Some health systems have moved faster than others in adopting performance indicators as tools for quality improvement and have made details of their indicators and systems for applying them publicly available at national, regional or institutional levels. The e-mail addresses that you supply to use this service will not be used for any other purpose without your consent. Health system performance comparison: new directions in research and policy, Methods to stimulate national and sub-national benchmarking through international health system performance comparisons: a Canadian approach, Measuring quality of care with routine data: avoiding confusion between performance indicators and health outcomes, What makes a good performance indicator? For more information view the SAGE Journals Article Sharing page. Concepts that focus on both health promotion and risk reduction are included in the performance indicators. Notwithstanding these kinds of shortcomings, it is useful to assess the frameworks and performance indicators in a sample of countries for the insights this provides. View or download all content the institution has subscribed to. As the term indicator suggests, performance indicators give a signal, and thus suggest a direction for research and actions by health care providers and policy makers. The timing and mechanism of reporting on indicators were not consistent between countries, nor were they always internally consistent. Local Performance Accounts information for the Directorate for People: Adults' Social Care Services. Canadian Institute for Health Information . 3. Background: There is continuing demand to demonstrate effectiveness and efficiency in health and social care and to communicate this at boardroom level. The purpose of the table was to compile an initial ‘long-list’ of available indicators and then to identify a ‘short-list’ of those reported in multiple countries. The Organisation for Economic Co-operation and Development (OECD) publishes 60 internationally comparable indicators of healthcare quality.9 These are useful and influential. If you have access to a journal via a society or association membership, please browse to your society journal, select an article to view, and follow the instructions in this box. Secondly, it reviews the evidence as to how we might develop targets and indicators as For more information view the SAGE Journals Sharing page. An example of a framework which operates at multiple geographical levels is that used in England’s National Health Service (NHS). Key Performance Indicators define factors the institution needs to benchmark and monitor. Find out about Lean Library here, If you have access to journal via a society or associations, read the instructions below. You should remember that performance management isn’t just about issues – it’s also key to motivating, supporting and encouraging hardworking staff. Health system performance comparison: an agenda for policy, information and research. Similarly, in Denmark, clinical indicators are reported, and a structured audit process is initiated every 6 months by audit groups of clinicians at national, regional and local levels to explain the risk-adjusted results and to plan improvements. Department of Health . The framework first illustrates how performance in the health financing functions of revenue collection, pooling and purchasing affects the realisation of health financing targets of resource generation, optimal resource use and financial accessibility of health services for all. The set of performance indicators provided in this article should help policy makers to monitor the development of social health insurance schemes and identify areas for improvement. The search found 401 indicators that fulfilled the ‘nationally consistent and locally relevant’ criteria. The reason is simple—quality of care can be enhanced by incorporating the management concepts of continuous quality improvement (CQI). Much of this interest in quality of care has developed in response to recent dramatic transformations of health care systems, accompanied by new organizational structures and reimbursement strategies that may affect quality of care. the Association of Directors of Adult Social Care (ADASS) and the Chartered Institute of Public Finance and Accountancy (Cipfa)). a number of key performance indicators (KPIs) for assessing the performance of healthcare accreditation programmes in order to contribute to the current knowledge in performance measurement and improvement in public sector and specifically health care. Regular review of the performance framework and indicators is conducted in most of the eight countries by government or government-funded, arm’s-length bodies. In reviewing existing targets and indicators for health and social care, this report considers first what the policy framework for public sector bodies tells us about the aims and objectives of the health and social care system. These comparative data inform researchers and policymakers internationally when designing health performance frameworks and indicator sets. Nationwide continuous quality improvement using clinical indicators: the Danish National Indicator Project, Connections between quality measurement and improvement, Clinical indicators in accreditation: an effective stimulus to improve patient care, Performance management in healthcare: part II – state of the science findings by stage of the performance measurement process, Using performance indicators to improve health care quality in the public sector: a review of the literature, What’s measured is what matters: targets and gaming in the English public health care system, Does providing feedback on patient-reported outcomes to healthcare professionals result in better outcomes for patients? Nationally consistent and locally relevant indicators by country. The process of review, seen especially in England, Canada and Australia, is critical to the continued development of performance indicators and their use. This product could help you, Accessing resources off campus can be a challenge. This will provide comparative cases and information on progress for the benefit of regulators, policymakers