performance indicators in health and social care

the UK NHS’s ‘star-ratings’ system of 2001–2005)47 and those that use results for non-publicised feedback to organisations to stimulate improvement. Australia’s health 2010 (Australia’s Health Series No. The atlas is organised according to clinical areas: maternity, demography, cardiovascular disease, gout, polypharmacy and surgical procedures.29 In 2013, the NZ Health Quality and Safety Commission’s campaign Open for Better Care was commenced to measure whether planned changes in practice occur and whether they have resulted in reduced costs and harms.28. Australian Institute of Health and Welfare . National Institute of Public Health and the Environment . Several of the indicators will measure progress towards more than one of the National Health … For more information view the SAGE Journals Article Sharing page. FundingThis work was supported, in part, by the National Health Performance Authority, Australia (but no one including the Authority’s officers had a role in the study, its conduct, results, interpretation or publication of this article) and the National Health and Medical Research Council (APP1054146). The HCP integrated commissioning framework defines KPIs as: Some health systems have moved faster than others in adopting performance indicators as tools for quality improvement and have made details of their indicators and systems for applying them publicly available at national, regional or institutional levels. Then, within each health financing function, key performance issues and associated measurable indicators are developed. A summary of each country’s approach to performance indicator use is shown in Tables 1 and 2. The paucity of research examining the links between indicators and improvement may be due to the difficulty in attributing change to any particular policy initiative or intervention.49, The literature supports the use of performance indicators, suggesting that their impact is more likely to be on provider rather than consumer behaviour.43,50 However, there is a general call for more good quality studies on impact.50–52. Performance indicators are quantitative tools and are usually expressed as a rate, ratio or percentage. While there is no answer to questions such as how many indicators, which domains should be targeted or what should be the right mix of indicators, there is a fundamental debate centred on whether the purpose of performance indicators is accountability or quality improvement.41–43,46 Internationally, there is a split between those countries which emphasise public reporting and accountability (e.g. The purpose of the table was to compile an initial ‘long-list’ of available indicators and then to identify a ‘short-list’ of those reported in multiple countries. This research aims to identify and analyse indicators and their frameworks which report on the performance of healthcare organisations and local health areas. Summary of the eight countries: demographic characteristics and health performance frameworks. Shekelle, P, Lim, Y-W, Mattke, S. Does public release of performance results improve quality of care? Within these, eight domains of health system performance are defined.19,21. I have read and accept the terms and conditions, View permissions information for this article. Login failed. 1.2.2 Recognize that there are multiple dimensions of health. There appears to be considerable overlap between the definitions of many of the domains such as effectiveness and appropriateness. England and Canada do the most extensive research and development work to select indicators. Sharing links are not available for this article. Manuscript content on this site is licensed under Creative Commons Licenses. Vision and Strategy for Adult Social Care and Health; What to do if you have changed, or are planning to change, your Care Quality Commission registration; Local Performance Account reports. Health system frameworks and performance indicators in eight countries: A comparative international analysis, http://www.creativecommons.org/licenses/by-nc/3.0/, https://us.sagepub.com/en-us/nam/open-access-at-sage, http://www.oecd-ilibrary.org/economics/country-statistical-profile-australia_20752288-table-aus, http://data.worldbank.org/income-level/OEC, http://apo.org.au/files/Resource/NPHC-supp.pdf, http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr11/measurespec/patient_centeredness.html, http://www.commonwealthfund.org/About-Us/Foundation-History.aspx, http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2012/Mar/Local%20Scorecard/1578_EXEC_SUMM_Commission_rising_to_challenge_local_scorecard_2012_FINAL.pdf, http://www.nhpa.gov.au/internet/nhpa/publishing.nsf/Content/About-us, http://www.comlaw.gov.au/Details/C2011C00952, http://www.nhpa.gov.au/internet/nhpa/publishing.nsf/Content/Performance-Indicator-Reporting, https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC2195&lang=fr, http://www.commonwealthfund.org/Publications/Fund-Reports/2012/Nov/International-Profiles-of-Health-Care-Systems-2012.aspx, http://www.health.govt.nz/new-zealand-health-system/health-targets/about-health-targets, http://www.health.govt.nz/our-work/primary-health-care/primary-health-care-subsidies-and-services/pho-performance-programme-and-transition-integrated-performance-and-incentive-framework, http://www.open.hqsc.govt.nz/open/about-the-campaign/, http://www.hqsc.govt.nz/our-programmes/health-quality-evaluation/projects/atlas-of-healthcare-variation/, http://www.oecd.org/els/health-systems/ReviewofHealthCareQualityDENMARK_ExecutiveSummary.pdf, http://www.nice.org.uk/standards-and-indicators/qofindicators, https://www.nice.org.uk/standards-and-indicators/How-we-develop-QOF, http://www.statcan.gc.ca/pub/82-221-x/2013001/tbl-eng.htm, http://publications.gc.ca/collections/collection_2013/icis-cihi/H118-86-1-2013-eng.pdf, http://www.hc-sc.gc.ca/hcs-sss/pubs/system-regime/2010-fed-comp-indicat/index-eng.php, http://www.rivm.nl/en/Documents_and_publications/Scientific/Reports/2012/april/Dutch_Health_Care_Performance_Report, http://www.healthpowerhouse.com/files/HCP-study-Best-hospital-final-101119.pdf, A