Hospital performance

Jenny Hargreaves
Economics and Health Services Group
AIHW

What is performance?
National Health Performance Framework
Chapter 9 in Australias Health 2010

National Healthcare Agreement

Productivity Commissions report Public and
Private Hospitals
Report on Government Services
AIHWs Australian Hospital Statistics
Other views

What is performance: Health

Ministers National Health
Performance Framework

What is performance: COAGs

National Healthcare Agreement
Outcomes

Hospital and related care

High quality, appropriate, timely

Patient experience
Suited to needs, informed, seamless, safe

Sustainability
Respond, adapt

Progress measures
Waiting times, adverse events, patient satisfaction

Outputs
Rates of services, training positions

What is performance: Report on

Government Services
Public hospitals, maternity services
Outputs
Equity
access

Effectiveness
access, appropriateness, quality (safety, responsiveness,
capability, continuity), sustainability

Efficiency

Outcomes

What is performance: Productivity

Commissions Public and Private Hospitals
Australian Government request for a report
(published December 2009) on the relative
performance of public and private hospital
systems:
Hospital and medical costs
Included measures of costs, productivity and access

Hospital-acquired infections
Included other safety and quality indicators

Rates of fully informed financial consent for privately

insured patients

What is performance: other views

Only some statistical information is labelled as
performance indicators in those frameworks
Other statistics may be also viewed as
measuring performance by stakeholders:
Minister Roxon highlighted numbers of doctors and
nurses in a speech to parliament last week
AMA highlighted occupancy rates in its Public
Hospital Report Card (published in 2009)
Adelaide Advertisers front page story on numbers of
people leaving emergency departments before being
seen by a doctor

What is performance? Other than

national
Performance measurement for different
purposes

local or state-level management of hospitals

funding agreements (public and private hospitals)
accountability or public reporting at the local or state
level

Measurement designed to support hospital

quality improvement activities
Hospital benchmarking or comparison activities

Hospital performance indicators in

Australias
Health
2010

And some others from Australian Hospital Statistics

2008-09; COAG reporting
National Health Performance Framework:

Effectiveness
Safety
Responsiveness
Continuity of care
Accessibility
Efficiency and sustainability

Comparisons: over time, between

states/sectors/countries, considering equity

Effectiveness: Accreditation of
hospitals

Safety: Adverse events treated in

hospitals

Safety: Unplanned readmissions

following surgery in public hospitals,
2008-09 (COAG)

Safety: Falls resulting in patient

harm in hospitals (COAG)
by age group, and socioeconomic status, 2007-08

Per 1,000 hospitalisations

Responsiveness
No indicators

Continuity of care
No indicators

Accessibility: Waiting times for

elective surgery (COAG)

Accessibility: Emergency Department

waiting times, 2008-09 (COAG)

Accessibility: Rates of services:

overnight separations (COAG)
2008-09, international, socioeconomic comparisons

Accessibility: Differential access to

hospital procedures (COAG)
Indigenous rate ratio, 2007-08; states, 2008-09

Access: Rates of services: nonacute care separations (COAG)

Change in separations, 2004-05 to 2008-09

Efficiency and sustainability: cost

per casemix-adjusted separation
(COAG)

Efficiency and sustainability:

relative stay index
public, private hospitals, 2008-09

What will be measured in 2020?

More safety and quality

against national clinical safety and quality standards

Healthcare associated infections
Readmission and mortality rates
Pressure ulcers
Other outcomes?

COAG indicators being developed/proposed by CRC

Patient experience
Waiting times after Emergency Department care, for radiotherapy
Better measures of comparative service use, eg against need
Affordability
Appropriateness
Sustainability

Other indicators associated with national health reform

Financial performance

What will be measured in 2020?

More for private hospitals
More for individual hospitals and hospital
groups/networks
Quarterly rather than annually
More timely?
Derived from data linkage?
Derived from e-health?