and researchers within those countries and elsewhere, but is of particular use to policymakers interested in constructing future frameworks. For example in the Australian PAF, the domain appropriateness is subordinate to, or sub-class of, the domain effectiveness.18 In Canada, these two domains are not grouped, but are classified as separate concepts. Of these, 45 indicators are reported in more than one country. National Institute of Public Health and the Environment . At the time of the study, this provides advanced indicators and applies them throughout the country. National minimum standards for certain services in social care, national occupational standards and codes of practice are shaping the performance management framework in the social care sector. Of the 11 frameworks published in five countries and the OECD, the most frequently used (self-reported) domains were effectiveness (eight), access and safety (seven each) and efficiency (five; Table 2). Performance indicators are quantitative tools and are usually expressed as a rate, ratio or percentage. The set of performance indicators provided in this article should help policy makers to monitor the development of social health insurance schemes … There were 101 performance indicators listed on the SC website.35 The CIHI also has indicators listed under the Canadian Hospital Reporting Project (CHRP). The progress they have made, and choices taken in selecting and using indicators, might be of value for other health systems in contemplating the development of their indicators or frameworks, or modifying their performance mechanisms. Coronavirus disease outbreak (COVID-2019), Coronavirus disease outbreak (COVID-19) », Applied Health Economics and Health Policy web site. Assessing commonalities and differences between indicator specification and application in comparable health systems may be of value to regulators, policymakers, researchers and clinicians and forms a foundation for further research into the practical impact of indicators on the quality of healthcare. These standards are overseen by the International Society for Quality in Healthcare (ISQua).22 The Danish National Indicator Project (DNIP) merged with the Clinical Quality Development Programme (RKKP) in 2010.8 Although Denmark lacks a formal framework, the DNIP manual outlines the thinking behind its clinical indicators and planned future indicators (1) to improve prevention, diagnostics, treatment and rehabilitation; (2) to provide documentation for setting priorities and (3) to create an information resource for patients and consumers. England and Canada do the most extensive research and development work to select indicators. Comprehending each patient’s stay, how long they must wait for services, and how they perceive you can lead to valuable BI insights and actionable results. Devising primary care performance indicators for New Zealand, A conceptual framework for the OECD Health Care Quality Indicators Project, Primary health care reform in Australia – report to support Australia’s first National Primary Health Care Strategy, 2011 National healthcare quality and disparities reports, Rising to the challenge – results from a scorecard on local health system performance, Conceptual frameworks for health systems performance: a quest for effectiveness, quality, and improvement, Correlates of health and healthcare performance: applying the Canadian health indicators framework at the provincial-territorial level, International profiles of health care systems, Developing a national performance indicator framework for the Dutch health system, Health care performance in the Netherlands: easy access, varying quality, rising costs, OECD reviews of health care quality: Denmark: executive summary, assessment and recommendations, About the Quality and Outcomes Framework (QOF), Unintended consequences of performance measurement in healthcare: 20 salutary lessons from the English National Health Service, Health indicators 2013: definitions, data sources and rationale, Canadian Hospital Reporting Project technical notes – clinical indicators, Healthy Canadians: a federal report on comparable health indicators. Please read and accept the terms and conditions and check the box to generate a sharing link. KPI is a measure used to define and evaluate how successful an organization is. The focus of this set of indicators is directed towards the question how care homes can measure and manage improvements with regard to the quality of life of their clients, and the related issues of quality of care, management, economic performance and relationships with external stakeholders. We selected eight prominent health systems for review and assessment based on purposively selecting a sample that were exemplars in using indicators and making their data and performance systems available: Australia, Canada, Denmark, England, the Netherlands, New Zealand, Scotland and the United States. Van den Berg, M, Heijink, R, Zwakhals, L. National Institute for Health and Clinical Excellence . Nationally consistent and locally relevant indicators by disease group. Table 4. Braithwaite, J, Matsuyama, Y, Mannion, R. Healthcare reform, quality and safety: perspectives, participants, partnerships and prospects in 30 countries. Shekelle, P, Lim, Y-W, Mattke, S. Does public release of performance results improve quality of care? Some indicators were classified into more than one category (Table 4). Healthcare and Social Assistance KPIs. CMH Community Mental Heath (CMH) Domain 1 - Enhancing the quality of life for people with care and support needs 40% 46% 5% The World Health Organisation (WHO)1 and others2,3 have attempted to rank health systems for the insights gained from global comparisons, while consumers have an interest in selecting the best provider for treatment for their particular condition and knowing that their taxes are being spent wisely.4 To meet these multiple demands, performance indicators (‘measurable elements of practice performance for which there is evidence or consensus that they can be used to assess the quality, and hence change of quality, of care provided’) and performance frameworks (‘conceptual