review of the Australian healthcare system: A policy perspective. The authors would like to thank their colleagues Dr Diane Watson, Bernie Harrison, Jessica Stewart, Dr Julia Langton, Jason Boyd, Jessica Herkes and Kristiana Ludlow for their support to the project. The PAF consists of 48 national indicators: 31 indicators for Medicare Locals now called Primary Health Care Networks; (geographically based primary care co-ordinating agencies) and 17 indicators for performance of Local Hospital Networks and hospitals18 (see Table 1). Indicators that were collected consistently on a national scale were included, but could be relevant and useful to local quality improvement efforts. People performance management is important and doing it well has a big impact on the quality of care that your service provides. Key Performance Indicators define factors the institution needs to benchmark and monitor. Much of this interest in quality of care has developed in response to recent dramatic transformations of health care systems, accompanied by new organizational structures and reimbursement strategies that may affect quality of care. As part of its Strategic Plan 2012–2015,16 NHPA is required to regularly review its Performance and Accountability Framework (PAF) to ensure it remains relevant and continues to address the needs of the Australian public for high-quality healthcare. 3. The number and focus of frameworks varied greatly between the eight countries, but typically included reference to both monitoring and improving quality and efficiency of the healthcare system. Simply select your manager software from the list below and click on download. Staff-To-Patient Ratio: Indicates the use and capacity of staff resources, which can affect the quality … SAGE Publications Ltd, unless otherwise noted. Of the 11 frameworks published in five countries and the OECD, the most frequently used (self-reported) domains were effectiveness (eight), access and safety (seven each) and efficiency (five; Table 2). Create a link to share a read only version of this article with your colleagues and friends. Assessing commonalities and differences between indicator specification and application in comparable health systems may be of value to regulators, policymakers, researchers and clinicians and forms a foundation for further research into the practical impact of indicators on the quality of healthcare. Nationally consistent and locally relevant indicators by country. Representatives of the Netherlands’ Ministry of Health, Welfare and Sport collaborated with academic researchers to develop the conceptual framework after reviewing the strategic goals of the healthcare system, information needs of policymakers and studying existing theory and international experiences.24 The resulting framework divides healthcare into four specific community needs: (1) staying healthy, (2) getting better, (3) living independently with a chronic illness and (4) end-of-life care.25, New Zealand has included an atlas of healthcare variation as one of its four health system performance monitoring mechanisms,26–29 and other countries such as the United States and the United Kingdom utilise an atlas, too. Meanwhile, in the Netherlands, a report detailing results for all 125 indicators is published every 2 years.38 From 2011, the information was updated via a website twice a year and from 2014, the report will be published every 4 years.38 The indicators are reported at the national level, not locally. Definitions for these domains are often not explicit in the policy documents.20 Definitional consistency between countries should be the subject of more research or efforts to internationally standardise. Notwithstanding these kinds of shortcomings, it is useful to assess the frameworks and performance indicators in a sample of countries for the insights this provides. Performance Indicators* Pre-K-Grade 2 1.2.1 Identify that healthy behaviors impact personal health. Cardiovascular, surgery and mental health were the most frequently reported disease groups. Devising primary care performance indicators for New Zealand, A conceptual framework for the OECD Health Care Quality Indicators Project, Primary health care reform in Australia – report to support Australia’s first National Primary Health Care Strategy, 2011 National healthcare quality and disparities reports, Rising to the challenge – results from a scorecard on local health system performance, Conceptual frameworks for health systems performance: a quest for effectiveness, quality, and improvement, Correlates