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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