frameworks that set out the rationale and design principles for an indicator set’)5,6 are typically designed to routinely monitor aspects of healthcare performance such as effectiveness, efficiency, safety and quality.7 The quest for a single composite indicator of quality, prevalent in the early days of indicator development, has largely been abandoned in favour of multidimensional frameworks.1 Indicator sets commonly contain a combination of structure, process and outcome assessments.8. The Canadian framework has two main goals: to determine (1) the health of Canadians and (2) how well the health system performs and operates according to the published principles of providing reports that respect Canadians’ privacy and are also consistent, relevant, flexible, integrated, user-friendly and accessible.19,20 The indicator framework is conceptualised in terms of the provision of high-quality comparative information across four dimensions. Cross border care EU: how to choose the best hospital? Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article. It is broadly agreed that monitoring performance imposes an inherent pressure on healthcare organisations or services to improve practice.48 However, the extent to which this is accomplished is disputed and under-researched. Key performance indicators in healthcare present you with a visual and easy-to-digest means of analyzing your operations. For more than two decades, regulators, policymakers, researchers and clinicians have endeavoured to improve the quality of healthcare by designing and applying indicators of performance. After the audit process is complete, the data are released publicly, including comments on the results from the audit groups.40 Reports on many of the indicators are available on the www.sundhed.dk website. For example, the Canadian framework has continually developed and evolved since its inception, as a result of collaboration from a dedicated group including the Canadian Institute for Health Information (CIHI), Statistics Canada (SC), Health Canada (HC) and representatives from other stakeholder groups.19 Similarly, the National Institute for Health and Clinical Excellence (NICE) has a key role in indicator development in England. For consumers, it suggests a direction for making choices on health care … While there is no answer to questions such as how many indicators, which domains should be targeted or what should be the right mix of indicators, there is a fundamental debate centred on whether the purpose of performance indicators is accountability or quality improvement.41–43,46 Internationally, there is a split between those countries which emphasise public reporting and accountability (e.g. Institute of Medicine . Domains of performance indicators by country. Table 5. There are national and international incentives for rating the performance of health systems. The search yielded 219 community-level, 231 hospital-level and 37 population-level indicators. Selected countries and indicators for performance evaluation of their health system 4.1. The National Skills Academy for Social Care (NSASC), part of Skills of Care, and the NHS Employers Organisation (NHS E), have been commissioned by the Department of Health to produce an online hub to support line managers in health and social care in the effective performance management of … The importance of a logical, universally acceptable and viable conceptual framework to underpin development of a national performance indicator set is also emphasised in the literature.41,42 A conceptual framework sets out the rationale and design principles for the indicator set and links it to the wider health system context. For example, every time you assess a patient you are using KPIs. For example, the Health Indicators 2013 report20 provides results for 88 indicators, 13 of which were additional indicators chosen to be included to measure performance by socioeconomic status at provincial and national levels.20 Although this appears confusing from an external perspective, variable reporting may be more effective in some instances, as CIHI addresses reporting needs by acknowledging different audiences and tailoring reporting for their requirements. Meanwhile, in the Netherlands, a report detailing results for all 125 indicators is published every 2 years.38 From 2011, the information was updated via a website twice a year and from 2014, the report will be published every 4 years.38 The indicators are reported at the national level, not locally. In Australia, the National Health Performance Authority (NHPA)16 was established under the Australian National Health Reform Act 201117 as an independent portfolio agency to monitor and report on healthcare system performance; it has since been merged with the Australian Institute of Health and Welfare. Within these, eight domains of health system performance are defined.19,21. The paucity of research examining the links between indicators and improvement may be due to the difficulty in attributing change to any particular policy initiative or intervention.49, The literature supports the use of performance indicators, suggesting that their impact is more likely to be on provider rather than consumer behaviour.43,50 However, there is a general call for more good quality studies on impact.50–52. The email address and/or password entered does not match our records, please check and try again. Local Performance Account Reports. These enable health and social care providers to: Identify gaps and areas for local improvement; Measure the quality of care they provide Representatives of the Netherlands’ Ministry of Health, Welfare and Sport collaborated with academic researchers to develop the conceptual framework after reviewing the strategic goals of the healthcare system, information needs of policymakers and studying existing theory and international experiences.24 The resulting framework divides healthcare into four specific community needs: (1) staying healthy, (2) getting better, (3) living independently with a chronic illness and (4) end-of-life care.25, New Zealand has included an atlas of healthcare variation as one of its four health system performance