of health and healthcare performance: applying the Canadian health indicators framework at the provincial-territorial level, International profiles of health care systems, Developing a national performance indicator framework for the Dutch health system, Health care performance in the Netherlands: easy access, varying quality, rising costs, OECD reviews of health care quality: Denmark: executive summary, assessment and recommendations, About the Quality and Outcomes Framework (QOF), Unintended consequences of performance measurement in healthcare: 20 salutary lessons from the English National Health Service, Health indicators 2013: definitions, data sources and rationale, Canadian Hospital Reporting Project technical notes – clinical indicators, Healthy Canadians: a federal report on comparable health indicators. To make comparison relevant, all selected countries are OECD members and have been classified by the World Bank as high income.10 Data on the rates of health expenditure and life expectancy for 19 countries were obtained from Australia’s Health 201011 and from OECD reports9 (including Australia, Austria, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Japan, the Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, the United Kingdom and the United States).12 After screening by the research team, the eight countries we noted above were selected for detailed review on the basis that each had made substantial progress in using indicators and developing performance frameworks and had made their indicators and performance frameworks widely available. 2010-11 is the last year of the NIS indicators and the Social Care and Mental Health indicators are being replaced by the Adult Social Care Outcomes Framework for 2011-12 onwards. This article provides a simple framework to analyse key performance issues related to the functions of health financing within the context of social health insurance. We conducted our study in four stages. The OECD and Departments or Ministries of Health and associated government health organisations in each country were searched. Healthcare Improvement Scotland develops standards and indicators to support health and social care organisations improve the quality of care and support they deliver. In the United States, three identifiable entities report on healthcare performance. A performance indicator is not a synonym for quality, but rather a proxy. Key performance indicators (KPIs) are defined by the NHS Institute as indicators that help you define and measure progress towards organisational goals (NHS Institute, 2008). Table 3. The population health approach: A qualitative study of conceptual and operational definitions f... Identifying the key performance improvement domains for home health agencies. For monitoring long-term progress, there are 12 Quality Outcome Indicators (QOIs) which do not have specific targets; short-term priority areas are focussed on by the ‘HEAT’ targets: Health improvement for the people of Scotland (H), Efficiency and governance improvements (E), Access to services (A) and Treatment appropriate to individuals (T); and the third category includes all other national and local reporting requirements. Countries involved are Australia, Canada, Denmark, England, the Netherlands, New Zealand, Scotland and the United States. Of these, 45 indicators are reported in more than one country. If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Department of Health . Final report: performance indicators used internationally to report publicly on healthcare organisations and local health systems. Number of pages: 15-22 The performance indicators were subjected to a detailed assessment and were classified according to whether they applied to community/hospital/population, country of origin and clinical specialty. National Institute for Health and Clinical Excellence . Access to society journal content varies across our titles. This study identifies and compares frameworks and performance indicators used in selected Organisation for Economic Co-operation and Development health systems to measure and report on the performance of healthcare organisations and local health systems. The description of the indicators therefore also The e-mail addresses that you supply to use this service will not be used for any other purpose without your consent. Then, within each health financing function, key performance issues and associated measurable indicators are developed. However, it is difficult to gauge how many indicators are in use, because only certain indicators are selected for inclusion in the annual reports and there appear to be various degrees of overlap. There are likely to be considerable overlap between the definitions of some of the domains such as effectiveness and appropriateness. quality indicators; mental health; Delphi; primary care; The central role played by primary care in the recognition and delivery of care for people with mental health problems is now widely acknowledged. Few studies make comparative assessments of different countries’ performance indicator frameworks. However, many countries, even those with advanced data systems, have difficulty linking practice performance to outcomes because of limitations in data availability and poor capabilities to link data. A review of the evidence, Australian Institute of Health Innovation, University of New South Wales, Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. However, only of late has systematic evidence about quality of care begun to be collected in most health care syst… Identification of comparable international indicators and analyses of their characteristics and of their broader national frameworks and contexts were undertaken. KPI is a measure used to define and evaluate how successful an organization is. Although we presented the self-reported domains by country, consistency of definitions between countries and the level of semantic overlap was not tested; however, these are likely to be substantial. Canadian Institute for Health Information . 