1 ehma annual conference, athens, greece katrien verleye 25 – 27 june 2008 increasing importance...
TRANSCRIPT
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EHMA Annual Conference, Athens, Greece
Katrien Verleye
25 – 27 June 2008
INCREASING IMPORTANCE OF PERFORMANCE MEASURES IN THE HOSPITAL SECTOR
Equity under pressure?
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Overview
1. Context
2. Research questions
3. Methodology
4. Results
5. Discussion
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CONTEXT
HOSPITAL’S PERFORMANCE
REGULATORS AND
OTHER ENTITIES
Suppliers
Consumers and purchasers
Internal members
Kanji & Sá (2003)
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CONTEXT
Need to control costs without losing qualitycf. increasing costs and need in budget
Increased attention for quality improvementcf. lapses in quality
Focus on controlling the financial performance
Ensuring quality as important issue in hospital sector
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CONTEXT
Demand for transparency and accountability
PERFORMANCE MEASUREMENT (PM)…
» … translates the hospital’s performance in quantifiable metrics
» … informs different stakeholders on the hospital’s performance
» … enables stakeholders to follow up, coordinate, control and improve (aspects of) the hospital’s performance
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RESEARCH QUESTIONS
performance
development
selection
measurement interpretation management
1. How is performance defined?
2. How is performance measured within the hospital sector?
3. How is performance information used within the hospital sector?
4. How do hospitals evaluate their performance measurement systems?
5. Which are the implications of PM on equity in healthcare?
PERFORMANCE MEASUREMENT MODEL
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METHODOLOGY
Evaluation of PM in hospitals in Belgium
FLEMISH CASE
- subjected to the Belgian government Cf. http://www.belgium.be/en/health/index.jsp
- subjected to the Flemish governmentCf. http://www.zorg-en-gezondheid.be/HomeEN.aspx?id=1182
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METHODOLOGY
Flemish Region Flemish Communtiy Population: 6,117,440
Total area: 13,522 km²
5 Flemish Provinces
Acute hospitals:
• 62 hospitals
• 104 campuses
Universitary hospitals:
• 4 hospitals
• 6 campuses
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METHODOLOGY
Survey in 13 Flemish hospitals
- 2 to 3 hospitals per Flemish province
- both universitary and non-universitary
- interpretation of each PM step
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RESULTS
*PERFORMANCE
- multidimensional
- influenced by stakeholders
- context
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RESULTS
SELECTION AND DEVELOPMENT OF PIs
- measuring all performance aspects: unfeasible and irrelevant
- several performance aspects and indicators
- motivation • statutory required !!!• supportive networks• self-developed indicators: result of historical factors
added value for hospital
**
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Statutary required financial indicators Statutary required minimal hospital data Clinical indicators Navigator Patient safety indicators Navigator Operational indicators Navigator Patient satisfaction indicators Employee satisfaction indicators HR indicators Financial indicators Clinical indicators VZN Leuven Clinical indicators Patient safety indicators Complaint services Clinical indicators PATH-2 HR indicators PATH-2 Logistic indicators
RESULTS
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RESULTS
BUT
- too many PI’s and unclear definitions
- “not reflecting the performance”
- “difficult to find reliable and valid indicators”
- no participation of employees in the selection
**
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RESULTS
PERFORMANCE MEASUREMENT
- measurement on the departmental level
- several employees are involved
- mostly supported by ICT
*
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RESULTS
BUT
- lack of motivation
- time consuming
- incorrect and incomplete data
- overlap
*
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RESULTS
ANALYSIS AND INTERPRETATION
- focus on deviating measures
- supported by ICT: basic analysis
- put out the data analysis to supportive network• Government• Navigator• Flemish Hospital Network Leuven
*
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RESULTS
BUT
- feedback government and supportive networks not satisfactory
- no integration of performance indicators
- lack of standards
*
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RESULTS
USING PERFORMANCE INFORMATION
“what gets measured, gets done”= ‘the most famous aphorism of performance measurement’ (Behn, 2003)
VERSUS
“to raise questions, not to provide answers”(Likierman, 1993)
*
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RESULTS
USING PERFORMANCE INFORMATION
*Heemskerk & van Zandwijk (2004)
Kanji & Sá (2003) FLEMISH HOSPITALS
(external) justification
communication to employees
communication and reporting
giving accountgiving account
(internal) direction examining progressstrategic planning &
implementation
driving improvementimproving
performance
supervisionresource allocation
decisionsdecision-making
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RESULTS
BUT
- employees are not informed
- external use, but limited internal usecf. ‘information is too general to use’cf. ‘PM is not embedded in the decision structure of the organization’
- PM does not achieve its goal
*
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DISCUSSION
FOCUS ON USING PERFORMANCE INFORMATION
1. Comparison among hospitals
2. Having decisions made by external stakeholdersCf. accreditation
Cf. pay-for-performance
3. Public disclosure of performance information Cf. rankings
Improving the performance of hospitals(Chandrima, 2005; Hamblin, 2007; Helm, Holladay & Tortella, 2007)
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DISCUSSION
COMPARISON AMONG HOSPITALS
- incomplete and incorrect measures- different ways of measuring indicators- different indicators
- different definitions
- based on different strategies
- different input !
