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Performance Management Framework

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									    Performance Management Framework – Proposal For Local Approach



1. WHAT IS PERFORMANCE MANAGEMENT?

Performance management is the process of evaluation against specific objectives,
standards, other organisations or historical data enabling judgement to be made on the
relative position or progress of the PCT’s priorities, services and responsibilities.

In the past, performance management has been seen as an annual review cycle of the
health system and there has been too much emphasis on looking backwards.
Assessments have been nationally driven and made against factors with little relevance or
contribution to the organisation’s local objectives or corporate performance.

The future value of performance management will be for analysing the current state of
systems and services and informing decisions and developments, thereby aiding the
PCT’s achievements. It is important that the PCTs performance management system is
routinely integrated with the values, priorities, business objectives and functions of the
organisation and provides timely information with a sharper focus on effective planning
and developments. The key objectives of performance management for the PCT are:

•    Regular reporting to the PEC and Board,
•    Facilitate the Management Team’s role of ensuring progress and identifying corrective
     action,
•    Risk management,
•    Inform priorities for management action, developments and funding,
•    Improve performance linked to benchmarking etc.,
•    Provide input for the appraisal and development process in regard to training and skills
     development.

2. DIFFERENT FOCUSES OF PERFORMANCE MANAGEMENT

There are many potential focuses of performance management for the PCT.                These
include monitoring:

•    National standards and targets,
•    Business objectives,
•    Organisational performance,
•    Service delivery linked to health need,
•    Clinical governance,
•    Cost effectiveness of commissioned and provider services,
•    Quality of patient care,
•    Individual’s performance.
In addition, the PCT has a responsibility to provide a better customer service and
communication with the public. The achievement of public standards and provision of
better services for the Bury population are important issues for the PCT to address.
Quality baselines must be set with continuous improvement as a driver and information
should be published in the PCT’s Patient Prospectus and Annual Report.

3. INTEGRATION WITH PLANNING CYCLE

Performance management is an essential support mechanism to the planning cycle.
Figure 3.1 shows how performance management integrates with the commissioning
model.

Figure 3.1: Integration with Commissioning Model`

                                          Identify
                                        Factors For
    Performance                             Poor
    Management                          Performance




                  Commissioning         Health Issues &
                                         Social Care
                                          Interface




Evaluation of
                                                            Priorities       Develop Action
Performance                             Focus on
                         Review                           Objectives for     Plan / Identify
  Against                              Patients and
                         Process                             Health           Improvement
Objectives /                             Health           Improvement        Requirements
  Others                              Improvements




                                       Implementation




                                             Set
                                          Objective
                                          Measures /
                                           Targets


Performance management can start at any point of the cycle. The implementation of
business objectives may start with identifying the measures of achivement and the setting
of targets for these. National targets are often given to organisations by the NHS
Executive and the first undertaking is to evaluate the current performance against the
targets with the measures set.

Poor performance of a local service can often be highlighted by service managers. The
factors determining this should be assessed and an improvement action plan developed.
The prioritisation of developments through the Service and Financial Framework (SaFF)
process can be informed by the predicted levels of improvements associated with the
costs of developments.

4. PERFORMANCE MANAGEMENT SYSTEM

The performance management system, or reporting mechanisms, is complex and driven
by organisational requirements, NHS Executive requirements and public accountability.
Figure 4.1 shows the performance management system for the PCT.

5. STANDARD REPORTING MECHANISM

A traffic light reporting mechanism has been developed for the PCT Board, committees
and external groups. Reports for the Board will be based on the PCT’s objectives and will
provide an overall status of performance for the objectives and an assessment of the
individual targets. An exception report of the reasons for any poor performances and the
local actions being taken to improve these will be provided for any areas of specific
concern. The Professional Executive Committee (PEC) will receive a more detailed
analysis of the key performance targets underlying the objectives and will have a role in
ensuring that these appropriate actions are being taken to address these. Figure 5.1
provides an example of a traffic light system report that would be presented to the PEC,
underlying the achievement of the access targets in primary and secondary care.

