A large amount of comparative information about international performance indicators is now available.53 We examined the systems in use in eight countries. 2010-11 is the last year of the NIS indicators and the Social Care and Mental Health indicators are being replaced by the Adult Social Care Outcomes Framework for 2011-12 onwards. Aims: The aim of this study was to gain consensus on key performance indicators that are appropriate and relevant for nursing and midwifery practice in the current policy context. Of course, this statement masks the contested and political components of indicator development and use, which does not figure explicitly in policy documentation, academic articles or this review and is mostly country-specific.34. Methodology It’s vital to understand how efficiently you are operating while finding areas to improve your services. Following this, we analysed performance indicators that were nationally consistent (used across the country rather than just regionally), locally relevant (measured and reported publicly at a local level, for example, a health service) and measured patient-level metrics. While there is no single integrated framework, the AHRQ measures health system performance across four dimensions13 and the Commonwealth Fund aims to be a catalyst for change by identifying promising practices to help the United States create a high-performing healthcare system.14 The Commonwealth Fund spans four dimensions of health system performance: access, including insurance and affordability of care; prevention and treatment, including quality of ambulatory, acute, post-acute and palliative care; avoidable hospital use and cost, such as care that could have been avoided if the patient received appropriate care initially; and indicators assessing the extent to which people can enjoy long and healthy lives.15. Quality indicators have also been developed for home care , post-acute care ), and mental health; • Commonly-used, standardized interRAI scales (e.g., the Cognitive Performance … There are two dedicated websites that provide consumers of healthcare with information about the quality of a service and provide ratings for their service.39 These are Independer – www.independer.nl – and Kiesbeter – www.kiesbeter.nl or ‘Choose Better’. Healthcare Improvement Scotland develops standards and indicators to support health and social care organisations improve the quality of care and support they deliver. Two dimensions of indicators – that they are nationally consistent (used across the country rather than just regionally) and locally relevant (measured and reported publicly at a local level, for example, a health service) – were deemed important. While some of the indicators are the same as those listed by SC, there are some additional hospital performance indicators (21 in total).36 Additionally, the Government of Canada37 has a candidate list of 70 indicators that were approved for use by Federal, Provincial and Territorial Ministers of Health in 2004. Domains within the performance frameworks were compared. Cardiovascular, surgery and mental health were the most frequently reported disease groups. Representatives of the Netherlands’ Ministry of Health, Welfare and Sport collaborated with academic researchers to develop the conceptual framework after reviewing the strategic goals of the healthcare system, information needs of policymakers and studying existing theory and international experiences.24 The resulting framework divides healthcare into four specific community needs: (1) staying healthy, (2) getting better, (3) living independently with a chronic illness and (4) end-of-life care.25, New Zealand has included an atlas of healthcare variation as one of its four health system performance monitoring mechanisms,26–29 and other countries such as the United States and the United Kingdom utilise an atlas, too. Health system frameworks and performance indicators in eight countries: A comparative international analysis, http://www.creativecommons.org/licenses/by-nc/3.0/, https://us.sagepub.com/en-us/nam/open-access-at-sage, http://www.oecd-ilibrary.org/economics/country-statistical-profile-australia_20752288-table-aus, http://data.worldbank.org/income-level/OEC, http://apo.org.au/files/Resource/NPHC-supp.pdf, http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr11/measurespec/patient_centeredness.html, http://www.commonwealthfund.org/About-Us/Foundation-History.aspx, http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2012/Mar/Local%20Scorecard/1578_EXEC_SUMM_Commission_rising_to_challenge_local_scorecard_2012_FINAL.pdf, http://www.nhpa.gov.au/internet/nhpa/publishing.nsf/Content/About-us, http://www.comlaw.gov.au/Details/C2011C00952, http://www.nhpa.gov.au/internet/nhpa/publishing.nsf/Content/Performance-Indicator-Reporting, https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC2195&lang=fr, http://www.commonwealthfund.org/Publications/Fund-Reports/2012/Nov/International-Profiles-of-Health-Care-Systems-2012.aspx, http://www.health.govt.nz/new-zealand-health-system/health-targets/about-health-targets, http://www.health.govt.nz/our-work/primary-health-care/primary-health-care-subsidies-and-services/pho-performance-programme-and-transition-integrated-performance-and-incentive-framework, http://www.open.hqsc.govt.nz/open/about-the-campaign/, http://www.hqsc.govt.nz/our-programmes/health-quality-evaluation/projects/atlas-of-healthcare-variation/, http://www.oecd.org/els/health-systems/ReviewofHealthCareQualityDENMARK_ExecutiveSummary.pdf, http://www.nice.org.uk/standards-and-indicators/qofindicators, https://www.nice.org.uk/standards-and-indicators/How-we-develop-QOF, http://www.statcan.gc.ca/pub/82-221-x/2013001/tbl-eng.htm, http://publications.gc.ca/collections/collection_2013/icis-cihi/H118-86-1-2013-eng.pdf, http://www.hc-sc.gc.ca/hcs-sss/pubs/system-regime/2010-fed-comp-indicat/index-eng.php, http://www.rivm.nl/en/Documents_and_publications/Scientific/Reports/2012/april/Dutch_Health_Care_Performance_Report, http://www.healthpowerhouse.com/files/HCP-study-Best-hospital-final-101119.pdf, A