aom-p1630 (2020 key performance indicator annual review)

- 1 -

For decision AOM-P1630

on 28.1.2021

Hospital Authority

2020 Key Performance Indicator Annual Review

Decision Sought

This paper invites Members to note and comment the recommendations of the 2020 Key Performance Indicator (KPI) annual review made by the KPI Review Working Group (Working Group) and approve the revised list of KPIs for reporting in 2021-22 as set out in Annex 4. The same has been reported to / endorsed by the Medical Services Development Committee (MSDC), Human Resources Committee (HRC), and Finance Committee (FC)1. Background

2. The KPI framework2 of the Hospital Authority (HA) covers three pillars, namely clinical services, human resources (HR) and finance. Each of the pillars is supported by a collection of KPIs which are selected based on a set of criteria as set out in Annex 1. For continuous development of the KPIs, the Working Group conducts annual review to ensure that the KPIs are in line with the service directions and priorities of HA. 3. Comments and feedback on the KPIs are collected during the course of the year through various channels, such as Coordinating Committees / Central Committees, Committee on Official Statistics, Medical Policy Group, Directors’ Meeting (DM), Cluster Management Meeting, HA Board’s Administrative and Operational Meeting (AOM) and related functional committees. The views are then put forward to the Working Group for consideration in the annual review. The overall framework of the current process of KPI development and review is presented in Annex 2. 2020 KPI Annual Review 4. In the 2020 KPI Annual Review, the Working Group agreed that the existing three-pillar KPI framework should remain unchanged. The Working Group has also recommended some revisions to the existing list of clinical service KPIs and HR KPIs, while the current KPI list on finance will remain unchanged. Review recommendations for KPIs

1 Clinical service KPIs to MSDC meeting on 7 December 2020 via MSDC Paper No. 618; human resources KPIs to

Central Training and Development Committee (CTDC), sub-committee under HRC, on 4 December 2020 via CTDC Paper No. 089 and to HRC on 19 January 2021 via HRC Paper No. P648; and finance KPIs to FC meeting on 8 December 2020 via FC Paper No. 882

2 AOM Paper No. 530 on “New Framework for Key Performance Indicators” discussed on 28 February 2008.

- 2 -

on clinical services, finance and HR were reported to the Board’s respective functional committees1. The proposed revisions are outlined in the ensuing paragraphs.

Clinical Service KPIs on Productivity 5. Casemix information has been developed in HA since 2008, with the initial target to support “Pay for Performance” for resource allocation. Clusters have reflected difficulties in interpreting the current KPIs on productivity of HA services, and prefer to have some refined indicators. To facilitate more in-depth costing analytics, another tool called “Total Patient Journey Costing” (TPJC) is under development. In order to minimise clusters’ effort and streamline the reporting process at the cluster level, the current KPIs on productivity, namely “total weighted episodes of acute inpatient services”, “growth index

for non-acute inpatient services (%)” and “growth index for ambulatory and community

care services (%)” are proposed not for KPI reporting with effect from 2021-22, while a new KPI on productivity would be explored and further enhanced along the development of the TPJC. Nevertheless, the annual casemix dataset will be maintained by Head Office and available to users if needed.

New HR KPIs on Training 6. Training and development (T&D) is always a priority for HA to ensure a healthcare workforce with the right skills to maintain the standard of care and improve patient outcomes. It is also expected that T&D will also bring about greater job and career satisfaction for staff. A designated government training fund3 has been allocated to HA since 2015-16 for enhancing staff training and development opportunities and activities. With the additional training resources in place as well as the implementation of grade-specific curriculums to facilitate professional growth and career development of staff, HRC4 suggested HA to compile KPIs on staff training for trend analysis on staff training opportunities. 7. A market research revealed that “training days” is a common training KPI adopted by sizable public and private organisations. It denotes the commitment of an organisation in staff training and development through the granting of training day / study leave for staff to acquire the knowledge and skills relevant to job requirement. The number of training days broadly reflects the training opportunities offered to staff. Currently, sizable organizations such as Civil Service Training and Development Institute, Mass Transit Railway Corporation, Hong Kong Airport Authority, China Light Power, Towngas, Sun Kung Kei Properties, Maxims and Hutchison Port Holdings adopt training days as KPI on training. As such, HA proposes to use “Total Training Days” and “Average Training

Days per Staff” as the training KPIs. The training days of local and overseas training in various staff groups will be reflected and compared against the prior year figures. With reference to the prevailing HR policies of HA, four major types of training activities will be included under the training KPIs, including:

3 In response to the HA Review recommendations, a one-off funding of $300 million for three years between 2015 -16

and 2017-18 (i.e. $100 million per year) was allocated to HA, and the CTDC was set up in 2015 under HRC for overall policy and coordinating training-related matters, including the monitoring of the designated government training fund. Subsequent to that, a recurrent training funding of $183.5 million per annum has been allocated to HA since 2018-19.