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DISCUSSION
DECISION-MAKING BY EXTERNAL STAKEHOLDERS AND PUBLIC DISCLOSURE
- reflecting performance?cf. tunnel vision (Vakkuri & Melkin, 2006)
- is standardization possible?cf. differences between hospitalscf. do hospitals have a sector-specific strategy?
- getting a good score in stead of improving performance cf. risk of misrepresentation (Vakkuri & Melkin, 2006)
• specializing in a few domains• refusing patients who lower score
- risk of ossification (Vakkuri & Melkin, 2006)
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DISCUSSION
CAUTION IS RECOMMENDED
revising previous steps before use- reflection- systematization
adjustment for patients’ characteristics
performance measures are “flags requiring cautious interpretation in the light of local circumstances” (Veillard et al., 2005; p. 492)
involvement of different stakeholders
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Interesting references
Behn, R.D. (2003). Why measure performance? Different purposes require different measures. Public Administration Review, 63( 5), 586-606. Aidemark, L.-G. (2001). The meaning of balanced scorecards in the health care organisation. Financial Accountability & Management, 17(1), 23-40.
Bauer, K. (2004). KPIs – the metrics that drive performance management. DM Review, 14(9), 63-64.
Becker, B., Formisano, A., & Roger, M.D. (2006). Strategic planning for departmental divisions in an academic health care centre. The American Journal of Medicine, 199(4), 357-365.
Chandrima, B.C. (2005). Accreditation in hospitals. Expressed Healthcare Management. Retrieved May 7, 2008, from http://www.expresshealthcaremgmt.com/20050915/accreditation01.shtml.
Heemskerk, P., & Van Zandwijk, M.C. (2004). Verantwoordingsprocessen in de zorg op basis van de balanced scorecard. Zoetermeer: het Expertise Centrum.
Helm, C., Holladay, C., & Tortorella, F.R. (2002). What’s in a name? Reporting data from public institutions. CMAJ, 22(2), 193-194.
Kanji, G.K., & Sá, P.M. (2003). Sustaining healthcare excellence through performance measurement. Total quality management, 14(3), 269-289.
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Interesting references
Kollberg, B. Elg, M., Lindmark, J. (2005). Design and implementation of a performance measurement system in Swedish health care services. Quality Management in Health Care, 14(2), 95-111.
Rooney, A.N., & van Ostenberg, P.R. (1999). Licensure, accreditation, and certification: approaches to health services quality. Center for Human Services. Retrieved May 4, 2008, from http://www.qaproject.org/pubs/PDFs/accredmon.pdf
Tarantino, D.P. (2003), Using the balanced scorecard as a performance management tool. The Physician Executive, September-October, 69-72.
Ten Asbroek, A.H.A., Arah, O.A., Geelhoed, J., Custer, T., Delnoij, D.M., & Klazinga, N.S. (2004). Developing a national performance indicator framework for the Dutch health system. International Journal for Quality in Health Care 16(1), 165-171.
Vakkuri, J., & Meklin, P. (2006). Ambiguity in performance measurement: a theoretical approach to organisational uses of performance measurement. Financial Accountability & Management, 22(3), 235-250.
Veillard, J., Champagne, F., Klazinga, N., Kazandjian, V., Arah, O.A., & Guisset, A.I. (2005). A performance assessment framework for hospitals: the WHO regional office for Europe PATH project. International Journal for Quality in Health Care, 17(6),487-496.
Yap, C., Siu, E., Baker, G.R., Brown, A.D., & Lowi-Young, M.P. (2005). A comparison of systemwide and hospital-specific performance measurement tools. Journal of Healthcare Management, 50(4), 251-264.
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Contact information
Katrien Verleye
Scientific Staff Member
+ 32 9 210 98 [email protected]
Reep 1B-9000 GentBelgium
www.vlerick.com
Vlerick Leuven Gent Management School