Activity Based Funding and Management Program. Monitoring and Managing Performance

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1 Activity Based Funding and Management Program Monitoring and Managing 30 June 2011

2 This presentation will: 1. Outline the goals and benefits of Management relevant to ABF/ABM and the use of Management in other States 2. Identify the elements of ABF/ABM Management introduced by WA Health in July 2010 as the Annual Management Framework 2010/11 3. Introduce the elements of Management for 2011/ June 2011 Slide 2

3 Implementation of Management The implementation of ABF/ABM is supported by a comprehensive Management Framework (PMF). The PMF is improving health system management by: 1. More clearly identifying organisational priorities and targets 2. Rewarding good performance in areas of patient access, quality & safety, managing within budgets 3. Monitoring and management of levels of performance. Source: Health Activity Purchasing Intentions Management Framework , PAQ, May June 2011 Slide 3

4 Managing Resources to Deliver Quality management in healthcare links clinical quality, operational effectiveness and financial outcomes. Clinical quality Clinicians outcomes Patient satisfaction Compliance with clinical protocols Operational effectiveness Throughput Resource utilisation Access targets Activity Financial performance Income Expense Growth Budget Return on assets 30 June 2011 Slide 4

5 Benefits of Management There are 6 key benefits of Management in healthcare: 1. Greater Understanding of Process encourages managers to review data to assess performance, which enables the business to better understand major variances against plan, and uncover operational issues. reports become the one version of the truth and are an historical repository of the business s performance. 2. Enables Improvement Management can understand where actual performance sits relative to performance targets and budget so that actions can be put in place to recover performance, if appropriate. Monitoring actual performance provides the baseline for measuring improvements. Allows the success of actions already in-place to be measured on a regular basis. 3. Increases Accountability Tracking performance against defined metrics allows people to be held accountable for the performance of areas under their responsibility. Operational performance can be linked to incentives and rewards. Individual performance reviews can be linked to operational performance indicators and results. 30 June 2011 Slide 5

6 Benefits of Management There are 6 key benefits of Management in healthcare: 4. Instils a Culture Reviewing performance regularly instils a performance improvement culture. Monitoring performance removes silos sites and specialities are more aware of the impact they have on overall performance. Allows comparisons across business units, highlighting quality issues and/or inefficiencies, or high performance which should be replicated in other areas. 5. Focus on the Patient The strategic intent of the organisation is the focus of the performance management framework. Key performance metrics are aligned with outcomes achieved for the patient. improvement initiatives are designed to improve the patient journey and the outcomes achieved. 6. Delivering Quality Care Safety and quality indicators are included in the performance management framework to monitor and assess the organisation s performance. Safety and quality indicators are aligned and reported at all levels within the organisation. 30 June 2011 Slide 6

7 Management in other States Victoria Annual Agreements 26 KPI score with weighted domains eg financial KPIs 30% of score 30 June 2011 Slide 7

8 Management in other States NSW Annual Agreements 51 KPI 3 categories QLD and SA in consultation 30 June 2011 Slide 8

9 Management in 2010/11 for WA Health The Management Framework (PMF) is designed to drive better patient outcomes and more efficient service delivery. The 2010/11 Management process established: Area Health Service (AHS) reporting obligations for 2010/11 Service Agreements (Activity & Budget) Service Providers (Undertake routine activity within the parameters of the Service Agreements) Reporting (KPI reported to DOH) Key Indicators (KPIs), targets and thresholds monitoring and evaluation Initially the PMF will included: 10 KPIs reported by facility (where applicable) Monitoring at the facility and AHS level Management (Incentives, remediation, penalties) Agreements (CEs ) Monitoring & Evaluation ( evaluated against targets and thresholds) evaluation only at the AHS level 30 June 2011 Slide 9

10 Management WA Health implemented a Management process to facilitate service improvement. This is jointly managed by the Director General and the Area Chief Executives. This involves: On-going review of the performance of Service Providers Identifying a performance issue and determining the appropriate response Determining when a performance recovery plan is required and the level of intervention required Determining when the performance intervention needs to be escalated / de-escalated Determining when a Service Provider is no longer on performance watch. Source: Health Activity Purchasing Intentions 2010/11 Management Framework , PAQ, May June 2011 Slide 10