review of the Australian healthcare system: A policy perspective. Comprehending each patient’s stay, how long they must wait for services, and how they perceive you can lead to valuable BI insights and actionable results. Table 4. Typically is expressed in term… Manuscript content on this site is licensed under Creative Commons Licenses. Sharing links are not available for this article. As such you will probably find that you are already using KPIs in your practice, but perhaps you don’t realise it. Papanicolas, I, Kringos, D, Klazinga, NS. Countries involved are Australia, Canada, Denmark, England, the Netherlands, New Zealand, Scotland and the United States. Within these, eight domains of health system performance are defined.19,21. For more than two decades, regulators, policymakers, researchers and clinicians have endeavoured to improve the quality of healthcare by designing and applying indicators of performance. Devising primary care performance indicators for New Zealand, A conceptual framework for the OECD Health Care Quality Indicators Project, Primary health care reform in Australia – report to support Australia’s first National Primary Health Care Strategy, 2011 National healthcare quality and disparities reports, Rising to the challenge – results from a scorecard on local health system performance, Conceptual frameworks for health systems performance: a quest for effectiveness, quality, and improvement, Correlates of health and healthcare performance: applying the Canadian health indicators framework at the provincial-territorial level, International profiles of health care systems, Developing a national performance indicator framework for the Dutch health system, Health care performance in the Netherlands: easy access, varying quality, rising costs, OECD reviews of health care quality: Denmark: executive summary, assessment and recommendations, About the Quality and Outcomes Framework (QOF), Unintended consequences of performance measurement in healthcare: 20 salutary lessons from the English National Health Service, Health indicators 2013: definitions, data sources and rationale, Canadian Hospital Reporting Project technical notes – clinical indicators, Healthy Canadians: a federal report on comparable health indicators. For monitoring long-term progress, there are 12 Quality Outcome Indicators (QOIs) which do not have specific targets; short-term priority areas are focussed on by the ‘HEAT’ targets: Health improvement for the people of Scotland (H), Efficiency and governance improvements (E), Access to services (A) and Treatment appropriate to individuals (T); and the third category includes all other national and local reporting requirements. Be partnership-oriented. If you have access to a journal via a society or association membership, please browse to your society journal, select an article to view, and follow the instructions in this box. The quality of health care is on the agenda in most health care systems. A systematic review, Public release of performance data in changing the behaviour of healthcare consumers, professionals or organisations, The public release of performance data: what do we expect to gain? Although we presented the self-reported domains by country, consistency of definitions between countries and the level of semantic overlap was not tested; however, these are likely to be substantial. In the United States, three identifiable entities report on healthcare performance. Table 1. A performance indicator is not a synonym for quality, but rather a proxy. Find out about Lean Library here, If you have access to journal via a society or associations, read the instructions below. These sample KPIs reflect common metrics for both departments and industries. NHPA commenced operations in 2012. Performance indicators are published for all 150 council-run social services departments in England. Vision and Strategy for Adult Social Care and Health; What to do if you have changed, or are planning to change, your Care Quality Commission registration; Local Performance Account reports. Regular review of the performance framework and indicators is conducted in most of the eight countries by government or government-funded, arm’s-length bodies. Login failed. However, it is difficult to gauge how many indicators are in use, because only certain indicators are selected for inclusion in the annual reports and there appear to be various degrees of overlap. Standards and indicators for care services. Nationally consistent and locally relevant indicators by country. Performance indicators are quantitative tools and are usually expressed as a rate, ratio or percentage. The set of performance indicators provided in this article should help policy makers to monitor the development of social health insurance schemes … Australia’s health 2010 (Australia’s Health Series No. Much of this interest in quality of care has developed in response to recent dramatic transformations of health care systems, accompanied by new organizational structures and reimbursement strategies that may affect quality of care. NI125, NI127, NI130, NI145, NI146, NI149 and NI150 will appear in the new framework, although there will be some small changes to the definitions. To make comparison relevant, all selected countries are OECD members and have been classified by the World Bank as high income.10 Data on the rates of health expenditure and life expectancy for 19 countries were obtained from Australia’s Health 201011 and from OECD reports9 (including Australia, Austria, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Japan, the Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, the United Kingdom and the United States).12 After screening by the research team, the eight countries we noted above were selected for detailed review on the basis that each had made substantial progress in using indicators and developing performance frameworks and had made their indicators and performance frameworks widely available. Secondly, it reviews the evidence as to how we might develop targets and indicators as Key performance indicators (KPIs) are defined by the NHS Institute as indicators that help you define and measure progress towards organisational goals (NHS Institute, 2008). Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article. The search in eight countries found 401 indicators that fulfilled the ‘nationally consistent and locally relevant’ criteria we applied. The Danish do not have a formal framework, but one is currently being developed. quality indicators; mental health; Delphi; primary care; The central role played by primary care in the recognition and delivery of care for people with mental health problems is now widely acknowledged. The supervisee should prepare for the supervision and have a copy of the agenda set out from the last meeting, 4 Be able to provide professional supervision in health and social care or children and young people s work setting 4.1Support supervisees to reflect their own practice Performance indicators are a good way to measure practice because they represent the recruits of performance criteria which have … The National Skills Academy for Social Care (NSASC), part of Skills of Care, and the NHS Employers Organisation (NHS E), have been commissioned by the Department of Health to produce an online hub to support line managers in health and social care in the effective performance management of … Approached in this way, performance management can promote excellence in service delivery and result in a more highly motivated and involved workforce. Instead, as a proxy framework, the Danish Institute for Quality and Accreditation in Healthcare (IKAS) manages the Danish Healthcare Quality Program (DDKM) as a national accreditation and standard–based programme. As the term indicator suggests, performance indicators give a signal, and thus suggest a direction for research and actions by health care providers and policy makers. We conducted our Internet search of performance indicator systems in the eight comparator countries in May 2013. Canadian Institute for Health Information . the site you are agreeing to our use of cookies. Healthcare and Social Assistance KPIs. Indicators are sometimes also used to promote consumer choice at a regional or local level. The World Health Organisation (WHO)1 and others2,3 have attempted to rank health systems for the insights gained from global comparisons, while consumers have an interest in selecting the best provider for treatment for their particular condition and knowing that their taxes are being spent wisely.4 To meet these multiple demands, performance indicators (‘measurable elements of practice performance for which there is evidence or consensus that they can be used to assess the quality, and hence change of quality, of care provided’) and performance frameworks (‘conceptual frameworks that set out the rationale and design principles for an indicator set’)5,6 are typically designed to routinely monitor aspects of healthcare performance such as effectiveness, efficiency, safety and quality.7 The quest for a single composite indicator of quality, prevalent in the early days of indicator development, has largely been abandoned in favour of multidimensional frameworks.1 Indicator sets commonly contain a combination of structure, process and outcome assessments.8. Cross border care EU: how to choose the best hospital? Department of Health . Selected countries Across all OECD countries, health care is financed by a mix of public and private spending. NICE indicators measure outcomes that reflect the quality of care, or processes linked, by evidence, to improved outcomes. The Organisation for Economic Co-operation and Development (OECD) publishes 60 internationally comparable indicators of healthcare quality.9 These are useful and influential. How do I know if my local council is providing good social care? the family in terms of performance of social roles. If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. By continuing to browse Meanwhile, in the Netherlands, a report detailing results for all 125 indicators is published every 2 years.38 From 2011, the information was updated via a website twice a year and from 2014, the report will be published every 4 years.38 The indicators are reported at the national level, not locally. This product could help you, Accessing resources off campus can be a challenge. Final report: performance indicators used internationally to report publicly on healthcare organisations and local health systems. So many health care systems in Europe can be identified as the mix health care models with some dominant source of funding. Of these, 45 indicators are reported in more than one country. Few studies make comparative assessments of different countries’ performance indicator frameworks. Social Care Key Performance Indicators - Performance to 30 November 2012 For Period Torbay Torbay exc. Shekelle, P, Lim, Y-W, Mattke, S. Does public release of performance results improve quality of care? The purpose of the table was to compile an initial ‘long-list’ of available indicators and then to identify a ‘short-list’ of those reported in multiple countries. Of the 11 frameworks published in five countries and