4. In this study, the eight countries selected for review were using indicators and had implemented a performance framework, several over more than a decade. Cordasev, H, Arne Björnberg, M, Hjertqvist, O. Raleigh, VS, Foot, C. Getting the measure of quality: opportunities and challenges. These enable health and social care providers to: Identify gaps and areas for local improvement; Measure the quality of care they provide The search found 401 indicators that fulfilled the ‘nationally consistent and locally relevant’ criteria. These standards are overseen by the International Society for Quality in Healthcare (ISQua).22 The Danish National Indicator Project (DNIP) merged with the Clinical Quality Development Programme (RKKP) in 2010.8 Although Denmark lacks a formal framework, the DNIP manual outlines the thinking behind its clinical indicators and planned future indicators (1) to improve prevention, diagnostics, treatment and rehabilitation; (2) to provide documentation for setting priorities and (3) to create an information resource for patients and consumers. You should remember that performance management isn’t just about issues – it’s also key to motivating, supporting and encouraging hardworking staff. The health system performance frameworks for each country were reviewed together with their accompanying online and published documentation. We selected eight prominent health systems for review and assessment based on purposively selecting a sample that were exemplars in using indicators and making their data and performance systems available: Australia, Canada, Denmark, England, the Netherlands, New Zealand, Scotland and the United States. Several low- and middle-income countries are interested in extending their existing health insurance for specific groups to eventually cover their entire populations. How do I know if my local council is providing good social care? It is broadly agreed that monitoring performance imposes an inherent pressure on healthcare organisations or services to improve practice.48 However, the extent to which this is accomplished is disputed and under-researched. The National Skills Academy for Social Care (NSASC), part of Skills of Care, and the NHS Employers Organisation (NHS E), have been commissioned by the Department of Health to produce an online hub to support line managers in health and social care in the effective performance management of … the family in terms of performance of social roles. So many health care systems in Europe can be identified as the mix health care models with some dominant source of funding. In Australia, the National Health Performance Authority (NHPA)16 was established under the Australian National Health Reform Act 201117 as an independent portfolio agency to monitor and report on healthcare system performance; it has since been merged with the Australian Institute of Health and Welfare. Sign in here to access free tools such as favourites and alerts, or to access personal subscriptions, If you have access to journal content via a university, library or employer, sign in here, Research off-campus without worrying about access issues. important role in achieving our mission to provide excellent and efficient services working in partnership with residents and the wider local community KPIs, which are specific and measurable elements of health and social care, can be used to assess the quality of care. This site uses cookies. In reviewing existing targets and indicators for health and social care, this report considers first what the policy framework for public sector bodies tells us about the aims and objectives of the health and social care system. Table 1. NICE has developed guides,32,33 which set out in detail the processes involved in managing the development of indicators. For example, the OECD considers these two domains as separate while the Australian framework considers appropriateness as a subset of effectiveness.6,18 Because of this, and hierarchical relationships between domains within some frameworks, it is difficult to report the number of indicators used against each domain for each country. Performance indicators are used to observe progress and to measure actual results compared to expected results. Effective improvements in health care require methods to evaluate professional practice. The focus of this set of indicators is directed towards the question how care homes can measure and manage improvements with regard to the quality of life of their clients, and the related issues of quality of care, management, economic performance and relationships with external stakeholders. 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