It is recommended that key indicators are identified covering each of the different foci
outlined above and all performance reports for the PCT are presented in this way where
possible. A traffic light reporting mechanism has been developed for the Services
Directorate (see Appendix B) and may be the basis of one of the indicators reported to the
PEC/Board. A traffic light system will shortly be developed for monitoring the PCT’s
service agreements (commissioned services) and SaFF targets.

In the near future development will commence on the inclusion of a performance
management module on the PCT’s intranet site. It is planned to include the traffic light
monitoring of the PCT’s objectives with a drill down facility to the underpinning reports.
Statutory returns collated for the NHS Executive and any local performance monitoring
reports will also be posted on the site for information.
   Figure 4.1                                                                      Press /
                                                                                   Published
   PERFORMANCE MANAGEMENT SYSTEM                                                   Information


                        Business                                  LITs /                          LSP
                        Objectives                                JIPs
                                         Monthly
                        Service          Quarterly                                                Health
           NHS          Delivery         Reports                  Action                          Policy
           Plan                                                   Planning            PCT         Group
                        SaFF                                                          Board
        National
        Standards                                       Traffic
                        Performance      Performance
NSFs    Targets                                         Light      EMT                            Council’s
                        Indicators       Management
                                                        System                                    Overview/
                Local                                                                             Scrutiny
                        Clinical
                                                                                      PEC         committee
                        Governance
           HIMP
                                         Strategic                                     +
                        Patient          Health                                   Subgroups
                        Focus -          Authority                                                Patients
                        Needs/                                                                    Prospectus /
                        Satisfaction                                                              Forums

                        Organisational
                        Performance       Department
                                          of
                                          Health



                                          Published                          Internal Systems    External Systems
                                          Information
Figure 5.1: Example Traffic Light System Performance Report For The PEC (For
Illustration Only).




            Performance Against Key Access Targets As At End Of May 2002


Overall Status:          Current -               Forecast -




          Objective                 Current   Current   Forecast              Actions
                                    Target    Status     Status
90% of patients to spend no          90%      70.90%     75.00%    •   Analysis of patient waiting
more than 4 hours in A & E from                                        over 4 hours.
arrival to admission, transfer or                                  •   Discussion with Bury A&E
discharge.                                                             regarding an action plan.
Reduce delayed discharges (all        35         6            6
ages) to the specified targets.

90% of patients who wish to do       90%      61.72%     85.00%    •   Check how practices are
so can see a primary health                                            collecting and reporting.
care professional within 1                                         •   Target underperforming
working day.                                                           practices.
90% of patients who wish to do       90%      70.74%     90.00%    •   Check how practices are
so can see a GP within 2                                               collecting and reporting.
working days.                                                      •   Target underperforming
                                                                       practices.
Reduce the total                     3409      3730       3500     •   Identify significant
inpatient/daycase waiting list by                                      underperformances.
8.4% from the December 2001                                        •   Ascertain Trust plans.
actual position.                                                   •   Discuss skew with Trusts.
Reduce the 9+ month waiters by        237       270       104
70.4% from the December 2001
actual position.
No 12+ month waiters.                  0        65            0    •   Check whether Trusts are
                                                                       on track for meeting.
No 15+ month waiters (must not         0         0            0
be any throughout the year in
2001 actual position.
Reduce the 13+ week outpatient        739       645       469
waiters by 58.0% from the
December 2001 actual position.

No 21+ week waiters.                  102       37            0
No 26+ week waiters (must not          0         0            0
be any throughout the year in
2002/2003).
6. PERFORMANCE MANAGEMENT PROCESS

Any PCT objective or standard should be managed through the process as set out in
figure 6.1, linking into the commissioning and Service and Financial Framework (SaFF)
process where necessary.

