of their
decisions and highlighting areas for efficiency gains.
Establishment, in conjunction with industry, a set of
clinical costing standards to significantly improve data
required for understanding operational performance
and informing tariff.
Establishment of a competitive supplier market for
patient level information and costing software.
Developing and implementing systems management and transactional reform in acute public
hospitals in Greece
27
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Establishing pilot programme to link detailed clinical
activities , costs and quality of clinical outcomes at a
patient level.
Building classification systems i.e. currencies for nonacute activities e.g. mental health, cystic fibrosis,
spinal cord injury.
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Liaise widely on financial issues with the health
industry on proposed changes to the public hospital
sector.
Northland Crown Health Enterprise, New Zealand
1993 – 1995
Executive Director of Finance reporting to Chief
Executive, North West London Strategic Health
Authority, London, England
(operating through 5 widely distributed hospitals)
2005 –August 2006
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Financial performance management of 8 Acute Trusts,
8 PCTs and 2 Mental Health Trusts £2.4 bn.
Develop and monitor financial turnaround strategies for
loss making Trusts and PCT’s
Establish, collect and analyse operational data in the
hospital sector and develop performance benchmarks
to maximise the effectiveness of resource utilisation in
the North West London sector.
Establish new processes and procedures to ensure
"the fitness of purpose" of hospitals to become
Foundation Trusts.
Assist Department of Health in the development and
implementation of PbR.
Negotiate transfer of NHS managed hospital to
international operator.
Director of Funding and Financial Policy
reporting to the Executive Director, Acute Health,
Department Of Human Services, Victoria,
Australia
General Manager Business and Finance reporting to Chief
Executive
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District Business Manager reporting to District
General Manager, South Auckland Area Health
District
1990 – 1993
(Operating via major 600 bed trauma hospital and satellite
facilities)
1996 - June 2005
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Develop and implement funding strategies (and refine
activity based based funding formulae) to promote
increased efficiency, accountability and customerresponsiveness in the Victorian public hospital sector.
Collect and analyse operational and financial data in
the hospital sector, and develop performance
benchmarks, in order to maximise the effectiveness of
Victoria's $7.0 bn expenditure on acute, sub-acute and
mental health care.
Provide sound and informed advice to the Minister, the
Secretary and the Department on the financial and
operational performance of the public sector hospital
system.
28
Strategic planning.
Preparing the Business and Operating Plans.
Negotiating contract with Department of Health for
treatment of public patients.
Deputising for Chief Executive in his absence.
Developing and implementing best practice information
systems in order to inform contract negotiations,
clinical resource usage and to optimise clinical
practice.
Managing, non clinical support services to provide
efficient, reliable and cost-effective services to
consumers.
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Providing advice on strategic planning.
Providing support to Clinical Service Manager to
identify and implement operational efficiencies.
Managing finances of the business to maximise
surplus.
Managing all hospital non-clinical support services –
Admitting/Booking, Hotel Services, Estate Services,
Medical Records, Finance/Administrative Services.
Developing and implementing systems management and transactional reform in acute public
hospitals in Greece
Prior work history
Company Secretary/Group Business Controller
reporting to the Managing Director, Asea Brown
Boveri Ltd (Multi-national Swedish/German Co.)
1987 - 1990
Chief Financial Officer responsible for all financial,
accounting, treasury and secretarial functions. As
Business Controller responsible to provide procedures,
processes and systems to ensure companies within the
group achieved financial performance.
Finance Manager reporting to the Managing
Director, Wella Ltd. (Mulit-national German Co.)
1983 - 1987
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All accounting and financial functions
Budget Director reporting to Financial Secretary
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Turnaround of Government budget from deficit to
surplus.
A permanent restructuring of budget expenditure to
focus on development areas.
Introduction of indirect tax (G.S.T).
Modified public charges in line with costs of service
delivery.
Tertiary Education
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Kellog Graduate School of Business
(Chicago, USA) 1992
Advanced Executive Programme (AEP)
Harvard Graduate School of Business
(Boston, USA) 1989
Managing Corporate Control and Planning (MCCP)
Auckland University Post-Graduate Diploma in
Business and Industrial Administration 1975
Bachelor of Commerce Degree 1971
Financial Advisor/Senior Aide reporting to the
Prime Minister, Cook Islands Government
1979 – 1983
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Retention of wide bodied airline services and main
shipping services to capital after proposals to
discontinue these services.
