Performance Framework

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1 Perfrmance Framewrk SA Health Fr Official Use Only I1-A1

2 Cntents 1. Overview 3 2. Purpse and Scpe f Framewrk Attributes f the Framewrk 4 3. Perfrmance Requirements Key Perfrmance Indicatrs Service Measures and Standards Other Measures 5 4. Operatin f the Overview Perfrmance Review Prcess Perfrmance Assessment Criteria and Perfrmance Triggers Prcess fr Escalatin and De-escalatin 7 5. Gvernance Arrangements DHA Rles and Respnsibilities LHN/SAAS Rles and Respnsibilities 10 P a g e 2

3 1. Overview This Framewrk applies t the Lcal Health Netwrks (LHNs), Suth Australia Ambulance Service (SAAS) and State-wide Clinical Supprt Services (SCSS) and sets ut the framewrk within which the Department fr Health and Ageing (DHA) mnitrs and assesses the perfrmance f public sectr health services in Suth Australia. It includes the perfrmance expected f health services t achieve levels f health imprvements, service delivery and financial perfrmance as set ut in their Service Level Agreements and respnses t perfrmance cncerns and management prcesses that supprt achievement f the utcmes in accrdance with gvernment plicy. This framewrk aligns t the revised gvernance arrangements and structures within SA Health. A brad range f strategic and perfrmance expectatins fr the SA Health system are articulated in the Service Level Agreements (SLAs), including perfrmance expectatins agreed thrugh a range f natinal agreements and the Natinal Health Perfrmance Authrity Perfrmance Framewrk and assciated indicatrs. 2. Purpse and Scpe f the Framewrk This framewrk prvides an integrated prcess fr perfrmance review and assessment and frms an integral cmpnent f the business planning cycle that establishes the annual SLAs between the DHA and each LHN, SAAS and SCSS. It utlines a transparent mnitring prcess thrugh which perfrmance will be assessed, respnses in cases f pr perfrmance and where perfrmance cncerns arise, the prcess f escalatin and cllabratin t restre and maintain effective perfrmance. The identificatin f high perfrmance will als be recgnised and lessns will be shared acrss SA Health. The SA Health cmprises: Annual Service Level Agreements. Clearly stated perfrmance requirements including strategic pririties and gvernance requirements as utlined in Service Level Agreements. The rles and respnsibilities f LHNs, SAAS, SCSS and the DHA in the peratin f the framewrk. Key Perfrmance Indicatrs (KPIs) and perfrmance threshlds that if nt met may raise a perfrmance cncern. Transparent mnitring and reprting prcesses. Clear levels f respnse t address perfrmance issues. Rbust gvernance prcesses thrugh which escalatin/de-escalatin f respnses is determined. Nv 2015 P a g e 3

4 2.1 Attributes f the Framewrk Transparency Accuntability Respnsiveness Predictability Recvery Integrated Cnsistency Recgnitin Infrmed Purchasing Clear agreed perfrmance milestnes t achieve perfrmance targets. Clear rles and respnsibilities f the DHA, LHNs, SAAS and State-wide Clinical Supprt Services Perfrmance issues are identified early and respnses are timely It is clear what cnstitutes gd perfrmance and when perfrmance cncerns arise what respnses are required Ensure recvery plans are clear and practical The Framewrk incrprates SA Health Strategic Pririties and links the bjectives f safe, effective, patient centred and efficient health service delivery Respnses t pr perfrmance are prprtinate t the issue being addressed Sustained and/r superir perfrmance is apprpriately recgnised The Framewrk prvides a prcess fr pre-emptive and pr-active decisin making t supprt current and future service needs 3. Perfrmance Requirements LHNs, SAAS and SCSS are t meet the perfrmance requirements as set ut in the SLAs, within the allcated budget and specifically: Managing activity vlumes within agreed parameters. Achieving the required prductivity imprvements and implementatin f agreed service transfers and ther agreed plans. Achieving KPI Targets t supprt implementatin f Transfrming Health and ther key strategic pririties. The KPIs are gruped under the headings: Effectiveness - Safety and Quality f care Equity - Access Prductivity and Efficiency Effectiveness - Cnsumer Experience Mental Health 3.1 Key Perfrmance Indicatrs Key Perfrmance Indicatrs have been established fr which perfrmance targets have been determined. Perfrmance against these indicatrs is reprted in the mnthly Prtfli Perfrmance Reprt prepared by the Department. The perfrmance f an LHN r SAAS is assessed in terms f whether it is meeting the perfrmance targets fr individual KPIs. Perfrming (at r better than target) Underperfrming (within tlerance range) Nt Perfrming Nv 2015 P a g e 4

