Briefing - Contractual Performance Management CET) Lerten eLearn eatSituation 'HMS is subject to a Contractual Performance Management Regime. * Abatements regime: ©. has been lve on Cl for about six months (also Manus/Nauru but regime is diferent) © six metrics have been implemented: a further six (at least! to be implemented in due course Incentives regime might be live 2014 No abatements have been incurred (yet!) EEMetric Abatement metrics - Summary Performance Threshold Implemented now ‘To be implemented 1.GP appointments (but only a subset) 2. Health Discharge Assessments ‘3. Bulk fit to travel assessments 4.Completion of Critical and Other incident Reports 6. Administration of complaints 7. Vaccinations (definite) - definition TBC A Mental health ecrecnings (definite) 8. Completeness - clients’ healthcare records (definite) 10.Diabetes - implementation of care plan (probable) ‘11 Health induction Assessments (probable) 12.Comprehensiveness ~ TB reporting Others?77 a Ee aT 90% 90% 90% 98% 95% 98% 90% 90% 90% 90% 90% ‘98% (probable)Characteristics — abatements regime * Performance measured at level of each site, NOT IHMS as a whole * Small numbers of events means performance threshold of say, 90% = performance threshold of 100% * Mostly, performance is defined in terms of deadlines. Combined wity high performance thresholds, that means: * _Confict between clinical objectives and contractual objectives: "requirement for National Office to help determine priorities so s:aff can resolve such conflicts * Fraud is inevitableRepeated and/or ‘severe’ failure means that abatements will escalate. Escalation i failure: + is ‘significant (failure: 1/3 of KPIs) * ‘continues’ (significant failure for 2 or more months) * ‘continues'— single metric (3 months)There is a contractual mechanism via which IHMS can claim relief from abatements. Current mechanism: ‘Excusable Performance Failures’. Future mechanism: ‘Discretionary Days simply extends deadiine (ie the event stil needs to occur) Mechanism can come into play when there are events beyond IHMSs control. Examples could be: * spike in workload = infrastructure failurefimitation = Interference, inaction/action by DIBP, Serco or client Process: + IHMS applies "Approval is solely at DIBP’s discretion ‘ihms See tu amUa ca nee Rue a ices a CR CMake serie LS a SseCompliance Challenges Compliance is a strategic issue but requires diligence at the lowest possible level Contract poorly drafted: obligations open to interpretation Inconsistency between contract and day-to-day activity Notice for implementing remaining metrics could be limited Major challenge: converting a contractual obligation (often vague) into procedures for staff at site DIBP's stance is confused Weaknesses within IHMS: * focus is here and now’, not hard yards needed to implement compliance measures * defining roles & responsibilities is counter-cultural * inability to implement basic procedures: eg HO/TO: to ensure new leaders (HSM, CTLs, MHTLs) understand metrics, procedures CIHMS =IWhat's the strategy for maximising compliance?Arrange of complementary measures will ¢ needed. ‘Appointments are ea [ 5%, ‘Sites do X, created automatically ‘when certain items of Define clear data are created roles & responsibilities Automate Data entry required {for performance ‘measurements is centralised Equip sites sites business inteligence re Daily scrutiny to ere _— | Sites are wamed ensure sites folow cn Data is only entered) | required priorities ‘once and into the one National "Office does Y_ | “Appointment siots_| are reserved for activities that risk abatements of imminent deadlines.The approach to maximising compliance will evolve. + Define clear roles + Transfer process + Standardise ‘Automate & responsibilities, steps to National routines and process steps Office procedures at + Micro-manage Stes sites + Equip sites with better business + Remove inteligence redundant work Practices StihNS =Anew team is being established to lead the compliance effort. National Compliance Manager St Reporting Team ‘Monthly Performance reports ‘Weekly interim reports Daily operational reports Respond to DI8p's contract monitoring requests 23 FTEs ‘Compliance Team Re-design processes Prevent non- compliances Investigate non- compliances Justify excuses for non- performance to DIBP. ATES Data Entry Team 7 Enter data needed for + Generate new reports measurements + Improve existing reports Merge permanent & temporary records Identity and remedy non-compliant healthcare records ‘Automate processes 2FTEs arte 3¢ihmsSpecific measures to improve complianceRecord why things weren't done. Performance is measured against C not A Total Due Declines, DNAs, Net Due Cancellations Upshot: we want one of two outcomes: + completion of action + _reason for non-completion recorded ¢ihmsImplement procedures to deal with weekend deadlines. ++ + Mon Tue Wed Thu Fri olf + there are no weekend staff + there's a task with a 72hr deadline + the clock starts past Wed * Then there's