Negotiation and purchase from NEC Japan of
extensively upgraded telephone system for major
population centre.
Increased the level of NZ Aid, based on economic
argument, to twice the previously capped level.
Chairman of Working Party to introduce tax haven.
Renegotiation of major commercial agreements on
behalf of government e.g. oil supply.
Secretary of Monetary Board.
Board Member Development Bank.
Secretary Overseas Investment Commission.
Negotiation and purchase of major tourist resort
including capital restructuring and management
change. Negotiation of management contract with US
based company. Board member of restructured
company.
Developing and implementing systems management and transactional reform in acute public
hospitals in Greece
29
Employment Record
Dr Richard Marshall
Manager Casemix Policy Unit, NSW Health
Department – Sydney, Australia
Profile
Jul 2009 to Present
Dr Marshall is recognised internationally and in Australia
as a health service funding reform and DRG and health
service costing expert. He has over 20 years health sector
experience with extensive specific experience in payment
systems and methodologies, health insurance, health
service delivery reform and health sector finance. Dr
Marshall’s health sector experience includes positions
where he had diverse work responsibilities of funder,
purchaser and regulator. This experience was established
after a background as a clinical practitioner in mental
health and National Director of a health service provider
network.
As an expert in the implementation of payment methods
within the health sector, Dr Marshall headed the team that
developed and implemented the refined casemix
classification for monitoring and funding admitted hospital
services in public and private hospitals in all States of
Australia (AN-DRG version 3.1 and AR-DRG version 4).
He was also involved in setting up systems for hospital
performance measurement.
Countries of Work Experience
Australia, Azerbaijan, Canada, China, Hong Kong,
Germany, Kosovo, Macedonia, Malaysia, Mauritius,
Romania, Slovenia, Turkey, United Kingdom
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Design and project management of Episode Funding
Implementation in New
South Wales (population 7 Million 8 Area Health
Services, 250 public
hospitals), Management of policy development for
DRG funding of public
hospital and healthcare services. Development of
workforce development and
skills transfer programs for Activity Based Funding
development.
HMIS Specialist – Azerbaijan, European Bank for
Reconstruction and Development
Jun 2009 to Jun 2009
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Support improvement of Heath Management
Information System for service
growth and development strategy. Define HMIS areas
for further
development. Analyse the IT and management
information system capability
in relation to
- supporting the existing services and
- scaling up to support future volume and geographical
expansion and
- electronic clinical recording capability to facilitate the
introducing care
pathways.
Health information and clinical coding and
costing system specialist, Karol Consulting.
May 2008 to Jun 2009
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30
Macedonia - Health Funding and Information Systems
Development Project.
Analysis of data, reporting and costing: analysing
hospital payment systems,
record keeping, and hospital informatics capabilities.
Undertaking a
comprehensive analysis of the existing reporting and
data collection systems;
Developing and implementing systems management and transactional reform in acute public
hospitals in Greece
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assessing the currently used classification and coding
systems Preparing and
delivering seminars for policy-makers to discuss the
proposed development
strategies. Advising on the establishment of functional
areas for operation of
the pilot implementation.
DRG Development And Funding Policy Expert,
Peking University, Beijing, China
Dec 2007 to Jan 2008
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Health Funding Specialist, Employer: Hong Kong
Hospital Authority HKHA
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Dec 2008 to Feb 2009
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Evaluate HKHA activity costing capability.
Consult stakeholders in DRG costing system
implementation and report on key system function
requirements.
Assess suitability and advise on alternative systems
options for implementation.
Provide report on requirements and business case
analysis for implementation
of clinical costing to DRG in the HKHA
Team Leader International Consultants, Turkey
HUAP2 projects, TCH Turkey, Hacettepe
University Hospital.
Lead sessions at National Conference on DRG
Funding of Hospitals
Provide tutorial sessions for key funding policy
development and research personnel.
Advise on establishment of pilot DRG funding program
in Beijing led by Beijing University.