the OECD, the most frequently used (self-reported) domains were effectiveness (eight), access and safety (seven each) and efficiency (five; Table 2). England and Canada do the most extensive research and development work to select indicators. View or download all the content the society has access to. CMH Community Mental Heath (CMH) Domain 1 - Enhancing the quality of life for people with care and support needs 40% 46% 5% We classified the indicators, where possible, into major disease groups (Table 5). Institute of Medicine . Hibbert, P, Hannaford, N, Long, J. After the audit process is complete, the data are released publicly, including comments on the results from the audit groups.40 Reports on many of the indicators are available on the www.sundhed.dk website. Comparison of Crude Population-Level Indicators of Opioid Use and Rela... Smith, P, Papanicolas, I. In doing so, policy makers can come closer to achieving universal coverage - access to appropriate healthcare for all at an affordable cost - the ultimate goal of social health insurance. Key performance indicators in healthcare present you with a visual and easy-to-digest means of analyzing your operations. Then, within each health financing function, key performance issues and associated measurable indicators are developed. Indicators that were collected consistently on a national scale were included, but could be relevant and useful to local quality improvement efforts. There are likely to be considerable overlap between the definitions of some of the domains such as effectiveness and appropriateness. Create a link to share a read only version of this article with your colleagues and friends. With the strong encouragement of leading health care agencies, business principles are being implemented throughout health care, including emergency medical services (EMS). The most commonly used domains in performance frameworks were safety, effectiveness and access. From King’s perspective, this would in-clude structural and functional dimensions of the family system. Most of the eight countries have an overarching framework for the selection and reporting of indicators which establish the broader aims for their implementation activity and play a large role in indicator selection and use. 1.2.2 Recognize that there are multiple dimensions of health. However, many countries, even those with advanced data systems, have difficulty linking practice performance to outcomes because of limitations in data availability and poor capabilities to link data. It seeks to answer the question ‘performance of what – and to what ends?’6 Reasons given for developing such a framework are as follows: (1) to define the scope and dimensions of measurement;24,6 (2) to help align the performance measurement system with other policy priorities and financial exigencies;43 (3) to provide a clearly defined vision to encourage buy-in by clinicians and consumers24,43 and (4) by involving potential end-users of the data in the design of the framework, to ensure its future usefulness.44 A conceptual framework encompassing multiple domains and with balanced representation across structure, process and outcome indicators is considered to be a key element of health reform over time.45. In Australia, the National Health Performance Authority (NHPA)16 was established under the Australian National Health Reform Act 201117 as an independent portfolio agency to monitor and report on healthcare system performance; it has since been merged with the Australian Institute of Health and Welfare. You should remember that performance management isn’t just about issues – it’s also key to motivating, supporting and encouraging hardworking staff. Health system performance comparison: new directions in research and policy, Methods to stimulate national and sub-national benchmarking through international health system performance comparisons: a Canadian approach, Measuring quality of care with routine data: avoiding confusion between performance indicators and health outcomes, What makes a good performance indicator? In reviewing existing targets and indicators for health and social care, this report considers first what the policy framework for public sector bodies tells us about the aims and objectives of the health and social care system. KPI is a measure used to define and evaluate how successful an organization is. The progress they have made, and choices taken in selecting and using indicators, might be of value for other health systems in contemplating the development of their indicators or frameworks, or modifying their performance mechanisms. In this study, the eight countries selected for review were using indicators and had implemented a performance framework, several over more than a decade. Simply select your manager software from the list below and click on download. A key finding was the widespread support for implementing a healthcare system performance framework. Indicators tend to be more specifically linked to a clinical condition or disease group in some countries such as Denmark.30. NICE has developed guides,32,33 which set out in detail the processes involved in managing the development of indicators. The authors would like to thank their colleagues Dr Diane Watson, Bernie Harrison, Jessica Stewart, Dr Julia Langton, Jason Boyd, Jessica Herkes and Kristiana Ludlow for their support to the project. For those countries interested in such an extension, it is important to understand what characterises a well performing social health insurance scheme. For more information view the SAGE Journals Sharing page. The focus of this set of indicators is directed towards the question how care homes can measure and manage improvements with regard to the quality of life of their clients, and the