monitoring mechanisms,26–29 and other countries such as the United States and the United Kingdom utilise an atlas, too. Instead, as a proxy framework, the Danish Institute for Quality and Accreditation in Healthcare (IKAS) manages the Danish Healthcare Quality Program (DDKM) as a national accreditation and standard–based programme. The atlas is organised according to clinical areas: maternity, demography, cardiovascular disease, gout, polypharmacy and surgical procedures.29 In 2013, the NZ Health Quality and Safety Commission’s campaign Open for Better Care was commenced to measure whether planned changes in practice occur and whether they have resulted in reduced costs and harms.28. Access to society journal content varies across our titles. Table 3 contains a breakdown of indicators by country. A particular characteristic or dimension used to measure intended changes defined by an organisational unit’s results framework. Performance indicators are a popular mechanism for measuring the quality of healthcare to facilitate both quality improvement and systems management. Performance indicators are used to observe progress and to measure actual results compared to expected results. Of course, this statement masks the contested and political components of indicator development and use, which does not figure explicitly in policy documentation, academic articles or this review and is mostly country-specific.34. Performance indicators are a popular mechanism for measuring the quality of healthcare to facilitate both quality improvement and systems management. FundingThis work was supported, in part, by the National Health Performance Authority, Australia (but no one including the Authority’s officers had a role in the study, its conduct, results, interpretation or publication of this article) and the National Health and Medical Research Council (APP1054146). 3. Several low- and middle-income countries are interested in extending their existing health insurance for specific groups to eventually cover their entire populations. Measuring the quality of health care. Some society journals require you to create a personal profile, then activate your society account, You are adding the following journals to your email alerts, Did you struggle to get access to this article? Then, within each health financing function, key performance issues and associated measurable indicators are developed. Understand, in particular, how the performance of adult social care and NHS services are dependent on each other, and that there is a shared imperative to prevent health the UK NHS’s ‘star-ratings’ system of 2001–2005)47 and those that use results for non-publicised feedback to organisations to stimulate improvement. Other indicators of family health could be extrapolated from the addi-tional concepts that King identified as impor-tant for understanding social systems: orga- One reports nationally (the US Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ)), one internationally (The Commonwealth Fund) and one locally (Hospital Compare). A systematic review, Public release of performance data in changing the behaviour of healthcare consumers, professionals or organisations, The public release of performance data: what do we expect to gain? Indicators are sometimes also used to promote consumer choice at a regional or local level. We conducted our Internet search of performance indicator systems in the eight comparator countries in May 2013. The search in eight countries found 401 indicators that fulfilled the ‘nationally consistent and locally relevant’ criteria we applied. The quality of health care is on the agenda in most health care systems. Contact us if you experience any difficulty logging in. Approached in this way, performance management can promote excellence in service delivery and result in a more highly motivated and involved workforce. Although we presented the self-reported domains by country, consistency of definitions between countries and the level of semantic overlap was not tested; however, these are likely to be substantial. Comparison of Crude Population-Level Indicators of Opioid Use and Rela... Smith, P, Papanicolas, I. Sign in here to access free tools such as favourites and alerts, or to access personal subscriptions, If you have access to journal content via a university, library or employer, sign in here, Research off-campus without worrying about access issues. How do I know if my local council is providing good social care? NICE has developed guides,32,33 which set out in detail the processes involved in managing the development of indicators. A performance indicator is not a synonym for quality, but rather a proxy. Number of pages: 15-22 the site you are agreeing to our use of cookies. With the strong encouragement of leading health care agencies, business principles are being implemented throughout health care, including emergency medical services (EMS). Languages: English. When autocomplete results are available use up and down arrows to review and enter to select. I have read and accept the terms and conditions, View permissions information for this article. Quality indicators have also been developed for home care , post-acute care ), and mental health; • Commonly-used, standardized interRAI scales (e.g., the Cognitive Performance … Be partnership-oriented. The OECD and Departments or Ministries of Health and associated government health organisations in each country were searched. By continuing to browse Performance indicators are published for all 150 council-run social services departments in England. Vision and Strategy for Adult Social Care and Health; What to do if you have changed, or are planning to change, your Care Quality Commission registration; Local Performance Account reports. However, it is difficult to gauge how many indicators are in use, because only certain indicators are selected for inclusion in the annual reports and there appear to be various degrees of overlap. Staff-To-Patient Ratio: Indicates the use and capacity of staff resources, which can affect the quality … Indicators that were collected consistently on a national scale were included, but could be relevant and