STRATEGIES TO USING KPIS TO

INFORM DECISIONS AND TO

BRING ACTUAL IMPROVEMENT

PLANS AND ACTIONS

Day 2

Fadi El-Jardali, MPH, PhD.

March 2016

Strategies to using KPIs to inform decisions and to

bring actual improvement plans and actions

• One of the main aims of indicators is to serve as mechanisms for:

National reporting

Evidence-based decision-making

• Reporting, disseminating & communicating results of KPIs is essential to:

Address the needs of healthcare managers and health system

policymakers

• This discussion aims to: Strengthen understanding of healthcare managers and health system

policymakers on strategies required to facilitate the use of indicators,

as an input to evidence-based decision making.

Drive improvements in health outcomes and performance

Critical success factors

• Competence and institutional capacity for:

using different packaging tools for different users

communication skills

using evidence in decision-making for improving the health system.

• Institutional mechanisms for tailoring reports to different users

• Building context into the analysis to empower decision-makers to take

action

• Dialogue-based approach with stakeholders

Focus on Kuwait

• Tools used at the health system and organizational levels are to be more

tailored to different users

• For example, feedback reports from MOH to healthcare organizations and

reply reports from healthcare organizations to the MOH:

Do not highlight decision- relevant information

Need to be more user- friendly

Need more focus on context

Need to include a structured follow- up protocol based on dialogue with

stakeholders

Effective reporting, dissemination, and communication at both system- and organizational levels Guiding Framework

Reporting, Dissemination & Communication

1. Present results in a Balanced Scorecard (BSC) format

2. Identify effective packages for different users

3. Share results with: staff, healthcare providers, government & public

4. Collect feedback and discuss

5. Review results and reports: Quarterly, bi-annual, annual review

6. Use results to foster evidence-informed decision- making

• Three main tools that can be used by both healthcare

managers or health system policymakers:

Tool 1: Quarterly Briefing Note

Tool 2: Yearly Briefing Note

Tool 3: Public Reporting

Effective reporting, dissemination, and communication at both system- and organizational levels

Tool 1: Quarterly briefing note

Quickly and effectively advise healthcare managers and

health system policymakers about healthcare

performance

Help inform evaluation on a regular basis, in order to

make revisions on indicator definitions, measurement

tools, and reporting periods

Aid healthcare managers and health system

policymakers in directing their attention to priority issues

and making decisions for improving healthcare quality

Tool 1: Quarterly briefing note

Key features

• User friendly, written in plain language and in an objective manner

• Highlight decision relevant information

Key components

• Key messages: clear and relevant messages.

• Findings: key findings on indicators with benchmarks.

• Analysis: interpretation of key findings.

• Recommendations: recommendations that are appropriate and

consistent with the briefing note and supported by the best available

evidence, for:

System-level

Organizational-level

Briefing Note Health Service Performance Agreements (HSPAs) Qatar 5

Dimensions

1 Processes, Appropriateness, and Outcomes

Providers appropriately and competently deliver clinical care services and achieve desired outcomes.

2 Access and Responsiveness

Providers are responsive to community needs, ensure access, continuity, and coordination of care, and promote health

3 Safety Patients and Staff

Providers have the appropriate structure, and use care delivery processes that measurably prevent or reduce harm or risk to patients, healthcare providers and the environment.

4 Health Workforce

Providers are qualified to deliver patient care, have the opportunity for continued learning and training, and work in positively enabling conditions.

5 Satisfaction / Experience Patients and Staff

Patients are satisfied with their care and staff are satisfied with their work.

6 Performance and Efficiency

Providers make optimal use of inputs to yield maximal outputs given the available resources.

Benchmarks were selected based on: 1. Comparability with

indicators measured as part of HSPAs (e.g., similar numerator, denominator, and inclusion/ exclusion criteria)

2. Accessible data that is clearly defined, regularly collected and publicly reported on international databases (e.g., Canadian Institute for Health Information and Agency for Healthcare Research & Quality)

Sample Briefing Note

Sample Briefing Note

Tool 2: Yearly briefing note

Advise healthcare managers and health system policymakers

about overall healthcare performance

Build on the quarterly briefing notes to highlight progress

achieved and areas requiring attention

Provide strategic level recommendations at the:

System-level (when used by health system policymakers)

Organizational-level (when used by healthcare managers)

Tool 2: Yearly briefing note

Key features

• User friendly and written in plain language and in an

objective manner

• Highlight decision relevant information

Tool 2: Yearly briefing note

Key features

• Graded entry including the following sections:

1. Key messages: clear and relevant messages

2. Findings: key findings on all (quarterly and yearly) indicators with

benchmarks.