Meet with senior Health Insurance and Ministry of
Health Officials and provide details of international
experience of alternative DRG funding models and
classification versions.
2006 to 2008
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Team Leader, UK, Kosovo – projects, HLSP
Kosovo – Consultant: Health priorities monitoring and
evaluation project.
United Kingdom - Health clinical costing systems
evaluation panel and
Training advisor for the NHS Mental Health reporting
and funding policy advisory consultancies,
2007 to 2009
Consultant: Malaysia - Healthcare Financing
Mechanism, Karol Consulting
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Apr 2006 to Apr 2008
Turkey – Infrastructure Development for Health
Financial Management
MARSHALL - 4
Responsibilities included: advising and assisting
development of instruments for health care services
payments, development of incentives mechanisms,
analysis of cost differences in inpatient healthcare services
by hospital types based on DRGs; development of coding
and costing capabilities and systems for DRG monitoring
and funding of healthcare services.
The project developed a detailed concept for the design
and implementation of a National Healthcare Financing
Mechanism (NHFM). The NHFM was to be a sustainable
and equitable health care financing framework which
provides universal health cover to the population of
Malaysia. Dr Marshall’s consultancy involved the design of
the provider payment model.
Team Leader International Consultants, Turkey
HUAP1 project, TCH Turkey
2005 to 2007
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Turkey – Infrastructure Development for Health
Financial Management
advising and assisting development of instruments for
health care services payments, development of
incentives mechanisms,
analysis of cost differences in inpatient healthcare
services by hospital types based on DRGs;
Developing and implementing systems management and transactional reform in acute public
hospitals in Greece
31
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development of coding and costing capabilities and
systems for DRG monitoring and funding of healthcare
services.
MARSHALL – 5
Manager, Information and Performance
Evaluation, Department of Human Services,
Victoria, Australia
1997 To: 2006
Dr Marshall has been a key player in Casemix
development in Australia and his work focused on better
alignment of Medicare (public health insurance) funding to
the efficient delivery of high quality health services.
In this position he was responsible for technical analyses
and modelling activities for the financing of 103 Victorian
public hospitals and mental health services. Additional
duties include the overseeing of the production of annual
Policy and Funding Guidelines and financing and health
information development advisor to Australian national
working groups for hospital health service financing policy
and service evaluation. Much of this work was a
continuation of working within the area of health funding
reform.
Outputs included patient costing system refinements and
reporting system development, central patient indexing
developments. (Population 4.8 million, 260 hospitals,
18,000 beds).
Projects and activities during this period:
2002-2004: Slovenia, Adapting and Improving the
Reimbursement System, World Bank Project (2002-04). As
Hospital Payment Specialist, Dr Marshall provided
technical inputs into the design of the ABF payment
system mechanisms including costing and pricing. He
evaluated the hospital service utilisation, advised on DRG
monitoring of hospital activity, product classification and
calculated cost-weights and funding formulae.
2001 – 2006: Australia – Health Connect Clinical
Information Project.
In this project which is sponsored by the Australian
Government, Dr Marshall was involved in the; evaluation
and piloting of a coding system for electronic health record
32
sharing; and design and piloting of information systems for
clinical record maintenance and access control.
2000-2006: Australian National University, Centre for
Mental Health Research, Visiting Research Fellow –
Health service data integration projects.
1999: Mauritius – Government of Mauritius, Financing
Information Advisor and Information Business Analyst.
Conducted a review of the Mauritius health information
systems, hospital performance monitoring and funding
systems. Consultancy resulted in the implementation of
coding and data management enhancements and progress
towards implementation of ICD10 classification and activity
funding as a basis for health service financing.
1998: Australia - National Health Performance Committee.
Developed a framework for performance reporting
development. Developed a framework for national health
performance measurement reporting.
1997: Australia – National Health Information Management
Group. As a member of this select group, Dr Marshall was
involved in: the provision of advice on the management of
national health information
MARSHALL – 6
policy; publication of comparative hospital performance
measurements; specification of national minimum dataset
reporting requirements; National Health Data Dictionary
annual updates and periodic modifications; health service
management reporting. He was also involved in the work
of national Health Informatics Standards Development and
Publication working groups.