Figure 6.1: Performance Management Process

                                  OBJECTIVE

                            Identify measures / targets

                             Evaluation of performance
                                 against objective

        Timeframe
                                      Is
                     YES           objective
                                    being
                                     met?
                                           NO
                                Identify factors
                                why not being met

                               Identify improvement
                              requirements / develop
                                    action plan

                                 Set measures /
                                     targets




                       NO         Prioritisation/         COMMISSIONING/SAFF PROCESS
                                    approval
                                     SaFF?
                                           YES

                                Implementation



7. INFORMATION SYSTEMS AND EVALUATION METHODS

Up-to-date information is important for informed decisions. The PCT has inherited
information systems from the Health Authority and Bury Health Care NHS Trust, which
continue to provide useful evaluation data for performance management. The larger and
more established systems consist of:

•   Exeter – registered population, screening (breast and cervical cytology) and contractor
    data that is held and managed by Shared Services,
•   AIS – GP/practice based information, includes downloads from the patient data system
    and a functionality for identifying fraudulent claims,
•   Episodes – inpatient and outpatient data from acute and mental health Trusts. Used
    primarily for commissioning, statutory performance management returns and quality
    analysis of secondary care services,
•   HES – National hospital data collection system predominantly used by the department
    of health. There is a larger time lag with the availability of data than with the Episodes
    system,
•   Public Health – common data sets, census information, population forecasts and births
    and deaths tapes. There is a large time lag with some of this data,
•   EPACT – prescribing information,
•   Kendata – community information system, currently under review,
•   ACCPAC – Financial management system, annual accounts,
•   Pisces – benchmarking of statutory returns against other organisations in the country,
    also includes public health common data set information,
•   Reference Costs – benchmarking information of the costs of secondary care services
    by Health Resource Group (HRG),
•   SaFF/CIC – planning and quarterly monitoring system for national targets and agreed
    plans,
•   Monthly Management Information – reporting mechanism of waiting list and secondary
    care activity levels against profiled targets,
•   STEIS – Department of Health’s weekly data collection system for reports of
    emergency pressures and waiting list information, will soon incorporate adverse events
    reporting, other modules are also under development,
•   Health survey – to be undertaken in 2002/2003,
•   Library – catalogued books and reports, some statistical reports received.

Other systems are under review or being developed by the Informatics Team. Service
leads can also hold data sets for the local management of their areas e.g. medical
condition registers, continuing care database.

The data available from systems is useful only if compared to other information. The
PCT’s performance is often monitored against national standards and targets, provided by
the NHS Executive. Historical trends are also a useful evaluation method for performance
and are often used to forecast year-end positions from current statuses. Benchmarking
local information against other similar organisation’s information is possible from national
data or data collection systems. Some benchmarking clubs have been established,
predominantly around secondary care provision to date, for sharing information and the
effects that local developments have on performance in areas where data is not routinely
collected or available.

Data quality checks are important for confidence in data analysis. The Informatics Team
performs basic analysis of the Episodes data received from secondary care. The PCT is
part of a consortium of organisations, which fund a data quality team to perform more
detailed analysis of information systems and data collection methods.

8. PERFORMANCE REVIEWS

The Department of Health performs routine reviews of performance each year. The data
collection system surrounding the SaFF process is a significant aspect of the planning and
performance management system. The NHS Executive and Greater Manchester Health
Authority often judge the performance of organisations from these reports.
The Commission for Health Audit and Improvement (CHAI) aims to help the NHS monitor
and improve the quality of patient care. Clinical governance reviews are conducted with
organisations as part of a rolling programme. Bury PCT is expecting a review by CHAI in
the near future to ensure that effective systems are in place to continuously improve
patient care. CHAI helps organisations develop best practice as well as identify areas for
improvement.

From 2002/2003 CHAI will be the independent regulator of NHS performance and will take
over the Department of Health’s responsibility for performance ratings and indicators. In
2002, performance indicators have been published for primary care organisations without
an overall star rating. In 2003, Primary Care Trusts will receive full performance ratings
and will be eligible for the benefits rewarding the success of achieving three stars. This
process and the delivery of improvements in services needs to be a key performance
management focus for the PCT as it informs public perception of the local services.

