levers for change in healthcare systems · healthcare systems: the role of performance measurement...

Levers for change in healthcare systems:The role of performance measurement and reporting

Jean-Frederic Levesque, MD, PhD

Chief Executive Officer, Bureau of Health Information

Conjoint Professor, Centre for Primary Health Care and Equity, UNSW

Levers for change in healthcare systems: The role of performance measurement and reporting

Healthcare systems are complex

and supporting them with

knowledge is as fundamental

as it is challenging

Levesque, Sutherland & Corscadden 2013

Levers for change in healthcare systems: The role of performance measurement and reporting

Concepts

Knowledge organisations

Enablement

Insights

1

2

3

4

Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

What do we mean byPerformance?

Knowledge?

Enablement?

1

Levers for change in healthcare systems: The role of performance measurement and reporting

Performance happens

when structures, resources,

providers and patients

interact in real contextsLevesque, Sutherland & Corscadden 2013

Levers for change in healthcare systems: The role of performance measurement and reporting

Hollnagel, Braithwaite & Wears 2013

The difference between

theory and practice is larger

in practice than in theory

Levers for change in healthcare systems: The role of performance measurement and reporting

If actors perform on stage,

athletes perform on the field,

surgeons perform in surgical theatres

and nurses perform at the bedside

or in community centresLevesque, Sutherland & Corscadden 2013

Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

Knowledge

Information

Data

Action

Change

Levers for change in healthcare systems: The role of performance measurement and reporting

Data

Data represents the codification of

real phenomena into a form that

can be analysed

Levers for change in healthcare systems: The role of performance measurement and reporting

Information

Data becomes information

by interpretation

Levers for change in healthcare systems: The role of performance measurement and reporting

Knowledge

Knowledge signifies understanding

of real things or abstract concepts

that data and information have

enabled to decipher and analyse

Levers for change in healthcare systems: The role of performance measurement and reporting

AccessibilityPrevalence

Avoidable deaths

Unmet needs Adverse events

Quality of life

High users

Duplications

Health risks

Team climate

Health literacyDisability

Hospital mortality

Costs

Safety

ResourcesSatisfaction

Coordination

Levers for change in healthcare systems: The role of performance measurement and reporting

The application of performance

indicators may involve simply

reporting data to actors for

accountability purposes, or it may

involve, in addition, taking action

to stimulate changeLeatherman 2002

Levers for change in healthcare systems: The role of performance measurement and reporting

Action

Knowledge supports action through

behaviour and decisions

Levers for change in healthcare systems: The role of performance measurement and reporting

Change

Healthcare systems constantly

change in terms of structures,

processes and their outcomes

Levers for change in healthcare systems: The role of performance measurement and reporting

Peer learning

Hug

Training

BenchmarkingRegulation

Continuous education

Pay for outcomes

Pay for performance

Quality improvement

Awareness

Self-regulation

Peer-pressure

Monitoring

Incentive

Judge

Provider feedback

Cross-fertilisation

Nudge

Contract management

Monitoring

Shove

Push

Levers for change in healthcare systems: The role of performance measurement and reporting

planned

emergent

internal external

supportive

formative

coercive

normative

structural

competitive

cognitive

mimetic

Levers for change in healthcare systems: The role of performance measurement and reporting

Multimodal approaches have the

biggest impactOECD 2002

Levers for change in healthcare systems: The role of performance measurement and reporting

Levers for change in healthcare systems: The role of performance measurement and reporting

Australian Commission for

Safety and Quality in

Healthcare

National Health

Performance

Authority (NHPA)

Independent Hospital

Pricing Authority

UK Care Quality

Commission The King’s FundThe Nuffield Trust

Dr Foster

RAND Corporation

Centres for Medicare and

Medicaid Services (CMS)

Agency for

Healthcare Research

and Quality (AHRQ)

USA Institute for

Health Improvement

Ambulatory Care

Quality Alliance (AQA) Hospital Quality

Alliance (HQA)Joint Commission on

Accreditation of Healthcare

Organizations (JCAHO)

National Committee for Quality

Assurance (NCQA)

National Quality

Forum (NQF)

Physician Consortium

for Performance

Improvement (AMA)

Leapfrog Group

Bureau of

Health Information (BHI)

USA Accountable

Care Organisation

Quebec’s Health

and Welfare

Commissioner

La haute autorité

de santé France

Canadian Institute of

Health Information

Ontario Care

Quality Council

Levers for change in healthcare systems: The role of performance measurement and reporting

Goals pursued and national

context influence the mix of

health system stewardship

functions required to achieve

health system goalsVeillard 2012

Levers for change in healthcare systems: The role of performance measurement and reporting

Knowledge

organisations

in New South Wales

2

Levers for change in healthcare systems: The role of performance measurement and reporting

Levers for change in healthcare systems: The role of performance measurement and reporting

Levers for change in healthcare systems: The role of performance measurement and reporting

Levers for change in healthcare systems: The role of performance measurement and reporting

Levers for change in healthcare systems: The role of performance measurement and reporting

BHI reports

• Annual performance report

• Hospital Quarterly

• Insights into Care

• Patient Perspectives

• Snapshots, briefs,

dashboards and profiles

Levers for change in healthcare systems: The role of performance measurement and reporting

Garling Report

The public reporting of information about the

health system and hospital performance is

essential for the future of NSW Health.

It is the single most important driver (or lever)

for the creation of public confidence in the

health system, engagement of clinicians,

improvement and enhancement of clinical

practice and cost efficiency.

Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

Levers for change in healthcare systems: The role of performance measurement and reporting

Levers for change in healthcare systems: The role of performance measurement and reporting

Levers for change in healthcare systems: The role of performance measurement and reporting

Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

Levers for change in healthcare systems: The role of performance measurement and reporting

Using information to

enable performance

in New South Wales

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Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

Coercive and cognitive levers

The example of hospital timeliness performance measures

Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

Percentage of patients leaving in four hours – hospitals

Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

Time from presentation to treatment – NSW

Levers for change in healthcare systems: The role of performance measurement and reporting

planned

emergent

internal external

supportive coercive

cognitive

competitive

Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

Normative and supportive levers

The example of mortality

Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

30-day mortality following hospitalisation

Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

30-day mortality following hospitalisation – hospital outliers

Levers for change in healthcare systems: The role of performance measurement and reporting

planned

emergent

internal external

supportive

normative

cognitive

mimetic

Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

Normative and structural levers

The example of Cancer ED performance measures

Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

ED use at the end of life – NSW

Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

ED use for cancer patients – hospital outliers

Levers for change in healthcare systems: The role of performance measurement and reporting

planned

emergent

internal external

normative

structuralcognitive

Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

Insights from the NSW

experience

4

Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

No organisation can use all levers

all the time…some levers are

synergistic, some are in tension

Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

Small organisations are more agile

and responsive… lack economies

of scale and depth of resources

Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

Specialisation brings focus and

concentration of expertise…

brings the risk of fragmentation

and duplication

Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

Splitting and overlapping

responsibilities enable emulation,

competition and diversity and

brings resilience

Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

Multiple organisations

can create confusion and impose

burdens on stakeholders

Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

A knowledge organisation acts in a

negotiated space

Levers for change in healthcare systems: The role of performance measurement and reporting

Concepts

Knowledge organisations

Enablement

Insights

1

2

3

4

Levers for change in healthcare systems: The role of performance measurement and reporting

planned

emergent

internal external

supportive

formative

coercive

normative

structural

competitive

cognitive

mimetic

Knowledge

Information

Data

Action

Change

Levers for change in healthcare systems: The role of performance measurement and reporting – 27 August 2015

Thank you!