5 A tlerance band fr each indicatr has been set. Actual perfrmance fr each indicatr will be assessed t determine whether the indicatr is utside the tlerance band. Each KPI has been designated int Tier One r Tier Tw categries: Tier One generates a perfrmance cncern where perfrmance is utside the tlerance threshld fr the applicable reprting perid. Tier Tw generates a perfrmance cncern when perfrmance is utside f the tlerance threshld fr mre than ne reprting perid. The level f perfrmance cncern in each case is determined by the particular indicatr, the seriusness f the issue, the speed with which the situatin culd deterirate further and the time it wuld take t achieve turnarund. The technical specificatins and tlerance bands fr each KPI can be btained at LHNs are required t flw their activity caps by mnth and prvide them t the Department (a template will be prvided). Perfrmance during the year will be mnitred against the mnthly caps. LHNs and SAAS may als be required t flw their targets by mnth t reflect the level f anticipated prgress twards the annual target, aligned t agreed strategies and peratinal plans. 3.2 Service Measures and Standards In additin t KPIs, a range f service standards have been agreed thrugh Transfrming Health which will be applied t future service redesign and develpment and implementatin f new service mdels. Service measures may be included in the perfrmance reprts t assist in mnitring perfrmance against these service standards and ther agreed utcmes. 3.3 Other Measures In additin t the KPIs and service measures and standards, DHA will cntinue t mnitr a brad range f measures, including strategic pririties, emerging health issues, reprting requirements t the Cmmnwealth and participatin in natinally agreed data cllectins with which health services need t cmply. Perfrmance issues related t these mnitring measures will be discussed with the LHN/SAAS/SCSS and may becme a KPI(s) until the perfrmance issue is reslved. 4. Operatin f the 4.1 Overview The peratin f the Framewrk invlves: Onging review f the perfrmance with each LHN/SAAS/SCSS; Identifying perfrmance issues and determining apprpriate respnses; Determining when a perfrmance recvery plan is required; Determining when the perfrmance respnse needs t be escalated r can be de-escalated; and Determining when an LHN/SAAS/SCSS n lnger needs a perfrmance respnse. Nv 2015 P a g e 5

