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Measuring Clinical Performance in Secondary Care
Bill Shields
Director of Finance & Performance
Portsmouth Hospitals NHS Trust
Measuring Clinical Performance in Secondary Care
• Where are we now?
• Why is measurement important?
• Future developments
• Current issues
Where are we now?
• The Impact of Payment by Results means:
Activity volumes = Income
• Star Ratings:
Primary Targets about Waiting Times
Secondary Targets include some indicators of clinical quality
• Measurement of outputs NOT outcomes
Elective Inpatient Activity (FFCEs)
-500
0
500
1,000
1,500
2,000
Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04 Jan-05 Feb-05 Mar-05
Profile
Actual
Cum Var v Profile
Day Case Activity
-1,000
-500
0
500
1,000
1,500
2,000
2,500
3,000
3,500
Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04 Jan-05 Feb-05 Mar-05
Profile
Actual
Cum Var v Profile
Emergency Inpatient Activity (FFCEs)
-1,000
0
1,000
2,000
3,000
4,000
5,000
Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04 Jan-05 Feb-05 Mar-05
Profile
Actual
Cum Var v Profile
All New Outpatient Attendances(inc non-GP referrals)
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04 Jan-05 Feb-05 Mar-05
Plan
Actual
Cum Var v Plan
NEW GP OUTPATIENT WL Shape
0
200
400
600
800
1000
1200
1400
1600
1800
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Shape
Change
Primary Star Targets
OUTPATIENT WAITING
INPATIENT WAITING
12 HOUR TROLLEY WAITS
4 HOUR A&E WAITS
BOOKING
2 WEEK CANCER WAITS
HOSPITAL CLEANLINESS
FINANCIAL PERFORMANCE
Secondary Star TargetsCLINICAL FOCUS:
Thrombolysis within 30 mins 5Child Protection 3
Clinical Governance 5Clinical Negligence 3
Participation in Audits 5Deaths within 30 days of heart bypass op NA
Deaths following selected non-elective surgical procedures 3Emergency Readmissions (Adults) 3
Emergency Readmissions following # hip 3Stroke Care NA
Infection control procedures 4"Winning Ways" 5
PATIENT FOCUS:
4 hour A&E admission waits 2Patient Survey - info/choice 3
Patient Survey - clean comfortable friendly 3Patient Survey - building relationships 3
Patient Survey - safe quality co-ord care 3Patient Survey - Access & waiting 3
Better Hospital Food 3Breast Cancer treatment <1mth from diagnosis 3Breast Cancer tTreatment <2 mth from referral 3
Cancelled Ops 4Day Case booking 5
Delayed transfers of care 2Patient complaints % resolved <4 weeks 2
heart op waits NA6 month inpatient waits 3
13 week outpatient waits 4
Secondary Star Targets
Benchmarking
• E.g. Day Case Rates; LoS; Beddays; mortality
• Sources include:– CHKS– Dr Foster– Performance Investigator
Standards for Better Health
• NHS Performance Rating developing beyond Stars
• Less Quantitative measures of waiting etc
• More holistic view of all aspects of NHS Organisations
• More on Quality of care and Patient Experience
Standards for Better Health
• New Framework for monitoring NHS performance• Core and Developmental Standards organised into the
following domains:• Safety• Clinical & Cost Effectiveness• Governance• Patient Focus• Accessible & Responsive Care• Care Environment & Amenities• Public Health
Current Issues
• Data Quality– Especially clinical coding – completeness, accuracy
and depth
• Credibility and relevance to Clinicians– Poor data quality prevents proper Clinician
Engagement
• Statistical significance– Improving methods for indicating whether “outliers”
are significant– Especially important for “alerts”