Stichting tot het Verzorgen van Verstandelijk Gehandicapten De Schutse, Uitgaande van de Gereformeerde Gemeenten in Nederland

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1 Benchmark report: Stichting tot het Verzorgen van Verstandelijk Gehandicapten De Schutse, Uitgaande van de Gereformeerde Gemeenten in Nederland 1

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3 1. General information General information Name Tow n/city Number of locations Number of organisational units Number of members of Board of Directors Number of members of Supervisory Board Stichting tot het Verzorgen van Verstandelijk Gehandicapten De Schutse, Uitgaande van de Gereformeerde Gemeenten in Nederland Kesteren Information disability care institutions Number of clients on the basis of a care intensity package (ZZP) including daytime activities Number of clients on the basis of a care intensity package (ZZP) excluding daytime activities Number of residential clients on the basis of a full package (VPT) Number of extramural clients Number of available beds/places w ith residential care Number of days of residential care including daytime activities Number of days of residential care w ithout daytime activities Number of days of care on the basis of a full package (VPT) Number of half-day sessions of daytime activities Number of hours of extramural production Number of permanent employees Number of FTEs of permanent staff Number of care intensity package (ZZP) days of forensic care Number of hours of extramural production forensic care Number of half-day sessions of daytime activities forensic care Spending on innovation ,699 34,928 35,859 3,738 3,742 3,361 25,138 24,910 25,

4 Income information Aggregate operating income 10,905,692 12,056,357 12,267,390 Operating income from disability care 10,905,692 11,650,792 11,910,480 Statutory budget for care under the ZVW Statutory budget for care under the AWBZ 10,180,036 11,175,359 11,483,202 Statutory budget for care under the AWBZ/ZVW 50,227 Statutory budget for care under the PGB 338, ,814 Municipal budget for care 725,656 Other operating income Other non-sector income 0 405, ,910 4

5 2. Key financial figures benchmark The table below shows the values for some commonly used key financial figures. Annex 1 contains an overview of the meaning and interpretation of each figure. The table also shows the relative scores vis-à-vis all institutions that provide disability care ( Z scores). The average score for the sector has been set at 0, so a positive value means the institution scores above average for the aspect concerned, and a negative value means it scores below average. The values do not indicate actual performance, only whether an institution performs above or below par. A Z score of -2 means the institution scores two standard deviations below the average value. The colour scale slides from dark pink (<-3) to dark yellow (>3). A strong yellow score for increase in turnover for example indicates the institution has shown strong growth compared to the average. Key financial figures Increase in turnover Operating income Solvency Buffer capital Capital intensity Liquidity Return on Assets Return on Equity EBITDA DSCR1 DSCR2 Budget per client Number of FTEs per client Absenteeism Average w age (corrected) Rate of labour costs for hired staff Part-time ratio 2013 value Z score value Z score value Z score 9.5% % % % % % % % % % % % % % % % % % % % % % % % , , , % % % , , , % % %

6 3. Spending categories The table and graph below show the spending of the institution per category. Institutions are free to divide the budget between the different spending categories, in part depending on the type of patients. No appraisal can be made on the relative values, as a high value on one category is not necessarily better than a low value. Again, the Z-scores represent the deviations from the average. Spending categories value Z score value Z score value Z score Labour costs 48.5% % % -0.1 Social security premiums 14.3% % % -0.1 Percentage of hired staff 7.6% % % 0.2 Food costs 4.2% % % -0.5 General costs 5.4% % % -0.6 Client-related costs 1.3% % % -0.3 Accommodation costs 11.6% % % 0.9 Depreciation costs -0.6% % % -0.5 Build-up of capital reserves 6.5% % % 0.9 Gross revenu 1.2% % % 0.6 6

7 Budget spending % 7% 5% Labour costs Social security premiums 11% Percentage of hired staff 1% 5% 48% Food costs General costs Client-related costs Accommodation costs 4% 5% Depreciation costs Build-up of capital reserves Gross revenu 14% 7

8 4. Quality The benchmark for quality is based on the score for the quality indicators at the level of the institution. This is not the same as the quality of care, which is much harder to measure. See Annex 2 for an explanation of the method used. Also in this respect, the average quality score has been set at 0, so a positive value means the institution scores above average for the quality indicator concerned. In addition to overall quality, a distinction is made between the set of quality indicators from pillar 1 and the set of quality indicators from pillar 2a. It is quite possible an institution has a 0 score or no score for quality in a certain year (see Annex 2). Institution: quality Quality Number of indicators Pllar 1 quality Number of indicators Pillar 2a quality Number of indicators z-score z score z score The tables below give a breakdown for each indicator per year, including the Z scores. A higher Z score indicates a relatively higher level of quality scores compared to average on each indicator. The set of indicators can differ from one year to another, complicating direct comparison of single indicators over the years. Again, Z-scores only measure relative performance, so low scores on indicators not necessarily translate to low quality. 8