6 4.2 Perfrmance Review Prcess The fllwing are the key steps in the perfrmance review prcess: Distributin f an integrated, mnthly Prtfli Perfrmance Reprt detailing perfrmance against the KPIs and service/ther measures. LHNs, SAAS and SCSS may be required t prvide input in the prductin f this reprt and/r respnse t the assessment. Mnthly Cntract Meetings between the Department and the LHN/SAAS/SCSS crdinated by System Perfrmance and Service Delivery (SPSD), t discuss perfrmance and cmmissining issues. Where a perfrmance issue is identified, cnfirmatin f the issue with the LHN/SAAS/SCSS and determinatin f apprpriate actin t address the issue in accrdance with the. A mnthly perfrmance status summary prvided t Chief Executive (CE) SA Health t infrm CEO/Grup Executive Directr ne n ne discussin and t escalate/de-escalate any perfrmance cncerns. Mnthly ne n ne meetings between the CE (r nminated Deputy where applicable) and LHN/SAAS Chief Executive Officer (CEO) and SCSS Grup Executive Directr t discuss specific r sustained perfrmance issues and t mnitr delivery f recvery plans and mitigatin strategies where applicable. Bi-annual perfrmance review t identify key pririties fr reslutin in year, t infrm any midyear budget allcatin/changes and variatins t the SLA and t supprt negtiatins in relatin t the develpment f the SLA fr the fllwing year. Where a perfrmance issue is identified, the frequency f meetings may be increased until the issue is reslved. Depending n the issues under review, attendance by the CE may be indicated. Cntract Meetings are c-rdinated by the SPSD Divisin and chaired by the Deputy CE, System Perfrmance and Service Delivery. The meetings are held in the LHN, SAAS, SCSS r a centrally cnvenient lcatin and videcnference facilities will be available t enable participatin. During 2015/16 a Prject Management Office (PMO) will be established t supprt successful delivery f the Transfrming Health (TH) Prgram with a primary fcus t advise, guide and prvide assurance services t the TH Implementatin Cmmittee and ther SA Health decisin making bdies, in respect t key actins t be made in the achievement f prgram milestnes and benefits (related t service delivery change). The PMO will cmplement perfrmance mnitring arrangements articulated in the, wrking clsely with key functinal grups acrss SA Health and the TH Implementatin Partner in mnitring and reprting n the implicatins f delivery prgress n prgram utcme achievement. 4.3 Perfrmance Assessment Criteria and Perfrmance Triggers Assessments will be made primarily thrugh cnsideratin f the mnthly Prtfli Perfrmance Reprts prepared by DHA alng with infrmatin prvided by the LHN/SAAS/SCSS. Table 1: Perfrmance Assessment Criteria and Triggers Perfrmance Requirement Strategic Pririties Tier 1 KPIs Tier 2 KPIs Agreed turnarund and/r recvery plans Perfrmance Trigger Failure t make satisfactry prgress r achieve key milestnes Generate a perfrmance cncern where perfrmance is utside the tlerance threshld fr the applicable reprting perid Generate a perfrmance cncern when perfrmance is utside f the tlerance threshld fr mre than ne reprting perid Failure t meet designated critical milestnes as per the agreed turnarund and/r recvery plan Nv 2015 P a g e 6

7 A turnarund plan relates t a financial and peratinal strategy t align expenditure t budget ver an agreed timeframe. A recvery plan is an agreed strategy and timeline t address a specific perfrmance cncern. At each Cntract Meeting, the LHN/SAAS/SCSS will reprt n perfrmance against KPIs and the prgress f recvery plans t address perfrmance utside tlerance bands. Annual review A frmal annual review f perfrmance under the Service Agreement will be undertaken between the SA Health CE and the CEO f each LHN/SAAS and Grup Executive Directr, SCSS. The annual review will cnsider perfrmance against the annual key perfrmance targets and assess capability t achieve the utcmes identified fr the fllwing year. A target will be cnsidered met if the annual target value lies within the tlerance limit f the target. A review will als be undertaken n an annual basis t assess LHN, SAAS and SCSS capability t achieve the utcmes identified in the SLAs. 4.4 Prcess fr Escalatin and De-escalatin The fllwing prcesses are undertaken t determine whether the perfrmance f the LHN/SAAS/SCSS warrants escalatin/de-escalatin. Where there are n existing perfrmance cncerns and a perfrmance cncern arises (any f the Tier 1 indicatrs), the issue will be discussed directly with the LHN/SAAS/SCSS r at the next Cntract Meeting depending n the nature f the cncern. The LHN/SAAS/SCSS will be asked t reprt n underlying factrs and if apprpriate, may be asked t develp a recvery plan. Thrugh discussins, and depending n the nature f the perfrmance issue, there may be pprtunity fr supprt frm ther LHNs, SAAS r ther Health Services and/r DHA t assist in perfrmance imprvement, such as tls, techniques and staffing resurce. Implementatin f the recvery plan (if applicable) and subsequent perfrmance will cntinue t be mnitred thrugh the Cntract Meetings. Where perfrmance des nt imprve, the perfrmance issue may be escalated t the CE ne n ne Meeting. Further actins may be agreed where perfrmance des nt imprve, including financial implicatins and targets may be adjusted t reflect the agreed recvery plan. Where there is an existing perfrmance cncern, prgress will be assessed t determine whether sufficient imprvement has been made r whether perfrmance escalatin is required t CE ne n ne Meeting. Where there is significant variatin in Tier 2 indicatrs r failure t make satisfactry prgress in relatin t strategic pririties, including milestnes assciated with delivery f Transfrming Health, these will be reviewed at the Cntract Meetings and a frmal recvery plan may be requested. Where perfrmance des nt imprve, the perfrmance issue may be escalated t the CE ne n ne Meeting. Fllwing a Cntract Meeting, the DHA will distribute the agreed actins frm the meeting within 2 wrking days. The actins agreed at CE ne n ne meetings will als be dcumented fr subsequent review f prgress. Where the perfrmance cncern is sustained, despite mitigatin strategies in place, r perfrmance deterirates further, the matter is referred t the SA Health CE and Minister fr Health fr reslutin. The fllwing table summarises the steps that guide a decisin t escalate r de-escalate. Escalatin and de-escalatin may nt be sequential. The initial level f escalatin and respnse is based n the seriusness f the perfrmance issue, the likelihd f rapid deteriratin and magnitude f the issue. Nv 2015 P a g e 7