3. Analysis: interpretation of trends and key findings.

4. Recommendations supported by best available evidence:

Strategic-level recommendations on the overall healthcare performance.

Action needed for areas requiring attention.

Tool 3: Public Reporting

• Used at the system- level as a mechanism for regulation and accountability

• Possible once the capacity of the system for valid and reliable reporting is built and a culture of trust is fostered among stakeholders.

• Reported quarterly, biannual, or annual- depending on indicators and capacity of system for accurate, timely data collection and reporting

• Share findings on indicators with the general public to:

foster healthy competition across providers

better inform healthcare users.

• Public reporting should focus on driving healthy competition and quality improvement rather than on judging low and high performers.

• This will help ensure buy in and support of stakeholders and will ensure reports and data are not misunderstood or misinterpreted.

Tool 3: Public Reporting

Key features

• Information presented on this web portal/ public report may include:

• Data on indicators with their definition and rationale, as well as risk-

adjustments for outcome measures.

• At the system- level:

Engage healthcare providers, patient groups, and other key

stakeholders in dialogue for the selection of indicators for public

reporting.

Involve patient groups and key stakeholders to ensure appropriate

design of public reporting mechanisms.

• Data on the services provided by healthcare providers

• Information on location of healthcare providers to enable users to

locate healthcare organizations

Tool 3: Public reporting

• General template on how the display of the web portal may

potentially look like:

DISCUSSION & GROUP

WORK

BARRIERS AND FACILITATORS TO

MEASUREMENT, REPORTING AND

IMPROVEMENT

Examples from different contexts

Barriers

• Lack of automated information systems for data collection

• Challenges on manpower and resources

• Shortage in staff for data collection and quality/ data analysis.

• Workload and time for data collection

• No regular feedback or reporting about the collected data

• Lack of policy or procedure/ regulatory mechanism to encourage measuring

indicators

• Incomplete documentation and coding by physicians

• Under- reporting and resistance by medical staff

• Lack of/ Incomplete ICD-10 coding

• Irregular medical audits

• Prompt corrective action not immediately undertaken when problems arise

Findings from similar initiatives (Regional and International)

Barriers

Communication

• There were challenges in coordination and communication between process owners

and those collecting data

Compliance issues

• Significant variation in compliance level with methodology in procedures manual,

especially with staff and patient satisfaction.

Patient Safety System

• System redesign including structured governance and reporting

• Comprehensive training on concepts, tools, and implementations

• There is no structure to allow for reporting medication errors and sentinel events.

Findings from similar initiatives (Regional and International)

Facilitators

• Leadership commitment and motivation at the organizational-

and system- levels

• Training on quality measurement

• ICD- 10 coding in hospitals for nurses, physicians, medical records

personnel.

• Compliance with measurement protocol

• QIPs and effective communication tools

• Mandate and institutionalize KPIs

• Policies and procedures/ regulatory mechanisms to mandate and

institutionalize measurement and reporting of indicators.

Findings from similar initiatives (Regional and International)

DISCUSSION ON

PRIORITIES AND NEXT

STEPS

Priorities and Next Steps

Balanced Scorecard (versus. Dashboard)

• Identify/ Shortlist a balanced comprehensive set of KPIs

• Measure indicators from various Domains of Performance: Access, efficiency, workforce, etc.

• Create a Balanced Scorecard (vs. Dashboard)

Quality Improvement Plans (QIPs)

• Build on QIPs to track progress on priority indicators and move quality agenda forward in Kuwait

• Continuous M&E, effective communication tools and strategies to facilitate evidence- based decision making at the system- and organizational- levels

WRAP UP AND

WORKSHOP EVALUATION