Manager, Private Hospital Case Payment
Development, Australia - Department of Health
and Family Services
1996 To: 1997
Dr Marshall championed reforms in the private health
insurance area to obtain more efficient, effective and
appropriate health service outputs and outcomes for
privately insured fund members through improved billing
and contracting practices with providers. The inauguration
of the Australian Private Hospital
Developing and implementing systems management and transactional reform in acute public
hospitals in Greece
Data Bureau and the Hospital Casemix Protocol database
of all transactions between private hospitals and private
health insurers. Major outcome was the regular monitoring
of total costs of combined hospital medical and other costs
for each episode of care in private hospitals.
National Director of DRG Development, Australia
- Department of Health and Family Services
1992 To: 1996
Managed an USD10 million program for development and
implementation of a refined casemix classification for
monitoring and funding admitted hospital services in public
and private hospitals in all states of Australia. Managed
and participated in the Australian Casemix Clinical
Committee with representatives of each of the clinical
specialties and care providers. Provided
analytical services and modelling of alternative
classification options recommended by clinicians or
suggested by analysis of service provision and resourcing
patterns. Major outcome was the AN-DRG version 3.1 and
ARDRG version 4 classifications. Use of these
classifications as the main vehicle for benchmarking
Australian, New Zealand, Singaporean and German
hospital performance and funding.
MARSHALL – 7
optimum cost desegregation. Reviewed efficiency and
performance comparisons between Repatriation hospitals
and State public hospitals and private hospital. Major
outcome was the sale of hospitals to private operators or
integration of the hospitals into the State public health
system.
Health Policy Analyst – health information
systems research, Australia - Centre for Health
Economics Research and Evaluation, Sydney
1991 To: 1992
Conducted a reviewed of the role, terms of reference and
relevance of the Centre to stakeholder expectations.
Evaluated costs against outputs against industry norms.
Major outcome was the research centre was consolidated
and repositioned to operate more closely with University of
Sydney’s Department of Community Health and the Health
Planning Unit of the Department of Health NSW.
National Director, Vietnam Veterans Counselling
Service, Australia - Department of Veterans
Affairs
1984 to 1990
1992: Private Hospital Reform Taskforce - Commonwealth
Minister for Health. Conducted morbidity and cost data
integration project. Included healthcare utilisation analysis
for outcome measurement of alternative private hospital
insurance payment options. Involved linking analysis of
major national health service administrative data
collections. Major outcome was the formulation of new
policies for private hospital payments by private health
insurers and better comparisons of total costs for like
services between public and private providers
Conducted a comprehensive efficiency and effectiveness
review of national counselling agency based in 9 centres
and 50 contracted agencies providing community support
programs.
1991 – 1993: Casemix review of utilisation and
performance of Repatriation General Hospitals,
Department of Veterans’ Affairs and State Health
Departments. Conducted first comprehensive casemix
analysis of hospital utilisation and throughput performance.
Conducted cost modelling studies in each hospital using
Cosmos Yale Cost Modelling software which was modified
to specification for this project), and extracts from general
ledgers with product fractions developed by hospital level
workshops to achieve
Developing and implementing systems management and transactional reform in acute public
hospitals in Greece
33
Membership of Professional Associations
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Medal of the Order of Australia – for service to
community health
Member Institute of Public Administration of Australia
Member Patient Classification Systems International
(PCSI)
Member of The National Health Performance
Committee (NHPC)
Chair – Statistical Information Management Committee
– responsible for specification
and maintenance of minimum national data collection
in Australia.
Member of the Public Health Association (PHA)
Member and Sponsor – Clinical Costing Standards
Association of Australia.
Member National Health Information Group – Parent
group for development of
Australia’s Health Informatics strategy.
Member, Health Informatics Society of Australia
Member, Standards Australia – Health Informatics
Standards Committee (IT14)
Chair – Health Messaging Standards Sub Committee
(IT14-6)
Member Information Communications Technology
Standards Committee (ICTSC)
Member Classifications and Terminologies Working
Group (CTWG)
Member HL7 International.
34
Developing and implementing systems management and transactional reform in acute public
hospitals in Greece
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