11 Service Agreements in 2010/11 Service Agreements have five components Service Agreements Service Providers Reporting 1. ABF for inpatients and ED 2. ABF for Ambulatory Surgery Initiative. Management 3. Remainder of services provided by AHS. 4. Mental health services which will be clearly identified in reporting and funds quarantined. Agreements Monitoring & Evaluation 5. Funding of special purpose programs. Source: Health Activity Purchasing Intentions Management Framework , PAQ, May June 2011 Slide 11

12 Management Framework Key Indicators 5 Domains Effectiveness Efficiency Equity Sustainability Processes Based on structure of the Report of Government Services (ROGS) Establishes a balanced scorecard for WA Health 30 June 2011 Slide 12

13 Key Indicators The PMF for includes five domains and ten KPIs. 1. EFFECTIVENESS Access 1. The proportion of emergency department patients seen within recommended times Hour Rule Program Percentage admitted, transferred or discharged within 4 hours. 3. Median wait time over boundary by category. 4. Elective surgery patients seen within boundary times. Appropriateness Quality 2. EFFICIENCY Inputs per output unit 3. EQUITY Access 4. SUSTAINABILITY Workforce 8. Staff turnover Facilities & Equipment 30 June 2011 Slide NET Expenditure to date distance to Budget. 6. Volume of activity to date proportion to target. 7. Elective surgery day of surgery admission rates. 5. PROCESSES Coding 9. Percentage of cases coded by end of month closing date. 10. Percentage of cases coded within boundary 80% in 2 weeks, remaining within 4 weeks. Finance Source: Management Framework , PAQ, May 2010

14 Management in 2010/11 The Management Framework (PMF) is designed to drive better patient outcomes and more efficient service delivery. 3 elements of Management AHS Service Agreements SHEF Operational Plan action items CE Personal Agreements Service Agreements (Activity & Budget) Service Providers (Undertake routine activity within the parameters of the Service Agreements) Reporting (KPI reported to DOH) The Management Report (PMR) will report monthly on: 10 PMF KPIs from Service Agreements against targets and thresholds Management (Incentives, remediation, penalties) Agreements (CEs ) Monitoring & Evaluation ( evaluated against targets and thresholds) The PMR commenced July 2010 Centrally prepared for AHS comment 30 June 2011 Slide 14

15 Management in 2010/11 Reporting Each KPI has been assessed against the thresholds at 4 levels of performance: Highly Performing- exceeding target Performing- meeting target Under-Performing- under target Not Performing- considerably under target No Indicator Strategic Pillar Target Thresholds Not Performing Underperforming Performing Highly Performing 4 Elective surgery patients seen within boundary times (a) Cat 1 < 30days (b) Cat 2 < 90 days (c) Cat 3 < 365 days Pillar 1 Cat 1: 100% Cat 2: 100% Cat 3: 100% Cat 1 <70% Cat 2:< 70% Cat 3:< 70% Cat 1: >70% < 95% Cat 2: >70% < 95% Cat 3: >70% < 95% Cat 1: >95% <98% Cat 2: >95% <98% Cat 3: >95% <98% Cat 1: >98% Cat 2: >98% Cat 3: >98% *In some instances these will be targets established by the Commonwealth Government's Department of Health and Ageing. Source: Health Activity Purchasing Intentions June 2011 Slide 15

