Benchmarking hospital productivity

Transcription

1 Benchmarking hospital productivity Country: Finland Partner Institute: National Institute for Health and Welfare (THL), Helsinki Survey no: (7)2006 Author(s): Miika Linna Health Policy Issues: System Organisation/ Integration, Funding / Pooling, Quality Improvement, Remuneration / Payment Current Process Stages Idea Pilot Policy Paper Legislation Implementation Evaluation Change Featured in half-yearly report: Health Policy Developments 7/8 1. Abstract Since 2006 hospital benchmarking data are integrated into national statistics. Data on specialised in- and outpatient care have been analysed in a project since 1997 to develop new measures for hospital productivity. The project has produced regional and provider level indicators on costs and productivity by specialties, wards and DRG groups. Data are used to reallocate resources and restructure care processes to manage and improve hospital activities. 2. Purpose of health policy or idea Inflation of hospital costs Concerns about the impact of hospital cost inflation on the economy have prompted the emergence of various initiatives for productivity improvements. Despite the economic recovery in Finland, recent OECD reports recommend that more effort should be put into narrowing the differences in efficiency between hospitals. Information management and benchmarking are expected to provide useful tools for enhancing efficiency in public health care. Improving hospital efficiency - Hospital Benchmarking In 1997, the National Research and Development Centre for Welfare and Health (STAKES) launched a R&D project in co-operation with hospital districts to produce benchmarking information on hospital performance and productivity. A major aim of the Hospital Benchmarking (HBM) project was to develop a new measure to describe the output of hospitals better than the traditional measures such as admissions or outpatient visits. A further aim was to provide the management of hospitals with benchmarking data for improving and directing activities at hospitals. The pilot project has expanded over the years, and at present, nearly all publicly delivered specialised health care in Finland is covered. In 2006, HBM data will be integrated into the production of national statistics. HBM data The data for the HBM project are collected annually from the patient administration systems of hospitals. They include data on both inpatient and outpatient care along with information on diagnoses and surgical procedures. Diagnosis Related Groups (DRG) are used to standardise the varying patient case-mix of hospitals. The project produces a wide range of hospital and regional (hospital district and municipality based) indicators on hospital productivity and costs by - 1 -

2 specialities, hospital wards and DRG groups. Using uniform personal identity codes, the episodes of care may be linked between hospitals allowing regional measurement of productivity and costs indicating, for instance, how much the costs of a hospital district or a municipality deviate from the national average and how much of this deviation depends on the inefficient delivery of services and the per capita use of services. Dissemination of results HBM feedback information for hospital administration is mainly distributed through the Internet. Moreover, seminars and meetings are organised, a report is produced annually and training in the use of the Internet databases is arranged. Use of HBM data HBM data have increasingly been used for appraising and directing hospital activities. For example, data have been used to set hospital budget target levels that take into account the savings potential or potential for productivity improvement. HBM data have also been used to sort out the most significant patient groups from an economic perspective and to assess the savings potential in resource usage by these groups. Moreover, HBM data have been employed to reallocate resources and restructure care processes (such as the balance between outpatient and inpatient care or between hospital and long-term care). HBM pilot projects Seven pilot projects to measure the effectiveness of care have been recently launched. Each pilot deals with one health problem: heart attack, hip fracture, schizophrenia, stroke, breast cancer, very low birth weight infants and hip and knee replacements. Initial results from the pilots are already available. The innovations in outcome measurement in the project will continue. The future aim is to have a set of effectiveness measures included into the routine HBM reporting system. Main objectives Improving productivity and cost-effectiveness Type of incentives The distribution of detailed information on hospital performance for hospital administration and in future also for purchasers and patients. Groups affected Hospital administration, patients in specialised hospital care, service purchasers = municipalities 3. Characteristics of this policy Degree of Innovation traditional innovative Structural or Systemic Impact marginal fundamental Public Visibility very low very high Transferability strongly system-dependent system-neutral - 2 -

3 4. Political and economic background The pilot hospital benchmarking project was launched as a R & D project to develop a feedback information system for hospital administration on hospital performance and to improve indicators for hospital productivity. During the pilot, the efficiency of public sector has gained importance on the Government agenda. In 2003 the Government launched a national programme for improving productivity in public services. In the health care sector the hospital benchmarking project is considered as a model initiative. Change based on an overall national health policy statement National Programme for Improving Public Sector Pruductivity 5. Purpose and process analysis Idea Pilot Policy Paper Legislation Implementation Evaluation Change Origins of health policy idea The original idea on developing an information system for hospital benchmarking was generated at the National Research and Development Centre for Welfare and Health (STAKES). It was marketed to hospital districts as an instrument to evaluate productivity improvement. To achieve the objectives of the idea, the development of an instrument for continuous hospital performance was needed. This goal could be attained only by creating new information systems which can provide sufficient data for benchmarking. STAKES has been the main organiser and implementor of the project. Initiators of idea/main actors Providers Approach of idea The approach of the idea is described as: new: Innovation or pilot project Local level - Municipalities Within institution - Hospitals Else - Cross-country comparisons (Finland-Norway) Actors and positions Description of actors and their positions Providers Ministry of Social Affairs and Health very supportive strongly opposed (public) Hospital administration very supportive strongly opposed Professionals within hospitals very supportive strongly opposed - 3 -

4 Influences in policy making and legislation No Legislative outcome Actors and influence Description of actors and their influence Providers Ministry of Social Affairs and Health very strong none (public) Hospital administration very strong none Professionals within hospitals very strong none Positions and Influences at a glance Adoption and implementation The most important prerequisite for successful implementation is to provide reliable, timely and interesting data for hospitals. The hardest obstacles also lie in the trust for data quality which largely depends on the hospital information systems and data recording practices. The next important step is to include the benchmarking information into the performance measures used by strategic and operative management. Finally, managerial measures should cause desired changes in the provision of services. Monitoring and evaluation As a part of the Hospital Benchmarking Project its outcomes are evaluated informally on a continuous basis. However, no concluding evaluation has been published

5 6. Expected outcome The Hospital Benchmarking project has raised growing interest and the number of cases where the results of the project have been used for appraising and directing activities is growing. Still, there remains a large potential to be explored through wider use of benchmarking databases. In the long run, the availability of productivity and outcomes information for hospital administration is expected to result in cost containment and quality improvement. Quality of Health Care Services marginal fundamental Level of Equity system less equitable system more equitable Cost Efficiency very low very high Author/s and/or contributors to this survey Miika Linna Suggested citation for this online article Miika Linna. "Benchmarking hospital productivity". Health Policy Monitor, Available at -