8 Table 2: Perfrmance Escalatin Levels Level f Respnse Pint f Escalatin Pint f De-escalatin Level 1 Under Review Assessment and advice Perfrmance issue identified The issue is satisfactrily reslved Respnse DHA ntifies LHN /SAAS/SCSS CEO/Grup Executive Directr f escalatin t Level 1. The LHN/SAAS/SCSS CEO/Grup Executive Directr t prvide frmal advice n: reasns that led t the perfrmance issue whether any actin is required and if s, intended actin and timeframe There may be pprtunity fr supprt such as tls, techniques and staffing resurce as apprpriate Level 2 Under-perfrming Recvery plan required DHA/Cntract Meeting cnsiders that a frmal recvery plan is required (riginal issue that triggered level 1 is nt reslved and/r ther perfrmance issues emerge) The issue is reslved and des nt re-emerge fr at least ne mre reprting perid (mnth/quarter as apprpriate) DHA ntifies LHN/SAAS/SCSS CEO/Grup Executive Directr f escalatin t Level 2. The LHN/SAAS/SCSS CEO/Grup Executive Directr is required t: undertake an in-depth assessment f the prblem and identify mitigatin prvide a detailed recvery plan fr apprval at Cntract Meeting (timeframe fr recvery will be agreed) reprt prgress Supprt may be prvided t wrk cllabratively t develp and implement apprpriate strategies Level 3 Serius underperfrmance risk Additinal supprt and invlvement The recvery plan is nt prgressing well and is unlikely t succeed withut additinal supprt/input A revised recvery strategy has been develped The revised recvery strategy has succeeded and the perfrmance issue is imprving (shws n indicatin f re-emergence in the ensuing 3 mnths) SA Health CE will meet with LHN/SAAS/SCSS CEO/Grup Executive Directr t frmally advise f escalatin t Level 3 and t agree recvery strategy. This may require assigning supprt frm DHA t wrk cllabratively with LHN/SAAS/SCSS t develp and implement the strategy r t have mre direct invlvement in the peratin f the service and/r ther measures such as cmmissining an independent/external review f gvernance, management, capability) LHN/SAAS/SCSS CEO/Grup Executive Directr is required t demnstrate that turnarund is achievable within a reasnable timeframe Prgress will be frmally mnitred fr an agreed timeframe. The timing and scpe f any actin will be determined by the nature f the perfrmance issue/s. Level 4 LHN/SAAS/SCSS challenged and failing Changes t the gvernance f the LHN/SAAS/SCSS may be required The recvery strategy has failed The perfrmance issue has imprved and there is demnstrable evidence that the LHN/SAAS/SCSS nw has the issue under cntrl/ capability The SA Health CE/ Minister fr Health will meet with LHN/SAAS/SCSS t frmally advise f escalatin t level 4. The timing and scpe f any actin will be determined by the nature f the perfrmance issues and is likely t invlve frmal turnarund measures. P a g e 8