related issues of quality of care, management, economic performance and relationships with external stakeholders. The health system performance frameworks for each country were reviewed together with their accompanying online and published documentation. For example, the OECD considers these two domains as separate while the Australian framework considers appropriateness as a subset of effectiveness.6,18 Because of this, and hierarchical relationships between domains within some frameworks, it is difficult to report the number of indicators used against each domain for each country. Australian Institute of Health and Welfare . Of these, 45 indicators are reported in more than one country. One reports nationally (the US Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ)), one internationally (The Commonwealth Fund) and one locally (Hospital Compare). A summary of each country’s approach to performance indicator use is shown in Tables 1 and 2. The Canadian framework has two main goals: to determine (1) the health of Canadians and (2) how well the health system performs and operates according to the published principles of providing reports that respect Canadians’ privacy and are also consistent, relevant, flexible, integrated, user-friendly and accessible.19,20 The indicator framework is conceptualised in terms of the provision of high-quality comparative information across four dimensions. It is broadly agreed that monitoring performance imposes an inherent pressure on healthcare organisations or services to improve practice.48 However, the extent to which this is accomplished is disputed and under-researched. For more information view the SAGE Journals Article Sharing page. Cardiovascular, surgery and mental health were the most frequently reported disease groups. National minimum standards for certain services in social care, national occupational standards and codes of practice are shaping the performance management framework in the social care sector. There are national and international incentives for rating the performance of health systems. At the time of the study, this provides advanced indicators and applies them throughout the country. Members of _ can log in with their society credentials below, Jeffrey Braithwaite, Peter Hibbert, Brette Blakely, Jennifer Plumb, Natalie Hannaford, Janet Cameron Long, and Danielle Marks, This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License (. The importance of a logical, universally acceptable and viable conceptual framework to underpin development of a national performance indicator set is also emphasised in the literature.41,42 A conceptual framework sets out the rationale and design principles for the indicator set and links it to the wider health system context. Assessment techniques provide the mechanism for measuring and evaluating the defined factors to evaluate progress or impact. FundingThis work was supported, in part, by the National Health Performance Authority, Australia (but no one including the Authority’s officers had a role in the study, its conduct, results, interpretation or publication of this article) and the National Health and Medical Research Council (APP1054146). Key performance indicators (KPIs) are just that, indicators that tell us how we are performing on the things that we think are important, or key, in our practice. Performance Indicators* Pre-K-Grade 2 1.2.1 Identify that healthy behaviors impact personal health. Performance indicators are a popular mechanism for measuring the quality of healthcare to facilitate both quality improvement and systems management. At the time of our review, all had made progress in selecting or applying indicators to measure or stimulate improved performance and most had developed a framework for conceptualising performance improvement or indicator use. The role of NICE in England exemplifies a thorough and considered approach to continued indicator development. The atlas is organised according to clinical areas: maternity, demography, cardiovascular disease, gout, polypharmacy and surgical procedures.29 In 2013, the NZ Health Quality and Safety Commission’s campaign Open for Better Care was commenced to measure whether planned changes in practice occur and whether they have resulted in reduced costs and harms.28. The CQI process couples carefully identified, measurable performance indicators … For example, the Canadian framework has continually developed and evolved since its inception, as a result of collaboration from a dedicated group including the Canadian Institute for Health Information (CIHI), Statistics Canada (SC), Health Canada (HC) and representatives from other stakeholder groups.19 Similarly, the National Institute for Health and Clinical Excellence (NICE) has a key role in indicator development in England. This paper outlines the core suite of indicators, summarising the rationale for inclusion and information on the proposed definition and data source for each indicator in section . Health system performance comparison: an agenda for policy, information and research. Number of pages: 15-22 Braithwaite, J, Matsuyama, Y, Mannion, R. Healthcare reform, quality and safety: perspectives, participants, partnerships and prospects in 30 countries. These standards are overseen by the International Society for Quality in Healthcare (ISQua).22 The Danish National Indicator Project (DNIP) merged with the Clinical Quality Development Programme (RKKP) in 2010.8 Although Denmark lacks a formal framework, the DNIP manual outlines the thinking behind its clinical indicators and planned future indicators (1) to improve prevention, diagnostics, treatment and rehabilitation; (2) to provide documentation for setting priorities and (3) to create an information resource for patients and consumers.