9 Quality 2013, concern Pillar 1 (Suspection of) Sexual abuse Client experience/satisfaction Qualities employees Client complaint settlement regulation Employee complaint settlement regulation Employee research Joint-decision making Mediction safety Incident registration and evaluation Risk categorizaion Confidentiality counsellor for emloyees Confidentiality regulation/counselling for clients Freedom-restricting measures Care and support plan value mean z-score Quality 2013, concern Pillar 2a (Suspection of) Sexual abuse - Perpetrator (Suspection of) Sexual abuse- Risk (Suspection of) Sexual abuse - Victim Medication Safety- Agression Safety- Falling Safety - Addiction Freedom-restricting measures - Confinement Force feeding Freedom-restricting measures - fixation Forced medication Freedom-restricting measures - separation Care and support plan value mean z-score

10 Quality 2012, concern Pillar 1 (Suspection of) Sexual abuse Client experience/satisfaction Qualities employees Client complaint settlement regulation Employee complaint settlement regulation Employee research Joint-decision making Mediction safety Incident registration and evaluation Risk categorizaion Confidentiality counsellor for emloyees Confidentiality regulation/counselling for clients Freedom-restricting measures Care and support plan value mean z-score

11 Quality 2012, concern Pillar 2a Physical health - Breast cancer Physical health - Diabetes Physical health - Epilepsy Physical health - Hearing Physical health - Vision Medication Safety - Agression Safety - Perpetrator sexual abuse Safety - Victim sexual abuse Safety - Falling Safety - Addiction Freedom-restricting measures - Confinement Force feeding Freedom-restricting measures - fixation Forced medication Freedom-restricting measures - separation Care and support plan value mean z-score

12 Quality 2011, concern Pillar 1 Client experience/satisfaction Qualities employees Client complaint settlement regulation Employee complaint settlement regulation Employee research Joint-decision making Mediction safety Incident registration and evaluation Risk categorizaion Confidentiality counsellor for emloyees Confidentiality regulation/counselling for clients Freedom-restricting measures Care and support plan value mean z-score

13 Quality 2011, concern Pillar 2a Reccommendation care organisation Interests Interests 1 (percentage) Interests 2 (scale) Interests 2 (percentage) Interests 1 (scale) Grade for help Grade for the organisation Interpersonal relations (scale) Interpersonal relations (percentage) Employee Quality 1 Employee Quality 2 Employee Quality Physical w ell-being 1 Physical w ell-being 2 Physical w ell-being Material w ell-being 1 (percentage) Material w ell-being 2 Material w ell-being Participation Personal development Psychological w ell-being Coordination of care 1 Coordination of care 2 Coordination of care Safety Self-decision making 1 Self-decision making 2 Self-decision making Care and support plan 1 (scale) Care and support plan 2 (percentage) Care and support plan 3 (scale) Care and support plan value mean z-score

14 Annex 1: Key financial figures description - Increase in turnover indicates the degree turnover has increased compared to the previous year. - Operating income indicates the percentage of receipts not used for expenditures. It may be considered an institution's profit and may be used in the future. Due to the not-for-profit nature of the institutions, operating income supplements an institution's equity position. - Solvency is the part of an institution's total assets that is its equity capital. A healthy institution will have a 15-20% solvency rate. - Buffer capital indicates the extent an institution can accommodate losses with its own equity capital, usually 15%. - Capital intensity indicates the capital required to generate 1 euro in earnings. The average ratio for the sector is approx Liquidity measures whether the institution has sufficient disposable equity to meet its current liabilities. A liquidity rate of 150% is generally recommended. If the liquidity rate is too high, money is left in the bank unused. - EBITDA is an institution's earnings before interests, taxes, depreciation and amortisation. This indicator might be less useful for the sector concerned (especially intramural disability care) as it is strongly dependent on whether an institution owns or rents its buildings. As rent is considered regular expenditure and depreciation of real estate is not, an institution renting its buildings has a much lower EBITDA. Apart from that, depreciation of assets outside of real estate is usually quite small, and care institutions generally do not pay taxes. - Debt Service Coverage Ratio (DSCR) can be measured in two ways: in the narrow sense (DSCR1: [operating income + interest income] / interest expenditure) and in the broad sense (DSCR2: EBITDA / interest expenditure). DSCR measures the extent to which an institution's earnings suffice to meet its financial liabilities. If the DSCR is smaller than 1, an institution cannot meet its financial liabilities, and if it exceeds 1, the institution can theoretically take out new loans. The figure for DSCR shows a large variation and may differ greatly from year to year. - Fixed assets ratio indicates the relation between fixed assets and turnover. Institutions owning a large share of fixed assets such as real estate compared to their turnover are potentially less flexible in their strategy. - Rent ratio indicates what proportion of capital expenses consists of rent. A large value indicates the institution rents a large part of its buildings, for example from housing corporations. As this often concerns long-term lease contracts, it decreases an institution's flexibility. - Budget per client indicates the average budget available for each client. This figure reflects an institution's possibilities to provide care, and is closely interrelated with an institution's average level of care intensity. 14