9 5. Gverning Arrangements This sectin utlines the arrangements that gvern the activities, rles and respnsibilities f bth the DHA and LHNs/SAAS/SCSS t peratinalise this Framewrk. 5.1 DHA Rles and Respnsibilities The DHA is respnsible fr mnitring and reviewing the verall perfrmance f the publicly funded health system. The SPSD will be respnsible fr the verall c-rdinatin f the DHA activities under the Framewrk t enable a cllabrative apprach t perfrmance imprvement. All perfrmance issues that require a respnse and/r escalatin will be channelled thrugh a single, integrated prcess. The c-rdinatin by SPSD includes: Liaisn with ther Branches and Divisins t prepare cnslidated perfrmance reprts and undertaking perfrmance analysis. Preparatin f a Perfrmance Summary Reprt fr CE ne n ne discussins with LHNs, SAAS and SCSS. Scheduling and c-rdinatin f mnthly Cntract Meetings and escalatin prcesses. Maintaining recrds f perfrmance assessment utcmes, turnarund and recvery plans. Issuing frmal actins agreed during Cntract Meetings r CE ne n ne Meeting within 2 business days. Arranging the apprpriate level f supprt when further escalatin is required, including liaisn with ther LHNs and Health Services where required t supprt recvery plans in rder t ensure there is a crdinated apprach. Identificatin f initiatives, evidence, plicies r prcesses that will r may cntribute t addressing perfrmance turnarund (eg new mdel f care). All Divisins will wrk clsely t ensure a c-rdinated and cnsistent apprach. The Funding and System Design Cmmittee will prvide advice and supprt t SA Health CE t assist in managing perfrmance and t ensure clear and cnsistent messages and prcesses. In particular the Cmmittee will determine funding and activity methdlgies, plicies, prtcls and apprpriate perfrmance measures t enable the health system t perfrm effectively. Other Divisins will cntinue t have dialgue with LHNs, SAAS and SCSS n a range f plicy and prgram matters as required. 5.2 LHN/SAAS/SCSS Rles and Respnsibilities Each LHN, SAAS and SCSS is t have in place an effective internal perfrmance framewrk which supprts delivery f the SLA, including; prcesses t actively mnitr the KPIs and ther measures apprpriate gvernance arrangements in place fr perfrmance management and imprvement that include clearly identified accuntabilities and respnsibilities identificatin f delegated respnsibility at service level fr delivery against KPIs. Each LHN/SAAS/SCSS will: Reprt prmptly t DHA any emerging r ptential perfrmance issue and/r perfrmance risk including immediate actins taken and/r early assessment f actin that may be required t prevent the issue frm deterirating. P a g e 9

10 Ensure infrmatin is submitted in accrdance with requirements f each data cllectin, ensuring data quality and timeliness. Ensure the prvisin f infrmatin and/r analysis t supprt perfrmance mnitring and imprvement prcesses, including preparatin and submissin f prgress reprts and risk assessments fr achieving successful utcmes and ptins t mitigate any risks t the mnthly Cntract Meetings as required. Wrk cllabratively with DHA t reslve perfrmance issues and adhere t all respnses t perfrmance cncerns as determined. Establish and maintain a culture f perfrmance imprvement by: prmting the at all levels within the LHN/SAAS/SCSS identifying shrtfalls in relatin t perfrmance and devising and implementing apprpriate supprt and develpment arrangements t facilitate lng-term and sustainable delivery prviding relevant tls and resurces t enable effective perfrmance imprvement and ensuring that key staff understand their perfrmance respnsibilities and the cnsequences f nt effectively executing these ensuring active mnitring f implementatin f agreed actins. Nv 2015 P a g e 10

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