less than 72hrs to complete the task Proposed procedures: + Ifpossible, reserve Friday appointment slots to avoid relying on weekend staff * If activities need to be completed on the weekend, ensure the handover Procedure is robustNational Office provide sites with better business intelligence Example: report of ‘imminent Deadlines’ ‘There's a ‘trigger’ to start the clock for the time-based metrics, ‘Imminent Deadiines' will record every instance where the trigger has been pulled for: + HIAs, HDAs, GP appointments - current Vaccinations, Diabetes, Complaints — future This report is sent to Cl every workday (but not on weekends) He iNMS eeWe need to remove redundant work practices. Indirect actions that prevent us from meeting performance thresholds Examples: collecting —~ Statistics manually, Pie rather than requesting automated reporting 3¢ihmsWe need to automate as many process steps as possible Case Study: pre-filled incident reports — Torture & Treuma disclosures * Client discloses T&T during Mental State Examination (MSE). * Clinician completes electronic MSE and saves to client's record. d + Message appears: “Has client disclosed T&T?” He ihis =The Discretionary Days MechanismWhat is the Discretionary Days mechanism? * Discretionary Day might exist when events occur that: © are beyond IHMS's reasonable contol, and © adversely affect those activities that are subject to performance measurement. * The DD mechanism helps make the performance management regime fair by recognising what is obvious: IHMS cannot influence all factors that affect its performance, Note: the DD mechanism will replace the 'Excusable Performance Failures’ mechanism. 3¢ihms 2]When might Discretionary Days apply? There was a requirement to focus on clinical priotes, rather than zctivtes that were subject to abatements Inaccessibilty of interpreters Clients cannot be accessed IT failure Forced clinic closure Excessive client population and/or client movements around the networkUse of Discretionary Days so far * Nauru: for the period 19 July ~ 31 August * Justification used by IHMS: clinic destroyed by fire * Process used to apply for Discretionary Days: * National Office liaised with HSM re: affected metrics = National Office drafted the Discretionary Day Form. * HSM submitted the application to DIBP on Nauru * Senior DIRP representative approved the application 3¢ihms a ao]How will the Discretionary Days mechanism work once the abatements regime is live? * Site contacts National Office or Site/National Office anticipates performance failure * National Office or Site can draft the Discretionary Day Form * National Office will approve drafting and determine whether to submit * National Office will save the form to the folder - S: \Operational Reports ~ Discretionary Days * HSM will submit application to the most senior DIBP representative at the site * Site scans and saves the application to the folder in the S Drive * National Office alters performance calculations. 3 DS =eWhat happens when DIBP approves an application for Discretionary Days? * _IfDIBP approves an application for Discretionary Days, the activitiss affected stil need to be completed - the deadline is merely extended. ‘That means: getting on with the job as normal so that work doesn’: mount up.Ground rules for using Discretionary Days * Apply the ‘reasonableness’ principle (even if DIBP doesn't) “take our medicine we need to (ie accept performance failures when we cause them) Need to maintain good relationships with DIBP: don't ‘cry wolf * National Office will maintain a bank of successful and failed Discretionary Days in the S Drive © Christmas Island performance failuresIndividual MetricsGP Appointments (but only a subset!)Metric definition: 90% of GPs appointments within 72 hrs of a request by a client confirmed by a nurse Time 1 Time 2 Performance measurements reflect this interval Client submits Nurse confirms the Datestime of Medical need for a GP to GP Request Form see the client Appointment, 3¢ ihms Re](crAvponenent Measurement will only be triggered if the correct ‘appointment type’ is chosen and the appointment is marked as ‘Attended. ‘Site Appt Type Date Request Received Scheduled C ‘Scherger IDC ‘25Nov 20120007 (24Nor 20111607 ACT - Correctional Facility (OAS This appointment would not be caught in the ALL Sites (Head Office. WT muy 2UT Tres eT ay ere Northern IDC ‘Nurse consultation 27 Jun 2011 08:35 27 Jun 2011 08:35 oO Villawood IDC 28 Jun 2012 15:39 28 Jun 2012 15:39 ¥ ALL Sites (Head Office. 