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KRAs and KPIs
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Key Result Area
KRAs group strategic objectives into a
small number of areas, which make
sense.
Focuses effort on a limited number ofissues
Prevents fragmentation of effort
Facilitates communication
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KRAs
For example KRAs for the Health Service
Management Development Unit are:
Curriculum development
Collaboration with internal and externalstakeholders
Financial performance
Offshore developments Research Development
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KRAs
Example (cont)
Curriculum
Review Financial Management Topic
Aboriginal Health
Aged Care
Mental Health
Health Informatics
Web-based delivery
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KRAs Example
Hospital
Patient services
Quality and safety
Financial resource management
Human Resource Management
Community Development
Research
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NHS (UK)New Directions 2005- 2008
Patients more in control
Contribute to the community and economy
Improve health for everyone, especially thepoorest
Priorities: Access to and quality of services
Chronic disease management pathways
Commisioning skills
Appropriate (outcome based) financial incentives
Nb 5% of patients use 42% of hospital bed days
Reference: Health Service Journal 22April2004 p5 (www.hsj.co.uk)
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KRSs in the NHS
QUALITY DOMAINS Safety
Clinical effectiveness
Cost effectiveness
Governance Patient focus
Accessible and responsive care
Amenities and environment Public health
Reference: www.dh.gov.uk/consultations/LiveConsultations/fs/en
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NHS and PerformanceManagement
Independent inspecting agency : The HealthcareCommission
Standards for Better Health
Policy driven parameters of good practice Apply to whole of health system
Focus is on chronic disease and the patientexperience
Standards depend on consensus of whatconstitutes good healthcare
Reference: Health Service Journal 22 April2004: p16 18 (www.hsj.co.uk)
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KRAs
Example Department of Human Services(SA)
Key Strategic Directions Improving services for better outcomes
Increasing the States capacity to promotequality of life
Redistributing resources in a changingenvironment
Strengthening a culture of working together
Providing sound management
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KPIs
Key performance indicators are measuresfor all strategic objectives and coreprocesses, to answer the questions:
How will you (we) know that you haveachieved your strategic objectives, or at leastare making progress towards achieving them?
How do you (we) know that your coreprocesses are working well
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KPIs
Assumes that you have a strategic planand have been through a strategicplanning process
Need to measure OUTCOMES (resultsand outputs) and DRIVERS (processesand inputs)
Focus on what is important and relevantCore process: major impact on customer, profitability or
viability of the organisation
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KPIs
KPI measures (general)
Quantity
Quality
Cost
Revenue
timeliness
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HOSPITAL KPI - 1For KRA patient services:
Patient throughput by department or service e.g.emergency department, outpatients, surgical,medical
Number of patient episodes by DRG (DiagnosticRelated Group) and ALOS (Average Length ofStay)
Waiting times in emergency department
Waiting times for elective surgery
Compare this information with previous years,predicted (planned) activity or benchmark data
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KPI Patient Services (cont)
Patient satisfaction levels (PSF surveys)
New patient services developed(milestones, throughput) e..g diabetic
footcare services, womens healthservices; health screening clinic
Were anticipated milestones and throughputachieved; are we maintaining or improvinglevels of customer satisfaction?
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HOSPITAL KPIs - 2
Quality and safety: Accreditation inspections by external agencies
Clinical performance indicators: Wound infection; IV site infection
Unplanned return to theatre
Unplanned re-admission to hospital
Anaesthetic deaths
Perinatal mortality rate
Adverse drug events Critical incident notifications
Death reviews and case record audits
Patient complaints by category
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HOSPITAL KPIs - 3
Financial performance
Revenue and expenditure against budget Debts (30 days, 90 days, written off)
Capital works within budget
Debt reduction
Specific funding program deliverables
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Hospital KPIs - 4
HUMAN RESOURCE MANAGEMENT
Staff turnover
Absenteism rates Total FTEs (Full time equivalent)
Salaried staff to visiting staff ratio
% staff undergoing training and examinationresults
awards
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Hospital KPIs 4Community Development
Hospital as employer of local people
Number of community programs Health promotion activities
Links with schools
Volunteer work force
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Hospital KPIs 5Research
Research grants ($ p.a.)
Publications in refereed journals Revenue from commercialization of
research
Number of PhD students employed
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Health System KPIs - Australia Effectiveness (e.g. 5 yrs cancer survival; immunisation
rates)
Appropriate (e.g. hospital rates for Caesarian section,tonsillectomies and meringotomies, drug prescribing)
Efficient (e.g. cost per casemix (DRG) adjusted hospitaladmission; average LOS)
Responsiveness (e.g.Emergency department waitingtimes by triage category; elective surgery waiting times
Accessiblity (e.g.Number of nursing home places per 1000 > 70yrs old)
Safety (e.g.Hospital separations with adverse event)
Sustainability (e.g. %General Practitioners over 50 yrs old)
Others - e.g. continuity of care; capability)
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SMART KPIs and strategic objectives
SPECIFIC or SIMPLE
MEASURABLE
ACHIEVABLE
REALISTIC
TIMELY--------------------