The Strategic Health Authority is developing a performance framework as part of its
franchise plan. This is expected to have the following focuses, with overarching analysis
of performance indicators, workforce development, information and quality, and user
involvement:

•   Capacity Planning and utilisation,
•   Key NHS access targets,
•   Franchise Plan strategic framework,
•   Capital developments,
•   Finance and performance,
•   Partnerships and strategy,
•   Star rating measures,
•   Clinical governance,
•   Demand management.

The PCT will need to engage with the development of Strategic Health Authority’s process
and shape its performance management framework sufficiently to be able to respond to
zonal requirements.

Quality indicators are an important part of performance management for which there is
little routine data collection by the NHS Executive. It is recommended that the PCT
develops and performs quality review processes and indicators on at least an annual
basis, or more frequently where there are specific issues.

9. PERFORMANCE TARGETS AND INDICATORS

Appendix A contains some examples of the performance management information
currently collected and reported by the PCT. Monitoring information on the key targets is
collected by the Department of Health on a regular basis through monthly and quarterly
returns. It is the PCT’s statutory responsibility to provide this information. The largest
regular data collection and reporting system surrounds the SaFF process, where planning,
monthly monitoring, quarterly monitoring, forecast outturn and final outturn reports are
required.

The PCT will expand performance information to include local information on priority
management areas, for example:
    •   Organisational issues,
    •   Prescribing,
    •   Continuing care,
    •   Financial balance,
    •   Public sector payment policy,
    •   Recruitment,
    •   Sickness/absence rates.

10. RECOMMENDATIONS

The Professional Executive Committee is requested to:

•   Adopt the Performance Management Framework and recommend the system to the
    PCT Board.
•   Consider the objectives and key performance targets at a future meeting and select
    which indicators the Professional Executive Committee would like regular reporting on.
•   Receive performance management reports on service areas or specific topics as
    required by the Executive Management Team or requested by the Professional
    Executive Committee.


ANN HALPIN
PROGRAMME DIRECTOR – COMMISSIONING & PERFORMANCE MANAGEMENT


STEVE MILLS
DIRECTOR OF FINANCE AND COMMISSIONING
                                                                          APPENDIX A

    Examples of Performance Management Information Currently Collected And
                            Reported By The PCT