4 At HRC meeting held on 11 May 2019 via HRC Paper No. 558 on “Report on Key Performance Indicators – Human Resources (up to March 2018)”.

- 3 -

(a) “In-service Training Programmes” organised or commissioned by HA Head Office / clusters / hospitals / departments;

(b) “External Training Programmes” organised by non-HA organisations;

(c) “Programmes for the Attainment of Professional Qualifications” required for staff’s career progression at related rank and grades; and

(d) “Scholarship / Fellowships organised by bona fide organisations recognised by HA” including local and overseas tertiary institutions, professional societies or scholarship / fellowship awarding bodies.

8. The training days for the training KPIs are based on training time (either official release or study leave) granted to staff. The training days of the above-mentioned training activities, as well as HA training resources (i.e. with financial sponsorship and/or study leave granted) taken by permanent and contract staff on headcount basis would be counted for the training KPIs. The training data below are excluded from the training KPIs at this stage, with respective reasons:

(a) e-Learning: Staff may take e-Learning during office or non-office hours. The current system only records the time taken for each e-Learning programme without differentiating between office and non-office hours. No official release / study leave is granted to the staff for taking e-Learning programmes;

(b) On-the-job training: Staff usually take work-based training subsumed under service delivery, and hence, it is difficult to differentiate between training and work elements during service delivery; and

(c) Fellowship training records for HA doctors under different Colleges: These training records are currently kept by the Hong Kong Academy of Medicine (HKAM). HA would liaise with HKAM for the records of fellowship training.

9. While supportive of the training KPIs, DM, CTDC and HRC also emphasised the emerging importance of e-Learning or mobile learning. In this light, HA will explore separately reporting e-Learning training data, currently being kept in the eLearning Centre (eLC), for internal reference at Cluster and Head Office levels. CTDC and HRC members also recommended exploring the feasibility to incorporate breakdown of the training days, for example, by trainers, trainees, active or passive roles of participants for more sophisticated analysis. To recognise the significance of on-the-job training, CTDC suggested exploring inclusion of on-the-job training data in the training KPIs. Given the likely variations on the definition of on-the-job training among different grades and specialities, further discussion for potential alignment and capturing of on-the-job training will be made. In addition, HRC suggested exploring the report of the training data related to smart initiatives e.g. adoption of new technologies for smart hospitals for internal reporting. HA will actively follow and consider these suggestions as appropriate. 10. Training KPIs will be reported annually to the Training and Development Executive Group, CTDC, HRC and the Board together with other HR KPIs in which the HA’s overall trend on training throughput in terms of total training days and average training days per staff will be reported so as to broadly reflect the training opportunities offered to

- 4 -

staff. Details of the training KPIs, including definition, calculation formula as well as the reporting cycle of the KPIs on training are set out in Annex 3. List of KPIs on Clinical Services, Finance and HR for Reporting in 2021-22 11. The revised list of KPIs for reporting in 2021-22, incorporating the recommendations of the Working Group mentioned above, is set out in Annex 4 for Members’ approval. The first reporting in accordance with the revised list will commence in 2021-22. 12. Continuous efforts are made to review the Guidebook on KPIs. The 2021-22 electronic edition will be released (available at the Members’ Corner) within the first quarter of 2021-22 to cover the latest revisions mentioned in the preceding paragraphs. Other textual refinements will be incorporated to keep the Guidebook updated. Hospital Authority AOM\PAPER\1630 21 January 2021

- 5 -

Annex 1 to AOM-P1630

Key Performance Indicator (KPI) Framework

KPI Selection Criteria

(a) Relevance to the overall corporate priorities and organisational objectives to facilitate ongoing monitoring in key areas at hospital, cluster and corporate levels;

(b) Availability of automated data to minimise manual efforts in the collection of data and compilation of reports;

(c) Reliability of available data to enhance confidence of stakeholders in using the data for performance benchmarking and service improvement;

(d) Comparability of data across clusters to facilitate meaningful discussion on service improvement and establishment of best practices;

(e) Materiality of the selected KPIs in affecting managers and clinicians’ behaviour to drive changes in service organisation or clinical practices for better quality and higher efficiency;

(f) Impact on service outcome and cost efficiency to maximise the benefits of KPIs; and

(g) Burden of disease in clinical services to ascertain relevant focus on diseases with high patient volume or diseases which consume significant proportion of the HA’s resources.

