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Levers for change in healthcare systems:The role of performance measurement and reporting
Jean-Frederic Levesque, MD, PhDChief Executive Officer, Bureau of Health InformationConjoint Professor, Centre for Primary Health Care and Equity, UNSW
27 August 2015
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Healthcare systems are complex and supporting them with knowledge is as fundamentalas it is challenging
Levesque, Sutherland & Corscadden 2013
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Concepts
Knowledge organisations
Enablement
Insights
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Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
What do we mean byPerformance?Knowledge?Enablement?
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Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Performance happens when structures, resources, providers and patients interact in real contexts
Levesque, Sutherland & Corscadden 2013
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Hollnagel, Braithwaite & Wears 2013
The difference between theory and practice is larger in practice than in theory
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
If actors perform on stage, athletes perform on the field,surgeons perform in surgical theatres and nurses perform at the bedside or in community centresLevesque, Sutherland & Corscadden 2013
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
DataData represents the codification of real phenomena into a form that can be analysed
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
InformationData becomes informationby interpretation
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
KnowledgeKnowledge signifies understanding of real things or abstract concepts that data and information have enabled to decipher and analyse
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
AccessibilityPrevalence
Avoidable deaths
Unmet needs Adverse events
Quality of life
High users
Duplications
Health risks
Team climate
Health literacyDisability
Hospital mortality
Costs
Safety
ResourcesSatisfaction
Coordination
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
The application of performance indicators may involve simply reporting data to actors for accountability purposes, or it may involve, in addition, taking action to stimulate changeLeatherman 2002
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
ActionKnowledge supports action through behaviour and decisions
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
ChangeHealthcare systems constantly change in terms of structures, processes and their outcomes
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Peer learning
HugTraining
BenchmarkingRegulation
Continuous education
Pay for outcomes
Pay for performance
Quality improvement
Awareness
Self-regulation
Peer-pressure
Monitoring
Incentive
Judge
Provider feedback
Cross-fertilisation
Nudge
Contract management
Monitoring
Shove
Push
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
planned
emergent
internal external
supportive
formative
coercive
normative
structural
competitive
cognitive
mimetic
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Multimodal approaches have the biggest impactOECD 2002
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Australian Commission for Safety and Quality in Healthcare
National Health Performance Authority (NHPA)
Independent Hospital Pricing Authority
UK Care Quality Commission The King’s Fund
The Nuffield Trust
Dr Foster
RAND Corporation
Centres for Medicare and Medicaid Services (CMS)
Agency for Healthcare Research and Quality (AHRQ)
USA Institute for Health Improvement
Ambulatory Care Quality Alliance (AQA) Hospital Quality
Alliance (HQA)Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
National Committee for Quality Assurance (NCQA)
National Quality Forum (NQF)
Physician Consortium for Performance Improvement (AMA)
Leapfrog Group
Bureau ofHealth Information (BHI)
USA Accountable Care Organisation
Quebec’s Health and Welfare Commissioner
La haute autoritéde santé France
Canadian Institute of Health Information
Ontario Care Quality Council
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Goals pursued and national context influence the mix of health system stewardship functions required to achieve health system goalsVeillard 2012
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Knowledgeorganisationsin New South Wales
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Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
BHI reports• Annual performance report
• Hospital Quarterly
• Insights into Care
• Patient Perspectives
• Snapshots, briefs, dashboards and profiles
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Garling Report
The public reporting of information about the health system and hospital performance is essential for the future of NSW Health. It is the single most important driver (or lever) for the creation of public confidence in the health system, engagement of clinicians, improvement and enhancement of clinical practice and cost efficiency.
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Using information to enable performance in New South Wales
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Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Coercive and cognitive leversThe example of hospital timeliness performance measures
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Percentage of patients leaving in four hours – hospitals
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Time from presentation to treatment – NSW
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
planned
emergent
internal external
supportive coercive
cognitive
competitive
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Normative and supportive leversThe example of mortality
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
30-day mortality following hospitalisation
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
30-day mortality following hospitalisation – hospital outliers
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
planned
emergent
internal external
supportive
normative
cognitive
mimetic
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Normative and structural leversThe example of Cancer ED performance measures
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
ED use at the end of life – NSW
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
ED use for cancer patients – hospital outliers
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
planned
emergent
internal external
normative
structuralcognitive
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Insights from the NSW experience
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Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
No organisation can use all levers all the time…some levers are synergistic, some are in tension
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Small organisations are more agile and responsive… lack economies of scale and depth of resources
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Specialisation brings focus and concentration of expertise…brings the risk of fragmentation and duplication
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Splitting and overlapping responsibilities enable emulation, competition and diversity andbrings resilience
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Multiple organisationscan create confusion and impose burdens on stakeholders
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
A knowledge organisation acts in a negotiated space
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
Concepts
Knowledge organisations
Enablement
Insights
1
2
3
4
Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015
planned
emergent
internal external
supportive
formative
coercive
normative
structural
competitive
cognitive
mimetic