15 - Number of FTEs per client is the average number of full time staff per client, and strongly depends on the balance between intramural and extramural clients. As extramural clients require significantly less contact hours, the number of FTEs per client for extramural institutions is much lower than for intramural institutions. - Absenteeism might be a related to quality, as a high rate of absenteeism is usually indicative of lower quality. The average rate of absenteeism is around 5%. - Average wage is calculated by dividing the total labour costs by the total number of full time equivalent jobs: the lower the average wage, the more FTEs are available for each client for the same share of labour costs. The average wage is corrected for any other activities an institution might engage in, so the corrected average wage will better reflect the disability care related wage. - Ideally, the Rate of labour costs for hired staff should be kept low. Hired staff is more expensive than permanent staff, as VAT is charged on hired services. A high percentage of hired staff might be indicative of lower quality. - Part-time ratio is the number of FTEs divided by the number of employees. If the figure is low, many employees work on a part-time contract. - Expenditure for 2012 is subdivided into a number of categories. Labour costs are usually by far the greatest item of expenditure. On average, an institution will spend 50% on Labour costs, 15% on social security premiums and other costs, 15% on subsistence costs ( Food costs ; General costs ; Client-related costs ), 15% on Accommodation costs, and 5% on General operational costs. - General operational costs include interest on loans as well as any allocations to be made. Interest received, extraordinary receipts or allocations released are not added to general operational costs. Therefore, the general operational income may differ from the (total) operating income. 15

16 Annex 2: Description and explanation of aggregation method for quality Description of variables The quality is measured using a publicly available set of process indicators. The set of indicators has been adjusted each year by the responsible agencies. Two pillars of quality measurements are used, of which pillar 1 and pillar 2a are publicly available. The process indicators are measured on a scale of 1 to 4, a score of 4 representing compliance to all indicator preconditions. In 2011 the set of pillar 1 consisted of 13 indicators, while 33 indicators were measured in pillar 2. In 2012 pillar 1 consisted of 14 indicators compared to 17 in pillar 2a. In 2013 pillar 1 hadd 14 indicators and pillar 2a 13. For the aggregated quality indicator both full sets for each year is used. For each institution an average score per indicator is calculated. The within-variation for each indicator at the concern level can be substantial, but is disregarded for the aggregate benchmark score. The variation between institutions is used to calculate benchmark scores. The method used here measures the extent to which institutions score above or below average. An institution with an average score is assigned the value 0. An institution that scores above average has a positive value, and an institution that scores below average has a negative one. The level of the score depends on how much better (or worse) the institution scores compared to the population. The values are transformed from a quality score to a benchmark score. Hence, the benchmark score does not say anything about the level of quality at the institution, but only says something about the position of the institution compared to the other institutions. The benchmark scores do not provide an absolute measure of quality, but a relative measure. If overall quality is good, a negative benchmark score not necessarily reflects poor quality. The benchmark score is the Z score (standard normal score) and is calculated as follows: Whereby i indicates the quality variable per institution, is the average of the population i, and is the standard deviation. This formula results in an average value of 0 for each variable and a standard deviation of 1 ( Z value). This formula has been employed for each quality indicator for each institution. These benchmark scores have the same scale, so they may be accumulated or averaged. Hence, the average benchmark score indicates the average score on all quality indicator compared to the other institutions. In addition to a single aggregate quality variable, a value is created for each pillar. The aggregate quality indicator is a weighted average of the two sub-indicators. Questions about methodology can be directed towards niek.stadhouders@radboudumc.nl. 16

17 5. Disclaimer This report was compiled by Celsus, academy for sustainable healthcare, (which is part of the Radboud University Nijmegen Medical Centre) and commissioned by the Ministry of Health, Welfare and Sport in the context of the Caretool developed by TNO. The report was produced on the basis of publicly available data. No rights may be derived from this report. Celsus is not responsible for the way the report is interpreted, nor for any consequences for the parties involved. The report has been compiled using data from 2011 through 2013, which may be out-of-date. The key figures show only a part of the entire picture, and must be interpreted in combination with additional information supplied by the institution concerned. Rather than drawing conclusions on the basis of key figures alone, the figures may serve as a basis for engaging in a dialogue with an institution. 17