- 6 -


Current Processes of

Key Performance Indicator Development and Review

COCs / CCs: Coordinating Committees / Central Committees CS: Cluster Services Division, HAHO Q&S: Quality and Safety Division, HAHO S&P: Strategy and Planning Division, HAHO

- 7 -


New HR Key Performance Indicators on Training (Contents to be incorporated in to the “Guidebook on KPIs 2021-22)

Total training days by staff group

Average training days per staff by staff group

- 8 -

New HR Key Performance Indicators on Training (Con’t) (Contents to be incorporated into the “Guidebook on KPIs 2021-22)

What are being measured

“Training days” is used as the training KPI which denotes the commitment of HA in staff training and through the granting of training day/study leave for staff to acquire the knowledge and skills relevant to job requirements. The training days for the Training KPIs are based on training time (either official release or study leave) granted to staff. Two components are measured :

(a) Total Training Days (b) Average Training Days per Staff

Rationale and Interpretation

A designated government training fund has been allocated to HA since 2015-16 for enhancing staff training and development opportunities and activities. Total training days and average training days per staff are identified as HR KPIs to facilitate the HA in monitoring overall trend of training throughout to broadly reflect on the training opportunities offered to staff.

This KPI focuses on reflecting the HA training throughput. The training days granted to permanent and contract staff for attending local and overseas training activities as defined below will be captured and compared with those of the prior year figures so as to review the training opportunities offered to staff in support of HA’s services.

KPI Total Training Days

Definition The total days of training during the fiscal year (including local and overseas training days). Inclusion Four major types of training activities with reference to the prevailing HR policies of HA -

(1) In-service Training Programmes organised or commissioned by HA Head

Office / clusters / hospitals / departments;

(2) External Training Programmes” organised by non-HA organisations;

(3) Programmes for the Attainment of Professional Qualifications required for staff’s career progression at related rank and grades; and

(4) Scholarship / Fellowships organised by bona fide organisations recognised

by HA, including local and overseas tertiary institutions, professional societies or scholarship / fellowship awarding bodies.

Exclusion (1) e-Learning: Staff may take e-Learning in office or non-office hours. The

current system only records the time taken for each e-Learning programme without differentiating between office and non-office hours. No official release/ study leave is granted to the staff for taking e-Learning programmes; and

(2) On-the-job training: Staff usually take work-based training subsumed under service delivery, and hence, it is difficult to differentiate between training and work elements during service delivery.

- 9 -

(3) Fellowship training records for HA doctors under different Colleges: These training records are currently kept by the Hong Kong Academy of Medicine (HKAM).

Calculation Formula

Sum of total days* of local and overseas training attended by permanent and contract staff on headcount basis during the fiscal year. * 7 hours = 1 day

Reporting Cycle

Annually (actual figure as at end of the fiscal year)

KPI Average Training Days per Staff

Definition The total days of training during the fiscal year (including local and overseas training days) per the average headcount of the fiscal year. Inclusion Four major types of training activities with reference to the prevailing HR policies of HA -

(1) In-service Training Programmes organised or commissioned by HA Head Office / clusters / hospitals / departments;

(2) External Training Programmes organised by non-HA organisations;

(3) Programmes for the Attainment of Professional Qualifications required for staff’s career progression at related rank and grades; and

(4) Scholarship / Fellowships organised by bona fide organisations recognised

by HA, including local and overseas tertiary institutions, professional societies or scholarship / fellowship awarding bodies.

Exclusion (1) e-Learning: Staff may take e-Learning in office or non-office hours. The

current system only records the time taken for each e-Learning programme without differentiating between office and non-office hours. No official release/ study leave is granted to the staff for taking e-Learning programmes; and

(2) On-the-job training: Staff usually take work-based training subsumed under

service delivery, and hence, it is difficult to differentiate between training and work elements during service delivery.

(3) Fellowship training records for HA doctors under different Colleges: These

training records are currently kept by the Hong Kong Academy of Medicine (HKAM).

