"Hospital Report Research Collaborative Performance Measurement"
Hospital Report Research Collaborative: Performance Measurement & Management for Ontario Hospitals Background Information for Hospital Report Liaisons Organizational structure, focused objectives, a solid framework, and adherence to principles are key enablers Diverse expertise in a distributed network contributes to a high standard and flexibility… Sponsors Researchers Ethics & Safety Committees OHA MOH 6 Universities U of T / Hospital 5 Institutes Ethics Steering 25 Faculty Committee 20 Staff Advisory Panel Ext. on Strategic Strategic Stakeholder Issues Advisory Advisory Committee CIHI Committee Communications Working Group HRRC’s objectives and audience provide direction… Objectives Quality Improvement Accountability Research - Determinants of Good Performance Target Audience Hospital Boards Senior Leaders A core set of principles provides guidance and credibility… Project Principles Public domain Provider-driven Indicator Principles Independent Voluntary Scientifically sound Feasible Relevant …and first principles guide indicator selection… • Does this indicator relate to hospital strategies or priorities? • Is this indicator relevant to most hospitals? • Can this indicator be used to judge performance? • Does this indicator have a valid and relevant benchmark? If no, use the Ontario average. • Indicators are evidence-based (best), or consensus-based (second- best). • Is this indicator related to any other Hospital Report indicator? • Are all of the indicators lead or lag? The balanced scorecard is based on Kaplan & Norton’s four quadrant framework… (Internal Business Perspective) Clinical Utilization and Outcomes System Integration Patient and Change Framework Satisfaction (Learning & Growth) (Customer Perspective) Financial Performance and Condition (Financial Perspective) …with an inherent logic underlying the quadrants… Financial Performance Patient Satisfaction and and Condition Perceptions of Care Clinical Utilization and Outcomes System Integration and Change The project has grown considerably since 1998, evolving to include multiple sectors and new products… Scope of HR project has grown from one to more than five sectors… 1998 1999 2000 2001 2002 2003 2004 2005 Acute Care Region Hospital Hospital Hospital Hospital Hospital Emergency Department Care Region Hospital Hospital Complex Region Hospital Hospital Continuing Care Province Region Hospital Rehabilitation Mental Health Province Region Hospital Reports draw on a variety of data sources… Quadrant Source Collection Period System Integration Survey sent to Single point in time and Change hospital administrators Clinical Utilization Routinely collected Fiscal year and Outcomes administrative data Patient Satisfaction Consumer surveys Continuous surveying on a monthly basis Financial Routinely collected Fiscal year Performance and administrative data Condition …and reports have evolved from a system to a hospital-specific level… 1 year 1 year 1.5 years 1.5 years Hospital Annual Establish Feasibility Regional Level Redevelopment & Principles Study Report Report Regular Releases Research Collaborative CIHI & Research Collaborative New products are tailored to an executive-level audience… From: To: 150 pp 40 pp + insert total ADL ADL ADL ADL ADL Improvement ADL Improvement Improvement Improvement Improvement Improvement Hospital Numerator Demoninator Numerator Demoninator Indicator Value Indicator Value (assessments) (assessments) (patients) (patients) (risk-adjusted) (raw) Algonquin Health Services NR NR NR NR NR NR Atikokan General Hospital NR NR NR NR NR NR Brant Community Healthcare System 16 13 39 24 38.9 41.0 Brant Community Healthcare System 16 13 39 24 38.9 41.0 Bridgepoint Health 47 35 215 92 20.0 21.9 Cambridge Memorial Hospital 12 10 27 19 46.7 44.4 Chatham-Kent Health Alliance 7 7 20 14 34.0 35.0 Chatham-Kent Health Alliance NR NR NR NR NR NR Chatham-Kent Health Alliance NR NR NR NR NR NR Chatham-Kent Health Alliance NR NR NR NR NR NR Credit Valley Hospital (The) 4 4 14 7 31.2 28.6 Dryden Regional Health Centre NR NR NR NR NR NR Grand River Hospital 70 56 172 87 41.4 40.7 Grand River Hospital 70 56 172 87 41.4 40.7 Grey Bruce Health Services 11 8 28 21 36.1 39.3 Grey Bruce Health Services 11 8 28 21 36.1 39.3 Halton Healthcare Services Corporation 19 15 61 35 31.4 31.1 Halton Healthcare 16 12 36 17 44.7 44.4 Halton Healthcare 3 3 25 18 12.2 12.0 Hamilton Health Sciences 29 23 127 48 24.8 22.8 …yet still provide detail for those requiring information on methods and templates for communication Technical Reports Results – System Integration & Change How does our hospital compare? Indicator Our Our The PowerPoint slide