28 Jun 2012 15:39 28 Jun 2012 15:38 ¥ ALL Sites (Head Office. (28 Jun 2012 15:39 28 Jun 2012 15:39 vw Villawood IDC ‘Nurse consultation 28 Jun 2012 15:39 26 Jun 2012 12:00 o BE ALL Stes (Head Ofice Bun 2012 1408 YF only) 7 Time 2 Time 1 Time 2 will be the datertime in the ‘Date’ field if Time 1 will be the date/time in the and only if, ‘Request Received’ field if and only if + ‘Appointment Type’ is ‘Nurse referral to GP - + ‘Appointment Type’ is ‘Nurse referral to MRF* GP - MRF’ + ‘Attended’ has been checked + ‘Scheduled’ has been checkedHow the ‘Imminent Deadlines’ report will assist. + By 09:30 Wed, sites know whether ‘Time 1’ was triggered here. oo) 00:01 00:01 09:30 Tuesday Wednesday Wednesday Procedures * Confirm whether the appointment should fall within the measurement net + Ifno appointment booked, book appointment + Ifappointment already booked and 12-11 > 72hrs: *+ Bring appointment forward + Cancel the appointment and add a ‘reason’: “GP shortage” S¢ihMS EEEHealth Discharge AssessmentsMetric definition: complete 90% of HDAs within 72 hrs of a request by DIBP. Time 1 Time 2 Performance measurements reflect this interval + DIBP emails request + Date/time HDA + Time 1 entered into competed ee client's record by + Captured National Office automatically S¢i)S EEENational Office will deal with all problems associated with DIBP’s HDA requests * _DIBP requests an HDA when only a Fit to Travel Assessmentis required * DIBP doesn't include the correct client details. + DIBP changes the request * _ DIBP submits multiple requests SCihS EEEHow the ‘Imminent Deadlines’ report will assist ‘Time 1’ is so the deadline triggered here. is here 15:30 09:30 15:30 Tue Wed Fri 00:01 oo01 00:01 00:01 Tue Wed Thur Fri Time 1 is captured on the Imminent Deadlines report issued here + Site: ‘A. arrange to complete HDA, or B. Maybe ask local DIBP for more time (informally), or C. lay groundwork to apply for Discretionary Day * Operational Performance Team ensures that Site is doing A., B or C. SCiNNS EEEBulk Fit to Travel AssessmentsMetric definition: complete 90% of Fit to Travel Assessments (FTTs) within 48 hrs of a request by DIBP DIBP may want to change this to something like: ‘maintain a minimum proportion of clients who are fit-to-fly’ Time 1 Time 2 Performance measurements reflect this interval + DIBP emails request + Dateftime Bulk + Captured by National ee ae Office + Captured by National OfficeFTT Tracker — used to be provided to staff on Cl 38Mar 1729 1 ar 1048 20War 3031, DAL wiDe 9/09/33 oc 29/3/23 atas5jea3 MaNPontie-21/03/13 Darwin 22/09/13‘Critical’ and ‘Other’ Incident ReportsMetric definition: 98% of incident reports completed within the time frame for ‘Critical’ incidents and ‘Other’ incidents Time 1 Time 2 Performance measurements e reflect this interval IHMS advised of Report sent (time incident (entered captured manually) automatically) Deadlines + ‘Critical’ incident - 4 hrs + ‘Other’ incidents - 24 hrs 3{ihMS REEMaintain up to date Clinicians’ Staff RecordsMetric definition: 95% of clinicians’ staff records are ‘up-to-date’ DIBP may want to change this to something like: ‘maintain a minimum proportion of staff qualified to work in remote health’ Current definition: * Only applies to clinicians at site * Asat first business day of the month need a current: * Police Check = AMPRA registration. AHPRA registration is not required for: © counsellors © paramedics © dental assistantsComplaints ManagementCurrent metric definition: complaints register is up-to-date as at the first business day of the month * The Complaints Register in Chiron is unusable. * Soa spreadsheet is used instead. * On the first business day of the month, the spreadsheet needs to be emailed to National Office (sites@ihms.com.au). For IHMS to compy, all fields need to be completed * Itis unclear who, on Cl, is responsible for maintaining the complaints register StihiS ==Proposed metric definition: for 90% of complaints, information is recorded, responses are provided and resolution occurs. Time 1 Time 2 Time 3 Time 4 Complaint Details of ‘Appropriate’ * Complaint resolved, or Received complaint response provided aaron eace: Deadlines: * Time 2 and Time 3 must occur within 72hrs * Time 4 must occur within 10 business days leeues: * What's an ‘appropriate’ response? * What qualifies as ‘resolution’? In whose eyes is the complaint resolved?VaccinationsMetric definition: 90% of clients are categorised and receive first vaccination within required deadlines DIBP may want to change this to: "90% of clients receive the first round of vaccinations within three weeks of arrival’ Time 1 Time 2 Time 3 1+ 48 hrs maximum 7 days maximum First GP Categorisation First vaccination appointment for clients in ‘Category A) vaccinatons | What are the vaccination categories? A- Clients who agree to be vaccinated (98% of all clients are in this category) B - Clients who decline to be vaccinated CC - Clients who do not require any further vaccinations D - Clients who claim to be able to obtain documentary evidence of previous vaccinations his =Mental Health ScreeningsMetric definition: complete 90% of mental health screenings within the ‘Screening Windows’ The screening wath orcas These srenings fom prof he part Mortl Heat Sroonife Met "I ‘—_@—_a 7 | f+ I T Time072hrs 10 30 5 6 1" 12 7 18 Every3 mths days days mths mths mths mths mths a“ thereafter Screening Widow Sernina Window as vee ont) S¢ihMS EE EEEMaintain up to date Healthcare RecordsMetric definition: 90% of