Calculation Formula

a / b a = Sum of training days* of the local and overseas training that attended by permanent and contract staff on headcount basis during the fiscal year. * 7 hours = 1 day b = Average strength in the fiscal year on a headcount basis. i.e. both full-time and part-time staff count as one

Reporting Cycle

Annually (actual figure as at end of the fiscal year)

- 10 -


List of Clinical Service Key Performance Indicators (KPIs) for 2021-22

Service Growth in response to Population Change & Ageing Effect

Service Capacity

* No. of hospital beds (overall)

* No. of geriatric day places

* No. of psychiatric day places

Service Throughput

Inpatient Services No. of inpatient discharges and deaths

* - Overall

* - General (acute and convalescent) No. of inpatient patient days

* - Overall

* - General (acute and convalescent)

* No. of day inpatient discharges and deaths

Accident & Emergency Services

* No. of accident & emergency attendances No. of accident & emergency first attendances

* - Triage I (Critical cases)

* - Triage II (Emergency cases)

* - Triage III (Urgent cases)

Specialist Outpatient Services

* No. of specialist outpatient (clinical) first attendances

* No. of specialist outpatient (clinical) follow-up attendances

* Total no. of specialist outpatient (clinical) attendances

Primary Care Services

* No. of general outpatient attendances

* No. of family medicine specialist clinic attendances

* Total no. of primary care attendances

Allied Health Outpatient Services

* No. of allied health (outpatient) attendances

Day Hospital Services

* No. of rehabilitation day and palliative care day attendances

* No. of geriatric day attendances

* No. of psychiatric day attendances

Community & Outreach Services

* No. of community nurse attendances

* No. of allied health (community) attendances

* No. of geriatric outreach attendances

* No. of geriatric elderly persons assessed for infirmary care service

* No. of psychiatric outreach attendances

* No. of psychogeriatric outreach attendances

* COR item

- 11 -

List of Clinical Service KPIs for 2021-22 (con’t)

Quality Improvement as a result of Technology Advancement or

Implementation of New Service Quality & Access Initiatives

Waiting Time for Accident & Emergency (A&E) Services % of A&E patient attendances seen within target waiting time

* - Triage I (critical cases – 0 minute)

* - Triage II (emergency cases – 15 minutes)

* - Triage III (urgent cases – 30 minutes)

- Triage IV (semi-urgent cases – 120 minutes)

Waiting Time for Specialist Outpatient (SOP) New Case Bookings Overall for ENT, GYN, MED, OPH, ORT, PAE, PSY and SUR

* - Median waiting time (weeks) of Priority 1 (P1) cases at SOPCs

* - Median waiting time (weeks) of Priority 2 (P2) cases at SOPCs For each of ENT, GYN, MED, OPH, ORT, PAE, PSY & SUR

- % of P1 cases at SOPCs with waiting time within 2 weeks

- % of P2 cases at SOPCs with waiting time within 8 weeks

- 90th percentile waiting time (weeks) of Routine cases at SOPCs

Waiting Time for Allied Health Outpatient (AHOP) New Case Bookings For each of OT & PT

- % of P1 cases at AHOP clinics with waiting time within 2 weeks

- % of P2 cases at AHOP clinics with waiting time within 8 weeks

- 90th percentile waiting time (weeks) of Routine cases at AHOP clinics

Waiting Time for Elective Surgery Total Joint Replacement

- Waiting time (months) at 90th percentile for patients receiving the treatment of total joint replacement Benign Prostatic Hyperplasia

- % of patients provided with surgery within 2 months for P1 patients

- % of patients provided with surgery within 12 months for P2 patients

Waiting Time for Diagnostic Radiological Investigations

For each of CT, MRI and US

- % of urgent cases with examination done within 24 hours

For each of CT, MRI, US and Mammogram

- Median waiting time (weeks) of P1 cases

- Median waiting time (weeks) of P2 cases

- 90th percentile waiting time (weeks) of Routine cases

Access Block Monitoring [via exception reporting]

- No. / % of patients with access block time more than [4 hours, 12 hours]

* COR item

- 12 -


Quality Improvement as a result of Technology Advancement or

Implementation of New Service Quality & Access Initiatives (con’t)

Access to General Outpatient Clinic (GOPC) Episodic Illness Service

- GOPC quota availability (for elders) (%)

Appropriateness of Care

- Standardised admission rate for A&E patients (%)