16 Reporting 2010/11 Example of Scorecard Report KPI 1 Effectiveness Efficiency Sustainability KPI 2 KPI 3 KPI 4 KPI 5 KPI 6 KPI 7 KPI 8 KPI 9 Processes KPI 10 (a-e) Proportion of Emergency patients seen within recommended times Elective % cases Four Surgery day of a b c d e a b c a b c Expenditure a b coded by Hour surgery Staff turnover a b to date end of Rule admission % Cat month % % Cat % Cat (DOSA) rates % Triage % Triage % Triage Cat 1 Cat 2 Cat 3 3 Triage 1 2 ED 80% in 2 Cat 3 - Cat 4 - Cat 5 - > 30 > 90 > 365 < = Separations Cat 2 - < = 30 < = 90 Attendances weeks 30 min 60 min 2 hours days days days min days days days % Triage Cat 1-2 mins (a-c) Elective surgery number of cases over boundary (a-c) Elective surgery % patients seen within boundary times (a-b) Volume of Activity to date - Proportion of target (a-b) % cases coded in boundary times FACILITY AHS 1 n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 n/a n/a n/a n/a n/a n/a n/a Hospital 1 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Hospital 2 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 n/a n/a Hospital n/a n/a n/a n/a AHS 2 n/a n/a n/a n/a n/a n/a n/a 0 n/a n/a n/a n/a 0 n/a n/a n/a n/a n/a n/a n/a Hospital n/a n/a n/a n/a Hospital n/a n/a n/a n/a AHS 3 n/a n/a n/a n/a n/a n/a n/a n/a n/a -1 n/a n/a n/a n/a n/a n/a n/a Hospital n/a n/a n/a n/a Hospital 7 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 n/a Hospital n/a n/a n/a n/a Hospital 9 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 n/a Remaining cases within 4 weeks of discharge COLOUR KEY: Not Performing Under Performing Performing Highly Performing n/a Not Applicable 30 June 2011 Slide 16

17 Future Directions The Management Strategic Directions 2011/12 to 2013/14 Consultation Framework will collaborate with stakeholders on the shape of the PMF. Consultation on Triennial Strategic Directions and Draft Annual PMF 2011/12 commenced 24 September 2010 and is now at a conclusion The 2011/12 PMF consultation was limited to the components of the PMF and their design including: Reporting obligations for 2011/12 KPIs, targets and thresholds monitoring and evaluation Management interventions Governance. Source: Management Strategic Directions to , PAQ, July June 2011 Slide 17

18 Management in 2011/12 The Management Framework (PMF) is designed to drive better patient outcomes and more efficient service delivery. The 2011/12 Management process establishes: Area Health Service (AHS) reporting obligations for 2011/12 Key Indicators (KPIs), targets and thresholds monitoring and evaluation The proposed PMF will include: Additional KPI to complete the dimensions Monitoring at the Agency, facility and AHS level evaluation only at the AHS level Rewards and penalties may apply Service Agreements (Activity & Budget) Service Providers (Undertake routine activity within the parameters of the Service Agreements) Management (Incentives, remediation, penalties) Agreements (CEs ) Reporting (KPI reported to DOH) Monitoring & Evaluation ( evaluated against targets and thresholds) 30 June 2011 Slide 18

19 Aligned to National Reporting Requirements Readiness for National Reform is critical to WA Health National Health Care Agreement National Partnership Agreements: For example, Closing the Gap in Indigenous Health Outcomes Australian Commission on Safety & Quality in Health Care COAG Agreement National Health and Hospitals Network Agreement 30 June 2011 Slide 19

20 Key Indicators Safety and Quality Clinical outcomes and current indicators will continue to be monitored by the OSQH. In addition the indicators endorsed in November 2009 by the Australian Health Ministers are listed below. The set of six national core hospital-level outcome indicators are: 1. Hospital standardised mortality ratio (HSMR); 2. Death in low-mortality Diagnosis Related Groups (DRGs); 3. In-hospital mortality rates for: acute myocardial infarction; heart failure; stroke; fractured neck of femur; and pneumonia; 4. Unplanned hospital re-admissions of patients discharged following management of: acute myocardial infarction; heart failure; knee and hip replacements; depression; schizophrenia; and paediatric tonsillectomy and adenoidectomy; 5. Healthcare associated Staphylococcus aureus bacteraemia infections, including Methicillin resistant Staphylococcus aureus (MRSA); and 6. Clostridium difficile (C.Diff) infections; Source: Health Activity Purchasing Intentions June 2011 Slide 20

21 Management in 2011/12 The Management Framework (PMF) is designed to drive better patient outcomes and more efficient service delivery. The proposed 2011/12 Management process establishes: Incentives- policy in drafting stage Service Agreements (Activity & Budget) Service Providers (Undertake routine activity within the parameters of the Service Agreements) Reporting (KPI reported to DOH) A process to address performance concerns 3 levels of Intervention Management (Incentives, remediation, penalties) Agreements (CEs ) Monitoring & Evaluation ( evaluated against targets and thresholds) 30 June 2011 Slide 21

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