Healthcare Records must meet an audit standard determined by IHMS and DIBP * The audit standard focuses on: © currency and comprehensiveness of medical records, © consultation notes © referral to specialists © pathology + There are distinet criteria © Abatable criteria: results are used to calculate any abatements © Overall criteria’ results are used for purposes other than to calculate abatements.Abatable Criteria ‘Abatable criteria generally relate to the inclusion of the following in a client's record * Dates that important actions/events are recorded. Examples + event dates = dates of pathology testing * Essential documentation and evidence. Examples: * consultation notes, * prescribed medications * evidence of consents * Referral letters to specialists, of a certain standard of quality and detail * Important client medical information. Examples: + details of diagnoses ‘+ updated and comprehensive client health summaries = care plansDiabetesMetric definition: place 90% of clients on a Care Plan within 72 hrs of diabetes being diagnosed Time 1 Time 2 1 am Performance measurements —— | reflect this interval Confirmed Client on diagnosis of Care Plan diabetesWe need to design processes & assign responsibilities for determining Time 1 and Time 2 Determining Time 1 + Aprocess is needed to identify records that contain a ‘confirmed’ diagnosis. * For the purpose of performance measurement, identification needs to occur quickly and daily. + Do GPs or nurses at site reliably enter the ICPC2 code(s) for diabetes? + If not, who should be responsible for identifying clients + National Office? + Sites? Determining Time 2 + Apollo will have built in ‘Care Plans’ for diabetes. Presumably, they can be attached to a client's record easily, + What happens if the metric is implemented prior to Apollo being implemented? S:ihS ETProvided there’s a ‘marker’ in Chiron/Apollo to confirm diagnosis of diabetes, the ‘Imminent Deadlines’ report can help us comply + By 09:30 Tue, sites would know whether ‘Time 1’ was triggered here. one | t —t 00:01 00:01 09:30 Monday Tuesday Tuesday + An identification process that involves using a common marker (eg ICPC2 code) means: * Sites can use the ‘Imminent Deadlines’ report to comply + National Office can ‘backstop’ sites S¢i)MS EEEHealth Induction AssessmentsCurrent Metric definition: complete 90% of HIAs within 72 hrs of a request by DIBP + Acompleted Health Induction Assessment involves completion of both the “HIA" and “first MSE". + Measurement points: "Time 1 ~ request from DIBP © Note: the point at which Time 1 is measure is subject to much debate between DIBP and IHMS. = Time 2 ~ latter of completion dateltime: HIA and first MSECurrent Metric Definition vs Proposed Current Proposed * Both HIA and MSE completed * Time thresholds on completing HIAs depend on whether within 72 hrs of a request Version A, B or C applies to the relevant facility * Version A (applies to Irregular Maritime Arrivals (IMA)) * Stage 1 (Initial FTT assessment including MSE) within 24 hrs of the time scheduled, * Stage 2 (GP examination) within 14 days or 21 days depending on the cireumstances. * Version B (applies to IMA): * Stage 2 within 24 hrs of the time scheduled, * Version C (applies to clients not from IMA): * Stage 2 within 72 hrs of a request. ih MS = E EEETB ReportingProposed definition: “no missed cases” (whatever that means!) Sree Soe 7 ReportingReporting Provided to SitesCurrent Report List - 1 ‘Mental Health Scheduler * Aim: help staff to schedule MH screenings when they're due * Provided week days Vaccinations Planner * Aim: help staff to determine which vaces are due and when the next vaccs are due * Provided week days Vaccinations Statistics * Aim: communicate productivity and some data entry error * Provided Mondays se ihS EEECurrent Report List - 2 Imminent Deadlines Report * Aim: warn staff of upcoming deadline and possible non-compliances (GP appointments metric) * Provided week days Critical & Other Incidents Aim: * provide month-to-date performance statistics * advise managers of staff who have cubmitted non-compliant Incident Reports, * Provided week days 3 ihMs EEEFuture Reports - Examples Vaccinations * month-to-date performance + productivity Mental Health Screenings. * month-to-date performance * diagnostic data to determine causes of non- compliance * productivity Health Discharge Assessments + month-to-date performance + productivity Healthcare Recores * diagnostic data to determine causes of non- ‘compliance Complaints + month-to-date performance * productivity Diabetes + month-to-date performance + productivity TB Reporting + month-to-date performance hs OTTNational Office can provide a vast range of reporting to make life easier for staff. * Any data entered into Apollo can be extracted and then presented in virtually any form * Please identify reporting that you and your staff require,DRO UC Ar ol teu ance mn ee Rea ~ Please identify reporting than could make life easier for staff and tell National Office.