* - Unplanned readmission rate within 28 days for general inpatients (%)

Breastfeeding Rate

- Breastfeeding rate on discharge (%)

Infection Rate

- MRSA bacteraemia in acute beds per 1 000 acute patient days

Access to Outreach Service

- % of RCHEs covered by Community Geriatric Assessment Service

Disease Specific Quality Indicators Stroke

- % of acute ischaemic stroke patients received IV tPA treatment Hip Fracture

- % of patients indicated for surgery on hip fracture with surgery performed ≤ 2 days after admission

through A&E Cancer

- Waiting time (days) at 90th percentile from decision to treat to start of radiotherapy (RT) for cancer

patients requiring radical RT

- Waiting time (days) at 90th percentile for patients with colorectal cancer receiving first treatment

after diagnosis

- Waiting time (days) at 90th percentile for patients with breast cancer receiving first treatment after

diagnosis

- Waiting time (days) at 90th percentile for patients with nasopharynx cancer receiving first treatment

after diagnosis Diabetes Mellitus

- % of diabetes mellitus patients with HbA1c < 7% Hypertension

- % of hypertension patients treated in GOPCs with BP < 140/90 mmHg End Stage Renal Disease

- % of end-stage renal disease patients receiving haemodialysis treatment Mental Health Services

- Average length of stay (LOS) (days) of acute inpatient care (with LOS ≤ 90 days)

- % of compulsory psychiatric admissions under the Mental Health Ordinance via AED for patients

receiving active Personalised Care Programme care Cardiac Services

- % of acute myocardial infarction patients prescribed with Statin at discharge

- % of ST-elevation myocardial Infarction patients received primary percutaneous coronary

intervention

Technology

- % of medical equipment with age beyond the expected life

* COR item

- 13 -


* COR item

♦♦♦♦ Proposed revision under 2020 KPI Annual Review

Efficiency in Use of Resources

Capacity and Throughput of Specialist Outpatient (SOP) Services For each of ENT, GYN, MED, OPH, ORT, PAE, PSY & SUR

- Throughput for SOP services

- No. of SOP first attendances per doctor

- No. of SOP follow-up attendances per doctor

- Waiting list management

- Growth of waiting list against throughput (%)

Operating Theatre (OT) Utilisation

- Ratio of scheduled to expected elective OT session hours (%)

- Utilisation rate of scheduled elective OT sessions (%)

Bed Management

- Bed occupancy rate (%)

* - Overall

* - General (acute and convalescent)

* - Average length of stay (days) for general inpatients

Day and Same Day Surgery Services

For each of OPH, ORT & SUR

- Rate of day surgery plus same day surgery (%)

Productivity

♦♦♦♦ - Total weighted episodes (WEs) of acute inpatient services (Not for reporting with effect from 2021/22)

♦♦♦♦ - Growth index for non-acute inpatient services (%) (Not for reporting with effect from 2021/22)

♦♦♦♦ - Growth index for ambulatory and community care services (%) (Not for reporting with effect from

2021/22)

- 14 -

List of Human Resources KPIs for 2021-22

Manpower Situation

Manpower Position

- By Staff Group Attrition (Wastage) Rate / Resignation

5 Years Trend Attrition (Wastage) Rate

- By Cluster

- By Staff Group

No. of Resignations (Doctor)

- No. of resignations

- No. of resignations per 100 staff (Resignation rate)

No. of Resignations (Nursing)



No. of Resignations (Allied Health)



No. of Resignations (Supporting (Care-related))



Staff Wellness

Sick Leave

Average Sick Leave Days taken per staff

- By Staff Group

Percentage of staff with Sick Leave taken ≥ 50 days

- By Staff Group Injury on Duty (IOD)

No. of IOD Cases per 100 FTE staff

- By Staff Group

No. of IOD Leave Days per 100 FTE staff

- By Staff Group

Training (new)

♦♦♦♦ Training Days

Total Training Days (new)

- By Staff Group

Average Training Days per Staff (new)

- By Staff Group

♦♦♦♦ Proposed revision under 2020 KPI Annual Review

- 15 -

List of Finance KPIs for 2021-22

(Nil revision under 2020 KPI Annual Review)

Budgetary Performance

Budget Performance

Capital Expenditure

Untaken Leave Balance

Drug Stock Balance and Stock Holding Period

aom-p1630 (2020 key performance indicator annual review)

Documents