useful to local quality improvement efforts. Of these, 45 indicators are reported in more than one country. This research aims to identify and analyse indicators and their frameworks which report on the performance of healthcare organisations and local health areas. National Institute for Health and Clinical Excellence . Domains within the performance frameworks were compared. The role of NICE in England exemplifies a thorough and considered approach to continued indicator development. Few studies make comparative assessments of different countries’ performance indicator frameworks. Selected countries Across all OECD countries, health care is financed by a mix of public and private spending. Login failed. Australian Institute of Health and Welfare . For those countries interested in such an extension, it is important to understand what characterises a well performing social health insurance scheme. However, many countries, even those with advanced data systems, have difficulty linking practice performance to outcomes because of limitations in data availability and poor capabilities to link data. Members of _ can log in with their society credentials below, Jeffrey Braithwaite, Peter Hibbert, Brette Blakely, Jennifer Plumb, Natalie Hannaford, Janet Cameron Long, and Danielle Marks, This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License (. Cardiovascular, surgery and mental health were the most frequently reported disease groups. The number and focus of frameworks varied greatly between the eight countries, but typically included reference to both monitoring and improving quality and efficiency of the healthcare system. Identification of comparable international indicators and analyses of their characteristics and of their broader national frameworks and contexts were undertaken. Table 1. The HCP integrated commissioning framework defines KPIs as: View or download all the content the society has access to. This site uses cookies. This study identifies and compares frameworks and performance indicators used in selected Organisation for Economic Co-operation and Development health systems to measure and report on the performance of healthcare organisations and local health systems. In this study, the eight countries selected for review were using indicators and had implemented a performance framework, several over more than a decade. Methodology This paper outlines the core suite of indicators, summarising the rationale for inclusion and information on the proposed definition and data source for each indicator in section . Most of the eight countries have an overarching framework for the selection and reporting of indicators which establish the broader aims for their implementation activity and play a large role in indicator selection and use. SAGE Publications Ltd, unless otherwise noted. The health system performance frameworks for each country were reviewed together with their accompanying online and published documentation. A scoping table detailing the indicators by country was developed. Cordasev, H, Arne Björnberg, M, Hjertqvist, O. Raleigh, VS, Foot, C. Getting the measure of quality: opportunities and challenges. Indicators reported locally (at regional levels) occur via the Dutch Hospital Database. Indicators tend to be more specifically linked to a clinical condition or disease group in some countries such as Denmark.30. Organisation for Economic Co-operation and Development . So many health care systems in Europe can be identified as the mix health care models with some dominant source of funding. Simply select your manager software from the list below and click on download. These sample KPIs reflect common metrics for both departments and industries. Summary of the eight countries: demographic characteristics and health performance frameworks. Manuscript content on this site is licensed under Creative Commons Licenses. There are likely to be considerable overlap between the definitions of some of the domains such as effectiveness and appropriateness. Number of international indicators by domain and community, hospital and population. 1.2.3 Describe ways to prevent communicable diseases. In doing so, policy makers can come closer to achieving universal coverage - access to appropriate healthcare for all at an affordable cost - the ultimate goal of social health insurance. Scotland conceptualised its Quality Measurement Framework on three levels to structure and coordinate the range of measurements that are taken across NHS Scotland. At the time of our review, all had made progress in selecting or applying indicators to measure or stimulate improved performance and most had developed a framework for conceptualising performance improvement or indicator use. For monitoring long-term progress, there are 12 Quality Outcome Indicators (QOIs) which do not have specific targets; short-term priority areas are focussed on by the ‘HEAT’ targets: Health improvement for the people of Scotland (H), Efficiency and governance improvements (E), Access to services (A) and Treatment appropriate to individuals (T); and the third category includes all other national and local reporting requirements. While there is no single integrated framework, the AHRQ measures health system performance across four dimensions13 and the Commonwealth Fund aims to be a catalyst for change by identifying promising practices to help the United States create a high-performing healthcare system.14 The Commonwealth Fund spans four dimensions of health system performance: access, including insurance and affordability of care; prevention and treatment, including quality of ambulatory, acute, post-acute and palliative care; avoidable hospital use and cost, such as care that could have been avoided if the patient received appropriate care initially; and indicators assessing the extent to which people can enjoy long and healthy lives.15. Boardroom level results framework software installed, you can be a challenge continuous quality improvement systems... Thorough and considered approach to continued indicator development via any or all of the family system measurable elements health. 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