•    Number of emergency re-admissions to inpatient hospital care under a psychiatric
     specialist of patients aged 16-64 within 90 days of discharge,
•    Number of discharges from inpatient hospital care under a psychiatric specialist of
     patients aged 16-64,
•    Number of emergency admissions for acute ear, nose & throat infection,
     kidney/urinary,
•    Number of emergency admissions for asthma & diabetes,
•    Number of people discharged from hospital,
•    Number of people re-admitted as an emergency within 28 days of discharge,
•    % of category A calls where the first response is within 8 minutes,
•    Number of patients waiting more than 12 months for CABG,
•    Number of patients waiting more than 12 months for PTCA,
•    Number of CABGs,
•    Number of PTCAs,
•    % coverage of women aged 50 to 64 screened for breast cancer,
•    % coverage of women aged 25 to 64 screened for cervical cancer,
•    Number of children vaccinated for Diphtheria and MMR reaching their 2nd birthday
     during 2001/2002,
•    Number of people aged 65 and over given the flu vaccination between September
     and December 2001,
•    Reduce the total inpatient / daycase waiting list by 8.4% from the December 2001
     actual position,
•    Reduce the 9+ month waiters by 70.4% from the December 2001 actual position,
•    No 12+ month waiters,
•    No 15+ month waiters (must not be any throughout the year in 2002/2003),
•    Reduce the 13+ week outpatient waiters by 58.0% from December 2001 actual
     Position,
•    No 21+ Week waiters,
•    No 26+ Week waiters (must not be any throughout the year in 2002/2003),
•    No patients waiting over 18 months for inpatient & Daycase Elective Admission,
•    Number of patients who have been waiting less than 6 months for elective
     admissions,
•    Number of patients waiting for elective inpatient admissions,
•    Number of Non-elective G&A FFCEs,
•    Number of children resident in the PCT reaching their 2nd Birthday during
     2001/2002,
•    90% of Patients who wish to do so can see primary health care professional within
     1 working day,
•    90% of Patients who wish to do so can see a GP within 2 working days,
•    Number of GP written referral requests seen within 13 weeks for first outpatient
     appointment,
•    Number of GP written referrals seen for 1st Outpatient appointment,
•    Number of GP written referral requests who have been waiting over 6 months (26
     weeks) for an outpatient appointment,
•   Number of patients seen within two weeks from urgent GP referral for suspected
    cancer to first OP appointment,
•   Number of patients seen after two weeks from urgent GP referral for suspected
    cancer to first OP appointment,
•   Number of patients with breast cancer receiving treatment within 31 days of
    diagnosis,
•   Number of patients with breast cancer receiving treatment after 31 days of
    diagnosis,
•   90% of Patients to spend no more than 4 hours in A&E from arrival to admission,
    transfer or discharge,
•   Reduce delayed discharges (all ages) to the specified targets,
•   % of patients admitted to hospital via A & E to be found a bed within four hours of
    the decision to admit,
•   % of patients occupying an "acute" hospital bed with a delayed discharge,
•   Number of patients (ALL ages) occupying an "Acute" hospital bed,
•   Number of patients detained under mental health act,
•   Number of patients detained under section 5(2) of mental health act,
•   Number of inpatient suicides.
                                                          APPENDIX B




                            SERVICES DIRECTORATE
                     TRAFFIC LIGHT EARLY WARNING SYSTEM

                     WEEKLY “RED ALERT” REPORT


Week ending …………………………………………..

Service ………………………………………………….


Current “Red Alert” situation :




Actions taken to address the situation:




Outcome:




Forecast for the week ahead :




To :   Evan Boucher
       All Service Directorate Managers
                             SERVICES DIRECTORATE
                      TRAFFIC LIGHT EARLY WARNING SYSTEM

                       MONTHLY “AMBER” REPORT


Month ……………………………………………………

Service ………………………………………………….


Details of current reduced level of service :




Actions taken to address the situation:




Outcome:




Forecast for the month ahead:




To :   Evan Boucher
                        BURY PRIMARY CARE TRUST

          TRAFFIC LIGHT EARLY WARNING SYSTEM
                             Services Directorate



Directorate: ………………………… …………………………………

Date : Wednesday …………………..……………………………….



GREEN           -     Normal service operating.
                      No problems envisaged or forecast in the
                      forthcoming week



AMBER           -     Reduced level of service which may adversely
                      affect delivery of service + forecast for the
                      forthcoming week.
                      (Brief explanatory report to be attached)


RED       -           Complete withdrawal of service or plans to
                      withdraw service in the near future.
                      (Detailed report to be attached)


*PLEASE CIRCLE WHERE APPROPRIATE – GREEN, AMBER OR RED *




Name of Director ………………………………………………….




      To be returned to Anne Kearns, Director of Services at Talbot Grove

                    by 12 noon on Wednesday of each week
                                                      APPENDIX C

                                    Glossary


ACCPAC – Main accounting system,
AIS – Advanced Information System,
CHAI – Commission For Health Audit and Improvement,
CIC – Common Information Core,
EMT – Executive Management Team,
HES – Hospital Episodes System,
HIMP – Health Improvement and Modernisation Plan,
JIP – Joint Investment Plans,
LITs – Local Implementation Teams,
LSP – Local Strategic Partnership,
NHS – National Health Service,
NSFs – National Service Frameworks,
PCT – Primary Care Trust,
PEC – Professional Executive Committee,
SaFF – Service and Financial Framework,
STEIS – Strategic Executive Information System.

								
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