decks (average scores) Hospital Region Province Healthy Work Environment 62.9 Interdisciplinary Integration of 73.8 Care Evidence of Client-Centred 71.2 Care Best Practices 69.0 Coordination and Continuity of 63.9 Care Across the Continuum – All RCGs Use of Admission and 67.3 Discharge Criteria – All RCGs Evidence of Organizational 60.2 Client-Centredness Organizational Commitment to 77.0 Staff Development Results are linked to hospitals’ strategic goals… …and high performing hospitals are now being recognized By mainstreaming women’s health, issues of equity are integrated… …and preliminary work has begun on understanding strategic relationships among indicators Through an evolutionary approach, hospitals are now willing to publicize their scores… …moving from symbols in 1998 to numerics in 2005 1998 First system level 1999 First hospital specific Symbols (3 levels) 2001 Hospital-specific Stars (5 levels) 2002 Hospital-specific Stars (5 levels) 2003 Hospital-specific Symbols (3 levels) & numeric ranges 2005 Hospital-specific Shading (3 levels) & numerics HRRC has harnessed technology to enhance knowledge transfer with the roll out of the e-Scorecard …to allow customized reporting and different levels of granularity… …with a variety of dynamic graphic displays… To address the challenge of data timeliness, HRRC developed the WHIC… …allowing indicator calculation based on routinely collected data in a timely way… …providing capacity for drill down functionality for quality improvement purposes It’s not so much what we do, but rather how we do it… Unique process that includes extensive involvement of the field contributes to credibility and buy-in… Data Literature Collection Expert Indicator Review and Panel Selection Analysis Hospital Indicator Report Data Refinement Expert Development Verification & Data Panel & Publication Analysis Strategy is the unifying framework for the scorecard at all levels in the system… Ministry Vision Provincial Health System Scorecard Healthier Ontarians in a Strategy Macro-level Indicators & Healthier Ontario Map Measures Local Health Integrated Networks Hospital Sector Hospitals’ Strategic Priorities Strategy Hospital Reports Map Individual Hospital Local Strategy Local Scorecard Vision/Priorities Map HRRC Liaisons need to know what reports are being issued next and should understand the data sources/years to be incorporated into these reports Hospital Reports being released in 2006 and 2007 include… • 2006 – Acute Care only (integration of access/ambulatory) – Clinical/financial – 2004/05 data – SIC survey – around Nov 2005 – Patient satisfaction – profile 2004/05; several months of 2005/06 – (update e-Scorecard ED, CCC, Rehab with clinical/financial 2004/05 data) • 2007 – Acute, ED, CCC, Rehab, MH – Clinical/financial – 2005/06 data – SIC survey – around Nov 2006 – Patient satisfaction – profile 2005/06; several months of 2006/07 …and the WHIC phased development plan across sectors includes… Ongoing Updates Winter 2004/ Summer/ Fall ‘05 Winter’0 Winter’0 Ongoing Spring 2005 Fall ‘05 5 5 HRRC has numerous projects on the horizon… Indicator development will be enhanced in 2006/07 (I)… • Indicators on: – Access to care – Ambulatory care – Governance – Data quality – Patient safety – Continuity of care (within LHINs) – Employee satisfaction/workplace health …as will research in the following areas • Benchmarks for individual indicators • Inter-quadrant research • Extending beyond inpatient care, where possible …and our focus on performance management will be further developed • Organize forums to share potentially best practices • Develop guidelines to assist hospitals in prioritizing quality improvement initiatives • Proposal to define essential ingredients for successful QI implementation through international scan, and assess readiness of Ontario hospitals for QI • Workbook to assist with local hospital strategy maps/performance management systems Success factors, lessons learned and challenges faced Some of HRRC’s success is owed to… • Positive collaborative partnerships • Independence of the research • Methods in public domain • Academic expertise and rigour • Involvement of stakeholders (clinicians, managers) in the process • Focus on knowledge transfer and quality improvement • Emphasis on customer service • High level of productivity You can facilitate the use of Hospital Report results at your hospital by targeting the following areas… • Using relevant indicators to assess your hospital’s progress in achieving corporate priorities • Targeting quality improvement initiatives to indicators with low scores for areas of importance to your hospital • Demonstrating accountability to your community through public relations